How to enjoy fireworks – not fractures – this summer
School is finally out! The days are longer, the fridge is stocked with popsicles and life moves into a more active, outside mode. With increased activity, travelling and summer sports comes slips, falls and subsequent broken bones/fractures, which frequently end up in my office.
A fracture is what we call a broken bone. Our bones have some degree of “give,” but they will break if the force transmitted through them is too great.
These are a few of the common fracture injuries I see in my office during the summer from both kids and adults alike:
Wrist fractures are a common summer injury – usually resulting from falling forward and extending an outstretched hand to break the fall. It is a natural reflex, but if enough force is transmitted, a fracture is sustained through the radius – the large bone on the inside of the wrist. I see a good number of these injuries in children – commonly from falling off bikes or jumping off of swing sets. Often, these fractures can be treated conservatively in a short-arm cast for a period of about six weeks. While the cast is an inconvenience, waterproof casting material is an option, and children usually heal quickly and quite well.
Sometimes, particularly in older adults with thinning of the bones from osteoporosis, falls cause a more complicated, displaced or poorly aligned fracture pattern that makes surgery necessary to restore the natural anatomy of the wrist. Without proper treatment, displacement of the wrist bones from a fracture can cause chronic pain or premature arthritis. In appropriate patients, I treat these injuries with surgery where I make an incision and insert a plate and screws to hold the bony fragments in position. Patients are immobilized for a short period of time postoperatively and then transition to a removable wrist splint to begin physical therapy that will restore their range of motion.
Ankle fractures are another common orthopedic problem that I frequently treat in the summer. A sudden misstep off a curb or any sudden inversion of the foot can result in a fracture of the thin bone on the outside of the lower leg called the fibula. The extent of injury determines treatment of these fractures. Sometimes, the sudden twist will pull off a small piece of bone and can be treated, for the most part, as a sprain.
If the break occurs at the lower portion of the bone and the alignment is good, patients are often placed in a walking boot while the injury heals for about six weeks. More complicated, displaced fractures will require surgery – an incision to allow for placement of a plate and screws to hold the pieces in position and to restore the ankle’s normal anatomy. Postoperatively, I put my patients in a short leg cast and keep them non-weight bearing orders for six weeks. The hardware holds the fracture in place, but it will fatigue and break if subjected to the force of weight bearing activities before the fracture heals.
With longer days to play outside, children frequently present to my office with pain in their shoulder after a fall from a height. This can be a tree, the arm of a sofa or any object where the child falls forward on the shoulder. The result is frequently a fracture of the clavicle or collarbone. In the pediatric population, these injuries typically heal very well – even with a certain degree of displacement. Since the bones of children are still growing, pediatric fractures heal quickly, and a slightly displaced or crooked fracture will usually straighten as the child grows and the bones lengthen. A special figure-8 strap provides for support of the fracture while allowing the patient to have free use of the arms. Most clavicle fractures resolve in about six weeks. In adults, these injuries can be similarly treated. Healing is sometimes slowed if the patient has osteoporosis or other chronic medical conditions. If there is substantial displacement of a clavicle fracture in an adult, surgery is sometimes recommended, with a plate and screws used to restore the anatomy of the clavicle.
The number of patients I see for stress fractures in the feet definitely increases in the summer with improved conditions for outdoor running and seasonal 5K races. The patient typically presents with a sudden onset of pain in the foot and points to tenderness over the metatarsals or bones of the foot. Suddenly increasing running mileage or pace can cause the bones to “react” or become irritated. If the offending pounding action continues, a frank fracture can occur. These are almost exclusively overuse injuries, which usually resolve well over six weeks with support and immobilization in a stiff-soled, orthopedic shoe.
Building strong bones for prevention
As a fracture specialist, I frequently use office visits to talk about the importance of calcium and vitamin D supplementation. We build the majority of our bone mass before the age of 30, and consumption of calcium-containing products is very important in those years. Calcium requirements are about 1,200 mg before the age of 50 and jumps to 1,500 mg daily after that. Particularly in women after menopause when bone-protective estrogen levels drop, osteoporosis-related fractures can be a significant risk. Dietary consumption, such as through dairy products or leafy, green vegetables is an ideal way to obtain needed calcium. Calcium tablets fortified with Vitamin D can also help meet needed calcium requirements. Weight-bearing exercise, such as walking or jogging, is also important in helping to maintain strong bones, as the bone remodels and, subsequently, strengthens through weight-bearing activities.
So, here’s to the sunny days of summer with time to enjoy family, friends and anticipated outdoor activities without the pain and limitations of broken bones. Fireworks, not fractures, this summer season!
Dr. Gregory G. Caronis is a board-certified orthopedic surgeon with Advocate Medical Group at Advocate Condell Medical Center. His practice specialties include disorders of the foot and ankle, fracture care and general orthopedics. Dr. Caronis is currently accepting new patients in his Lincolnshire and Libertyville offices. For more information or for orthopedic questions, he can be reached at firstname.lastname@example.org or at AMG Orthopedics (847) 634-1766.
About the Author
Dr. Gregory Caronis is a board-certified Lake County surgeon with Advocate Medical Group Orthopedics and Advocate Condell Medical Center. A specialist in disorders of the foot and ankle and fracture care, Dr. Caronis sees patients in Gurnee, Lincolnshire and Libertyville.