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Common Winter Fractures and Ice Safety

Tuesday, January 24th, 2012

Fractures (or broken bones) of the ankle and wrist are common injuries during the winter months. We thought it might be useful to review some of the common injuries that often require urgent treatment.

Wrist (Distal Radius)Fracture
A “Colles” (distal radius) fracture is a particular type of wrist fracture involving the distal radius. This very common fracture occurs with a fall on an outstretched hand, often breaking a fall. Diatal radial fractures also occur during skiing, snowboarding or other falls . This particular fracture type is relatively common and can often be treated in a cast. In our clinic, we can usually treat these with waterproof Goretex casting that allows the cast to get wet during the treatment process However, some cases of Colles’ fractures require surgical intervention when proper alignment is necessary.

Bennett’s Fracture of the Thumb, Skier’s Thumb
A Bennett fracture is an injury that occurs at the bottom of the thumb. This type of fracture involves the joint between the thumb and the wrist bones. A Bennett’s fracture occurs as the result of a fall, and people who participate in activities like ice-skating, skiing, and snowboarding are at high risk. Another common injury is skier’s thumb, where a skier excessively stretches out their thumb causing a fracture or a torn ligament. Patients who sustain a Bennett’s fracture or skier’s thumb. usually require surgery to realign the bones and to stabilize the joint area. If the joint surface is out of position, surgery is typically recommended.

Hand/Finger Fractures
Hand fractures are common injuries that can occur during the winter months. These occur in any of the hand or finger bones. Most fractures in the hand can be treated with application of a simple waterproof cast, however for some cases hand fractures may require surgery. Surgery is recommended if there is damage to the joints, the bones are not aligned properly, adverse function will occur. It is important to have all hand, wrist and finger fractures evaluated by an orthopedic specialist. Our hand specialists are happy to prioritize your fracture to speed your recovery.

Scaphoid (Navicular) Fracture
A Scaphoid (navicular) fracture is caused by a fall on an outstretched wrist, causing persistent wrist pain at the base of the thumb. This can occur when walking on ice or doing activities outdoors during the wintertime. These fractures are unfortunately often misdiagnosed as sprains causing problematic complications as this bone has a complex blood supply, which unfortunately can lead to healing problems. This bone is one of the eight important wrist bones. If the scaphoid bone is broken (fractured), often surgery can allow for early recovery.

Finger Fractures
A broken finger is a common injury that is seen during the wintertime. Finger fractures can have serious consequences if not treated properly. These injuries require appropriate treatment to ensure that function of the hands and fingers is not limited after the healing process. In order to determine the best treatment, these fractures require evaluation by an expert orthopedic specialist. Sometimes, finger fractures require surgery if the phalange bones (the finger bones) are not aligned properly.

What are the common fractures of the ankle and foot that are associated with winter weather?

Ankle Fracture
An ankle fracture is the most common fracture that occurs with twisting injuries during winter months. Broken ankles are among the most prevalent of the fracture types and include injuries to the distal fibula (lateral malleolus) and medial malleolus. These injuries occur when the bones of the ankle sustain injury from a fall or twisting type injury. Surgery is often necessary for ankle fractures to achieve proper alignment during the healing process. Our orthopedic specialists will align the structures of the ankle during the operation and cast the region afterwards to achieve and maintain the alignment.

Talus Fractures
A talus fracture occurs when the talus bone of the foot is broken. The talus bone is one of the important connecting bones between the leg and the foot. The talus bone has cartilage that connects to the hind-foot region and the ankle. Talus fractures usually require surgery and unfortunately, many patients have long-term ankle arthritis after this type of fracture.

Jones Fracture
A Jones fracture is a fracture of the fifth metatarsal of the foot. The metatarsals are the long bones that lead to the toes. Patients who sustain a Jones type fracture typically will have pain over this middle and outside areas of their foot. Snowboarders, skiers, and ice skaters all are at risk for this type of fracture. Swelling and difficulty walking are also common. The treatment of a Jones fracture involves immobilization with a waterproof cast. Surgery might be recommended by our surgeons with competitive athletes or in poor healing fractures to accelerate the healing process. Surgery usually involves screw placement, and occasionally bone grafting when the fracture in not healing properly.

Calcaneus Fracture
The calcaneus is the large bone of the heel. This bone helps support the foot and is vital for proper walking motion. Calcaneus fractures often occur in the wintertime as the result of high-energy injuries. These fractures are the result from a fall from height or sporting activity related injuries. These types of breaks can lead to chronic pain of the foot, and treatment could involve surgery, depending on the severity of the fracture. Most procedures involve making an incision over the outside of the foot and placement of a metal plate and screws directly into the broken heel bone. Our orthopedic specialists make every attempt to realign the bone and return the cartilage surface to normal position.

Lisfranc Fracture/Sprain
This type of fracture/sprain occurs when there is an injury to the joint in the mid-foot region. Dislocation is usually involved with a Lisfranc fracture, and this injury is the result of a dislocation between the mid-foot joint and the forefoot region. These types of fractures occur when the person steps improperly and the foot is twisted with much force. Many sustain a Lisfranc injury during sporting activities outdoors and from falls on ice. Most Lisfranc fractures and dislocations require surgery, and afterwards, casting is common. The more common treatment the orthopedic surgeon employs involves placement of internal screws or external pins for fixation.

Metatarsal Stress Fracture
Metatarsal stress fractures occur in people who have a sudden increase in activity. In the winter months, this could include snow shoveling, working on icy walkways, skiing, and snowboarding. Metatarsal stress fractures cause a considerable amount of foot pain, especially with activity. When these injuries are not allowed adequate healing time, surgery is often necessary. Most of the time, however, these can be treated with rest and possibly a cast. You should check with our orthopedic specialists if you think you have a metatarsal stress fracture as timely treatment can lead to early recovery.

Ice Safety Tips

Wear boots with grip soles such as those made of rubber and neoprene. Slick leather or plastic soles on shoes will definitely increase your risk of falling.

When getting out of your vehicle, look down and analyze the surface. If it’s coated with ice you should attempt to park in a different place.

Use special care when entering or exiting your car. Be sure to use the vehicle for support when walking, too. Before standing brace yourself, using the car door and seat back, this will give you some stability so you won’t fall.

Step – don’t jump – from vehicles and outdoor equipment.

Don’t walk with your hands tucked in your pockets, as this reduces your ability to use your arms for balance should you slip.

Take short shuffling steps in icy and slick areas.

Don’t carry or swing heavy loads. This includes large boxes, cases, or purses that may cause you to lose your balance when you are moving along a slick surface.

When walking, curl your toes under and walk as flat-footed as possible.

Avoid curbs and other uneven surfaces that have ice on them.

Place your full attention on walking and avoid searching in your purse or backpack while walking on ice or slick areas.

Test potentially slick areas by tapping your foot on them or sliding your foot along them.

Keep walkways clear of debris, water, ice, and slippery materials by using rock salt.

Contact our orthopedic specialists or a doctor if you think you have a fracture or injury.

Orthopedic Specialists of Seattle’s New Ballard Location: Grand Opening January 3, 2012

Tuesday, January 3rd, 2012

After 40 years of service and the addition of expert surgeons, Orthopedic Specialists of Seattle has outgrown its NW Market Street Ballard location. It has now moved to a new Ballard location at 5350 Tallman Avenue NW, Suite 500. This office is located in the same building as the Swedish Hospital/Ballard emergency room.

The new Ballard location serves as an orthopedic clinic, while also offering same day emergency appointments. This clinic is using new, state-of-the-art X-ray equipment and offers a full scope of orthopedic services. Along with these services, this location gives access to all of its orthopedic surgeons.

All surgeons working at the Ballad location, Dr. Downer, Franklin, Ruhlman, Shapiro, Weil, Peterson, and Watt are experts in many orthopedic problems including sports injuries, total joint replacements, hand surgery and pediatric orthopedic care. To make an appointment with an orthopedic surgeon please call (206) 784-8833.


Pediatric Orthopedics at OSS – Highly Specialized Care, Easy Appointment Access, and Plenty of Stickers and Teddy Bears

Wednesday, October 26th, 2011



Did you know that you – and your 9-year-old son who just took a serious tumble and likely has a broken or sprained wrist – can receive top-quality pediatric orthopedic care, quick – right in our cozy Wallingford, Ballard and Mercer Island offices? Drs. Franklin, Peterson, Ruhlman, Watt and Weil all provide orthopedic care for pediatric patients, from infants to adolescents.

The most common pediatric conditions our physicians see are fractures (broken bones), ACL and meniscal tears in adolescents, as well as a wide range of sports- and activity-related injuries in active kids. OSS physicians also care for children with orthopedic deformities, such as webbed digits or congenital trigger thumb; often there are simple treatment options, and if surgery is required, we pride ourselves in a child-friendly experience from start to finish.

Many of our pediatric fracture patients require casting – and we offer exciting casting options, including waterproof Goretex® casts which can even allow for swimming while your child heals. For some of our younger patients, we take special attention to support your child through the experiences of X-rays and casting – including model casting on teddy bears, and plenty of “I graduated from X-ray school!” and “I met the doctor!” stickers.

And importantly – as any parent with an injured child certainly knows – time is of the essence. For many of our patients, visiting one of the OSS neighborhood clinics offered them the best of both worlds – the highest-quality care along with easy appointment access, especially for more routine – and urgent – orthopedic issues like fractures and severe sports injuries.

“For your child with a knee injury or a wrist fracture, we are regularly able to see them right away –always by a fully-trained attending provider – and get them on the road to healing much more quickly and always with the most state-of-the-art treatments,” says Dr. Scott Ruhlman, orthopedic surgeon at OSS.

He adds: “Children require a unique approach – as a physician, I really care for both the parent and the child as we navigate through the condition together, finding appropriate treatments and solutions to what they are experiencing – whether it’s a broken bone or a birth deformity – all in a way that reflects our genuine love of working with children to help them achieve their fullest potential,” says Dr. Scott Ruhlman. “And I always notice when our clinic has been full of children that day – because our entire staff is wearing a smile.”

Educational Feature: Common Shoulder Injuries

Thursday, October 6th, 2011



Common shoulder injuries typically involve the muscles, ligaments and tendons – and rarely, fractured bones. Repetitive, stressful sport activities as tennis, pitching, or weightlifting can weaken the shoulder and injure the ligaments. Intensive training routines, involving excessive, repetitive overhead motion of the arm and shoulder, can over time cause shoulder instability and impingement, and a great deal of pain.

• Shoulder Instability is caused by injured shoulder ligaments allowing the shoulder joint to move out of its normal position. This condition can lead to dislocation of the shoulder joint.
• Shoulder Impingement is caused by the overuse or abrasion of shoulder muscles on the shoulder blade. This occurs when the arm is lifted away from the body, putting pressure on the rotator cuff soft tissues.

These problems of instability and impingement of the soft tissue or bony structures of the shoulder most often result in weakness in the arm, a limited ability for joint motion and temporary or continuous pain – eventually requiring medical treatment. Ignoring or underestimating the pain and weakness of a shoulder injury may lead to continued aggravation of the condition, potentially causing additional problems.

• Loose or torn ligaments, tendons, and shoulder muscles may lead to a constant state of instability and recurring dislocations.
• Continuous, severe impingement of the rotator cuff tendons, bursa and muscles can lead to tendinitis and bursitis, and even a rotator cuff tear – all causing pain and restricted movements.
• Bursitis is caused by swollen bursae – which are thin, jelly-like sacs that create a cushion between the bones and soft tissues. Bursae usually contain a small amount of lubricating fluid that helps reduce friction between the gliding muscles and the underlying bone. The shoulder bursa is located between the rotator cuff and the shoulder blade. Swelling of the shoulder bursa may be a result of excessive use of the shoulder, causing pain and restriction of movements. Shoulder bursitis often occurs together with rotator cuff tendinitis.
• Tendinitis causes swelling of the tendons – which are cords that connect muscle to bone. In the shoulder, there are four rotator cuff tendons and one bicep tendon. Most forms of tendinitis develop over time, due to long-term overuse wearing down the tendon. At first the tendon becomes swollen, causing pain and tenderness in the shoulder. As the tendonitis develops, the tendon may thicken or grow larger, and pain may radiate towards the upper arm. Acute tendinitis can develop from excessive overhead sport activities as ball pitching or throwing. Chronic tendinitis may develop due to degenerative diseases like arthritis.
• Tendon tears. Over time, the stress from repetitive shoulder movements may lead to the development of overuse tendon tears. Tendon tears are caused by a partial or complete split of the tendon into two parts – it’s painful and causes weakness in the upper arm. Tears can occur through an acute injury, degenerative changes due to age, or long-term overuse wearing out the tendons. Complete tendon tears – in which the tendon is pulled from the attachment to the bone – are among the most common rotator cuff and bicep tendon injuries.

Educational Feature: Runner’s Knee

Monday, August 15th, 2011



The knee is a complex joint comprised of many components, highly vulnerable and easily injured. The large ligaments of the knee provide stability while the meniscus, which is a soft wedge of cartilage between the thighbone and shinbone, cushions the knee and absorbs shock from the movements of the knee.

RUNNER’S KNEE – WHAT IS IT & WHAT CAUSES IT?

Runner’s knee – or patellofemoral pain – is a condition caused by continual heavy stress on the knees, which is common in physically demanding activities such as running, jumping, skiing, cycling and playing soccer. It causes a dull, aching pain either under or around the front of the knee. The pain can be felt walking up or down stairs, kneeling, squatting or sitting for a long time with knees bent.

Runner’s knee refers to a number of conditions which may cause pain under or around the front of the knee. These include:

• Anterior knee pain syndrome: a result of irritation to the soft tissues, most often strained tendons, causing chronic pain in the front and center of the knee.
• Patellofemoral malalignment: when the kneecap is out of alignment, symptoms often intensified by intensive training or activities causing excessive stress on the cartilage of the kneecap.
• Chondromalacia patella: a condition which causes the softening and breakdown of the cartilage on the patella. Symptoms are irritation of the joint lining and pain in the underlying bone.

The knee has a complex and sensitive structure, and there are a number of contributing factors which may cause patellofemoral pain: malalignment of the kneecap, a partial or complete dislocation of the knee cap, a knee injury, excessive training and overuse putting stress on the knee, and inadequate stretching before and after running or participation in sports activities. Thigh muscle weakness, soft tissue tightness or muscle imbalance, and flat feet can also cause pain in the knees.

TREATMENT

If you suffer from knee pain following sports activities, it’s important to stop doing any physical activities that hurt the knee, and don’t start up again until you can do so without feeling pain.

For first aid treatment for the pain and swelling, remember:

R.I.C.E. — Rest, Ice, Compression, Elevation

• Rest and avoid putting pressure on the painful knee. Swimming is a safe, non-weight-bearing activity for this period of healing.
• Ice. Use cold packs or ice wrapped in a towel several times a day for short periods of time on the injured area to help relieve pain and swelling.
• Compression can be achieved using an elastic bandage or knee sleeve with a hole cut out for the kneecap. It should fit snugly without causing additional pain.
• Elevate the injured area by placing the knee on a pillow so it’s raised up higher than the level of the heart.

Additional methods of pain relief include taking nonsteroidal anti-inflammatory medications such as aspirin or ibuprofen. After rest and pain medication, if you don’t feel any improvement in your knee, you should consult your doctor. As with all sport injuries, it’s important to consult a doctor for early diagnosis and treatment recommendations. The good news is that runner’s knee usually heals with early diagnosis and treatment including reconditioning.

Individual treatment recommendations depend on the reasons for the knee pain. You may require reconditioning to recover your full range of motion, strength, endurance power, speed, dexterity and coordination. Rehabilitation typically includes an exercise program to regain the flexibility and strength of your thigh muscles, and exercises for stretching.

There are various other treatments including taping the kneecap or using a knee support brace or shoe insert – these may also help relieve knee pain and help in gradually returning to running or other sporting activities.