3 Tips to Prevent Common Holiday Injuries

From the American Academy of Orthopedic Surgeons

No one wants to be hurt during the holidays, yet injuries sustained as part of the season’s festivities are actually very common. To help you prepare for and enjoy your holidays in a safe and enjoyable way this year, the AAOS offers these safety tips.

1. Master the ladder
Yes, we’ve all been up a ladder hundreds of times, but 566,000 Americans were injured due to ladder falls in 2015. Many of these injuries took place during the holidays when outside conditions are more conducive to accidents.

Before using a ladder for any task, you should inspect it thoroughly for loose screws, hinges or rungs, and never climb a ladder that is damaged. Even the shortest job can still cause an accident. Once the ladder has been deemed to be in good working order, make sure it is set on level even ground — even if this means removing debris or snow to do so. Then, be sure you have a spotter ready below before beginning your climb. Once your task is finished, climb down the ladder and move it to the next position — don’t overreach. Relocating the ladder is just as easy and safer.

2. Pack smart
If travel is an essential component of your holiday plans, how you pack and handle your luggage can mean the difference between arriving healthy or injured at your final destination. More than 84,000 people were treated in hospital emergency rooms, doctor’s offices and clinics for injuries related to luggage in 2015. Here’s how to keep yourself off that list in 2016.

Start by packing lightly and resist the urge to drag that single, massive suitcase around. Several, lighter bags will be easier on your body. And when lifting luggage — no matter the weight — stand alongside your luggage and bend at the knees instead of the waist. Grab the handle and straighten up with the luggage close to your body — this allows you to lift with your leg muscles instead of your back.

Once you’ve lifted your luggage, it’s important you handle it properly. If you’re carrying a duffel bag, resist the urge to keep it on your dominant shoulder for the duration of the trip — rotate shoulders instead. Likewise, if you are using a backpack, make sure both shoulder straps are used and tightened accordingly so the weight is evenly distributed.

Finally, when handling a roller bag, don’t drag it up the stairs. Pick it up and carry instead. This simple adjustment will protect your body and the bag.

3.Walking safely in a winter wonderland
Walking is something people take for granted, but during the holiday season when everyone’s in a hurry, the opportunity for accident and injury increases. That’s why it’s important to walk defensively, just as you drive defensively, paying attention to the people, vehicles and objects around you, especially when it’s dark. Avoid jaywalking or other potentially dangerous situations. And if you need to switch your attention for a moment — perhaps to make a phone call or talk to a child — stop and step out of the main walkway to do so.

If you like to listen to music while you walk, make sure to keep the volume to a reasonable level so as not to block out the outside world. Being able to hear a car horn, for example, may just save your life.

The holidays can be an enjoyable time of year when we all look forward to visiting with family and friends, taking some time off to relax and crossing those wishes off our list. Follow the tips listed above and you’ll enjoy a safe and spirited holiday s

OCI Sports Medicine Patient Perspective

One of the greatest fears of any parent of a student athlete is injury. We spoke with Dana Spencer about her recent expereince with OCI Sports Medicine for her twin boys, Dustin and Derrick Dawson, both football players at Porta High School. Dustin was seen by Dr. Maender and underwent surgery for a hand injury. Derrick was seen by Dr. Herrin and treated for a knee injury.

What was your thought when your sons’ trainer called you to tell you that they had been injured?
My first thought was that we’ll have to go to the emergency room and spend the entire night in the ER only to be referred to a specialist.

Did you find that your access to OCI physicians was timely?
Our access was very timely and convenient for a working mother of twin boys, it was really helpful.

What is something that stood out to you about your sons’ care at OCI?
The accessability and that staff at OCI getting the situation taken care of promptly. There wasn’t months of waiting. We saw the doctor, got the MRI, and realized my son needed surgery which took place a week after his injury.

Would you recommend OCI Sports Medicine to other student athletes and their parents?
I very much would!

What type of encouragement would you give other parents with student athletes that are facing injury?
I would tell them, that if you get your child into the right place, it will really help their overall outcome. Because I came to OCI, my son will play sports again. The doctors at OCI are wonderful and answered all of our questions before we could even ask them. We are very happy that this service is available. Having children in sports can be difficult enough, especially when one of them gets injured. We are just glad that OCI Sports Medicine was there for us when we needed them!

Spine Manifestations of Osteoporosis

by Timothy VanFleet, MD

Vertebral compression fracture in the setting of osteoporosis is a frequently encountered clinical problem that is becoming even more common with an aging population. Osteoporosis is characterized by decreased bone density and increased susceptibility to fractures. According to the World Health Organization osteoporosis is defined as diminished bone density measuring 2.5 standard deviations
below the mean bone density of healthy 25-year old same sex members of the population evaluated with a bone density study. Based upon this definition, an estimated 25% of postmenopausal women and 35% of women over the age of 65 in the United States suffer from osteoporosis.

The risk of hip, wrist, and shoulder fractures is significantly increased in postmenopausal women though vertebral compression fractures are the most common. The number of osteoporotic fractures of the spine is greater than 500,000 per year in the United States with women being affected twice as often as men. One quarter of women reaching menopause can expect to suffer one or more vertebral compression fractures in their lifetime. In the United States, 25% of women over the age of 70 years and 50% of women over the age of 80 years have x-ray evidence of vertebral compression fractures.

Vertebral compression fractures can be classified into three types: wedge, biconcave, or crush. Wedge fractures are the most common and the severity of the deformity seems to be directly related to the bone mineral density. Wedge type fractures cause increased kyphosis, or the rounding of the back we see in little old ladies, as well as decreased spinal column height making one shorter in height. Biconcave or codfish fractures occur mainly in the lumbar spine and can result in loss of lordosis and decreased spinal column height. Crush fractures are associated with greater than 50% loss of height and may occur in both the thoracic and lumbar spine. These fractures may have fragments of bone into the spinal canal, which can lead to neurologic deficits or leg pain.

The deformity associated with each of these fracture types may lead to loss of height and thoracic hyperkyphosis (dowager’s hump), abdominal protuberance, and loss of lumbar lordosis. The loss of height may lead to abdominal compression resulting in loss of appetite, early fullness, and weight loss. Thoracic hyperkyphosis leads to compression of the lungs resulting in decreased lung function and an increased risk of dying. One thoracic vertebra fracture increases the risk of pneumonia and lung
disease. Neurologic involvement is not usual although not rare and late neurologic involvement can be seen up to 18 months after a fracture. Aside from the various physical effects vertebral compression fractures also have a negative effect on the psyche with higher than average rate of depression and loss of self-esteem in addition to a deteriorating quality of life. Lastly the overall rate of mortality is increased 5-fold compared to the general population and is comparable to survival rates after
hip fracture.

The treatment of the patient with osteoporotic compression fractures is twofold: pain
management and prevention of instability or neurologic deterioration. Certainly to be complete in the workup it is important to understand the cause of the fracture. A medical workup is needed to determine the cause of the underlying osteoporosis to ensure that an occult cancer is not being overlooked. Laboratory studies including a CBC, and other blood studies should be completed.

Imaging studies include plain x-rays, CAT scans as well as MRI scans. MRI is quite helpful in distinguishing an acute fracture from a subacute or chronic fracture. MRI is also helpful in differentiating a benign fracture from a fracture as a result of
a tumor.

Pain management consists of non-narcotic pain relievers, muscle relaxants for muscle spasm, and narcotic pain relievers. Typically the severe pain resolves over a period of 6-8 weeks. Often times it can be difficult for elderly patients to tolerate these
medications due to the side effects of confusion, constipation,
increased fall risk, and potential for addiction.

Bracing is the treatment of choice for most fractures. A short period of bed rest may help to relieve severe pain but is contraindicated beyond a few days. Bracing is typically necessary the first 6-8 weeks or until the acute pain resolves. The type of brace is dependant on the location of the fracture. Most patients do not like the brace initially because it is somewhat constraining. Bracing may provide comfort however with activities of daily living or with prolonged standing or car rides at a later point.

Although most patients will recover from the acute pain associated with a new vertebral compression fracture, some will not and do continue to experience chronic persistent or recurrent pain. These patients may benefit from surgical intervention. The surgical treatment of vertebral compression fractures is challenging because of the deficient mechanical properties of osteoporotic bone. The surgical treatment for vertebral compression fractures ideally should address the pain associated with the fracture and the kyphotic deformity. Vertebroplasty and kyphoplasty are two techniques that address the pain but kyphoplasty also addresses the deformity. These operations utilize x-ray guidance to inject bone cement into the fractured vertebral body.

Vetebroplasty (see Fig. 1) was first described in 1987 in Europe and in the U.S. in 1993. The pain relief brought about by vertebroplasty is probably secondary to the fracture being solidified. The injected cement hardens and stabilizes micromotion at the fracture site. Ideally the patient with unimproving pain and less than 60% compressed is a candidate. If there is more compression it becomes difficult to do the procedure. Risks associated with the procedure include cement extending into the spinal canal, nerve root compression, or death. Additionally a new fracture is a relatively frequent occurrence. There is about a 50% chance for a new fracture within several years.
Kyphoplasty (see Fig. 2) is a similar technique that uses a balloon that is expanded within the vertebral body. It has several advantages: lower risk of cement squirting out, and better restoration of vertebral body height. By creating a cavity with the balloon the process of cement injection becomes safer as it is creating a low-pressure cavity into which the cement will preferentially flow. It can be used for any progressive or painful osteoporotic compression fracture. The technique is similar to that of vertebroplasty and in addition the inflatable balloon tamp is expanded under x-ray guidance until
maximum fracture reduction is achieved. The patient is discharged usually the following or same day without a brace.

Certainly early management of osteoporosis by prevention affords the least morbidity possible. However with a continually aging population and increasing incidence of vertebral compression fractures surgical reconstruction of the spine will be of significant interest. The development of new procedures such as vertebroplasty and kyphoplasty offer advancement in the field and newer techniques for open treatment will continue to evolve.