How Broken Bones Are Healed

Orthopedic surgeon explains treatments for Olympians, and us

By Kevin McKeough for Midwesto Orthopaedics at Rush

The 2016 Summer Olympics have included legend-making performances by athletesGymnast such as Katie Ledecky and Simone Biles. They also have included devastating injuries: French gymnast Samir Ait Said suffered a gruesome broken leg early in the games; crashes by cyclists Vincenzo Nibali of Italy and Annemiek van Vleuten of the Netherlands left them with a broken collarbone and cracked vertebrae, respectively; and Armenian weightlifter Andranik Karapetyan dislocated his elbow while trying to lift 195 kilograms (about 430 pounds).

“No matter how many rules and regulations, how much safety equipment and caution you have in the situation, you have powerful, athletic individuals trying their hardest to move a ball or jump their highest,” says Joel Williams, MD, an assistant professor of orthopedics and a specialist in orthopedic trauma and hip preservation at Rush. “It’s a lot of mass and a lot of velocity, and these sorts of injuries are a risk of being active in these sort of sports.”

Fortunately, medicine and the body’s own healing power in most cases can heal even the most dramatic injuries. Here, Williams answers questions about what doctors do to mend the broken bones of both Olympic athletes and the ordinary patients he sees in his practice, where he treats broken arms and legs.

Outside of competitive events, are broken bones common among athletes?

Williams: The two most common demographics of trauma are young men with too much testosterone who engage in dangerous behaviors that result in an accident, and elderly folks who have a ground-level fall. If these patients were 20 years old, they would get right up, but now they wind up with a fracture.

A close third subset is athletes that are mid-sport or mid-practice and end up with a real traumatic injury like the ones we’re seeing in the Olympics. Just this week I cared for a 14-year-old eighth-grader throwing 80 miles-an-hour fastballs. He was able to generate enough force with his momentum and his muscles that he twisted his humerus (upper arm bone) in such a way that it caused a fracture.

What are the options for treating broken bones?

Surgery is not necessary for every patient. Some can be treated with immobilization, like a splint, cast or brace.

The next modality of treatment is a device called an external fixator. They have metal pins that go through the skin and into the bone above and below the injury. The pins are connected to each other with carbon fiber rods.  Sometimes they’re used as the patient’s definitive treatment — the device is put on and kept on until the fracture heals — but most of the time we’ll put it on as a temporary measure until another operation at a later date.

The two most common reasons to use them are if somebody comes in and they’re too sick for surgery, or if there’s a large amount of swelling and it’s not safe to make an incision.

The last two options are internal fixation with a plate or a rod. Plates come in a variety of shapes and sizes, and they’re applied to the bone with screws. Typically, the fracture is aligned to its correct position using X-rays before the application of internal fixation.  Sometimes we put them on while we’re looking directly at the entire bone and plate and do not rely heavily on X-rays. Alternatively, we’ll make small incisions and slide the plate under the skin and muscle and use X-rays to place the implant in the correct position.

If we decide to use a rod, it goes inside the bone rather than on the surface of the bone. The decision to use a plate versus a rod is injury specific and surgeon preference. Especially with the rod, we use a lot of X-rays to make sure everything is lined up correctly before the implant goes in.

How do a fixator, plate or rod help bones heal?

They’re all devices we use to hold things in the correct position. At some point, if the body doesn’t heal, any of these devices will fail. Once the surgery is done, the patient needs to heal the fracture on his or her own.

If you’re fixing a broken chair or table, it doesn’t have any healing capacity, so the fixation has to last. But the human skeleton is much cooler, because you align things back where they’re supposed to be, and the body actually builds new bone.  It fills in the broken pieces with new bone.

A lot of people may not realize that the body keeps producing new bone even after a person is fully grown. Can you talk a little more about that process and how it helps broken bones heal?

From before you’re born until the day you die, your entire skeleton is digested and rebuilt by very specific cells. Your skeleton remodels itself roughly every 15 years. It’s a highly regulated system and breaks down bone at certain points and builds it back up at other points.

A child’s skeleton is very different. There are growth plates all over the skeleton that are responsible for increasing the length of your arms and legs.  Once someone reaches skeletal maturity, the remodeling process still continues. The cells that break down bones are called osteoclasts and the ones that build bone are called osteoblasts, and they signal each other.

The process is accelerated by a broken bone, which sets off all kinds of signals. There’s a huge recruitment of osteoblasts and they gather to repair the broken bone.

I realize you don’t have first-hand knowledge of the incidents at the Olympics, but I’m hoping can you offer some general perspective on them. Have you seen any of the injuries?

I was watching the French guy (gymnast Samir Ait Said) with a small group of people. Most people look away or have an audible reaction, and my fiancé was teasing me because I was bringing my nose closer to the screen and trying to guess what the X-ray would look like.

Can athletes recover from these kinds of injuries?

It just depends on the injury, people’s age and their overall physical health. It’s a factor in our decision-making and how we’re going treat them, and it’s a factor after surgery when they’re going to go to physical therapy.

Young people heal more quickly than older people. Olympic athletes, who are at the younger end of the age spectrum and are in fantastic shape, are going to heal more quickly. Whether they’re going to return to the Olympics depends on the injury.

The weight lifter probably is going to lose some extension of his elbow, which is a huge set back for a weightlifter. He’s probably not going to be able to lift as much weight. For the French gymnast, there are plenty of athletes who have an injury like that and return to competitive sports, but there also are plenty of people for whom that’s a career-ending injury.

(Said, who was attempting an Olympics comeback after missing the 2012 Summer Olympics due to injury, has vowed to compete in the 2020 Summer Olympics in Tokyo and to win a medal.)

My impression is that a broken collarbone, which is what one of the cyclists suffered, isn’t as severe.

Most competitive cyclists have had a clavicle fracture at some point or another because it’s so common. I just finished operating on a 40-year-old bicyclist with a collarbone injury an hour ago.

Without surgery, patients with a broken collarbone do extremely well — 85 to 90 percent of them heal and patients have no complaints long term without an operation. If you put them in a sling and let them be, they’ll recover so why put them in the risk of surgery. This gentleman had an injury that almost was poking through his skin, so I realigned him so he wasn’t at risk of the bone breaking the skin.

The body’s healing power is extraordinary, but obviously, the best thing to do is avoid broken bones in the first place. Are there things people can do to help keep their bones strong, especially older adults who are at risk for bone loss?

Staying active with weight bearing activities. Walking, running if your knees and ankles and hips are in good shape, weightlifting are all great ways to increase bone formation and decrease your chance of getting osteoporosis.

The other thing you can do later in life, after age 50 or 60, to increase your bone mass is to take calcium and vitamin D supplements, which are available over the counter. It’s always better to do it under the supervision of a primary care doctor or an endocrinologist, but for calcium and vitamin D supplements there’s not a whole lot of downside of taking them.

NEVER TAPE AGAIN: DONJOY PERFORMANCE LAUNCHES POD, REVOLUTIONARY ANKLE SUPPORT FOR ATHLETES

Pod Ankle for Soccer

No more taping to protect your ankle. Choose ankle bracing that prevents your ankle from rolling over tape. Taping is inefficient, time consuming, and wasteful. Today, DonJoy Performance releases a new “Protection On Demand” ankle brace that features patent-pending technology to prevent ankle rolls and sprains without limiting range of motion:  POD Ankle Brace.

The new ankle brace is a game changer. Created with the athlete in mind, the POD meets the needs of athletes across a wide-array of sports. An alternative to taping, this low-profile brace provides compression and support an athlete needs when playing or training. Designed without metal or stays, the POD Ankle Brace features ultra-lightweight construction, super soft EVA lining, low-profile cuff and adjustable underfoot closure. At 30 percent lighter than the average ankle brace, athletes will experience enhanced footwork and speed while remaining safely supported when needed. Designed for all athletes of all sports, the POD Ankle Brace can be worn to support one weak ankle or worn on both ankles helping to prevent injuries. Simple to put on and easy to clean, athletes can focus on their movement and be proactive, preventing future ankle rolls or sprains, with the POD Ankle. Order Now.

While most ankle braces are bulky and constricting, the POD Ankle allows for 360-degree movement. This brace allows athletes to focus on their sport of choice instead of carrying tape, spending time taping their injury and worrying about if the brace will stay put.

COMMON TAPING ISSUES:

  • Tape goes over the ankle too tightly causing discomfort
  • Limits range of motion, restrictive, and stiff
  • Tape is not always readily available
  • Ankle is not taped appropriately
  • Difficult to tape yourself
  • Difficult to find someone that knows how to tape properly
  • Tape does not stay on or comes off during play
  • Skin gets irritated due to adhesive, prolonged use, or tape gets wet from sweat
  • Blisters or cuts
  • Difficult to remove without scissors
  • Costly; not reusable

HOW DOES THE POD ANKLE BRACE WORK?

Delivering ultimate protection to prevent ankle rolls and sprains, the POD offers the following benefits:

  • 30% lighter than the average ankle support on the market weighing only 4 ounces
  • Super soft lining provides ultimate comfort
  • Anatomical shell helps the brace mold and fit to every foot shape
  • Easily tighten or loosen brace with velcro strap
  • Sleek and low-profile design fits any shoe or cleat
  • No bulky straps and laces make this brace easy to put-on
  • Ideal for all sports

POD Ankle Benefits

Recommended for: Athletes or active individuals who’ve suffered from ankle rolls, sprains or chronic weakness. Not meant for acute injuries.

Activities: Basketball, volleyball, football, soccer, tennis, lacrosse and more.

POD Ankle Brace for Basketball

Speed Ladder Warm-up with POD Ankle

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5 Great Benefits of Kettle Bell Training

Kettle bell training benefits

For a simple and efficient way to incorporate full body resistance training into your routine, kettle bells are the answer. Kettle bells are an excellent piece of portable, inexpensive and compact kit. A highly adaptable piece of equipment, this simple piece of kit provides a full body workout, working the upper body, legs, back and core muscles.

The main kettle bell exercises are the kettle bell swing, press and clean, and squats. Delivering a dynamic and ballistic resistance training work out strategy whilst targeting major muscle groups, kettle bells are an excellent and efficient piece of equipment. Training correctly with kettle bells builds overall strength and mobility which helps guard against the risk of sporting injury.

1. Improves Muscular Strength and Endurance

 Performing kettle bell swings is a whole-body compound movement – which is proven to be more powerful in building muscle strength than isolated movement. Furthermore the singular weight of the kettle bell necessitates the recruitment of more stabiliser muscles, and engages more muscles to support the dynamic nature of the movement whilst supporting the weight-bearing aspect of the work out. Kettle bells are excellent for building and improving strength in the arms, shoulders, core, upper and lower back, and thighs.

2. Provides An Efficient Workout

Perfect for busy people, just 5 minutes of a kettle bell workout provides a comprehensive full body conditioning and cardio workout, to get the blood pumping and provide full body conditioning. A compact piece of kit, a kettle bell at your chosen weight is easy to store at home, so it is a highly convenient way to fit in resistance and cardio training regardless of your schedule.

3. Excellent for Strengthening the Back

The main advantage of kettle bell exercises is that a dynamic movement is performed without overloading the back. It is of particular benefit for improving strength and mobility in the lower back. Providing a kettle bell swing is performed correctly, it is a ballistic movement powered by the hips, which allows for comprehensive lower back strength training without the risk of overloading the lower back.

4. Core Strength

Kettle bell swings encourage the development of core strength, as the abdominal muscles are relied upon to contract and support the ballistic nature of the movement. Developing and maintaining core strength is of fundamental importance to athletes and of particular significance to those wishing to guide against back pain and injury.

5. Promotes Fat Loss

The combined dynamic and weight-bearing nature of kettle bell reps have a powerful effect on the metabolism and burn calories efficiently over a short period of time. Furthermore, increasing lean muscle-mass promotes on-going fat loss and an increase in metabolic rate and efficacy. Due the the duality of a kettle bell work out – dynamic cardio and weight training – these benefits are particularly powerful.

By Sports Injury Clinic

Improve your Understanding of Patella (Knee Cap) Pain Procedures

The patella is a flat triangular shaped bone that protects the knee joint and helps muscles move your leg more efficiently. A healthy patella glides up and down a groove at the end of your femur, pain free.

patella

View 3D Animation Videos-Brochures on the following Patella Pain Procedures:

Visit  our Patient Education page for the full Library of 51 specific Orthopedic Surgical Procedures in 3D Animation. Produced by an experienced team of medical writers, 3D animators, and project managers with a detailed understanding of anatomy and surgery; they take complex surgical procedures and animate the steps to tell a visually stunning story in 3D that is both educational and entertaining. Each animation is embedded with an illustrated script which can be shared, viewed or printed separately.

Medial Knee Ligament Injury

A medial ligament sprain or MCL injury is a tear of the ligament on the inside of the knee, usually a result of twisting or direct impact. Medial ligament injuries are common in contact sports such as football and rugby, as well as martial arts. They can also occur in daily life through falls and twists of the knee joint.

Anatomy: The medial collateral ligament or MCL for short connects the thigh bone (or femur) to the shin bone (or tibia) on the inside of the knee and prevents the knee joint from moving sideways, particularly from forces on the outside of the knee.

The medial knee ligament itself has two parts to it; a deep inner section which attaches to the cartilage meniscus at the top of the shin bone, and a superficial band that originates higher up on the femur to an area lower down on the inner surface of the tibia.

Causes: Injury to the MCL often occurs after an impact to the outside of the knee when the knee is slightly bent. The ligament on the inside of the knee becomes stretched and if the force is great enough, some or even all of the fibres will tear. The deep part of ligament is prone to becoming damaged first and this may lead to a medial cartilage meniscus injury.

Twisting the knee can also cause a medial ligament sprain as well as the possibility of an ACL tear. If the foot is planted and the player tries to turn quickly this can also lead to stressing the joint causing the inside of the joint to open and tear the ligament. Whilst repetitive valgus forces can gradually over time lead to a MCL sprain, pain on the inside of the knee which does not occur after a sudden injury, should be considered for pes anserine tendinopathy or bursitis.

Symptoms: Graded 1, 2 or 3 depend on on severity of the injury.

Grade 1 symptoms: For a grade 1 MCL injury there may be mild tenderness on the inside of the knee over the ligament. There is usually no swelling. When the knee is bent to 30 degrees and an outward force applied to the lower leg to stress the medial ligament, pain is felt but there is no joint laxity (play valgus stress test video). A grade one tear consists of fewer than 10% of the fibres being torn.

Grade 2 symptoms: Significant tenderness will be felt on the inside of the knee along the medial ligament. Some swelling may seen over the ligament. When the valgus stress test is applied there is pain with mild to moderate laxity in the joint, although there is a definite end point (the knee cannot be bent sideways completely).

Grade 3 symptoms: This is a complete tear of the ligament. Pain can vary and is sometimes not as bad as that of a grade 2 MCL sprain. The valgus stress test will reveal significant joint laxity and the patient may complain of having a very wobbly or unstable knee.

Treatment for medial ligament sprains: Treatment can be divided into immediate first aid during the acute stage and longer term rehabilitation.

Immediate first aid

  • Apply P.R.I.C.E. principles (Rest, Ice, Compression, Elevation) to the injured knee.
  • Rest from training or any activities or movements which are painful to allow healing to take place
  • Apply ice or cold therapy wrap for 10 to 15 minutes every hour initially reducing frequency as symptoms allow. Ice should not be applied directly to the skin but use a wet tea towel or similar. Specialist cold therapy knee wraps are convenient to use and will apply compression as well.
  • Wear a compression bandage or knee support to help reduce any swelling and protect the joint. A hinged knee brace is best particularly for grade 2 and 3 injuries.

Wear a hinged knee brace: A hinged knee brace is a strong knee support which has solid metal supports down the sides to prevent sideways movement of the joint and protect the knee ligaments while healing. More severe grade 2 and full grade 3 injuries may require a limited motion hinged knee brace which restricts the amount of movement or knee bend in the joint whilst healing.

Electrotherapy: Ultrasound treatment involves applying high frequency sound waves to the injured tissues. A professional therapist may do this in the early more acute stages to help control swelling and pain. Interferential or tens involves applying electric currents to the tissue around the injury which can also help with pain and swelling.

Knee tapingTaping: Taping the knee joint can also provide a high level of support and protection. It can be done in the early stages as well as later on when returning to full training. A good taping technique can provide excellent support and often more support than some of the cheaper hinged knee braces, but the effectiveness of tape will reduce over time as the tape stretches slightly. It will need to be re-applied to maintain good support for the joint, particularly during competitive sport.

Knee rehabilitationExercises: A full rehabilitation program consisting of mobility and strengthening exercises should begin as soon as pain allows. Initially range of motion mobility exercises are done to restore full pain free range of movement. In the early stages isometric strengthening exercises (static muscle conractions) can be done to help maintain muscle strength and prevent muscle wasting whilst the ligament heals.

As the ligament heals strengthening exercises such as mini squats, leg press and step ups can be done but movements involving change of direction or sideways stresses should be avoided until much later in the rehabilitation program. A hinged knee brace should be worn to protect the ligament whilst exercising.

Massage: Manual therapy techniques including massage may be used as part of a rehabilitation program. Massage to the injured tissues should be avoided in the early acute stages. Later as the ligament starts to heel then light cross friction massage may be used and in particular if there is persistant pain in the later stages of rehabilitation then cross friction massage may be beneficial.

Do I need surgery? Most medial ligament injuries do not require surgical treatment. If there is additional damage to the joint for example an ACL tear as well then surgery may be considered. However, it is thought there is no advantage even with grade 3 injuries to treating them surgically as opposed to bracing and rehabilitation exercises.

How long will it take to recover?

  • A mild MCL injury or grade one sprain should take 3 to 6 weeks to make a full recover.
  • A more severe grade 2 or grade 3 injury may take 8 to 12 weeks.

Contributed by: Sports Injury Clinic