Putting back your Bones, Putting back your Life!

Basketball fans, not only in America, but throughout the world, witnessed the “gruesome” injury of Louisville guard Kevin Ware last week.  

  And since this kind of injury is one of the common injuries orthopedic surgeons deal with, allow me to discuss a few things about this.

Reports showed how the player came down wrong on his leg as he tried to block the shot of an opponent player. His right tibia, or shinbone, broke through the skin in what is called an open or compound fracture.  This caused fans and players alike to shut their eyes in horror and disbelief.  Some nearly hurled.  (Just look at the reaction of the bench of Ware’s team in the above YouTube clip.  (Napaiktad sa gulat!)

 

www.thehollywoodgossip.com

So what happens in open fractures?

Not only does the bone get broken, open fractures often cause damage to the surrounding muscles, tendons, ligaments, and more importantly, blood vessels.  The usual concern here is infection because once the skin is broken, harmful germs or bacteria may prevent the wound and the bone to heal.

I am not privy to the exact treatment that the player got, but the typical procedure for this kind of injury, is that the patient will be immediately brought to the hospital. After thoroughly cleaning the broken soft tissues (muscles, ligaments, etc), the bone will be reset and a metal rod will be inserted into the shin bone. That’s either a stainless steel or titanium placed inside the hollow leg bone to reconnect it where it broke.  After surgery, we place patients on antibiotics to lower the risk of infection.

  Although the fracture looked gruesome and extraordinary, orthopedic surgeons like me see this often, especially if you trained in a major government  hospital like PGH (Philippine General Hospital) or POC (Philippine Orthopedic Center).

     The thing here is that open fractures are usually the result of a "high-energy" trauma, such as a vehicular accident or a fall from a height. The injury was extremely unusual given the circumstance (jumping in basketball). The player may have twisted his leg as he landed, causing the bone to snap. It's possible Ware had a “stress” fracture or benign bone tumor that weakened the tibia before his fall.  This is called a ”pathologic fracture.  As I’ve mentioned, I am not involved in his care so I am just stating my own personal opinion here.

Can the player go back to playing basketball again?

A good friend of mine from High School asked me this.

My answer?

Ware’s doctors probably got him up and moving the day after surgery. And with intensive daily physical therapy, he could be back on the basketball court in six months to a year, barring any complications. In a "best-case scenario," Ware would begin to show signs of healing within 8-12 weeks. In other words, the injury is not likely a career-ending one.

However, the three most common complications for open fractures are infection, difficulty healing and a condition called acute compartment syndrome. That develops when pressure builds in the muscles surrounding the injury. This very painful and can cause tissue death if the pressure is not relieved.

If Ware's leg doesn't heal properly, he may need more surgery.

Should we be more concerned now and discourage our children from playing basketball since these injuries occur?

Before leaving the court on that fateful day, Ware reportedly told his teammates to focus on winning the game.  “Win the game.  Just win the game!”.

The gruesome injury and words apparently left his teammates in tears, and they went on to win the game.

A photo posted on the Internet shows his jubilant teammates holding up Ware's jersey as they celebrated their win. Another showed Ware in his hospital bed, holding the trophy his teammates brought to him.

www.grizzlybomb.com

So my answer to the question is NO. We should not get disheartened when injuries like these happen. Because we all know that everything happens for a reason.

Kevin Ware himself was not disheartened. Remember he was more concerned for his team to win. It can serve as an inspiration to any injured player. As a good friend of mine from Medical school commented, “If you'll pardon the expression, Ware has balls of titanium and now a leg to match”. 

      And besides, you can always call your friendly and well-trained orthopedic surgeon to put back your bones (and possibly your life) together again. 

Welcome New year With Hope, not with Injuries!

         Happy New Year to everyone! No long blog post for today.  Just a quick greeting and reminder to everyone to welcome the coming new year with hope, not with injuries from playing with firecrackers!

          I know the Department of Health has been educating the public about the risks and hazards of playing with firecrackers, but the latest news as of this writing is that at least 200 have already been injured from playing with these firecrackers. Since orthopedic injury or disease prevention has also been my advocate, I might as well join them in trying to scare you. hehe

     The following are some pictures or the orthopedic instruments we use in the process of treating firecracker injuries

       The figure above is a bone saw. You know what a bone saw is? It is used to saw a bone.   (Sometimes, I get mesmerized by my own intelligence).   It's my favorite instrument.(joke)

       This is a Gigli saw.  It is also used to cut bones. The saw is composed of a wire blade and two handles.  Easier to use and more soft tissue-friendly than the first picture above.

       This is a drill, the same kind we use for house construction (I'm not kidding!). This is used to drill the pins or wires through the bone.

         As you can see, I'm trying to gross you out, and I'm having fun!

This is a mallet. It is used to pound on the chisel or osteotome to cut the bone smoothly.

     The above picture is an antenna-like structure called external fixator. It is usually used in wrist and forearm injuries to connect together broken bones.

      And now to scare the daylights out of you, my non-medical, non-ortho friends, the following is a picture of a firecracker injury...

 

photo courtesy of Dr Edsel Arandia

And another one....

Photo courtesy of Dr. Harem Deiparine

       Seriously, firecracker injuries are senseless injuries that are highly preventable and will have  great impact on your future.  You will definitely regret playing with one for the rest of your life.

Happy New Year and stay safe everyone!

Getting out of the Sidelines: 6 Rules to Follow to Prevent Sports Injuries

Before anything else, I’d really like to thank you.  Why?  The mere fact that you are reading this blog is an honor for me.  I just recently started blogging as a way for me to share my opinions on topics I am knowledgeable about (mainly Orthopedics) and help patients take charge of their health.  If I can perhaps entertain those who happen to stumble upon this little blog site of mine, that’s a bonus for me.  

Sometimes, it is difficult to think about what topic to blog about next.  But as soon as the kids sleep at night and my wife starts snoring (Don’t tell that to her, ok. It’s a secret between you and me), then that’s the time I think about what happened to my day that can inspire me to put in my next post. 

Last weekend, being the opening games of the University Athletic Association of the Philippines (UAAP) Men’s Basketball tournament, I was inspired to discuss the prevention of sports injuries.  Why? Because being a sports enthusiast myself, I understand that the worst feeling for any athlete is to sitting out injured in the sidelines, watching his team struggle without him. (Hmmm. On second thought, some athletes’ team struggle more if they are around).

As a long-time UAAP fan, I volunteered this year to be one of a team of UAAP doctors tapped by the Ateneo school to be at ringside during games.  You know, just in case someone needs medical attention.  Ironically, I was also part of the medical team last year which was organized by the La Salle team.    

 

     But don’t get me wrong here, my blood is neither blue nor green, it’s as Maroon as it can ever be.  I was an “Iskolar ng Bayan” from Kindergarten up to Medical School.  With that I am obviously a Fighting Maroons fan, win or lose.  However, for those in the know, the UP Fighting Maroons has perennially been a cellar dweller in the UAAP Men’s Basketball games and this year doesn’t seem to be any different.  Still hoping I’m wrong about that.  

So my involvement in the UAAP medical team transcends color boundaries, more for the love of sports in general and just happened to be due to my hospital/ clinic affiliations. 

But going back to the point, as a medic, I’ve seen many injuries during games, and many players’ spirits crushed by the diagnosis of serious injury.  I believe prevention should be the key. It’s wiser to learn how to prevent injuries instead of dragging your way through rehab or surgery.

Recently, it was reported that Yao Ming of the Houston Rockets retired due to his injuries. I must admit that I have not read enough about his exact injury, but the fact that at his prime, and with all the medical resources available to him, US state-of-the-art facilities and all, his forced retirement is a wake-up call for us mere mortals.

    So whatever your sport may be -- basketball, running, swimming, badminton, golf – it does well to know that while it is impossible to prevent any injury in sports, their rates and extent can be drastically reduced if only we take appropriate preventive actions:

1.    Be in proper physical condition.

      The “weekend warrior” has a higher rate of injury, especially if you are into competitive sports. If you play any sports, you should adequately train for that sport. Don’t expect the sport itself to get you into shape. Many injuries can be prevented by following a regular conditioning program of exercises designed specifically for your sports. 

2. Don’t ignore warming up. 

    You have to get your blood flowing through your muscles and get your Central Nervous System programmed and ready to exercise by warming- up for at least 15 minutes. Warm muscles are less susceptible to injuries.  Start with an easy cardiovascular workout to raise your body temperature and heart rate, and finish with slow easy stretching.  Stretch slowly and don’t bounce!  Stretching lengthens muscles while it increases blood flow and muscle temperature.  When you’re finished, your muscles are ready to perform and are less likely to be injured.  

3. Know and abide by the rules of your sport.  

       The rules are designed, in part, to keep the players safe, especially in contact sports. Rules of the sport, including avoiding illegal blocks, deliberate fouls, are enforced to keep athletes healthy. Know them and follow them!  

4. Wear appropriate protective gear and equipment if required for the sport. 

    Some may think that wearing protective equipment may look like you’re a sissy. Sissy, my foot! Protective pads, mouth guards, helmets, gloves and other equipment are designed to help prevent major injuries, even death.  And needless to say, these equipment must be well fitting and in good condition. Never play without your safety gear.

5. Rest and hydrate. 

          Athletes who continuously train every single day will have more injuries. While many athletes think the more they train, the better they'll play, this is not true anymore. Rest is a critical component of proper training. Rest can make you stronger and prevent injuries of overuse, overtraining and eventual fatigue. 

6. Avoid playing when very tired, in pain, or in obvious injury.

       Pain indicates a problem.  Also, overuse injuries occur when you increase your exercise intensity more quickly than your body can adapt to the change. You need to pay attention to warning signs your body provides. 

     Although this list is meant to prevent many injuries, injuries may still occur. When this happens, don’t try to “play through” the pain.  Rest and let the injury heal before returning to sport.  Continuing to play can only make it worse and may lead to more serious and career –threatening chronic problems.  Taking a few days off, may prevent the loss of an entire season or career. 

      Good luck and play safe!  May the best team wins!

P.S.  Just want to share a video link for some of the worst sports injuries Worst Sports injuries