Fracture equals broken equals cracked

Monday, June 29, 2015

Words matter, especially in medicine. There are unique terms that help describe anatomy, physiology, disease and injury and it’s important that doctors speak the same language with their colleagues. It’s just as important that doctors translate medical speak into regular English, so that patients and families can understand their situation. For that reason, it is not terribly helpful when the media and press misuse medical terms that might confuse and mislead their audience.

This diatribe starts with the Sports Illustrated article that discussed the ability of hockey players to neglect injuries during their quest for the Stanley Cup:

  • Montreal’s Nathan Beaulieu – fractured sternum
  • Rangers’ Mats Zuccarello – fractured skull
  • Tampa’s Tyler Johnson – broken wrist
  • Ottawa’s Mark Stone – fractured wrist
  • Minnesota’s Jason Zucker – broken bone in his thumb
  • Ranger’s Marc Steel – hairline fracture in the ankle
  • Red Wings’ Jonathan Ericksson – broken big toe

At the bedside, patients and families seem to have the same concept when it comes to bone injuries. Routinely, there are questions. “I hope it’s only cracked and not broken” or “is it fractured or just broken?”

Let us be clear with the words… fractured, broken and cracked all mean the same thing. The integrity of the bone has been disrupted. One term does not imply a more severe injury and another does not presume that healing will be quicker or that surgery might not be needed.

When talking about fractures (the same thing as broken or cracked), there are other descriptive terms that are helpful in explaining the injury:

Is the fracture open or closed? The skin protects the body from the outside world. If the skin over a fracture is broken and the dirty outside work can communicate with the broken bone fragments and the risk of a bacterial infection increases dramatically. Often, this requires a trip to the operating room for the orthopedic surgeon to clean out the wound and prevent osteomyelitis, an infection of the bone.

Is the fracture comminuted? A bone can brake into two parts, it can shatter into multiple fragments or the fracture is somewhere in between. Comminuted equals more than two pieces and may signal a more complicated healing process…or not. Every injury is distinct and needs to be individually assessed.

Is the fracture aligned or is it displaced? If the bone fragments appear to be in reasonable position, they may heal nicely without much intervention. Sometimes, though, the fracture needs to be reduced or realigned to make it heal as close to abnormal anatomic position as possible. Knowing anatomy helps. Even though a fracture may appear to be normally aligned initially, the pull of muscles or gravity may cause the pieces to move.

Is the neurovascular status intact? Arteries, veins and nerves may be located near the fracture site and it’s important to know whether there is good blood flow and sensation beyond the injury. Looking for complications is the first step in potentially finding them.

And there are special terms used for certain bone injuries. Fractures may enter joints. Skull fractures may be depressed. The Salter Harris classification system is used to describe fractures that involve growth plate fractures in children. Compression fractures may occur in the vertebrae of the neck or back.

Each fracture has its own healing potential and treatment need. The goal for treatment is to return the bone to anatomic alignment and allow it to heal so that the body can be returned to normal function. If an ankle fracture heals poorly or is misaligned, arthritis may set in and cause problems to develop years later. Bones in the hand and finger cannot be allowed to have any rotation issue; otherwise the hand might not be able to form a fist. Bones that support the eye cannot trap muscle otherwise, the eye will not move properly and double vision might result.

The language of bone is important so that an injury can be described and explained in words. For that reason, it’s important that the doctor, patient and family know what words mean, so that they have the same game plan for care and the same expectation for healing. For that reason, the writers and editors of Sports Illustrated need to learn medical terminology, just like they learned the words used to describe the action on the field that caused the broken, fractured, cracked bone.


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trans fat kills, but smoking massacres

Monday, June 22, 2015

In sports, fans get to boo and cheer because they have an emotional connection to their team and are invested in the outcome of the game. If only the same were true in the real world, where decisions made by the courts, elected officials and others have an impact on individual lives and society as a whole. For that reason, it would be very appropriate to take the FDA to task and boo loud and long. Given the responsibility for protecting the public by regulating food and drugs, those in charge of the Food and Drug Administration have forgotten their mission. Instead, they have allowed politicians to misshape their mission and in the process, allow millions of people to die.

Why the diatribe now? It’s about the announcement that trans fats (partially hydrogenated oils) will be an effectively banned substance in the food supply. It only took 14 years for that decision to occur, since transfats were found to be a health risk by the National Academy of Science Institute of medicine in 2002. That led to the 2006 requirement that trans fat be labeled and 2013 FDA determination that transfats were no longer generally recognized as safe. FDA Commissioner, Margaret Hamburg, was quoted: “Further reduction in the amount of trans fat in the American diet could prevent an additional 20,000 heart attacks and 7,000 deaths from heart disease each year – a critical step in the protection of Americans’ health.”

That’s a lot of deaths to prevent, but in the scheme of things, there is a bigger fish and the FDA, the Surgeon General, the President and Congress have turned a blind eye to the tragedy of tobacco because it might be too hard work to mount a war against tobacco companies and their lobby. Plus, it would be extremely expensive, since the huge government income derived from taxes on tobacco would need to be replaced.

The numbers are compelling:

  • The American Heart Association estimates that cigarettes cause a quarter of all preventable deaths in the US each year, a total of 440,000 deaths. (The math says that is 60 times the expected numbers of lives to be saved by removing trans fat from the American diet.
  • In 2012, the Brooking Institute reports that federal and state governments collected 17.6 billion dollars in tobacco tax.
  • In 2012, the Federal government spent $231 million for lung cancer research.
  • The vast majority of lung cancers, more than 80% are attributed to tobacco use and second hand smoke.

There is no positive medical use for tobacco products. It is addictive and significant efforts are made to treat that addiction and stop people from smoking. New smokers are created day, though not as many as in past years. The high school smoking rate is 15.7% and that beats the 2020 US government goal of 16%. That rate should be zero or as close to zero as possible. More than 2,000 youths become regular smokers every day. Those new smokers are more than enough to replace the people who die every year from tobacco use and continue the demand for a product whose recognized side effect is disease and death.

Tobacco is a tough battle and government workers and elected officials have chosen not to take the high road because it is tough. Their lack of fortitude can be seen in their battle against trans fat that took so many years and their less forceful, politically expedient than approach. For a food product that is generally recognized as unsafe, food manufacturers can still apply for waivers for its use and are being given a three-year window to alter their product. Knowing that research showed their product to be unsafe in 2002 presumably did not give them enough time to do the right thing.

Saving 7,000 lives is a big deal ,but it is not time to cheer the FDA. It is time to boo them loudly, for the more than 400,000 people it allows to die each year.



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