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Wednesday, June 23, 2010

It doesn’t seem fair that a pro athlete can get hurt playing touch football in his backyard but survived unscathed while being hit by 300 pound linemen who are paid to inflict pain and suffering. Such is the fate of Carolina Panther, Steve Smith, who broke his arm. The injury required surgery to insert a metal plate to hold the bones in place but will also allow him to be healed in time for training camp.

Fracture, break, crack. It’s all the same. The integrity of the bone has been compromised and the issue becomes alignment and function. Are the bones in a position where they are going to heal in proper position and if a joint is involved, will the surface heals smoothly to prevent future arthritis?

Orthopedics has changed over time. Once upon a time bones were casted until they healed and it took forever to get the injured part moving again. Less than perfect alignments were acceptable, especially in older patients because life expectancy was short enough that the complications of arthritis and loss of range of motion didn’t have years to happen.

But times change. The movement to get the body moving more quickly has led to operating more and waiting less. Thin plates and screws made of metals like titanium are capable of holding bone fragments together so that immobilization times are decreased and patients can start rehabilitating their injuries sooner. Less cast time means less muscle loss and easier return of range of motion.
Injuries as diverse as collarbone or clavicle fractures in athletes (think Lance Armstrong) and the grandmother next door who broke her wrist have benefitted from more the more aggressive philosophy. Lance bets on his bike within days instead of the weeks required of normal healing. And grandma has her wrist plated so that the joint surface aligns and she can still swing a golf club well into her 80s and beyond

Better imaging with CT and MRI scans can show bones and joints in 3D, allowing the surgeon a chance to examine the inside workings of the body without cutting into it. Surgical repairs can be planned in advance and options explored before an incision is made.
Risks do exist for surgery. Older patients may have underlying health issues, from heart disease to diabetes that increase potential problems with anesthesia and healing. Infection is always a possibility when a cut is made into the skin. But there is always a balance in any medical decision. Risk – benefit analysis is not limited to picking stocks on Wall Street; every decision made to treat the human body has its upsides and downsides. Want to avoid an operation and be treated for three months in a cast? Remember the risk of blood clot formation in a limb that isn’t moving and pumping blood back to the heart.

While Mr. Smith’s injury isn’t fair, because of advances in orthopedics, he’ll be attending training camp field where the risk of getting hurt may be less than playing ball in his backyard.

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