Transcription:
Recovering from Orthopedic Trauma

Melanie Cole (Host): If you have experienced orthopedic trauma, you know that the injuries can sometimes take weeks or months to completely heal. My guest today is Dr. Alon Antebi. He is an orthopedic trauma surgeon and a member of the medical staff at Palmdale Regional Medical Center. Dr. Antebi, so what constitutes an orthopedic trauma? What do you see most commonly?

Dr. Alon Antebi (Guest): Orthopedic trauma varies. There are different mechanisms that can cause, obviously, trauma. Living here in southern California where people are very active, orthopedic trauma can occur anywhere from falling from a tree, motorcycle accidents, motor vehicle accidents--pretty much anything that causes a bone to break is considered a fracture, but by definition from an ER classification, the orthopedic trauma has a strict stipulation, meaning depending on the velocity, for example, from a gunshot. If it’s just a handgun, it may not be considered a trauma patient, depending on the type of injury. But, most of the time, it’s what we consider high velocity type injuries. Fall from a height, motor vehicle accidents, motorcycle accidents, pedestrians getting hit by cars. A kid falling from a skateboard is not considered a trauma victim, although he sustained a traumatic injury to his wrist or leg, is not considered a "trauma patient".

Melanie: If you broke a bone, do you always know it?

Dr. Antebi: Usually, with orthopedic fractures, a lot of times patients will experience pain. Depending on the type of fracture, location of fracture as well as what we call a displacement of a fracture will determine the degree of the pain. Now, everybody deals with pain a little differently, but most of the time when patients fall or injure themselves, they hurt and a lot of times, they don't know if they are broken or not if they are fractured. So, they would go to the urgent care or emergency where an x-ray will take place and, at that point, a diagnosis will be made. But, I have seen patients who have gone a week or two thinking just they just "sprained" their wrist. They come in and they, sure enough, have a fracture. So, a lot of it depends on the degree of injury and the degree of a fracture involvement.

Melanie: Are muscular-skeletal injuries considered an orthopedic trauma? If somebody, say, tears their bicep or really tears there ACL as in girls in soccer, is that considered a trauma situation?

Dr. Antebi: That is not considered an emergent trauma, but it is considered a traumatic injury, mostly sports-related type injury, whether it's a soccer injury or lifting a heavy weight or fixing your car with wrench. Sometimes people can get biceps tendon injuries, ACL injuries. These are not trauma victims, but they are traumatic injuries and do need orthopedic attention.

Melanie: Is this treated the same way that it used to be, doctor? Do they now do splints and casts and I seem to not see so many people in casts anymore.

Dr. Antebi: That is correct. A lot of times--very frequently--when a patient needs orthopedic surgical care, our goal is to get the patient mobilized as quickly as possible. So, we use what's called “internal fixation”. So, if you have a broken bone, instead of putting a cast on it, we often treat it with plates and screws, which is like an internal cast that stabilizes the bone and you may have a splint on just to protect the soft tissues for a week or two and then take it off in the office and are allowed to immediately start moving the leg or the knee or the wrist or whatever it may be. Now, not all broken bones need surgery and that's what we are there for to determine and if the bone does not require surgery, then we do immobilize it with the splint or cast for a few weeks and then remove it once the fracture starts to heal little bit, again, to get mobility of a joint, get the patient up and moving and function as quick as possible.

Melanie: If a bone is fractured, doctor, does it ever truly heal? Does it develop arthritic conditions in the joints of that fractured bone? How does that work for after the fact?

Dr. Antebi: That's a good question. So, anytime there is a fracture, our bones, especially our long bones, could be fractured anywhere. So, if you have a long bone injury like a femur or a tibia or a forearm, if it's in the middle of the bone, most likely you will not develop any arthritic conditions as long as the bone heals and is fixed appropriately. However, if the fracture occurs near or into a joint like a knee joint or a wrist joint, then the cartilage inside that joint will eventually deteriorate especially if the injury is very severe to that joint. So, eventually one of the things that we educate patients on is years down the road you may develop what we call “post traumatic arthritis”. So, it’s not arthritis from being old, it's arthritis from having a previous injury to that joint and future surgeries may be required depending on the degree of arthritis and the severity.

Melanie: And, what about things like clavicle fractures? How are those fixed? Is it almost always a surgical situation because that would seem hard to splint?

Dr. Antebi: Funny you ask that. I am about to fix one in a little bit. But, anyways, so clavicle fractures back when I was in training, we used to not fix a lot of them, but the research, we have noticed that people just do better, return to function better and have less of future issues with their shoulder when we do fix them. Because the clavicle is a very superficial bone, studies have shown that putting these figure of eight splints really do not work. So, if somebody has a clavicle fracture, really all they need is some immobilization with an arm sling or sling and swathe. Depending on the patient's age, location of the fracture and, again, displacement of the fracture will determine whether they require surgery or not. If they do require a surgery, it's usually through plating and screws to stabilize the fracture and, again, allow for early mobilization.

Melanie: Is dislocation considered an orthopedic trauma? You see in the media and on TV, somebody popping something back into place. Is that really how it works, doctor?

Dr. Antebi: Yes. So, anytime somebody sustains an injury in football, car accident, motorcycle, they can sustain what's called “dislocation”. So, when a joint pops out of place--most commonly it occurs in the shoulder, in the hip and the knee. And, usually these are very severe injuries. They require a lot of force to force that joint to pop out of place. Sometimes you can have fractures associated with that dislocation which makes the severity of the injury much worse in addition to neurological injury like a nerve injury or a vascular injury, injuring the vessels of that joint. These are usually considered more complex cases.

Melanie: What about something like a femur fracture and the need for a rod? If the femur, being such a long bone does fracture or the shaft fractures, do you still put rods in and do those stay in, then, for the life of the person?

Dr. Antebi: Yes. Rods are used in all long bone fractures usually when they are in the top, middle or end of the bone. Once they get really close to the joint, we tend not to use rods. Rods are an internal splint so they go into the marrow or the bone. All of our bones are hollow, like tubes, inside and when a bone is fractured in the middle, we are able to slip the rod in between the shaft of the bone to act as an internal splint. These rods usually stay in forever, unless there are complications, such as infection that develops several months later or the fracture, despite our best efforts and the patient’s biology, the fracture doesn't heal and those rods need to be removed and the fractured is fixed either with another rod or a different device.

Melanie: And, most of what we've been talking about, as you say, are long bones or more external, but what about spinal fractures? What's different about them and is that considered a real emergent situation?

Dr. Antebi: Yes. I am not a spine surgeon, but I do know about spinal fractures. Usually, with spine injuries, especially with high velocity injuries, one of the big fear, because our spinal cord is wrapped around this spine or is protected by the spine, so anytime there is a spine fracture, it’s always about neurological injury. So, depending, again, on the degree of the spine injury, the location and the possible involvement of the spinal cord or the nerves coming out of the spine, will depend if somebody needs surgery or not. Sometimes spine injuries, depending on the severities, are just treated with bed rest or a brace up into a major surgery with the screws and rods to stabilize the spine. So, depending on the severity, depends on the treatment.

Melanie: So, wrap it up for us here in just a few minutes, in the last few minutes, Dr. Antebi, about orthopedic trauma. What it constitutes and really what people should think about when they are trying to prevent these type of injuries?

Dr. Antebi: Sure. So, as an orthopedic surgeon I see people from all walks of life and injuries can occur in anything from hanging your Christmas lights at Christmas and falling from a ladder all the way to waking up in the morning, going to work and just a traumatic accident happens. You just never know. So, one of the things we also educate here in southern California are the use of all-terrain vehicles, motorcycles. These are very dangerous pieces of motorized equipment. It has very little protection, unlike a car. We have four doors around you in a shell. So, try to avoid--I mean everybody likes to have fun--but we need to be smart and protect ourselves. Wear protective gear such as helmets, wrist pads when riding these devices and, obviously, seatbelts. But, unfortunately, sometimes things happen despite our best efforts and people get injured and that's why we exist--to help get people back into shape and get them healed. And, like you said in your earlier comments, sometimes patients have multiple injuries, multiple fractures in different locations, the severities may change and in one split second after a major accident, your whole life takes a different turn of events and you are severely injured and it can take months to years to sometimes heal. Sometimes people don't get back all their function where they are partially crippled, disabled, whatever it is, but most people with one or two injuries can heal appropriately, can return back to function and live productive lives.

Melanie: And, doctor, why should they come to Palmdale Regional Medical Center for their care?

Dr. Antebi: Sure. So, Palmdale offers excellent treatment in orthopedic care, others in emergency room there are well qualified to diagnose fractures. If it’s something that is emergent and urgent, then these patients will get admitted to the hospital. We have orthopedic doctors on call here who come and evaluate the patient and determine whether they need to be orthopedically surgically treated. In addition, we have excellent equipment here that is able to treat most orthopedic injuries.

Melanie: Thank you so much for being with us today. You are listening to Palmdale Regional Radio and for more information you can go to palmdaleragional.com. That's palmdaleregional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.