On the slippery slope to winter tumbles

February 2013

Despite the recent weather conditions, airport closures and general chaos in the UK, many skiers and snowboarders will once again brave the conditions and head overseas to find snow covered slopes and do it all again! 

Breaking last years ski run times will be the intention of many taking to the slopes – unfortunately, breaking bones is just as common.  Collar bone and wrist fractures suffered by skiers and snowboarders are commonly seen by Consultants at Spire Norwich Hospital early in the New Year. Mr Peter Hallam and Mr Adrian Chojnowski, Consultant Orthopaedic Surgeons discuss the treatments available for these common upper limb injuries.

Collar bones are regularly broken after a spill, usually as the result of an outstretched hand being used to soften the impact during a fall - the force travels up the arm to the collar bone. There will usually be instant pain and sometimes an obvious deformity will be immediately apparent.  While it might just be possible to ski back to the bottom of the slope this is not recommended, normally a long, slow and careful walk is the safest option! 

Consultant Orthopaedic Surgeon Peter Hallam advises, “Seek a diagnosis straight away, and have it confirmed with an x-ray. The vast majority of collar bone fractures are treated with a sling to allow the bone to heal.  The bone is normally solid enough to resume a near normal life after 6-8 weeks but in some cases it can take 3-6 months.  The shoulder might be stiff after the fracture has healed therefore, to recover full movement swiftly, physiotherapy comes highly recommended”. 

“High energy injuries created by high speed impact or a heavy fall can result in the bone ends losing contact with each other or being badly shattered.  Research suggests that early surgery using a plate and screws leads to better long-term results.  Although this type of surgery is not an emergency, it is probably best performed within one week of the injury.  This should also allow time to discuss its potential benefits with your orthopaedic surgeon”. 

Another common injury is a dislocated shoulder. The dislocation should be put back in joint as soon as possible (this may be feasible under sedation in the resort). Once correctly realigned, the arm is placed in a sling making ski-ing impossible but there is no reason why the holiday should be cut short (site-seeing and après ski is still possible).  

Many young people may experience re-dislocations which can be investigated with X rays and an  MRI scan. The recurrent dislocations may be treated with physiotherapy but modern keyhole surgery provides a quicker and more permanent solution.  

At the other end of the limb, Consultant Orthopaedic Surgeon Adrian Chojnowski sees numerous wrist injuries from falls on the outstretched hand.  Trying to break your fall is a natural reaction but, placing your hand down with ski pole still gripped is a recipe for disaster.  “Of the two bones that comprise the forearm, wrist fractures tend to affect the bone on the side of the thumb, the radius.  Often the other bone, the ulnar, remains intact but the ligaments around it are damaged.  If the fracture causes a deformity then a bone is certainly broken.  If you’re still on the slope, the wrist should be supported with a temporary splint (be imaginative) and medical help must be sought urgently”.   

“Undisplaced wrist fractures should be put in a plaster cast before returning home. Injured limbs can swell in the first week, and air travel can exacerbate the swelling, make sure the cast is an open type allowing both support and expansion.  A full plaster cast can be applied on your return to the UK.  A wrist fracture will normally heal in around 6 weeks however, it is still a long way from being a normal pain-free joint.  Stiffness may persist for many months, and in some cases for up to a year. Hand therapy can help to speed up recovery allowing you to return to your chosen sport or pastime”. 

“Displaced fractures may need to be straightened using manipulation. You’ll be glad to know that unlike in the movies, this is carried out with a local anaesthetic and not simply forced back into place while the patient screams!  In rare cases, the fracture can be unstable and an operation is carried out to ‘pin’ the fracture using metal implants. This requires either, a general anaesthetic or, a special injection that numbs the entire arm”. 

“Many people develop pain in their wrist after a fall and sufferers should be very aware of persistent pain.  Pain can be the result of a chronic wrist sprain, alternatively, it could be as a result of a fracture to the scaphoid bone (found at the base of the thumb).  The scaphoid fracture is potentially very serious as sometimes, this troublesome bone simply does not heal and an operation is required.  Initial x-rays are notoriously poor at detecting scaphoid fractures early on and therefore, if the area remains tender, repeat x-rays are taken for diagnosis”. 

“A painful wrist might not be broken but simply sprained. Look out for persistent pain over a prolonged period and consult a medical professional if you are concerned.  Normally the wrist can take many weeks to settle down after the impact of a fall and painkillers along with gentle exercises are encouraged to aid the healing process.  It is also important to keep your fingers moving to avoid swelling and stiffness.  The aim of all intervention is to stop chronic disability so don’t stay on the slopes and take the ‘worry about it later’ approach.  There is always next season".

The content of this page is provided for general information only. It should not be treated as a substitute for the professional medical advice of your doctor or other healthcare professional

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