By Dr. Jeff Daniels EBS Medical Columnist

When the end of December comes, we look forward to one of the busiest weeks of the entire ski season at the Medical Clinic of Big Sky. As the hotel rooms and condos fill, more people are zooming down the slopes, and we are bound to see more injuries—especially injuries to the knee and the shoulder.

With the deep, powdery snow, some unlucky skiers got caught and fell with enough force to tear apart the ligaments and bones of the knee joint. On Christmas Day, one woman took a slow fall in the powder and ended up fracturing her knee joint in three different places. It was not the most devastating knee injury I’ve seen in the clinic, but a very unusual one that would require surgery once she got home, and her journey there would be all the more difficult with a knee brace and crutches.

Every day this winter we’ve had a number of ACL injuries, where a major internal ligament of the knee gets torn. Interestingly, so far most have not followed the usual pattern of a twisting fall, followed by a pop, pain and an unstable knee. We’ve been surprised by some patients who didn’t sound like they did much damage, only to find a very loose knee on examination and a torn ACL on an MRI.

Other injuries to the knee occur during the same traumatic events, but the loss of an ACL in most people these days leads to a surgical repair. It’s not a great way to end a ski vacation.

With all of the soft snow, you would expect that the number of shoulder injuries—which often occur with a fall onto rocks or hard-packed snow—would be less than what we saw in the sketchy conditions earlier this season. Unfortunately for a few people, they’re still coming in with dislocated shoulders, fractures through the upper arm and clavicle injuries.

Some skiers manage to find the rocks hidden under the powder. We saw one young man who landed in a pile of rocks and took a direct hit to his kneecap (patella), which then shattered from the blow. He was on a steep slope, but was expertly brought down off the mountain by the Big Sky Ski Patrol.

We suspected a patella fracture when we saw the tremendous amount of swelling over that part of his knee, and X-rays proved that he split his patella in half. This will require surgery when he gets home from his holiday.

We’ve evaluated and treated several people for concussions this season. All were wearing helmets at the time of their head trauma, and all of the concussions were comparatively mild. These cases remind us that wearing a helmet can be a lifesaver, yet there are still people out there who refuse to ski with a helmet on.

This was my 23rd Christmas season caring for the injuries and illnesses that happen over this busy holiday week. Half of the people that come in to see us have been to the clinic in previous years, either accompanying family members or friends, or as patients themselves.

Most of them remember me and my assistant Brad Poore, who has only been here for 21 Christmas seasons! They even remember some of the students and residents who helped take care of them.

Dr. Jeff Daniels was the recipient of the 2016 Big Sky Chamber of Commerce Chet Huntley Lifetime Achievement Award and has been practicing medicine in Big Sky since 1994, when he and his family moved here from New York City. A unique program he implements has attracted more than 700 medical students and young doctors to train with the Medical Clinic of Big Sky.