By Dr. Jeff Daniels EBS Medical Columnist

Over the 21 years I’ve treated medical problems of the residents, workers, and visitors in Big Sky, injuries to kids seem to hit me the hardest. Although some of them present hysterically, most are subdued, favoring the injury, and holding on tight to a parent without making a sound.

We all see kids zooming down the mountain, once they get over their initial fear of skiing or snowboarding, and wonder how they do it. But sometimes accidents happen, and the speeds they reach, the bumps – or jumps – they hit, and occasional harsh conditions all contribute to injuries similar to what we see in adults.

Very young children can sustain fairly bad leg injuries, most common being spiral fractures of the tibia, or shin. Luckily, these heal well in a cast and rarely need surgery. If kids sprain a knee ligament, 95 percent of the time it will involve the medial collateral ligament, or MCL.

It’s unusual for a youngster to tear the anterior cruciate ligament, or ACL. Until recently, it had been several years since we’ve seen a case like that. On Dec. 8, an 8-year-old boy hyperextended his right knee after going too fast, hitting a bump, and flying through the air.

His parents didn’t think he was injured when they asked ski patrol to give him a courtesy ride to the base, but they soon realized he had a problem, and came into the Medical Clinic at the end of the day.

I took one look at his knee and knew this was not a minor injury. The knee was swollen, about 50 percent bigger than the uninjured side. We could feel both the fluid filling up the knee joint and the abnormal movement of the bones with gentle manipulation. The boy remained calm, while his parents were anxious to know what was happening.

An 8-year-old’s ACL may be injured in several ways. Like an adult’s, it can tear apart completely, or sometimes partially tear, but the most common way is for a piece of bone holding the ACL to break off the tibia, with the ACL attached. I’ve rarely seen this happen in adults.

The fragment of bone, called an avulsion, coming from the top of tibia, can float freely inside the knee joint, or still be hanging onto the bulk of the tibia by a thread. This type of injury in an adult is frequently treated surgically, within days of the accident. The same holds true for children who experience this avulsion injury.

We put the 8-year-old boy in a long splint that completely wrapped his leg like a cast, taught him how to walk with crutches, and explained everything to his parents. I also was able to get them the latest review article of this type of injury, so they would more easily understand what an orthopedist at home would be explaining to them in a few days. I hope this is the only one we see all ski season!

Here’s hoping that you all have a great, safe holiday season.

Dr. Jeff Daniels 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.