By Dr. Jeff Daniels EBS Medical Columnist
Nearly every day during the ski season a patient with an unusual or interesting injury comes through the doors of the Medical Clinic of Big Sky. The busier it is on the mountain, the more likely it is we’ll see one of these unusual injuries.
During the last week of December we saw what has to be the worst shoulder injury to ever come into the clinic. A Big Sky visitor had a terrible accident while skiing in some very steep terrain – both of his shoulders were dislocated, and one suffered a complete shattering of the dislocated proximal humerus.
He came in with both shoulders immobilized by swaths of cloth, screaming in pain. Feeling through his ski jacket, I could tell that both shoulders were dislocated. Within a minute, we had an X-ray showing the fracture.
Some dislocated shoulders – about 15 percent – have small associated fractures that don’t hinder us from reducing the dislocation. However, in my experience about one in 1,000 shoulder dislocations ends up with a serious fracture that makes reducing the dislocation impossible in the clinic. The chance of damaging nerves and arteries in the shoulder is too great with these complications, and it’s imperative that a hospital orthopedist treat this rare type of injury.
So what did we do? The next X-ray identified an uncomplicated dislocation of his left shoulder, which we gently pulled back into place, giving the patient a good deal of pain relief. In that same arm we started an IV, then immobilized the right arm and called an ambulance.
I sent the X-rays to the orthopedist who would be caring for our patient once he arrived in Bozeman, and later found the doctor had a relatively easy time fixing the problem.
Most injuries that come into our mountain clinic don’t need the immediate help of an orthopedic surgeon and many injuries heal themselves with immobilization, followed by physical therapy. If surgery is necessary, a period of time between the actual injury and the surgery is the rule, not the exception – surgeons generally get better results once the swelling and bleeding diminishes.
ACL injuries of the knee are unfortunately too common, and many people opt for surgery, which is most effectively performed by a knee specialist several weeks or longer after the incident. Other severe knee injuries, like a tibial plateau fracture, will be given time for the swelling to dissipate before the surgeon goes in to put the fractured knee joint back together.
More common injuries that require immediate surgery include fractured femurs, badly broken and swollen tibia and fibula fractures, and complicated elbow fractures. These all have known complications if surgery is delayed including blood loss or compartment syndrome, when excessive tissue damage from a fracture leads to such pressure build-up that a limb could be lost.
Stabilizing an injury, in order to get someone home safely, is something I try to instill in the medical students and young doctors that work in the Medical Clinic of Big Sky. In fact, the orthopedist in Bozeman who fixed the shoulder dislocation was one of my students in 2002.
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.