Sunday, January 8, 2012

Ithaca Lawyer Explains Car Accident Bone Fracture 101

I love the human body. It never ceases to amaze me. I believe we are all born with this amazing gift.

When I practiced as a chiropractor I was privileged to see the insides and outsides of thousands of people. Back in "the" day we took "real" x-rays. You know how today we have digital (computerized images) X-rays, they were not always around.

My History of X-rays

Back in the 1980s (I graduated in 1986) we used real film in big, heavy framed plates. I had a dark room (developing room) to process the exposed films. I bought my first X-ray machine for $12,000. I can remember using dipping tanks (open chemicals) to develop these films because I could not afford an "automatic" processor.

Can you imagine? Orange lights, film, and open chemicals. How archaic? Like the way cameras used to be.

But it all worked, and I was able to diagnose a great many conditions.
X-ray was an invaluable part of my practice. Showing the films to my patients, and explaining their problems was something I enjoyed.

I once had a patient who only wanted me to "pop" his back back into alignment. I insisted he have some X-rays first. Thank g-d, the X-rays showed a huge growth in his lung pressing upon his back (he had cancer). I often treated people after car accidents but not before I saw some films. There were many people with hand and wrist pain that turned out to be fractures. The best thing I learned about being a doctor of anything was knowing my limits. Everyone has limits. It was important to only treat those people I believed I could help with conservative care.

Sometimes the outer world is merely a reflection of the inner world. Those sick on the outside looked diseased on the inside as well.

As a Chiropractor I took more spinal films than anything else. With a steady flow of work related and accident related injuries I also shot some extremities (legs and arms), ribs, and various other body parts.

The Purpose of Bones

Bones protect our internal organs, give our body a base of stability, and manufacture blood. They also get broken (fractured) if the stress upon them exceeds their ability to bend. They do have some give. High velocity or high energy impacts, like those from a car crash or truck accident do not allow a bone the time to adapt to a large stress.

The most common bone that can break in a car accident is the collarbone aka the clavicle. Why does it fracture? Located between the sternum (breastplate) and shoulder, with a slight s shape, the collarbone is close to the skin with no fat or padding for protection.

Usual Mechanism of Injury

Doctors talk about the "FOOSH" injury. Fall on an outstretched hand (arm) that transmits forces up into the shoulder and clavicle area. But we can have FOOSH like injuries from any outstretched arm. Most of these injuries to the clavicle heal without major surgery. They merely require immobilization with a sling. If they heal improperly (malunion of bone) or not at all (nonunion of bone) then someone is left with an imbalanced looking (and/or functioning) upper body.

Arm fractures (humerus bone) can be injured in many auto accidents as well. This is common because they are a long bone, and it is a natural involuntary reflex to extend out the arms upon a severe or traumatic impact. Babies are born without fear except for loud noises and falling. This inborn reflex is one of mother nature's protective mechanisms.

Next in line is the forearm fracture. When the forearm is traumatized in a crash usually both the Ulna (closest to the pinky) and the Radius bone are involved. These particular bones are known to splint into sharp pieces, and can shatter at the fracture edges. Complications can arise due to these fragments. Potential damage to the nerves and blood vessels must always be considered when doctors are assessing an early forearm fracture.

My video about forearm fracture complications:

The hand has 27 bones (19 in the hand and 8 wrist/ carpal bones). The issues with hand and wrist bone fractures from an auto accident are numerous. We depend upon precision movements of the fingers, wrist, and thumb everyday. Our hands and opposable thumbs make us human. Whether we are using tools, making tools, using a computer keyboard, or writing, the simplest of hand motions can be lost from a fracture or traumatic injury to any of the hand bones.

The mechanism of injury runs the gamut: Gripping a steering wheel, holding on for bracing upon impact, or trying to keep the body upright can all cause a hand injury.

The foot has 26 bones. It is similar to the hand in it's complexity of motion. There are whole books devoted to gait (walking) problems from foot trauma. The feet mean more to us than walking, they provide balance to the body's frame. One fractured bone can disable the entire system of coordinated movements. A foot fracture transmits unequal forces and muscle imbalances all the way up through the knee, leg, and hip.

What can start as a foot problem can turn into a patella (kneecap) tracking issue, a sacroiliac problem, or lower hip joint problem. Transmitted forces can cause an imbalanced pelvis and early lumbar (degenerative) arthritis.

All the body's attempts at adaptation and accommodation to injured areas can lead to early arthritis in other joints throughout the lower extremity. I have had clients who because of attempting to break down hard in a crash have suffered broken bones in the foot and ankle area. I have also had clients with "crush" trauma to the feet and ankle from being pressed up against car parts in side impact crashes.

How the After Effects can be Greater than the Effects

Sometimes the worst injuries are not the ones directly after a car accident. Often the surgeries that valiantly attempt to fix and correct these broken bones, torn ligaments, and ruptured tendons can be unsuccessful. I have also seen many an infection set in after a successful procedure. You have heard the old joke, the surgery turned out perfect but unfortunately the patient died. It is not funny to families that have experienced it.

Post-surgucal complications are especially true in those people who are immunosuppressed from rheumatoid arthritis, lupus, Reiter's syndrome, take many medications, or have diabetes. They just can't fight off the infections. The sad part is that complete healing and recovery for these folks can be difficult to unobtainable. I have seen it, these folks must endure chronic pain, multiple surgeries, rounds of intravenous antibiotics, therapy, and unwanted trips to the hospital.

Dr. Lawrence Newman
Doctor of Chiropractic
Attorney at Law

504 North Aurora Street
Ithaca, NY 14850