You’re Ready If Summer Fun Takes a Painful Turn

Leslie Laine: Welcome Premier Health Now On Air. Today we're talking summer and the trio of injuries that too often take the fun right out of the season. We have timely tips straight from the source to help you be prepared. We're glad you're along. I'm your moderator, Leslie Laine. With me today is Dr. Michael Griesser, an orthopedic surgeon and sports medicine specialist with Premier Orthopedics. Thank you for joining us.

Dr. Griesser: No problem. Happy to be here.

Leslie Laine: We are just more active in the summer, right? Playing sports, enjoying the outdoors. Sometimes even doing more strenuous chores around the house. Because we're having more fun, maybe we're just not paying all that much attention to being real careful, or sometimes stuff just happens. Dr. Griesser is here to help us deal with the three big pain points of summer. Cuts, breaks, and concussion. We can safely call these accidents I think, did you have an excellent, prone youth, Dr. Griesser?

Dr. Griesser: Yeah, I did. I was athletic. I was always involved in some form of sports or athletic activities. I've had everything from a broken kneecap to cuts and bruises and you name it.

Leslie Laine: Broken kneecap sounds serious.

Dr. Griesser: Yeah, that was pretty serious. I was in a cast for several months one summer. That was not a fun process.

Leslie Laine: Ouch, I'll just say. We call them cuts, doctors call them lacerations, but whatever you call them, they often surprise us. Just by brushing by something super sharp can leave you wondering why you're bleeding. Other times you know it's coming, like taking a cleat up your leg as you slide into second base. Dr. Griesser, how do you evaluate or rate the severity of a cut?

Dr. Griesser: From a clinical perspective, we rate the severity of a laceration based on how deep it is, how long it is, how wide it is. Simple sort of mathematic measurements. But the important part for us is a laceration one that you can control the bleeding and get rid of those symptoms without the needs for some sort of intervention like stitches or sutures? Or is it something that you can't stop the bleeding and the pain, and you need to seek higher medical attention at that point?

Leslie Laine: In order for me to determine whether this tear in my skin needs a trip to an urgent care, or an emergency department, or just some first aid, is bleeding the main thing I should be thinking about?

Dr. Griesser: I think that's a ground rule. If it's something that you can hold pressure on, and stop the bleeding, then it's generally something your body is going to be able to heal without the need for a trip to the emergency room. If you hold pressure for several minutes, and the bleeding doesn't stop, and the pain doesn't get better, those are times when we might seek higher medical attention.

Leslie Laine: What if it's really dirty?

Dr. Griesser: Really dirty is certainly a problem. If there is visible dirt within the wound, that's almost always an instance where you'd want to see someone sooner rather than later. In the instance that is really dirty, one of the best things you can do when you first get a laceration is just washing it with some hot water, and getting some of that visible soil out of the wound, which can help the process in the long term as well.

Leslie Laine: Are you concerned about where the cut is? Does the location of the cut make a difference in whether I need to seek help or not? On my face versus on my hand or foot?

Dr. Griesser: Yeah, you hit the nail on the head. Cosmetic areas of the body, face, eyes, lips, nose, those are areas where we'd want to seek medical attention sooner rather than later because if a laceration isn't paid the proper attention initially, it could leave for an ugly scar, which most people are not happy with on their face. The foot or the hand might be a different story, people don't quite care about cosmesis, or how beautiful their foot is, that's something where sometimes you can sort of wait a little while, and see how your body does on its own.

Leslie Laine: As an orthopedic person, are you concerned about all of the functionality of the hand then?

Dr. Griesser: Absolutely. I tell patients that in an instance where they have numbness, or tingling into one or several of their fingers, or toes, that's usually a cause for concern. In the instance where they lose function of their hand, or fingers, or toes, or foot, in other words, they can't bend it or move it like they used to, that would be another cause for concern. In other words, when you sustain the laceration, if you then lose function or feeling, those are times when I would seek higher medical attention as well. Once again, referring to things like acute cares, or emergency departments, or even coming into your local orthopedist office, we see cuts and scrapes and bruises here all the time.

Leslie Laine: Are there special case cuts that really should be evaluated even if they don't look particularly nasty?

Dr. Griesser: In the instance of an animal bite, a dog bite, a cat bite, cat scratch, those are things where, even though they don't look bad, they're very bad actors in terms of infection, and particularly cat bites, or puncture wounds from a cat bite, there is a high rate of infection after those. Even in an area where there is a tiny puncture wound from a cat bite, or a dog bite, those are things where I would seek medical attention immediately.

Leslie Laine: If I do determine that this is a job for first aid on my own, what steps should I take to treat it myself? I heard stop the bleeding, wash it, stop the bleeding.

Dr. Griesser: Yeah. First thing I would do is rinse it under hot water to get rid of any soil, or bacteria, or any sort of contaminant in or around the wound. Once I'd sort of thoroughly cleaned out the laceration, and had any visible soil, and bacteria out of there, you might consider sort of washing it with some soap, some sort of anti-bacterial soap. Then, I would work on stopping the bleeding. The easiest way to do that is with pressure. Take a soft, absorbent tissue, even if it's a bath towel that you can afford to get some blood on, and hold pressure on it for three to five minutes. Generally, you now have a clean wound, the bleeding has stopped, from there you can turn attention to whether it's band-aids, an antibiotic ointment, or maybe you need nothing, maybe that's all you have to do.

Leslie Laine: Once we've taken care of that first aid, are there danger signs to watch for with a cut as it heals?

Dr. Griesser: Absolutely. If the cut starts to get, what we refer to in the medical field as erythematous, but it actually means redness. If it gets surrounding redness, that would be a cause for concern. If it gets drainage, and when I refer to drainage, I mean thick, once again, what we call purulent drainage. But what I tell patients would be comparable to mucus, if you get drainage that looks like mucus, that can be a sign of an infection. The third thing I would say is that if the wound is not healing, that is usually a bad sign. If you've paid attention to it on your own for several days to a week, and it's not getting better, that's a sign that you probably need to seek better care.

Leslie Laine: Another summer pain point is broken bones, and they may or may not come with cuts. It doesn't always take a lot of force to crack a bone. Dr. Griesser, can you talk about the difference between a fracture and a break? If there's any way for the average summer fun seeker to tell if they have a fracture or a break, or they just really hurt?

Dr. Griesser: That's a very interesting question. It's a question I get on a daily basis here in the office. A fracture and a broken bone are exactly the same thing. It's two words describing the exact same phenomenon. There is no difference between a fracture and a broken bone. It's just simple terminology. One is a medical term, the other is sort of what we refer to in common language. In terms of knowing if you have a fracture or a broken bone or nothing, one of the primary determinants of that is an x-ray. X-rays are things you can do at your local orthopedist office. Patients can seek those at urgent cares, or emergency departments. Something as simple as a two-minute x-ray can usually determine if you have a broken bone or not.

If you have visible deformity of your arm, or your leg, or something.

Leslie Laine: Meaning?

Dr. Griesser: That would almost always imply that you have a broken bone. I would seek attention sooner rather than later for that.

Leslie Laine: What do you mean by visible deformity?

Dr. Griesser: Visible deformity, if your arm was straight, and then you fell on the sidewalk, and now it looks crooked, that's usually a bad sign. That's something I would seek attention for right away.

Leslie Laine: You mentioned x-ray. What would I expect in terms of treatment after that for a break?

Dr. Griesser: Treatment ranges across the board. The simplest treatment is often something like a cast or a splint, which is made with fiberglass. Let's take a broken arm for example. Maybe you're talking about a cast that sort of goes up to the level of your elbow. If the break is worse than that, then sometimes it can require setting the bone into a more appropriate position. Then, putting on a cast or a splint. Sometimes, in the instance where it can't be done, just setting the bone with a cast or a splint, then sometimes you discuss surgery, where we actually use metal plates and screws to straighten the bones and fix it into proper orientation so that it can heal.

Leslie Laine: When you had that kneecap broken, what happened there?

Dr. Griesser: I actually hit my kneecap with a tennis racket and I split my kneecap in half. We were able to treat it non-operatively, but I was in what we call a long-leg cast for about two, two and a half months while this patella fracture, or kneecap fracture healed. I was on crutches and a cast for quite some time. But it healed up, and I never had problems with it afterward.

Leslie Laine: Are ribs a special category of broken bones? I learned after a recent x-ray that I had, at some point, broken two ribs, they healed and I never knew it. Are they a special case?

Dr. Griesser: No, they heal like any other bone. The interesting part with rib fractures is that the treatment for rib fractures is evolving very recently. For hundreds of years now, rib fractures were treated non-operatively, and you told people that they would have pain for six to eight weeks, and that they can just live with it, and their body will heal it. 99% of the time you're correct, the body does heal those. However, in recent years, there's been some literature talking about surgical fixation of rib fractures. But it's only in very specific cases. But I would tell you, in terms of common knowledge, 99% of rib fractures will heal on their own no matter what you do. But, they hurt.

Leslie Laine: Tailbones and toes are kind of like that, are they not?

Dr. Griesser: They're very similar to that. Yeah.

Leslie Laine: Kids are notorious for breaking bones, what would you want parents or coaches to know about managing a child who has broken a bone?

Dr. Griesser: If you know the bone is broken, I would seek attention with an orthopedic surgeon immediately. If you don't know if the bone is broken or not, I would always prefer early evaluation rather than late. In other words, if let's say it's a finger, you don't know if it's broken or not, I would send the kid for a quick x-ray, and you'd know right away whether it needs to be treated, or if it can be sort of pleasantly ignored and will heal up. The other thing with kids, particularly small children who can't communicate their pain, or their disability, we'll pay very special attention to how they use that digit or part of their body. In other words, if we suspect an arm fracture in a child, and we notice that the kid is three, can't really communicate what's going on with their arm effectively, but they've stopped using the arm, that would be a bad sign, and something where I would take him to a doctor right away.

Leslie Laine: One bone we are hearing a lot more about these days is the one that protects our brains. Because when the skull takes a hard knock, it can result in a concussion, or an injury to the brain itself. Can you remind us, Dr. Griesser, what happens in a concussion?

Dr. Griesser: A concussion is essentially a bruising injury to your brain. There are different terminologies for different types of concussions, but effectively, the way we think of it is your skull contains your brain, but the brain is not tight against the skull. The brain has some room between the bone and the brain. If you're hit hard enough, that bone can hit into the brain, and actually cause bruising. That's essentially how a concussion happens.

Leslie Laine: What are the signs of a concussion that demand emergency treatment?

Dr. Griesser: Loss of consciousness, loss of memory, numbness and tingling into any of the extremities. Those would all be very worrisome signs that we would want to seek attention for immediately. Confusion, slurring of speech, deviation or the eyes, those are, once again, warning signs where you'd want to seek immediate medical attention.

Leslie Laine: Going back to the question of how I know the difference between a break or it just hurts a lot, are there other symptoms we should be aware of that maybe suggest a concussion, but it's nothing as dramatic as you have just described?

Dr. Griesser: A concussion that doesn't involve loss of consciousness and you're not really sure if it was an innocent injury or not, if a kid is confused afterwards, has trouble concentrating, has sensitivity to light, or loss of memory, those would all be concerning even if they didn't lose consciousness on the field, or wherever this happened.

Leslie Laine: How do you treat a concussion?

Dr. Griesser: The treatment for a concussion essentially involves brain rest, where we typically talk about giving the kid a break from school, giving the kid a break from light, giving the kid a chance to rest and relax, and recuperate. Taking the kid out of physical activity. Those are all things that we would do in the treatment of a concussion. Once again, the treatment ranges depending on the severity of the concussion, but essentially brain rest is the key idea and treatment for a concussion.

Leslie Laine: Let's talk prevention for a moment. You grew up in this area, you were an athlete. Has concussion prevention changed? What would you like to see maybe more or different?

Dr. Griesser: The answer is that concussion prevention has changed, obviously, there has been a lot of money into the research on concussions in the last five to 10 years. A lot of it centered around the National Football League. Helmets are getting better, padding is getting better, there are certainly improvements in the prevention of concussions. But I think the most important development over the last 10 years is the treatment of concussions. What I mean by that is when I was in high school, I remember it was not uncommon to "get your bell rung" then you ran back out onto the field, and went right back to the same activity that "got your bell rung." Nowadays, we're much more sensitive about removing an athlete from that environment, and truly evaluating them before you put them back into physical activity. That's been where we've gotten remarkably better.

I think continued attention to the appropriate treatment after a concussion is by far the most important thing we have to work on over the next 10 to 20 years.

Leslie Laine: We hope you know more now about how to handle common summer injuries. We also hope you never need to use that knowledge. We wish you a healthy and fun summer season, and we thank our guest today, Dr. Michael Griesser, orthopedic surgeon and sports medicine specialist with Premier Orthopedics. If you want to know more, visit premierhealth.com/healthnow. We'll be back and we hope you will. I'm Leslie Laine, and thanks for joining us. Watch for our next edition of Premier Health Now On Air.