DR. HOOK-- Fractured: Be careful not to roll dem bones!

"High on a hill a lonely goatherd, Lay ee odl lay ee old lay hee hoo!" 

I love The Sound of Music. I have even been on The Sound of Music tour in Salzburg, Austria– twice! But you know what? I love every song except... "The Lonely Goatherd." Now the puppets are great to watch, but the soundtrack– eh!

When I was 15 years old in Salzburg, we did sing that song while hiking up the Maria von Trapp hills. Let me tell you, there were some very narrow paths. I asked our hiking leader, "Has anyone ever fallen to their death?" 

He pointed to small metal plaques mounted on the side of the mountain mentioning all the people who had fallen to their death. I asked him why we were hiking the same trails. He said, "Just don't slip." Oh, great!

As we were coming down the mountain, my hyper-extended lower back started to hurt– the hills were not only alive with the sound of music; they were very steep. So I leaned forward, which caused me to accelerate from a walk to a jog to a full gallop. I was running so fast– well, I couldn't stop! 

There were people on the trail ahead of me, so I ran to the left to avoid mowing them down. This was my first experience as a skier/skater. Every time I tried to slow down, my feet would sliiiiide on the wet grass. Before I knew it, there were Sound of Music cows ahead of me and I bit it. Before I knew it, my group of Ohio classmates became Japanese tourists clicking away with their cameras. 

I was lucky, though. I didn't get a small metal plaque on the side of the mountain, and I didn't fracture any bones. The cows must have steered me away from total disaster. 

What does happen with a fracture? For kiddies, nose and upper mouth fractures are most common– usually from falling down, contact sports, car accidents, and crashes (how many kids try to imitate Evel Knievel on their bicycles?).

Persons with osteopenia and osteoporosis are more at risk for fractures of the wrists, hips, and spine. Compression fractures are the worst because the vertebrae itself squishes– and ouch! That hurts! Certain hand/wrist and hip fractures can cut off blood supply to the bone, which leads to osteonecrosis– meaning dead bone. And we know you can't pick a bone with someone if the bone is dead.

Tibial fractures (shin) are the most common closed long-bone fractures. I had one in third grade from a bicycle accident– and wore a cast for three months. Annually, there are over 70,000 hospitalizations and 800,000 office visits due to this type of fracture alone. Two hundred and fifty thousand hip fractures occur every year in the US. Hip fractures can be deadly because fat from the marrow can embolize (travel up the blood stream) to the lungs.

Stress fractures are pretty common and tend to occur in athletes who increase their training. On x-ray, it looks like a sliver down the bone. Walking with improper shoes, like boots in the military, can cause a March fracture in the fifth metatarsal bone. Figure skater Michele Kwan had a foot cast on for two months before the Olympics due to a stress fracture from jumping.

Open fractures can pierce the skin– looking very gnarly. An orthopedic surgeon has to manipulate the bone back into normal place and might need to stick a rod to hold the separated bones together.

There are too many types of fractures to write about in one article. The bottom line is there are many types of fractures– each having its own treatment. Any bone in the body can be broken– even the funny bone– and that's serious! 

Got a medical question? Dr. Hook wants to hear from you!