DocTalk

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A Bennett's fracture is a fracture dislocation through the base of the first metacarpal (the long hand bone at the base of the thumb). It is unstable and often requires pinning to keep it stable during the healing process. After surgery a thumb spica cast is usually worn for 4-6 weeks and afterwards a protective plastic splint is kept on, usually for the duration of the season.

 

Re: DocTalk at your service

Yeah, the foul tips have tendency to snap the thumb back, I have noticed.

 

Re: DocTalk at your service

Sometimes I get lucky enough to be asked to write for a medical website and even luckier when they publsih the stuff. The latest installment on fracture basics:

http://www.medicinenet.com/fracture/article.htm

 

Re: DocTalk at your service

The PGA Championship...in Tulsa... in the middle of the summer. Why would the heat be a story?

Thought I should visit the subject on the web. Thanks for reading.

http://www.mddirect.org/blog

 

Re: DocTalk at your service

Sunday night and the football weekend almost over. Little god can come of an athlete's injury except to allow me to use them as examples and teaching points at the bedside of my patients. Fortunately in Wisconsin almost everybody is a Packer fan and can relate. Talking about ribs this week on the website.

http://www.mddirect.org/blog

By the way, it's been my turn on night shift in the ER this week and yesterday was just a little out of the ordinary. Rains, floods, dams bursting, trains derailing, mudslides... http://www.cnn.com/2007/US/08/19/flooding.ap/index.html We're the regional trauma and referral center.

 

Re: DocTalk at your service

I've had a hard time forgetting about Jerome Bettis and his declaration that he faked an injury to keep from getting cut by the Steelers. I have always pretended that players would give their best to make the roster. I'm saddened that Bettis effectively lied to his coaches, his teammates, his doctors and the fans. It's a trust thing. More on the website about trust, doctors and patients. Thanks for reading.

http://www.mddirect.org/blog

 

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I had a hard time deciding which training camp injury I should talk about and I just couldn't deal with Beckham's $250 million MCL injury. There was also another sudden death in an eltie athlete in Spanish soccer to consider, but instead I decided to be more philosophic on the latest web entry today.

And while most of you will have to work this weekend, please know that I'll be right there with you on night shift in the ER.

Thanks for reading.
www.MDdirect.org

 

Re: DocTalk at your service

The European Society of Cardiology is meeting in Vienna this week and hidden in their proceedings is the issue of screening athlete to prevent sudden cardiac death. You can read my take on the website, but I thought it was important to post it here. One of the goals that I have is to use athletics and the sports pages to influence and teach the general public. This is one such time.

There are three kinds of lies: lies, damned lies and statistics.

The risk of an athlete dying of a heart problem during exercise is little more than one in a million. Last week,within 5 days, three elite soccer players died while playing. 22 year old Antonia Puerta had a heart attack in the middle of a game, in front of a stadium full of fans in Seville, Spain. Chaswe Nsofwa died while practicing in Israel and Anton Reid, a 16 year old pro soccer player, collapsed in the middle of a game in England.

Young people aren’t supposed to die. Young people aren’t supposed to have heart attacks. Elite athletes are supposed to have finely tuned bodies that are the envy of every armchair quarterback in front of their television set. We tune in to see the thrill of victory and the agony of defeat, but not the morbidity of death.

Every fall, the sports participation physical comes home with students and parent grumble about having to see a doctor to get it filled out just to let their aspiring athlete suit up. The family doctor does a cursory check, signs the paper and everybody is good to go. But is there a better way?

The Italians and Americans differ in what is required to allow kids to play and the old world is thumbing its nose a little at the US approach this week at the annual meeting of the European Society of Cardiology. For the past 25 years, all athletes in Italy are required to have a heart screening assessment, which includes a family ad personal history, physical examination and electrocardiogram. Sudden cardiac deaths have fallen from 4 per 100,000 to one tenth of that. Italian researchers and cardiologists believe that this standard should be accepted worldwide.

Doctors in other countries aren’t so sure. At the American College of Cardiology meetings in 2006, Drs. Estes and Zipes discussed the controversies in screening athletes. They pointed out that the Italian studies dealt with relatively homogeneous populations and the doctors were well trained to screen adolescent athletes. The US had a more diverse population and that history and physical examination were adequate screening tools. Dr. Estes wrote: “Currently, EKGs are not advocated, and there is only selective use of stress test and echo(cardiograms) …The cost per diagnosis when it's been looked at for screening in the United States is prohibitive; it's hundreds of thousands of dollars per patient identified.”

It seems that it always comes down to money and it may be too expensive to save a handful of lives each year. The risk is relatively minimal for high school students, but gradually increases as the athlete gets older, so that the risk for a senior citizen athlete may be 50 times greater than of a teenager. But statistics are only good for talking about lots of people. How does a parent decide what is right for their son or daughter? One in a million doesn’t mean much unless your kid happens to be the one.

And now it’s September and time for those participation forms to be turned in. It doesn’t matter who’s more right, Italian or American. The lesson to be learned from the death of three elite athletes is that the screening exam shouldn’t be considered an inconvenience; it may be a matter of life or death.

 

Re: DocTalk at your service

The first weekend of the NFL season brought an inordinate amount of injuries to visit about from Eli Manning's separated shoulder, to torn tendons (patellar-Jason Simmons; bicep- Jason Ferguson). And while I can add little to the medical news regarding Kevin Everett's fractured neck and spinal cord injury, it is the subject of web entry today. The level of his injury, C3/C4, is crucial to survival. His ability to move, even a little, is a testament to miracles and to medicine.

www.MDdirect.org

 

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Being away from the internet for a couple of days makes it tough to update the website in a timely fashion. Plenty to see on the weekend in sports, but the latest post visits Juan Posada and his run in with a truck at the plate on Saturday. It bought him a visit to the ER after the game. Wonder why?

Thanks for reading.

Ben

 

Re: DocTalk at your service

I'm pretty much insulated form the trauma scene. I work in a clean, warm, well lighted ER, as opposed to the paramedics who care for people in the dark and dirt of accident scenes. My ER colleagues and I rarely see the accident that brings people to my doorstep. This week's entry is about John Force hitting the wall and trauma resuscitation.

www.MDdirect.org/blog

 

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No sports references on the website this time. Instead it's a response to research that says the annual doctor visit is a waste of time and money. I'm a little ticked that people don't invest in a relationship with a family doc. We live in a time where technology can do lots of things to the body and I'm not certain everybody wants or needs every possible intervention. There needs to be somebody who coordinates a patient's care. We have enough specialists that look after a heart or a lung or a hip or a liver, that we forget that somebody needs to look after the whole person, body and soul.

Thanks for reading. I promise to get back to sports next time.

www.MDdirect.org/blog