A Slippery Slope?

sledding 1As powerful blizzards hit the Midwest, leaving more than a foot of snow in parts of  Texas, Oklahoma, Illinois  and Missouri, many schools are closed leaving  kids to enjoy extended snow days, snowball fights, snowman building and maybe even some sledding.

But before heading to the hills, SRxA’s Word on Health wants to remind parents and children that although the adrenaline from speeding down an icy hill and feeling the snow spraying your face is hard to beat, serious injuries can also occur. While sledding has this connotation of innocence but you have to recognize that there is a potential for harm.

According to the CPSC (Consumer Products Safety Commission), each year there are more than 160,000 sledding, snow tubing and tobogganing-related injuries treated at hospital emergency rooms, doctors’ offices and clinics.

There are some hidden dangers to sledding. It’s a great winter pastime, but there are risks involved. Parents need to be aware of these risks to help prevent injuries,” says Terri Cappello, MD, pediatric orthopaedic surgeon at Loyola University Medical Center.

sledding 2In adults and older children extremity injuries such as broken fingers, wrists and ankles are the most common, while children aged 6 and under often suffer head and neck injuries. While some result in nothing more than minor concussion each year children suffer brain trauma, paralysis and even death as a result of sledding.

Over a 10 year period, the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio found an estimated 229,023 sledding injuries serious enough for ER treatment among children under 19. They also noted that:

  • 26% of the injuries were fractures
  • 25% were cuts and bruises
  • 51% of the injuries occurred during a collision
  • Collision injuries were most likely to result in traumatic brain injury
  • 34% of the injuries involved the head
  • 52% of the injuries occurred at a place of sports or recreation
  • 31% of injuries occurred on private property
  • 42.5% of injuries involved children aged 10 -14
  • 59.8% of all injuries were sustained by boys
  • 4.1% of all emergency department visits required hospitalization

sledding injuryParents don’t often think about putting a helmet on a child when they go sledding, but if the child is under the age of 6 it’s important. Also, never let your child sled head first. Injuries have been associated with the leading body part. If you lead with your head, you’re more likely to get a head injury,” warns Cappello.

Here’s a few more tips to keep kids safe while sledding:

  1. Adult supervision is critical. 41% of children injured while sledding are unsupervised. Ensure someone is there to assess the area and make sure it’s safe as well as to evaluate and respond should an injury occur.
  2. Make sure the hill is safe: that means a hill without obstacles in the sledding path, which doesn’t end near a street, parking lot, pond, or other danger
  3. Sledding should only be done in designated areas that are open, obstacle-free and groomed. Most injuries occur when a sled collides with a stationary object. Make sure there are no trees, poles, rocks, fences or cars in the sledding area.
  4. sled1Kids should be taught to be on the lookout for other sledders and to avoid collisions.
  5. Use helmets to avoid injuries and wear multiple layers of clothing for protection from injuries and cold
  6. Always sled feet first. Sledders should sit in a forward-facing position, steering with their feet.
  7. Use a sled that can steer—it’s safer than flat sheets, toboggans or snow discs

Stay safe in the snow!

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A Bad Break for PPIs

A question for all our orthopedic, primary care, emergency medicine and physical therapy readers. When your patients come into see you with fractures do you ask them about their stomach?  No! – Well, maybe you should.  According to a recent meta-analysis, some of the drugs most commonly used to treat acid reflux can lead to fractures.

This is no small problem.  Millions of people worldwide are currently using these medicines often on a long-term basis. Each year sales of such drugs top $30 billion.

The type of medicines we’re talking about are more commonly known as Proton Pump Inhibitors (PPI) or Histamine-2 receptor antagonists (H2RAs). Among the former group are the best sellers such as Prilosec, Prevacid, and “the purple pill”- Nexium.  Among the latter: Tagamet (cimetidine) and Zantac (ranitidine). many are available over-the-counter.

The authors of the meta-analysis found that PPIs, which block acid production by up to 98%, are associated with an increased risk of both hip and any type of fracture. On the other hand, no significant relation was found between the H2RAs and fracture risk. Interestingly, H2RAs block only 70% of gastric acid production.

It’s thought that bone fractures resulting from the use of PPIs are due to defective calcium absorption.  This can lead to hyperparathyroidism which in turn may modify acid-related enzymes in bones.

Given the widespread use of PPIs this study has great importance to public health. Clinicians should carefully consider their decision to prescribe PPIs for patients, especially the over-50’s who already have an elevated risk of fracture, and the orthopedic / emergency medicine community should routinely question their patients about the use of such drugs.


(Wo)Man’s Best Friend???

The press recently reported how an accidental head butt from Martha Stewart’s French Bulldog Francesca resulted in an injury requiring nine stitches to repair the damage to the domestic diva’s lip.

I feel your pain, Ms. Stewart, I really do.

This post is brought to you as your Word on Health blogger recovers from knee surgery stemming from another pet-related injury. And while I wish the analgesia would take away not only the pain, but also the humiliating memory of being dragged face first along a muddy riverbank by my canine companions as they attempted to become better acquainted with a passing pooch, I take some comfort from the fact that Martha and I are not alone.

People, it seems are not only falling for their pets, apparently, large numbers of us are falling over them, too.

In fact, a national sample of ER visits from 60 hospitals over a six year period reported 7,456 visits were related to falls caused by pets. On a national level, this translates to nearly 90,000 fall injuries associated with cats and dogs per year. Dogs are 7 times more likely to cause falls than cats and women are twice as likely as men to be injured as a result.

That’s the equivalent of 240 ER trips a day, and roughly 1% of the 8 million visits for falls of all sorts.

Exactly how many of the falls occurred isn’t known. Nevertheless, the study, gives a rough sketch of hazardous activities. Almost 35% of injuries are caused by tripping over the animal while about 25% occurred during walks. Surprisingly, less than 3% result from running away from a dog, and <0.5% percent while breaking up a dog-fight.  Being pulled by the animal caused a fifth of the falls.

While one-third of the falls broke bones, about one-quarter caused bruises, one-fifth caused sprains and a little more than one-tenth caused cuts.   Nothing on the list, I note, about tearing a cartilage – trust my dogs to  go one step better!

Been injured by Fido or Fluffy?  Share your stories with us.