By Dev K. Mishra, M.D.
By now we've all heard about the tragic leg fracture sustained by University of Louisville basketball player Kevin Ware in during NCAA basketball tournament. It was a gut-wrenching injury to witness, even for orthopedic surgeons who are trained in dealing with these types of injuries. But what should you do if you are an untrained youth sports coach facing a possible leg fracture in one of your young players?
What Is A Fracture?
A fracture is the proper medical term for “broken bone.” This can range from a tiny crack in the bone, to a very severe injury where the skin over the bone is broken, showing the exposed bone.
Regardless of how severe the injury is, it is still a fracture. A fracture can happen from any number of different causes, although in youth sports the most common reason is direct contact.
Twisting injuries can result in ankle fractures, a fall on the ground can cause a wrist or collarbone fracture, and there is a fracture that occurs from overuse called a “stress fracture.” For the purposes of this post, the focus is on immediate basic evaluation and field management for fractures that occur from injuries on the field of play.
The Typical Story
The young athlete will often be able to tell you there was a “pop” or sensation of a “crack” at the time of injury -- if you hear this description beware of a possible fracture. Pain is almost always present, and can be severe. Swelling can set in within minutes, and gentle pressure around the suspected area of injury will be painful. If the elements above are part of your initial evaluation you should suspect a fracture.
‘Splint It As It Lies’ and do not Attempt To 'Set' The Break
This part is important -- you should not attempt to treat the fracture by aligning it, setting it back in to position, etc. If you are not specifically trained in management of fractures your best and most reasonable course of action is to call for professional help (EMT or other emergency medical provider).
If it is a lower extremity injury it is best to use whatever materials you have nearby to splint and stabilize the limb as you find it -- cardboard boxes, pieces of wood, popsicle sticks, just about anything reasonably rigid can be used until the professionals arrive.
If it is an upper extremity injury it is still a good idea to temporarily stabilize it but in these instances the athlete’s parents can often provide transport by car.
If pain is severe or if you have any questions at all about what is reasonable then you should be cautious and call for professional assistance. Apply RICE (rest, ice, compression, elevation) if possible, and try to remain calm and reassuring to the athlete.
(Dr. Dev K. Mishra is the creator of the SidelineSportsDoc.com injury management program for coaches. He is an orthopedic surgeon in private practice in Burlingame, Calif. He is a member of the team physician pool with the U.S. Soccer Federation and has served as team physician at the University of California, Berkeley. This article first appeared on SidelineSportsDoc.com.)