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 NCAAbasketball 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 untrainedyouth 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 “brokenbone.” 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 injuryis, 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 inankle 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 athletewill 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 almostalways 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 initialevaluation you should suspect a fracture.
‘Splint It As It Lies’ and do not Attempt To ‘Set’ The Break
This part is important — you should notattempt 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 tocall 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
If it is an upper extremity injury it is still a good idea to temporarily stabilize it but in these instances theathlete’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 forprofessional 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 inBurlingame, 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 onSidelineSportsDoc.com.)
This is a horror injury, and I’ve been there with my players and opponents. The good news? The player will not be in extreme pain for some time, the adrenaline will take over everything else. 911. Keep the player stationary until the ambulance arrives. There is NO REASON to continue the game or move the player until qualified medical personnel are on the scene. Morphine will be given when they arrive. Expect a year long rehab. Keep the player as involved in the team as much as possible. Encouragement is the best medicine.
Tell the refs to ban sliding tackles…..
Good info up there.The best way to care for this injury, is to have Certified Athletic Trainers on the sidelines of every game. Certified Athletic Trainers are the only licensed health care practitioner specifically trained to provide care for sports injuries on and off the field.
What is interesting here, is that no word is given about identifying any signs that the victim might be also susceptiple to going into shock. Every chance you get, you should look to comfort someone down with a severe injury with some sort of blanket or covering, at least initially. That will help calm the person and not allow other’s faces who may be in view to effect the victim and their anxiety level. Reassurance in this manner, as well as verbally, goes a long way!