Nicholas Sama, MD
Newswise — The summer months are prime time for outdoor activities, and the health benefits of more movement and sports participation are hard to deny. But as activities increase, so does the risk for an orthopedic injury, and bone fractures are among the most common. For a less serious fracture, such as a tiny crack in a bone, the main treatment is often rest or immobilization. At the other end of the spectrum, broken bones resulting from a serious accident could require emergency surgery.
Although any bone in the body can break, the collarbone, wrist, ankle, spinal vertebrae and hip are most prone to a fracture, says Nicholas Sama, MD, director of Orthopedic Trauma at HSS Florida, the West Palm Beach location of Hospital for Special Surgery. As an orthopedic trauma specialist, he has high-level training and expertise in treating fractures.
Breaking a bone can be a difficult and sometimes frightening experience, but with the right treatment, bones have a natural ability to heal, Dr. Sama says. What should you do if you sustain an injury and think you may have a fracture? Dr. Sama’s advice aims to give patients the best chance for proper treatment, healthy healing and a good medical outcome.
1 – Know the signs and act in a timely fashion. After an injury, signs of a broken bone may include severe pain, swelling, a deformity in the affected body part and the inability to bear weight. Sometimes, it is evident that emergency medical care is necessary. A bone may look out of place or come through the skin, or an individual may experience extreme pain. However, if that’s not the case and the injury is less severe, Dr. Sama says people can try basic first aid: resting the injured body part, applying ice on and off, and elevating it above the level of the heart. If it doesn’t improve within a few days, a visit to an orthopedic surgeon is in order. If in doubt, it is essential to get an accurate diagnosis and treatment sooner, rather than later, Dr. Sama says. By identifying an injury in its earlier stages, it is much easier to treat and yields better results.
2 – See a fellowship-trained orthopedic trauma specialist. Orthopedic trauma refers to a sudden significant injury to the bones, muscles, tendons or another part of the musculoskeletal system. Orthopedic surgeons with subspecialty training in trauma have the expertise, diagnostic tools and skill to evaluate injuries and develop the most appropriate treatment plan. Dr. Sama explains that seeing an orthopedic trauma specialist for a fracture is no different from consulting a joint replacement specialist when considering hip or knee replacement surgery. A trauma specialist is trained to determine the best operative or nonoperative treatment options. A patient will need surgery if a bone is broken in such a way that it is poorly aligned, unstable, penetrating through the skin or pushing on vital structures.
3 – Be an educated patient and play an active role in your recovery. In Dr. Sama’s view, patient education is essential, and individuals who actively participate in their care have better outcomes. “I feel that educating the patient is more important in the specialty of orthopedic surgery than in any other subspecialty,” he explains. “This is because while the outcome is dependent upon the surgeon and the surgical procedure that he or she does, it is also largely dependent upon patients knowing what to do and what not to do, participating in physical therapy and understanding what to expect.” Dr. Sama adds that a good doctor will get to know a patient and their lifestyle to determine the best care plan, answering all their questions for shared decision-making. After treatment, if patients have any doubts about their healing or recovery, he advises them to go back to their doctor to express their concerns. If not satisfied, it is reasonable to seek a second opinion.
4 – After a fracture, follow-up may be needed to assess your overall bone health. When a fracture occurs from less trauma than normally required to break a healthy bone, it is essential to determine the cause. This is especially important for older adults who may have sustained a “fragility” fracture – one that occurs in a bone weakened due to osteoporosis. Patients should be referred for follow-up with their primary care doctor, an endocrinologist or a rheumatologist. It usually entails a bone density scan and appropriate treatment to help prevent a future fracture.
Safety Measures to Avoid Injury
Dr. Sama stresses the importance of taking preventive measures to help avoid a fracture in the first place. “That means doing everything you can to be as safe as you can,” he says. “It means trying to maintain a level of physical fitness to optimize balance, strength and flexibility; using appropriate protective gear when participating in sports and athletic activities; and seeing an orthopedic specialist for evaluation if experiencing ongoing pain or a minor injury that isn’t improving.”
Fall prevention is critical, especially for older adults who may have weakened bones, Dr. Sama notes. “Some people may have medical conditions that predispose them to falling, such as problems with blood pressure, problems with vision or vertigo. They should be mindful of medications that can make them dizzy or unsteady on their feet and take precautions to avoid falling in the home or outdoors,” he says.
Dr. Sama advises people to evaluate their surroundings, ensuring that the floor is free of clutter and other tripping hazards, such as rugs that are not securely fastened. Homes and outdoor areas should have good lighting. Steps should always have handrails, and grab bars should be installed in the bathroom as needed for support. Adults who are unsteady on their feet may want to use a cane or walker and consider seeing a physical therapist for exercises to improve their balance and build up their strength. Dr. Sama encourages family and friends to check the homes of loved ones to ensure they are in a safe environment.
About HSS
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 14th consecutive year), No. 2 in rheumatology by U.S. News & World Report (2023-2024), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2023-2024). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a fourth consecutive year (2023). Founded in 1863, the Hospital has the lowest readmission rates in the nation for orthopedics, and among the lowest infection and complication rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. In addition, more than 200 HSS clinical investigators are working to improve patient outcomes through better ways to prevent, diagnose, and treat orthopedic, rheumatic and musculoskeletal diseases. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 165 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.
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