If you slip and fall

There seems only one sure way to avoid the sprains, strains, snaps and splints that come with slipping on the winter ice and snow: carefully climb into bed and set the alarm for the vernal equinox.

"We've seen our share of broken bones, ankles, legs, wrists, forearms, shoulder dislocations, all those types of things, basically since the ice and snow has persisted," says Dr. William Frohna, chief of emergency medicine at Union Memorial Hospital. "I would say that on those type of injuries, the traumatic orthopedic things, we're probably seeing a 30 to 40 percent bump since the weather's turned sour."


Frohna, who's originally from Milwaukee, says, "I guess most people around here are used to a cold blast coming through but not persisting."

But when the temperature gets above freezing during the day and then plummets at night, all that moisture on the ground turns to ice. "And what was maybe a safe path," Frohna says, "becomes an icy nightmare the next morning."


As a result, Frohna says, the emergency room sees a lot of action in the morning. "The first couple hours of day ... we start seeing patients coming in."

Almost on cue John Kratz, a 57-year-old lawyer from Roland Park, comes into Union Memorial's emergency room with a wrist injury.

"I just was out pushing the latest little bit of snow off the sidewalk," he says. "And I went down."

He was shoveling the snow at about 8 o'clock in the morning before going to work. His wife drove him to the emergency room.

How does it feel? he is asked.

"It feels like it hurts."

Kratz is given an icepack for his right wrist as he waits for X-ray results. He says he's mostly left-handed. "I throw right, but I write left-handed. I type with both hands."

He won't be typing with both hands for a few weeks. It turns out his wrist is broken, maybe in a couple of places.


Jill Shandrowski, a physician's assistant, wraps his arm in a cast up to the elbow, then fits him for a sling. She's efficient -- she's been doing lots of wrists and ankles lately. Kratz's thumb sticks up through the cast like a tower.

"Just to be on the safe side," Shandrowski says, because Kratz may have a multiple fracture, "[his wrist] is going to have to be immobilized."

The casting procedure takes about 10 minutes, and then Kratz is ready to be signed out.

"This is a little heavier-duty than I might have thought," he says of the bulky cast. "It gets your attention."

His fracture, however, is fairly typical of the slip-sliding injuries being treated in area emergency rooms.

"Everybody's susceptible to all the injuries," Frohna says. But generally, he adds, hip injuries show up in older patients while lacerations and lower-extremity injuries are more common with younger patients.


Dr. John Wogan, chief of the emergency department at Greater Baltimore Medical Center, has also seen "a bit of a bump in the ice-related injuries," but not as big as at Union Memorial.

"The number of people who have come in with extremity trauma -- wrists, ankles, back injuries, things like that -- have increased probably about 10 percent," Wogan estimates.

"I've had some broken hips," he adds. "It sort of runs the gamut."

Like Frohna, Wogan says types of injuries are often dependent on age.

"The older folks who fall tend to break their hips," he says. "The younger people tend to break their wrists and arms."

Both doctors suggest Tylenol for pain. Some in the medical community believe that anti-inflammatory drugs, such as Advil and Motrin, might lead to further bleeding at an injury site, and that could lead to further swelling.


And Wogan cautions people who take blood thinners such as Coumadin to be doubly cautious. "They are at increased risk to develop complications," he says.

An older person on blood-thinning medication who gets a head injury, for example, might experience internal bleeding for days without being aware of it. Older people in general are at greater risk from falls, Wogan notes.

"It's very treacherous out there" for the elderly, he adds. "Not only are their bones weaker, but their balance is impaired and [so is] their ability to react. ... They may have trouble seeing that patch of ice someone else might be able to see."

If you have fallen, how can you tell if it's a bump, bruise or worse?

The ability to bear weight on the injured area is crucial, doctors say.

"If you lose the ability to bear weight," Frohna explains, "whether it's your ankle, your knee or your hip, you better get it checked out."


Wogan adds that people have been known to walk around with fractures without realizing it.

If you don't think your injury is a fracture or otherwise serious enough to visit the emergency room, apply a cold compress, take a pain reliever for discomfort and elevate the injured area above the level of your heart.

"There's not a whole lot of magic wisdom out there about these things," Frohna says. If the injury looks bad, he explains, there's a good chance it is bad. If you have any doubt, go to the emergency room -- that's what they're for.

What to do -- and not to do

Doctors advise people at greater of injuries when they fall -- the elderly and those with osteoporosis, for example -- to stay home when the footing is treacherous.

If you must go out in icy conditions, Dr. William Frohna, chief of emergency medicine at Union Memorial Hospital, urges proper footwear. Stash the spike heels or your leather-soled wingtips in your backpack or the back of the car.


"Wear a flat-sole tennis shoe," he says, "or a boot with a better gripping sole on it."

And he offered the advice that Dr. Tommy Turner, the longtime head of Johns Hopkins Hospital, offered years earlier. "In going down steps, hold on to the railing." Turner lived to be a very spry 100.

If you do fall and it's not a serious injury, Dr. John Wogan, chief of the emergency department at Greater Baltimore Medical Center, recommends the RICE formula for treating bruises and sprains:

* Rest

* Ice

* Compression


* Elevation

Rest allows the body to heal itself. Ice helps ease the pain, and compression -- an ACE bandage or support stockings -- and elevation will keep the swelling down.

Wogan says people should be patient: "Some of these sprains and bruises [may take] weeks and weeks to go down."

He adds that many people don't adequately elevate or ice. The elevation should be at heart level or above. When treating with ice, he says, "The general recommendation is 20 or perhaps 30 minutes every two hours while you're awake, during the first two days. You're reducing further bleeding or further swelling."

Wogan's advice: Lie down on the couch with your leg or arm or ankle on a pillow and let everybody else baby you.