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Dr. Miller: What happens in a level 1 trauma center? We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists, with Dr. Tom Miller, is on The Scope.

Dr. Miller: I'm Dr. Tom Miller and I'm here with Dr. David Rothberg. He's an orthopedic surgeon specializing in trauma surgery. He's also a professor of orthopedic surgery.

David, tell us a little bit about what it means to work in a level 1 trauma center as an orthopedic surgeon.

Dr. Rothberg: Well, we're a member of the team that takes care of patients on their worst day generally. A lot of the patients that come to a Level 1 trauma center are patients who have been in a car accident or have fallen from an extreme height or some sort of accident along these lines. And we're a member of the team along with the general surgeons and neurosurgeons that take care of all sorts of trauma. Anything you can think of, from head trauma, spine trauma, belly trauma and extremity trauma.

Dr. Miller: So these could include industrial accidents. It could include automotive accidents. Just about any type of traumatic injury that would involve, what, multiple organs or just orthopedic injuries?

Dr. Rothberg: Really multiple organs. Orthopedics tends to take a lead role, often times in the operative care of these patients. But we're a member of a huge team and what it means to be a level 1 trauma center is that we can take care of anything.

Dr. Miller: Give me some examples of the types of injuries you particularly take care of.

Dr. Rothberg: In orthopedic trauma, we take care of just about any broken bone or soft tissue injury, but our specialty has evolved around the care of pelvic and acetabular fractures and fractures into people's joints.

Dr. Miller: Do you see these types of injuries mostly in automobile accidents?

Dr. Rothberg: They can be in automobile accidents but we see them ranging from recreational activities, like rock climbing to industrial accidents like you mentioned.

Dr. Miller: Now in a patient who's being sent to a level 1 trauma center, how far away are they coming to our center from? What is our outreach or ability to take care of these patients in terms of geography and distance?

Dr. Rothberg: Well, we're fortunate to have an incredibly large geographic catchment that involves Idaho, Montana, Nevada, parts of Northern Arizona, Wyoming and occasionally people from all around the United States who may be here.

Dr. Miller: Would the patients who are injured then be sent directly to us by helicopter or fixed wing or would they come from another hospital usually?

Dr. Rothberg: It's really variable. We have an incredible active helicopter service because of how large the geography is. But we also consult with physicians and outside hospitals who have patients that are above and beyond what they can take care of. And so we are commonly talking with them on the phone, brining patients here to help with their definitive care.

Dr. Miller: Tell me a little bit about the families of these patients. How are they directed to our hospital to follow up on their loved ones and be sure they're being taken care of?

Dr. Rothberg: That's an incredible process. So in the very beginning it's really patient-focused but as soon as that level 1 trauma activation, which can vary in time but usually is quite quick, somewhere in the ballpark of 15 to 30 minutes, we're already involving the patients. They've been in the ER talking with our social workers and then our surgeons and other providers are already talking to them as soon as possible.

Dr. Miller: Now you work with other types of specialists outside of orthopedics. Could you talk a little bit about that team approach? I mean, what happens when a patient hits the emergency department and they come in with a trauma? How do you begin to take care of them in conjunction with other specialists?

Dr. Rothberg: What happens is the general surgeons are usually kind of the quarterback of the football team. They're really in charge of what's going on in the trauma bay, along with the ER doctors and the anesthesiologists.

But when they come in, it's an incredible amount of people that are there on the spot, so orthopedics and neurosurgery and EMT and plastics. They're all there so that all injuries can be identified and taken care of in a timely manner. But we end up being involved with the vast majority of these because of the amount of extremity injuries that are involved in these traumas.

Dr. Miller: Sounds like chaos.

Dr. Rothberg: It can be but it's a pretty incredible process that we review and have almost a script that we follow each time so that nothing is missed.

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Interviewer: You come back from the slopes, and your thumb is hurting really, really badly. Is it something you should worry about or not? We'll find out next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. David Rothberg is an orthopedic surgeon at the University of Utah Hospital. We're going to talk about something called "skier's thumb" right now. So you go for a day of skiing, you come back, your thumb hurts. Do you have skier's thumb or not? How do you even know? First of all, what is skier's thumb?

Dr. Rothberg: Skier's thumb is a relatively common injury of the upper extremity suffered when someone falls on a pole. So the most common scenario is with a grip-fitted poles, you fall, and the pole is forced into the palm as you place your hand down to slow your fall.

People know when they have it because the actual ligament that's hurt is your ulnar collateral ligament on your thumb, and it supports your thumb as a post. So when you pinch with your forefinger and your thumb . . .

Interviewer: Kind of making the "OK" symbol except for against the side of your thumb . . .

Dr. Rothberg:That's putting pressure on that collateral ligament.

Interviewer: Okay.

Dr. Rothberg: If you think about all the daily tasks we do with grip strength and manipulating objects with your hand, it's really common that we use your thumb as a post. So the quickest and dirtiest way to figure this out is to use your thumb as a post. Press your forefinger against the side of your thumb and see if it hurts at the large knuckle at the base of your palm, or your MCP joint.

Interviewer: So it refers pain down, because you're touching at the very top part of the thumb, and it's kind of coming down, the base of the nail almost, off to the side.

Dr. Rothberg: Right, and you're going to feel that.

Interviewer: Okay. And if you feel that, is it for sure that you've got skier's thumb?

Dr. Rothberg: It may not be for sure, because like all ligament injuries, it can really come with a grade of injury, from a sprain, which the vast majorities will be, to complete tears, to fractures of the insertion of the ligament.

Interviewer: So if you're feeling pain, should you go see somebody right away? Is it important that you see somebody or should you just kind of wait and see if it goes away?

Dr. Rothberg: I think, in the very beginning, if this is something that gets better very quickly, then you're probably safe. But if you have a persistent pain lasting more than a day or two, and it's causing dysfunction, it's worthwhile to get checked out by an orthopedic hand surgeon.

They're most commonly going to take an X-ray to rule out that scenario where there may be fracture associated with it. The reason that you want to take care of this is it can lead to a chronic instability of that joint, meaning that you're no longer able to fully use your thumb as a post because of non-healing of the ligament.

So the typical course of treatment is in a non-operative setting, which is the vast majority, is a brace. That brace is going to hold your thumb in a position that protects it from being used as a post or really straining or stressing that ligament as it attaches at the MCP joint.

Interviewer: So it sounds like kind of a big deal, because it could hinder your usage of that for the rest of your life if you don't have something done to it, and it's simple. It's a brace.

Dr. Rothberg: That's exactly right. When chronically injured, then it becomes something kind of interesting historically. It's called a "gamekeeper's thumb," and that referred to when people who farmed chickens they would break the neck of the chicken over their thumb, and it could lead to repetitive stress on the ligament, that then loosened it and then caused chronic disability.

So that's the worry when you don't take care of this skier's thumb is that it becomes a chronic instability that causes pain and dysfunction.

Interviewer: How long does it take for this to recover at this point, after you get the brace?

Dr. Rothberg: Typically, people are in the brace from four to six weeks, and then depending on the range of motion and tasks that they have in their daily life, they may start some hand therapy. Motion tends to help with the healing process. All in all, people can be back to activities around the six week mark.

Interviewer: So just for perspective, not something to be taken lightly. Not to go, "Aw, it's just my thumb. I won't worry about it."

Dr. Rothberg: That's very true, and I think it's a real common one that people get and take lightly, and then are presenting to us later with problems.

Interviewer: Then it's too late. Is it too late at that point? I guess that's a good question. What if three years down the road, I come in? Is it too late to fix that problem?

Dr. Rothberg: It isn't necessarily too late, depending on whether you've developed any arthritis in the joint because of instability. Certainly, there are late reconstructions, where we can reconstruct the ligament to give you stability. In most people, this tends to be something they pick up and don't really miss, because it does cause quite a bit of dysfunction. But getting it looked at sooner is always better than later.

Announcer: TheScopeRadio.com is University of Utah Health Sciences radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com

Interviewer: Why buying a new pair of skis should also change the way you prepare for your ski season. That's next on The Scope.

Announcer: Medical news and research from University of Utah specialists and physicians you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. David Rothberg is an orthopedic surgeon at the University of Utah Health Care, and the new type of parabolic skis actually mean that you might be opening yourself up to a different type of injury that you are not used to before, and mean that you need to get back to the basics of skiing. Talk about that a little bit. What are you seeing with the new parabolic skis, which are great, they give you so much more control and make it more fun, but they also can make it more dangerous.

Dr. Rothberg: We absolutely love the new ski shapes we are seeing because they allow us to do things that we weren't able to before. We can turn more quickly, we can navigate steeper slopes, and do so with a shorter lighter ski. But one of the problems that we think we are seeing with this is because the ski is shorter and we can turn more quickly we're actually putting more force on our knee. Because of that when you buy your new pair of skis you need to think about your knees fitness and how you're training for the season. As we know to prevent injuries you both need to be fit, and aware of your surroundings but also battle fatigue. When you get fatigued your technique becomes poor and you set yourself up for knee injuries.

Interviewer: So it sounds like if you get a new set of these skis and maybe you are going from an old style you may be in far a little bit of a surprise and you may want to reevaluate your physical condition.

Dr. Rothberg: Absolutely, at the result of some pretty serious knee injuries. The most common thing we see is an MCL strain which really is more of a beginners knee injury, which you have been stuck in the pizza pie, or snow plow position all day long and just strained the inside of the knee. Further more we start to see more ligament injuries, like an ACL tear which is so common. Both in non-ski athletes and skiers alike where the ski continues down hill with the lower leg, but your body is going backwards and puts that anterior-ly directed force on your tibia and tears the ACL ligament.
Then to a higher level of trauma, what we see so frequently here at the University of Utah is the tibial plateau fracture, or the top of the tibia, base of the knee fracture. We think that a lot of these are coming because you are able to put so much force on the knee with your shorter tighter turn radius.

Interviewer: So even experienced skiers might be a little surprised if they switch to this different type of ski. They're going to get what are typically considered beginner injuries maybe.

Dr. Rothberg: Absolutely, it is all related to how much force you can put on your knee.

Interviewer: You mentioned the importance of being more aware of your surroundings if you switch to this type of ski. What exactly do you mean there and how does that affect what I'm doing on the slopes?

Dr. Rothberg: Being aware of your surroundings is a combination of knowing what is physically around you as in the slope and snow conditions, weather conditions, visibility, and also it is really just as important to know what your own limitations are. Being aware of where you should be on the mountain and when you should be there, and what time of day it is, are you tired and is it time to take a break.

Interviewer: So what is your advise to somebody that if they are switching to a parabolic type ski to maybe help prevent these types of injury that you might be seeing as a result of better control, faster more torque on the body?

Dr. Rothberg: Well control is really going to come from about two or three muscle groups in your body. The obvious ones are your quadriceps and hamstrings, muscles around the knee. But secondarily, the hip stabilizing muscles, the abductors, and then thirdly the core strength. All these things are going to play into your body awareness and balance and ability to manipulate uneven surfaces and abnormal body angles so you can recover from variations as you turn and navigate the slopes.

Interviewer: How do I know before it's to late that maybe I shouldn't be pushing myself as hard as I think I can? Is there a way to determine that?

Dr. Rothberg: That's the hardest question to answer because it is always the last run of the day you get hurt.

Interviewer: Oh, is that because of fatigue?

Dr. Rothberg: No, it's because once you got hurt you're done.

Interviewer: Oh okay, is it last run of the day you get because of fatigue?

Dr. Rothberg: Yeah, probably. In addition to fitness and awareness comes in hydration as well. So one of the important things about being on the mountain is staying adequately hydrated.

Interviewer: Do the new parabolic type of skis actually tire you out more quickly?

Dr. Rothberg: It may not be that the ski itself tires you out more quickly, but your ability to navigate more difficult terrain and push yourself because of the tighter turn radius may in effect cause the fatigue.

Interviewer: So what would your final word of advice be to a skier putting on a pair of parabolic skis?

Dr. Rothberg: I think the most important thing is to know your skill level, be aware of the terrain you are on, and be aware that you are going to be able to make much tighter turns which are going to make you have to react more quickly to the slope that you're on.

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