Listener Question: What Should I Do About Bone Fractures?A common question people may ask is whether a bone fracture will heal itself or if it needs to be treated by a doctor. Orthopedic surgeon Dr. Justin Haller says it depends on the severity. Some…
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May 10, 2017
Bone Health Announcer: Need reliable health and wellness information? Don't listen to the guy in the cube next to you, get it from a trusted source, straight from the doctor's mouth. Here's this week's listener question on The Scope. Interviewer: This week's listener question is about fractures, and we've got an expert here to answer it, orthopedic surgeon Dr. Justin Haller. So the question is if this parent suspects that their child has a fracture, or if somebody suspects that they have a fracture, is that something that you need to have treated, or can that just heal on its own? I mean, because it's not like a broken bone. Dr. Haller: Sure, that's a great question, and a fracture is a broken bone. And it's. . . Interviewer: Okay. Dr. Haller: And so it depends on the type of fracture and the severity of the fracture, whether it needs an operation or whether it can be treated with a cast. To really be evaluated, the patient needs to have an x-ray to determine the amount of displacement or the amount that the bone has moved, and the location of the fracture as to whether it needs an operation or not. Interviewer: So I guess the question is, how would this person even know that they have a fracture? I mean, what are the symptoms of that? Because a broken bone is pretty obvious if you've got a malformed arm. Dr. Haller: That's right. Yeah, so, a fairly displaced fracture is pretty obvious, where an arm or leg doesn't look right, as patients say, but a non-displaced fracture can be as simple as just pain in a wrist. And the only way to really know is to get an x-ray. Interviewer: Yeah, and ultimately, it sounds like what you're saying is, if you have symptoms, you believe it's a fracture, realize that that is a broken bone. Dr. Haller: Right, exactly, that's a broken bone. Interviewer: That something might need to be manipulated to make sure that it heals properly. Dr. Haller: Yes. Interviewer: And you should seek treatment. Dr. Haller: You should seek treatment to have it evaluated to see if it's something that needs a manipulation in a cast, or whether it's something that needs an operation. Announcer: If you like what you heard, be sure to get our latest content. Sign up for weekly content updates at thescoperadio.com. This is The Scope, powered by University of Utah Health Sciences. |
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Physician Profile: Justin HallerDr. Justin Haller talks about his medical philosophy and what makes his practice unique.
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Trauma Center or ER for Broken Bone?When injuries occur, patients may have choices for different trauma centers to visit. Dr. Tom Miller speaks with orthopedic surgeon Dr. Justin Haller about what a Level I trauma center is and why he…
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January 10, 2017
Bone Health Dr. Miller: Break a bone, where should you go? 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: This is Tom Miller from Scope Radio and I'm here with Justin Haller. He's an orthopedic surgeon here at the University of Utah. We're going to talk a little bit about level one trauma centers. Now, you know that if you have a very severe injury, you're likely to end up at a level one trauma center, whether you're referred or end up there initially. But if you've fallen and you hurt your wrist or break your wrist, being at a level one trauma center might not even be a better place to get cure than some of the other type trauma centers, such as level two and three. And we're going to talk about that a little bit with Justin. Justin, tell me a little bit about what trauma one means or trauma one center. And then we're going to get into how patients who have a fracture or some other musculoskeletal injury would be treated. Dr. Haller: Sure, Tom. So the level of trauma center designation, there's a level one, level two, and level three designations for hospital trauma centers. And it's based on the number of resources that are available. Dr. Miller: So you generally have more specialists at a level one center? Dr. Haller: So level one has the most services available and the most services available acutely. So they have a neurosurgeon, general surgeon, orthopedic surgeon in-house, ready to see patients, depending on their acuity. Level two and level three centers have some of those resources available, but they're just not within the hospital at the time when a patient might arrive. Dr. Miller: Now, just briefly, what kinds of injuries would a level one trauma center see? Dr. Haller: So level one trauma centers are best at treating patients with multiple injuries that span general surgery issues, such as chest injuries, head injuries, as well as orthopedic or neurosurgery injuries because they have all the medical subspecialties available. And again, they're available acutely. Dr. Miller: Now, you're an orthopedic surgeon. So would you say that a level one center handles all kinds of fractures and musculoskeletal injuries that happen during accidents or other strange things? Dr. Haller: Yes. So level one centers tend to deal with the whole spectrum of orthopedic injuries that a patient could have. And they tend to see anything from referrals from level two and level three centers that are transferred and are complex enough that they do not have the resources available, as well as they see patients from a motor vehicle accident, motorcycle accident from the scene, brought in by the emergency providers. Dr. Miller: Now, the University of Utah has a level one trauma center, as I understand it. And there are a couple in the state. So we end up getting a lot of referrals, I would guess, from outlying hospitals for severe injuries. Dr. Haller: Yes, that's accurate. We get referrals from not only within the state but also from surrounding states, including Montana, Idaho, Nevada, Wyoming. Dr. Miller: Well, let me ask you this, let's say you have a less severe injury. Let's say that you fall and you hurt your ankle or you break your leg or you think it's broken. I mean, would you come to a level one trauma center or should you go to another trauma center, like a level two or a level three because there are more of those? Dr. Haller: There absolutely are more of those and some might view the access there as being a little bit better. However, the benefit of a level one trauma center is that they have all of the resources available to actually evaluate what's going on with your leg. Because when you first injure it, it can be tough to know whether it's broken or not. And they have the resources available to figure that out and treat you appropriately. And sometimes, even though the access is easier at the level two or level three centers, if it's a complex problem, you'll ultimately get referred anyway. And so it might actually turn out to be easier in the long run just to go to level one. Dr. Miller: Well, the way that the emergency rooms work, as you know, is they triage patients. And if you have a serious injury, even if that's a fracture, you're going to go ahead of a lot of people to get treatment. You're not going to sit in the waiting room very long with a fracture, I wouldn't think. Dr. Haller: That's accurate, yeah. Normally, patients with obvious fractures are moved along the emergency room triage board. Dr. Miller: So before the show, we started talking a little bit about some studies that had been done to show that level one trauma centers actually provide better outcomes, even for simpler injuries. Is that something that you can talk about? Dr. Haller: Yeah, so there have been a few studies that have looked at level one trauma centers and if they're necessary because they do have a lot of resources available, and if they're cost-effective. And they've demonstrated that level one trauma centers with specialized orthopedic trauma surgeons are cost-effective at treating patients, especially patients with complex injuries. Dr. Miller: So to wrap it up, if you're a person that has some type of an injury and you have access to a level one trauma center, whether it's something that you think is fairly simple or maybe even more complex, you should maybe come to a trauma . . . you would recommend coming to a level one trauma center. Is that right? Dr. Haller: I would recommend it if it's reasonably accessible, in terms of geographic location. 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. |
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How to Treat a Broken Bone that Didn't Heal CorrectlyBroken bones can occasionally heal in the wrong position, forming a “malunion” or “malalignment” after treatment. These misaligned bones can cause further problems and pain in…
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August 14, 2018
Bone Health Dr. Miller: You broke a bone and now it's painful? And maybe you're not walking on it correctly? 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 here with Justin Haller. He's an orthopedic surgeon here at the University of Utah. Justin, tell me a little bit about what we call malunion or malalignment. And this occurs in patients who have had fractures and then subsequently develop pain or mechanical dysfunction because maybe the fracture just didn't heal right. Maybe they didn't have it set correctly, something like that. What does that mean? Did Your Bone Heal Twisted or Crooked?Dr. Haller: So a malunion by definition is a bone that breaks and then heals in either a malaligned position or it's malrotated, so the bone itself is twisted and heals in that position. Dr. Miller: What's the most common cause of that? I mean, obviously it's a fracture, but then is it because it didn't receive the right treatment or maybe they didn't follow instructions after they were casted? Dr. Haller: The most common cause tends to be when patients are treated non-operatively with cast or something like that, in the United States, in the past. Dr. Miller: So what do you do? How do you treat these? And then again, what are the most common fracture sites where malalignment occurs? Dr. Haller: So most commonly symptomatic malalignment occurs in the lower extremities. So either the tibia or shin bone or femur or thigh bone. And what we do for those is first, to determine whether it's healed in a malaligned or malrotated position. Dr. Miller: So you can see that on X-ray. So CT scan or MRI might show you that? Dr. Haller: It starts with a full X-ray standing profile to see the mechanical axis of a patient's lower extremities and using a CT scan to see if there's any rotational component to that. Dr. Miller: Do you see leg length discrepancy sometimes with these fractures if they've healed incorrectly? Is One Leg Longer Than the Other?Dr. Haller: Commonly you do see a leg length discrepancy with these, and that's picked up on the long standing X-ray. Dr. Miller: What would somebody experience if one leg was a little bit shorter than the other after a fracture? And I gather they don't have to be that much shorter for them to develop symptoms, maybe if you're an athlete it's even more common. Dr. Haller: Yeah, really, patients can become symptomatic for a couple centimeters of leg length discrepancy. And most commonly, the symptoms associated with that are back pain, hip pain, and if it's also, it can get some knee pain if it's in the tibia bone or shin bone. Dr. Miller: So how do you treat that? I mean, obviously you don't put them on a rack and stretch out their leg. So how do you repair the leg and make the leg the right length? Dr. Haller: Sure. So we typically will do an osteotomy, or we cut the bone or re-break the bone as people will typically say, and we'll realign it and fix it there with plate and screws or a rod down the middle of the bone. Dr. Miller: How effective is that? Does that work pretty well? Dr. Haller: It works very well so long as patients can heal the cut in the bone. Normally, patient symptoms are pretty much resolved. Dr. Miller: Now, do you do the same thing for a malrotation, where the bone is twisted? Dr. Haller: It's pretty similar. Again, you do an osteotomy or a cut or re-break the bone and you can rotate the bone and fix it with plate and screws or with a rod down the middle of the bone. Dr. Miller: Well, final question. How would a patient find their way to you if they had symptoms? What would they look for and how would they know to come to you? Dr. Haller: Most commonly people will present saying that their family members noticed that they have either a limb length discrepancy or they walk funny or one leg is rotated in or out. Normally it's family members that notice the most and will point the patient to either an orthopedic surgeon or general practitioner to take an X-ray. And then it can be pretty obvious that the bone is not quite the same as the other side. Dr. Miller: Do you think going to a specialist is a good idea if you need to have this type of surgery, where you're going in and repairing a prior fracture that's been healed? Dr. Haller: Absolutely. Orthopedic specialists, particularly orthopedic trauma surgeons, are the ones who are trained to fully evaluate and understand the malalignment that's present and then can fully correct what's going on. Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.
What to do if your broken bone did not heal properly |