Column: Understanding and Treating Trauma Injuries

By Andrew Grose, MD

What are traumatic injuries? The technical definition is tissue disruption caused by a specific mechanical event. On a simpler level, it’s when you hurt yourself, often due to a loss of balance, a fall or an accident.

Most traumatic injuries involve gravity — a fall off a bike, a car accident, a bad tackle on the soccer field, a misstep off a curb or a host of other scenarios. As a bone trauma specialist at HSS, I specialize in injuries involving fractures from accidents, falls and other traumatic events.

Two Spike Groups

Given that most traumatic injuries are unforeseen events, they can happen to anyone at any time. We see these injuries most often among patients in two age categories. The first spike occurs among those aged 15 to 30, the most active age segment. These tend to be higher energy injuries, more common among men, who tend to take greater risks which can lead to injuries.

The second spike is among those 60 to 80 years old. As you might guess, this group is more prone to loss of balance and falls, often resulting in hip and other fractures.

Spring and Fall Surge

The most significant number of high-energy trauma injuries occur from April to May, followed by September to October. I’m not entirely sure why, but when spring arrives, many head outside and some push themselves too hard in their athletic pursuits. The injury rate flattens a bit over summer, then picks up again during late summer and early fall when people want to get that last rock climb or trail run in before the weather turns. Meanwhile, landscapers and construction workers see an uptick in trauma injuries during their busy summer months.

Impact of COVID

COVID was strange in terms of what we saw at HSS. For much of the pandemic, no one traveled anywhere. During this period, we mostly treated work injuries for essential employees and elderly patients who fell and broke bones. As the pandemic has eased, we see a rise in high-energy trauma as more people get out and ramp up activity. Trauma volume is up all over.

In some respects, it’s like the roaring 20s after World War I and the flu epidemic. We’ve all been suffering through a horrible pandemic and can’t wait to be active. The downside of doing exciting things and letting loose is increasing the chances of meeting me in my office.

Treating Traumatic Injuries

Eighty percent of the trauma patients I treat I meet in the ER or on the hospital floor after they’ve been admitted. Rest is essential to recovery, especially during the early stages of an injury. Slowly the scale tips to more activity during the recovery process. We talk about fractures as involving soft tissue injuries with a bony component. The most important thing is to get the soft tissues healthy and ensure they stay healthy.

Splinting is a crucial step to hold the soft tissue in place and realign the bone so the whole system can quiet down. We can then restore skeletal stability and fix the fracture with a cast or, if needed, a plate, screws or a rod. Ice and anti-inflammatories are advised for pain management, along with elevation of the injured joint no higher than the level of your heart.

As the patient recovers, we layer in more activity to return the body to its regular routine and prevent secondary injury from immobility. Some injuries require more rest before surgery due to swelling. With hip or femur fractures, say from a car accident, we need to operate within the first 24-36 hours after injury to get patients stabilized quickly and then out of bed.

For those patients who have already been seen in the ER and come to my office, we ensure they’re comfortable, have a good blood supply and don’t have nerve damage to the fracture area. We then discuss with the patient whether to treat their lower or upper extremity injury surgically or non-operatively, and how to manage this process. I perform all my surgeries at HSS Orthopedics with Stamford Health in Stamford, CT.

What I Like Most

What I enjoy most about my job is seeing patients that I’ve treated for severe injuries return to my office months later in an improved state, with increased mobility. I get as much joy in dealing with the onslaught of elderly patients who have fallen, helping families navigate mom’s or dad’s situation. We all fall apart at some point; it’s the human condition. It’s very rewarding to help those late in life improve their outcomes and regain meaningful function.

Dr. Andrew Grose of HSS Orthopedics

Andrew Grose, MD, is an orthopedic surgeon at HSS Orthopedics with Stamford Health, specializing in trauma, hip and knee replacement.

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