Dealing with multiple fractures

July 12, 2020

This week our panel of experts answers your questions on a variety of issues ranging from finger injury to cramps suffered during swimming.

Q: Cycling is my passion, and before Covid-19 situation my routine was a daily two hours of cycling. During the lockdown, I stopped the practice. I want to resume cycling. Is there any possibility? —Javed K. Baloch

A: Good to hear that you like cycling as it’s an important form of exercise. It improves cardiovascular fitness, enhances muscle strength, flexibility, endurance and most importantly helps in burning body fat.

Covid-19 has reduced the mobility to a considerable extent resulting in sedentary life style with lack of activity. Getting back to cycling is both easy and exciting. However, you need to be progressive in your approach, and in addition must implement SOPS of covid-19 like use of gloves and social distancing. Initially you can start with stationery vertical bicycle at home and when the pandemic is over you can resume outdoor cycling. Try to avoid using a mask continuously when cycling outside as it reduces the ability to breathe comfortably resulting in limited ventilation.

It is good to start with two three rides a week and enhance frequency gradually. After cycling don’t forget to rehydrate yourself, use good nutrition and do stretching exercises. Also take care of your health and immunity which is quite necessary in this pandemic.

Syed Hasan Abbas Rizvi

Senior Manager & Principal

School of Physical Therapy & Rehabilitation

Liaquat National Hospital and Medical College

Q: I play cricket. I’m a wicket-keeper. A few months ago my index finger had a fracture. I was rushed to the hospital where the doctor bandaged my Index finger. After four weeks the bandage was removed and I was declared fit. Lately, I attended a practice session, where I realized that still there is a severe pain in my finger, and I had to leave the practice. Please suggest a doctor who can help me. —Qaiser Ali Khan

A: Finger injury is very common in wicket-keeping. You sustained a fracture in your finger which was managed conservatively with plaster. Finger fractures often results in deformities and stiffness after plaster management. Prolonged phase of physiotherapy and rehabilitation is often required for complete recovery. It is advisable that you visit hand surgery department and see a hand surgery specialist so that complete evaluation of your hand is done. Previous record is required along with all details of previous management. A highly trained physiotherapist will look after fine movements of hand which will lead to complete recovery.

Dr. Muhammad Sufyan

FCPS (Ortho) AO Fellow (Germany), Sports Medicine Fellowship (Singapore)

Assistant Professor | Department of Orthopaedic Surgery

Liaquat National Hospital and Medical College

Q: I am a swimmer, 24 years, and take part in various competitions. Lately, while swimming I had cramps in my neck muscles, and thigh muscle. The pain was unbearable, and since then I stopped swimming. Is there any cure for these cramps? —Zahid Bukhari

A: Swimming is the best of exercises, and the perfect way to get a full body workout. Since it involves most muscle groups; it is usually intense, and can strain certain muscle groups, especially the neck, back and thigh muscles. The strained muscles eventually get stiff.

A sound swimming technique is vital to avoid neck and thigh cramps. Proper positioning of the neck is very important to avoid unnecessary strain. In fact, a good swimming technique helps resolve neck and back pain. Swimming requires a lot of stamina, and continuous practice should be the norm between competitions. Regular exercises to strengthen the neck and thigh muscles will be very helpful.

A balanced diet, with good protein intake helps build your muscles. A good mix of short and long acting carbohydrates before the swim gives a good calorie supply to your muscles. It is important to munch onto some short acting carbs and light drinks between the heats.

I am sure you would be in contact with your physician, as certain illnesses and certain vitamin deficiencies can also cause muscle weakness and cramps. If you haven’t met your physician recently, I would advise to do so and get checked up.

With this, I would advise you to see your swimming trainer or coach again, and with a more balanced approach with your diet and exercise routine, begin swimming again for shorter distances initially to gain that much needed confidence in this fantastic sport.

Dr. Ali Asghar

MRCP (UK), FACE (USA) Fellowship in Diabetes & Endocrinology

Assistant Professor | Department of Diabetes, Endocrinology and Metabolism

Liaquat National Hospital and Medical College

Q: While skiing in the northern areas last year, I met an accident, resulting in multiple knee fractures. My knee had a plaster cast and after three months it was removed, but a severe pain is still there. —Saleem Laghari

A: There can be two things that can be the cause of your pain. One is post traumatic stiffness and second is post traumatic knee arthritis.

If it is because of stiffness then it can get better with exercise, or manipulation under anaesthesia or release of fibrous tissue surgically. This can be decided when I will examine you clinically. Post traumatic arthritis due to mal-united fracture and cartilage damage causes the same symptoms as osteoarthritis.

Even though a knee fracture may heal completely but cause severe damage to the joint cartilage, leads to post traumatic knee arthritis later in life.

Treatment options range from pain killers, physiotherapy to surgical procedures.

Some of the possible conservative treatment options for knee arthritis may include:

• Rest

• Abstaining from activities that cause significant stress on the knees

• Physical therapy

• Exercise (low impact)

• Weight loss

If conservative treatments fail to improve knee function and discomfort, operative treatment such as arthroscopic debridement and in advanced cases, total knee replacement.

We will discuss in detail about your issue when we will meet and will do examination and X-rays.

Dr. Nasir Ahmed

Assistant Professor and Consultant Orthopedic Surgeon

Department of Orthopedic Surgery

Liaquat National Hospital and Medical College

(All the specialists on our experts’ panel are associated with Liaquat National Hospital. Please send your queries at [email protected] or [email protected])

Dealing with multiple fractures