Friday, November 9, 2012

Author Question: Treatment of Minor Injuries

Maisie Asks:

I'm writing today with a medical question, I really appreciated the flow of your medical expertise in Proof, with it being a part of the story, and not a distraction from the story. I want to accomplish that same steady flow with my current work in progress.

My 16-year-old female main character is going to jump down from something (akin to jumping from a tree branch), the ground below is pitted and sloped though, and I need her to get injured. In my mind, it would be her ankle or her wrist (from catching herself) with some minor lacerations to her face. I've never broken anything to know how it feels.

I want the medical scene that follows to be realistic. Her Mom will meet her at the hospital, it's late at night. What would be the steps, the healing process, pain management, any specialists, and healing time. I want her to be injured, but I don't want her to be crippled for the entire summer (length of the novel). I want to know how the hospital scene and future doctor appointments will go, what they'll look for, and how this is going to encumber her in her regular life.

Jordyn Says:

Thanks so much for sending me your question.
The thing to know about ankles is that they rarely fracture-- 95% of the time they are sprained. For a sprained ankle, an air splint (crutches if the patient can't bear weight) for 7-10 days and then the patient should work themselves out of the splint at that point. If still painful-- they should follow-up with their regular doctor or orthopedic doctor at that time.
It's more likely, with your scenario of falling down a hill, for a simple break to the lower forearm. Treatment in the ER would be x-ray to evaluate for fracture, and pain medication (usually Ibuprofen suffices). These would be the same initial treatments for an ankle injury as well. If fractured, the patient is placed in a splint and NOT a cast. Patient will follow-up with ortho in 7-10 days for cast placement. Cast is on for 4-6 weeks. There shouldn't be any permanent damage.
Lacerations: generally a topical numbing agent is applied. This sets in place for 20-30 minutes. Or, the patient is directly injected with Lidocaine. Wound is irrigated with normal saline. Stitched up. Antibiotic ointment over the stitches. Wound should be cleansed twice daily with mild soap and water then Neosporin or equivalent over top. Stitches to the face are usually removed in 5-7 days. Tetanus shot if the patient hasn't had one in the last five years.


  1. Maisie,
    You said you don't know what it feels like to break a bone. Well, in my case it was my tibia, but I imagine it would be similar for other long bones. Anyway, in my experience:
    It snaps, with something between a click and a crunch. You feel it, and someone close enough will hear it. And it starts hurting, not right as it breaks, but within a moment or two. It's not unbearable at first.
    You know you've done something serious. Even without trying to move it (you won't try and move it) you can tell that it's not something you're going to walk off.
    The tissue around the break swells up, and after a few minutes it starts to get *really* painful. At this point any slight movement is agonising. After a while your muscles get tired from trying to keep still for so long, and start to twitch occasinally. You can't do anything about it, and it hurts like &^%)!
    As Jordyn said, they only give you ibuprofen, and it does no apparent good (probably it would be even worse without it, but at the time it doesn't feel like it). But if you're lucky, you'll get gas and air while they set it, which is *awesome*. It numbs the pain to a dull ache, which you don't mind because you are as high as a kite.
    After the bone is set, it's excruciatingly sore for a few days, and then for some time you will *notice* when you knock it against anything, and then it's mostly just an annoyance until you get the cast/splint off.

  2. Thanks for all the great information, Carrie!