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Falling Down Stairs (Injuries and Recovery)
kooky_cupcake wrote in little_details
Hello. My story takes place in a modern day school. My character is seventeen years old and he got in a violent argument that ended with him being pushed down a staircase. This accident happened in a secluded part of the school during class time, so no one was around to witness the event firsthand, though two of his friends do eventually find him and call for help. His arm sort of acted as a cushion and prevented him from hitting his head directly on the ground below. I think he would still have a concussion from hitting the steps before falling on the ground.

I've googled what sort of injuries are common from this type of accident and, after wading through lawyer pages and statistics, decided that he would definitely have an arm fracture as well as some bruising and minor cuts. He didn't fall from the very top, but the way he fell is what resulted in his broken arm.

I checked through medical sites for pictures and descriptions of these type of injuries. I read about people who have had broken arms and what if felt like, as well as their recovery period. I have most of it down, but there I still have a few questions that I couldn't get specific answers on.

1. After the arm has healed and the cast removed, how long does it take to resume normal activities? I read that after recovery from a fracture, the injured party may not be able to do some things normally for a while. My character is a musician and plays the guitar. Would he be able to play as soon as he got the cast off or would he require some time and physical therapy? Even after everything has healed, is it possible that he may not be able to play at the same skill level again?

2. What exactly happens at the hospital? Would he be kept under observation for a bit and then sent home, or would he be there for a while? Would he be given any type of medication? If so, what sort of effects would the medication have on him (make him really sleepy, a little too happy, ect.)?
Edit: Thank you all for your wonderful help! I really appreciate it. ^_^

I broke my wrist slipping on a steep grassy bank (normally I'd tuck my shoulder in and roll, but I was holding my husband's expensive new camera). I knew straight away I'd done a damage, but wasn't sure how bad. But anyway, as it was the start of a special guided day visit to a historic site and I'd paid quite a bit for it, so I told myself it was just a sprain and carried on. The visit lasted a whole day, and I managed to ignore my wrist, even take a lot of photographs. Then there I was on my own, with my car, 50 miles from home. Deciding I couldn't drive home simply wasn't an option, so I did. It had swollen up a lot by then, and it hurt, but I was still assuming it was a sprain. I went on doing that for three days till a doctor colleague of mine said 'you know, if it was me I'd really go to A&E and get that X-rayed'. So next morning I did, and when the fracture showed up it got put in plaster and the nurse gave me some painkillers, and I went in to work. I was in plaster for about 3 weeks and for a couple of weeks after the plaster came off I was given a splint to wear, just to stop it getting wrenched. I could do everything that I'd been able to do before, there was no difference, although it was a bit feeble at first - muscle tone drops away very fast when a joint is immobilised, but it comes back just as fast. They just send you away with a leaflet advising you on some hand exeercises to do to help it along. I imagine that a musician who normally practises daily would find himself a bit stiff and clumsy at first, but it would soon be quite normal. I don't think professional physio would be needed for an ordinary break and it would take a really fearful smash to permanently damage his playing ability.

Do you actually want him to have concussion? If so, you'll have to have him crack his head on a wall or a banister as he falls, because the fall you describe wouldn't necessarily or even likely damage his head at all. Certainly head injury is the first thing medics look for when anyone has had a fall. If he just had a slight bump on his head but no signs of damage (eyes not reacting, slurring words, etc) they might let him go home with stern instructions to come straight back if he feels at all badly and if he had hit his head badly they probably would keep him overnight. But if they suspected head damage they'd give him as little medication as possible - certainly nothing that would make him sleepy or happy.

My mum determinedly ignored what she decided was a sprained wrist - for three weeks. When she eventually went to the doctor with it, they found that the broken bones had sawed through the tendon to her thumb. I don't know the details of the repair, but she was then in plaster for weeks and weeks.

I know a woman whose legs slipped out from under her on ice, so that she sat. Two days later, when she found she still hurt just as much when she took fewer pain killers, she went to the ER and told them she had a stiff neck and a headache and had thrown up. Then she did the last one again on the spot.

Instantly whipped off to check for a concussion.

As it turned out, she didn't have one, but it was a possibility even though she didn't hit her head.

Hmm, I might rethink the concussion. I suppose it is more likely for him to have suffered a bump on the head. Didn't think that through very well. ^^;

Falling (or being pushed) downstairs is something that can damage you catastrophically - if the steps are stone or concrete and your character cracks his skull on the edge of one, farewell sweet prince - or not at all. Just as 'a broken arm' can be anything from a hairline crack that will mend in three weeks, to having bone fragments sticking out of the skin, needing to be repaired with metal pins and plates.

Just another family anecdote, to demonstrate how random such falls are: my 83-year-old father had such terribly painful sciatica that his doctor prescribed him mega-strength analgesics, which made him woozy. So woozy that one day when he got to the top of his stairs he simply toppled backwards, and went tobogganing helplessly all the way down the stairs on his back, head first, and landed at the bottom on the (flagstone) floor. He thought he couldn't possibly not have done himself some major injury, but when he got up and checked himself the only damage was carpet-burns on both elbows. And an hour or so later it dawned on him that his sciatica, which he had suffered from for months, had vanished! It never recurred.

his sciatica, which he had suffered from for months, had vanished!

That is wonderful! I don't suppose many doctors would risk shoving their patients down the stairs to see what happens, though. Although I am reminded of the anecdote in one of James Herriot's books where a cow had - if I remember rightly - displacement of the abomasum (one of the stomachs) and the local postman cured it by goading the cow into a "bloody good gallop".

Similarly, when I was in the process of giving birth (at home, as planned) to my youngest, he got so thoroughly stuck that they called an ambulance to take me in. One astonishingly bumpy fifteen-minute ride later, I got up on the table and he popped out within five minutes. The midwife said that if we'd been in hospital all along, she'd have been on with the forceps at the stage where she called the ambulance.

One ER doctor I knew online observed that he was continually astounded at one things: how little it took to kill someone, and how much it took.

You don't say which country this school is in, but you might like to know that in the UK the kind of schools where this sort of event is likely to happen tend to have cctv cameras around the place.

It takes place in the US. Around here, at least where I live and the areas around them, schools don't have any kind of cameras except maybe in the parking lot and usually only in the security guard's box at the front gate where the cars are coming in and out. That's interesting about the schools in the UK though.

I think it's only the ones where they've sadly learned to take trouble for granted - I must ask my kids if their (reasonably well-behaved) school has cameras.

security guard's box at the front gate

Wow, we don't have those at schools, only at factories!

I fell off of the top of a swingset, and syntinen_laulu's description sounds right to me for a clean fracture (no re-setting of the bone/skin damage, which is what mine was). I will say that my thumb was also broken (dominant wrist & thumb) and it took another week post-cast for my handwriting to even out due to gripping strength issues. I was given no pain medicine beyond an initial "prescription dose" of ibuprofen, and then maitenance (normal dosing instructions for kids) after that until my parents managed to macguyver a splint out of two rulers, surgical tape, and ace bandage (due to good reasons it took 3 days for me to get medical attention) if you need a temporary splint idea. Er, I suppose it helps to clarify I was 8, so I doubt doctors would've wanted me to take anything narcotic, but I honestly only felt a slight tenderness in my arm until i was asked to turn my wrist which is when everything felt like death.

If you want a more severe break, a friend of mine who teaches guitar had a complex fracture (some bone through skin) in his non-dominant arm (which is still used for guitar-playing) after being thrown over his bike (probably similar to a fairly high fall? He "fell badly," which means--from how he explained it-- the heel of his hand caught the sidewalk, but at an angle, so the force applied was not "straight" so he had basically a twisting break-line through the bone, and it pushed things where they should not be), which required two surgical rods, and he was kept overnight for the surgeryand he had to do a lot of medical after care in terms of wound washing, etc. It's taken him about three months to return to a level of being able to actively play guitar, but he was given permission to use his fingers (he was never casted due to the surgical site needing care, but told to "hold very still" and had a splint which he wore for 2 months and then was allowed to slowly stop using, like "keep it off for 2 hours," until now I thiiiink he only wears it to bed but he might've stopped using it entirely) after a couple weeks and started practicing & working up to where he'd been? He still complains about it occasionally when shuffling cards, etc., but he's mostly better (he broke it in May). I think he had a couple sessions of PT, but to be quite honest I am not sure if I remember that correctly -- I suspect it could be whichever you wanted, as arms are tricksy creatures and different patients for severe breaks probably need different things. I know he got a supply of pain meds, but I have really no idea the dosage/amount/etc.

I should also say that while it's been 15 years since I broke my wrist, and I have no other complications, I have arthritis in it which is very painful during cold and/or storm-y (pressure change) weather. Painful enough that I have experience with narcotic pain meds! Doctors tend to be pretty stingy with them in the US, so if your story is set here be aware of that? Depending on where this occurs, I'd check country/regional laws & best practices (googling best practices has worked for me in the past). I'll say that narcotics tend to make people (myself, and 2 other people I know irl, which I realize is a small sample size) seem very sleepy, but in the sleep depped way (with a lot of zoning out); I personally find the experience unpleasant (and somewhat likely to incite anxiety because I know I cannot respond to threats), but I know my friends & family find drugged!me kind of hilarious, so realize his friends might be really entertained. And also not everyone finds it unpleasant; my mom finds it "cozy feeling".

I... hope that helps!

edited to remove prescription dosage amount, as I realized while the internet said that's the prescription dose I rather suspect mine was less than that given I was a tiny person.

Edited at 2012-09-06 11:35 am (UTC)

As you say, doctors are pretty wary of narcotic painkillers anyway. And if there's any suspicion of a possibility of damage to the head they are absolutely not going to give any - because being sleepy, slurry or eyes-out-of-focus are all classic signs of concussion which they can't afford to mask with medication.

Thank you! This helps a bunch. ^^

Length of recovery time depends entirely on the type of fracture and where on the arm it is located. Injuries to the joints tend to take longer to heal than to the shaft of the bone, for instance.

If you're going with one of the most common fractures from falling, a distal radial fracture commonly called a "colles' fracture" is a good bet. This happens when you try to stabilize your fall with your outstretched hands. If it is a simple fracture, the bone will be repositioned by pulling on the hand, then the lower arm will end up in a cast for 4-6 weeks.

After that, the lower arm will be weak but can be used normally. Treatment might involve physical therapy. And I'd hold off on sports for another few weeks ;-)

More complicated fractures (such as a comminuted fracture or an open fracture) are not treated with casts. They are operated on and a small metal plate is attached to fixate the injury to the bone internally.

Agreed. My brother, aged 25, managed to break both his arms in separate incidents in two weeks. The first was a simple wrist fracture and was put in a cast. The other was a complex but not open wrist fracture and he got a plate put in for 3 months. The simpler break had a cast for 4 weeks but after the first day or two he could use his fingers normally and once the cast came off it only took a day or two to regain strength. The other arm needed physical therapy before he could make a fist or type with all his fingers, and he's a computer programmer so it was a major issue! He was back to normal after about 8 months total, but still gets occasional stabbing hand pains.

The exact location of the fracture determines where exactly the cast is and how much he is able to do with the hand while the cast is on, and that in turn will have quite some effect on how well he's able to function right after it is taken off, because the level of muscle loss will vary. My mother-in-law once broke something in her elbow and had to wear a cast for weeks, but since her arm was in a bent position she could still do quite a lot - including lots of crocheting to pass the time! And when she got rid of the cast the doctor was quite impressed at how well the arm functioned, so even something as "light" as handicraft had helped prevent the muscles from getting too lazy.

If your character was pushed violently, he may clear the first few steps at the top altogether and try to rotate to land face-down, but may not have time to fully put his arms out to catch himself. At any rate, I have an anecdote about guitars and break locations and recovery times.

From my anecdotal experience: when I was 8 years old, I was playing on the "helmets" at my elementary school's playground, which were probably ~9 feet off the ground at the highest point. I got nervous in the middle of a "maneuver" and fell, doing a 180 and landing with the bulk of my torso/ribcage on my right (dominant) arm with the arm rotated sideways so that the distal (pinkie-side) part of my fist was planted on the ground. I displaced both my lower arm bones about an inch from the wrist (the narrowest part of your forearm, for reference) so that my radius moved "up" and over to where my ulna normally was, and my ulna moved so that only half of the bone was in contact with its former termination point. I was put in a full arm cast -- from the base of my fingers, leaving a hole for my thumb to poke through, bending 90 degrees at the elbow, and all the way up to my deltoid insertion point. I was told this was because my break was so close to a wrist injury. I had very little range of motion, couldn't rotate my hand (if I wanted to be palm down, I had to move my entire arm), and couldn't make a complete fist or arrange my finger bones well enough to hold a pencil. Basically, I could do almost nothing with that arm except swing it and hold it in front of me to plow through people I was playing flag football against during PE. I was in that cast for either 4 or 6 weeks. When the cast came off, my arm was totally wasted. I had no musculature in my bicep or forearm and only had the barest of functionality. My grip was exceedingly weak. I had to rebuild it by wearing a splint for another 3 weeks and gradually resuming everyday usage of my arm, but (for example) writing was painful for two weeks after I got my cast off - I would get cramps in my hand as I attempted to complete my very basic 3rd grade assignments.

Additionally, and here's where it gets really relevant, I had wrist strain problems for about 8 years after that break, specifically only in the arm and location that I broke. I couldn't play sports like volleyball because I couldn't set the ball, tennis became difficult after a period of time because my wrist became too strained from holding the tennis racket in one position, and, you guessed it, I couldn't learn to play guitar because the repetitive movement of strumming and picking aggravated my problems. If he breaks his non-dominant/left hand, that's even worse. You have to have a lot a lot of finger strength and wrist flexibility to play the guitar, and especially to obtain the proper placement on the fretboard. Although he may technically be able to "play" as soon as he gets his cast off, assuming he doesn't have pain from turning his arm "upside down and backwards" like I did, he's going to be extremely lacking in the stamina and coordination required to successfully play the guitar up to his standards as a musician. His wrist and fingers are going to get sore very easily, he probably won't be able to play for longer than a few minutes at the beginning, and additionally all the calluses he developed on his fingers over the years from both halves of the guitar (strumming or just holding his fingers on the frets as one normally does when playing) will have disappeared if he hasn't been playing for a while. Those can also take a long time to build back up. As for his skill level moving forward, that's really up to you - he could have a problem like I did that held me back from learning guitar from years, or his arm could heal perfectly fine, as most peoples' do, and he could be back to playing semi-normally within 3 weeks or so. Of course, all of this is assuming you don't also want to bring in potential nerve damage, because that's a whole other ballgame!

PTA: Oops, I just realized you posted this yesterday. I hope my information can still be of use to you!

Yup, it still helps. Thank you so much! ^^


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