Interview with Orthopedic Surgeon
Richard S. Gilbert, M.D.
Mount Sinai School of Medicine Department
Dr. Gilbert specializes in hand and upper extremity surgery.
Q. Dr. Gilbert, what
kind of snowboard and ski injuries are you seeing lately?
A. The most common
snowboard injury is a wrist injury. [Editor's note - up to 100,000 snowboard
wrist injuries occur each year worldwide.] 62% of all fractures in
snowboarders are wrist fractures. Snowboard injuries to the upper
extremities (hand, arm shoulder) vary from fractures that requires a cast,
to injuries requiring surgeries.
fractures of the distal radius (main bone toward wrist) are the most common
due to falling forward onto outstretched hands.
There are different kinds
of injuries besides fractures. There is also the ligamentous injury or
sprain. This can be a small stretch of the ligament, or a complete rupture.
Q. How is the sprain
A. Sprains are usually
sutured back into place. Sometimes with an incision (cut) or sometimes
orthoscopically (tiny incision with camera and tools inserted.)
Studies show that the most
common ski injury is to the thumb ligament. Skiers have more knee injuries
than upper body injuries.
Q. How are fractures
A. Fractures can be
treated surgically or non-surgically depending on the injury. If the bone
is really out of position, it needs to be placed back into position with
metal pins or plates and screws. These devices may stay in, or may be taken
out. Sometimes we drive a pin through the skin and just cut off the part
that sticks out past the skin.
Q. What kind of
recovery can patients expect?
A. It depends on
the injury. If it's a cast injury it needs about 6 weeks of immobilization,
and 6 weeks of rehab. For injuries that need surgery, it depends on
the type. Fractures generally fare better than ligament wounds. Bone heals
better. Patients may be at risk of arthritis in the future, or stiffness.
Q. What about growth
A. Growth plate fractures
happen in the young (skeletally immature) because the growth plate is the
weakest point. It is less common to have to operate on those. Usually growth
plate injuries require just pushing them back into place. With children's
fractures, the biggest risk is that you can have an injury that impairs
It is important to push
the growth plate displacement back into place within 24 hours to avoid
permanent injury. With an older person, the timing is not as critical.
Q. What do you think
about snowboard wrist guards?
A. I have never seen a
patient with a wrist fracture who was wearing a
wrist guard. Though I have seen many patients who say "I wish I was
wearing a wrist guard." Certainly wrist guards have been shown by studies to
Q. What about the "hard
core" snowboarders who want to ride before their injuries are healed?
A. I would not recommend a
person who has a fracture to snowboard. Before it's healed you can convert a
non-displaced fracture to a displaced fracture.
Gilbert, M.D. is a Board Certified Orthopedic Surgeon
specializing in surgery of the hand and upper extremity. He has a
Certificate of Added Qualification (CAQ) in hand surgery. After receiving a
Bachelors degree from the John Hopkins University, he went on to obtain his
medical degree from the Mount Sinai School of Medicine. He completed his
residency in Orthopedic Surgery at the Mount Sinai Hospital. He further
sub-specialized as a hand and upper extremity fellow at the Yale University
School of Medicine.
Dr. Gilbert is a
clinical assistant at the Mount Sinai School of Medicine and a vital member
of the hand surgery service. He is actively involved in the education of
residents and medical students on the orthopedic surgery and hand surgery
services. In addition to general orthopedics, his specialty interest is in
the reconstruction and treatment of fractures, soft tissue injuries, and
neuropathies involving the hand and upper extremity. Outside of medicine,
his interests include reading, music, sports and photography.