Question
My father fell off of a ladder on 11/29/06 and has broken 4 to 5 ribs and his scapula! He is a tremendous amount of pain. The doctor says there is nothing to do about the ribs and there is a possible surgery for the scapula.  Any input?  Do you know what is usually done for things like this?

Answer
Dear Patricia,

The doctor you spoke with is correct.  You don't do anything for broken ribs unless there are rib fragments that have punctured the lungs, or may cause a puncture to the lungs.  Some physicians may advise to wrap the ribs with a large ace bandage for support which will tend to alleviate some of the pain, but this should only be done on a limited basis such as when greater activity is being performed.  Wrapping the ribs will have a tendency to constrict the ability to take a deep breath (full lung expansion and expulsion). This can easily lead to a lung infection.  The absolute last thing you want is for the lungs to become infected while the ribs are broken.

Concerning the scapula, yes they sometimes do surgery to correct a break there, but more often this type of injury also is left to heal on its own.  If the scapula has broken into multiple pieces, there is a chance that they may go inside and screw a small plate over the breaks to speed the re-union.  When this happens they will often go back and remove the screws and plate a year later, so if you can get by without surgery it would be best.

The best solution for the initial care is to begin with increasing proper nutrient delivery...get good food and supplements into the body so that the bone will have the natural substrates it needs to form a callous around the break, reduce inflammation, and heal cartilage that is inevitably torn as breaks occur.  Let me outline some common nutrients to help repair tissue after injury..

A well-balanced and healthy diet obtains vitamins and minerals from natural sources. You should always use food first and supplements second. However, in times of physiologic stress, such as your fathers scapula/rib injuries,  it can be hard to meet the body's increased needs through diet alone. It is also important to stress that nutritional supplements do not work immediately and must be taken consistently, even if effects are not immediately and directly noticed.  The underlying repair mechanisms of the body only work when they have the correct substrates and cofactors. Following are some notes on nutrients for bone and wound healing.

Bone-Healing:
Bone healing rates may be enhanced by following some of the recommendations for preventing and reversing age-associated bone loss, such as supplementing with the nutrients calcium, magnesium, boron, and vitamin K. It should also be noted that you must have sufficient vitamin D (D3) to facilitate the absorption of calcium and magnesium.  The preferred forms of calcium and magnesium are the citrate forms. Do not use calcium carbonate. You can obtain enough vitamin D from 20-30 minutes of sun exposure daily.

Glucosamine/Chondroitin/MSM:
Glucosamine is thought to promote the formation and repair of cartilage.  Glucosamine hydrocloride is the form that is best absorbed by the body, but glucosamine sulfate is utilized more appropriately for repair. Chondroitin sulfate promotes water retention and elasticity in cartilage and inhibits enzymes that break down cartilage. MSM is also important in cartilaginous repair.  You need to consume a minimum of 1500mg/day of glucosamine, 1500mg/day of chondroitin and 750mg/day MSM.  If the injury is less than a week old, double this dosage for the first month.

Copper:
Copper supplementation is important in fracture healing and in the early formation of collagen in a wound. Eight milligrams of copper daily provides adequate supplementation and should be taken for six weeks for a fracture of a non-weight-bearing bone. It should be taken for 2-3 months for a major weight-bearing bone. Because copper is also a pro-oxidant, supplementation should be stopped after this period of time.  In addition you will need to have an increased intake of antioxidants such as vitamins a, c ,e, selenium, bioflavanoids, quercetin, pycnogenol, co-enzyme q-10, and ginko biloba  to combat the excess oxidant actions of copper.

Zinc:
Zinc has been recommended at a dose of 90 mg daily (as recommended for early healing of wounds). Zinc's enhancement of fracture healing may be related to its effects on increasing IGF-1 and TGF-beta.

Vitamin-C:
Vitamin C and additional anti-oxidants have also been shown to speed the healing process.  Whole food complexes of vitamin c are preferred over synthetic forms.  Ascorbic acid is a poor form. Vitamin C is a major constituent concerning collagen repair.

Omega-III-Fatty-Acids:
The omega-3 fatty acids act as anti-inflammatory agents, making them beneficial for patients with any inflammatory condition. There are three major types of omega 3 fatty acids that are ingested in foods and used by the body: alpha-linolenic acid (ALA)-18 carbons, eicosapentaenoic acid (EPA)-20 carbons, and docosahexaenoic acid (DHA)-22 carbons. Once eaten, the body converts ALA to EPA and DHA, the two types of omega-3 fatty acids more readily used by the body. Extensive research indicates that omega-3 fatty acids reduce inflammation and help prevent certain chronic diseases such as heart disease and arthritis.  Typical dosage after injury is 4000 to 6000 mg daily for 3 months.  Then reduce to a maintenance dose of 3000 to 4000 mg daily.  In addition the supplement should be molecularly distilled, pharmaceutical grade, and free of toxins.

Flaxseed-Oil:
One or two tablespoons of flaxseed oil daily is considered optimal for a healthy individual. Capsule doses are 3,000 mg per day for disease prevention and 6,000 mg per day for treatment to reduce inflammation.  Flaxseed is not utilized as well by the body as omega III fatty acids, but it is still important in eicosanoid management (pain management).

Linolenic-Acid:
A diet that gets 1-2 percent of its calories from Alpha-linolenic acid has been shown to give maximum tissue levels of DHA, avoiding any apparent deficiency symptoms.  ALA does have to be converted in the body through an enzymatic process using delta-5-desturase, before it can enter the cell membrane.

Precautions:
The ratio of omega-3 fatty acids to other essential fatty acids is important, but some caution is warranted. Take omega-3 oils cautiously if you bruise easily, have a bleeding disorder, or take blood-thinning medication. Excessive amounts of omega-3 fatty acids may increase the amount of time that it takes for the blood to clot following a cut or other injury.

In addition Patricia, your father must reduce his activity levels and eliminate and activity that will jar the body. Heavy breathing will exaggerate pain, and may increase healing time. Moreover, he needs to try to limit pain meds such as ibuprofen, and acetaminophen.  These meds actually reduce the healing capacity of your body tissue when metabolically active.  Obviously if the pain is severe, you have to do whatever it takes, and you may also need to talk to your physician again for a prescription for something stronger than over the counter medication.

Remember that this will take some time, most fractures heal in 6-8 weeks, but you can usually cast them as well.  With multiple rib injuries you should expect 8-12 weeks for a good resolution.  Hope this helps Patricia, feel free to follow-up with additional questions if you need to. Good luck.

Respectfully,
Dr. J. Shawn Leatherman