Preventing Frostbite

Exposure to cold temperatures for a prolonged time can result in frostbite, which causes the skin and surrounding tissues to freeze. Frostbite commonly occurs in the fingers, which may lead to loss of feeling and skin discoloration. In severe cases, frostbite can also cause permanent damage and/or loss of fingers. If you’re going to be outside in the cold weather, be sure to protect your hands.

Frostbite can occur even when the temperature is above 32 degrees fahrenheit. Wind chill and moisture contribute to frostbite conditions. Dress in layers, including warm insulated gloves and always carry a pair in your car in case you become stranded or encounter car trouble.

Recognize frostbite symptoms

• Numbness/tingling feeling
• Skin discoloration
• Hard or waxy skin
• Blisters or blackened skin

If you suspect frostbite, follow these guidelines and seek immediate medical attention:

• Go immediately to a warm place.
• Carefully remove wet gloves.
• Refrain from rubbing or scratching the affected area.
• Carefully submerse affected affected fingers in warm (not hot) water for 30 minutes until medical care is available.
• Cover the area with a warm towel or blanket to thaw.
• If available wrap each frostbitten finger loosely with sterile gauze.
• Thaw a frostbitten area only if it can be kept warm. Refreezing a frostbitten finger can result in permanent loss.
• Do not touch blisters occurring from frostbite.

Coping With a Cast

After a bone is broken, either accidentally or for a surgical procedure, a cast is often used to let the bone heal properly. While uncomfortable and cumbersome, casts are extremely important in the treatment of fractures and preventing further problems. And caring for that cast is an essential part of that healing process. So how do you deal with a cast – especially when it starts to itch?

Keep the cast dry: Keep the cast and the cotton wrap around the injury dry at all times. If you want to wash, carefully wrap the cast in plastic and protect the cast from any water.

Don’t stick anything under the cast: Try to keep objects out from under the cast, and especially avoid the urge to stick coat hangers under the cast-this can damage both your skin and the cast material.

Trim rough edges: Rough edges of the cast can be trimmed with an emery board. Do not cut the cast with scissors or attempt to break off rough edges.

Relieve itching the right way: To relieve itching under the cast, try pointing a hairdryer on a cool-air setting down the cast to relieve the itch. Over-the-counter medications such as Benadryl can sometimes help.

Inspect the cast carefully: Examine the cast regularly and alert your doctor if it cracks, breaks, or becomes loose. Also look for reddened or raw skin around the cast edges-your doctor can pad these areas to prevent problems.

Tips for comfort:
• Elevate the injured extremity to prevent swelling in the initial days following the injury.
• Exercise the extremity. Even if your arm is in a cast, don’t neglect the fingers. Alert your doctor if the exercise causes pain.
• Apply an ice bag to the cast to help reduce swelling. If you attempt to ice the broken bone, be certain you keep the cast dry.

Indiana Hand to Shoulder Center Physicians named in Indianapolis Monthly Top Docs



The annual Top Docs issue of Indianapolis Monthly (November) is out and 6 of our physicians are featured in the Hand Surgery section. Congratulations Dr. Baltera, Dr. Creighton, Dr. Fischer, Dr. Greenberg, Dr. Kaplan and Dr. Merrell.


William B. Kleinman, MD awarded the Lee Osterman Teaching Award

It is with deep gratitude and respect that the Physicians of the Indiana Hand to Shoulder Center congratulate their colleague William B. Kleinman on the reception of the Lee Osterman Teaching Award.  The Osterman award is granted to only one member of the ASSH (American Society for Surgery of the Hand).  The recipient is a member who has dedicated his or her career to the advancement of the Surgery of the Hand education.  The recipient is deemed to have demonstrated excellence in educating students, resident and fellows, as well as other Hand Surgeons.  During the course of his career Dr. Kleinman has trained thousands in his specialty.  He has been in the practice of hand and upper extremity surgery at the Indiana Hand to Shoulder Center since the completion of his post-residency Fellowship training in 1978. He earned his doctorate degree in medicine from Cornell University/New York Hospital in New York City in 1972. He completed a two-year general surgery residency at the University of Colorado Medical Center in Denver in 1974, followed by a return to New York City to complete his three-year residency training in orthopaedic surgery at Columbia-Presbyterian Medical Center in 1977. His formal one-year Fellowship training in Hand Surgery was also completed at Columbia-Presbyterian, under the tutelage of his legendary mentor, Dr. Robert E. Carroll. Dr. Kleinman’s training in microvascular reconstruction followed at Duke University Medical Center in North Carolina.

He is a full Clinical Professor of Orthopaedic Surgery at the Indiana University School of Medicine. Much of his work at the I.U. Medical Center throughout his career has been in children with hand and upper extremity birth defects. Services have been provided through the Congenital Hand Deformities Clinic at the Riley Children’s Hospital, where he served as founder and director from 1978 to 1995.

The Indiana Hand to Shoulder Center has provided excellence in care of the hand, wrist, elbow and shoulder for over 45 years.  Their world class team treats simple conditions to complex/traumatic injuries.  With teaching requests worldwide, and patients coming from around the globe, the physicians at the Indiana Hand to Shoulder Center stand ready to offer compassionate care and excellent surgical outcomes.

Gregory A. Merrell, MD publishes new article in the Journal of Hand Surgery

Gregory A. Merrell, MD had an article titled “Suture constructs for rehabilitation using early active motion after tendon transfer surgery” in the Journal of Hand Surgery (European Volume). The purpose of this study was to better define an ideal tendon transfer suture construct to allow for early active range of motion.

Gregory Merrell article

Work Comp Seminar Held at IHTSC

Dr. Greg Merrell and our team at the Indiana Hand to Shoulder Center held another successful Work Comp educational luncheon last week, Dr. Merrell’s presentation and Q&A on Causation in Work Related Injuries was another step forward in providing excellence in patient care.


Fireworks Safety

The American Society for Surgery of the Hand (ASSH) Urges Firework Safety in an Effort to Reduce the Number of Injuries Each Year

Fireworks are a part of many seasonal celebrations, but many people fail to realize just how dangerous they really are. Many accidents each year result in life-altering injuries for people of all ages. Firework injuries can be particularly difficult to treat because they involve both burns and blast injuries, which damage tissues from the skin through the bone and can even cause partial or complete hand amputation.

Fireworks caused over 11,000 injuries in 2016, most commonly damaging hands and fingers. Sparklers, which many parents consider to be safe, burn at greater than 1,000 degrees F and can quickly cause serious injury. Injuries to the hand may include disfigurement and permanent disability, affecting jobs and life satisfaction.

Many states recognize the danger and limit the use of consumer fireworks at varying levels. As hand surgeons who specialize in this type of injury, ASSH urges the public to understand that:

– All fireworks are inherently dangerous.
– Firework use should be limited to professional display; explosive materials should only be handled by professionals.
– Firework injuries to the hand can be devastating and have large personal and economic costs.

Fireworks are unpredictable, and even trained technicians are susceptible to injury. Yet, we understand that consumers may continue to use fireworks, so we recommend additional safety precautions should always be taken:

1. Use personal protective equipment, including eye protection, when handling any flammable material.
2. Ensure that people nearby are aware of any plan to ignite fireworks and are in a safe area.
3. If attending a public display, pay close attention and obey all rules and regulations established by the authorities and crew in charge of safety.
4. Do not consume alcohol or use other drugs when choosing to use a firework, as it may impair judgment and dexterity.
5. ASSH’s full position statement includes additional safety recommendations from the National Council on Firework Safety.

Hands are our primary tools for exploring the world; an injury can permanently impact your home and work life. Please be safe this season!

“As a young child, I clearly remember asking my mother to buy fireworks for the 4th of July. She told me about her childhood classmate who lost an eye due to a firework injury and told me ‘no,’” recalls hand surgeon Steven H. Goldberg, MD. “Now, as a hand surgeon, I’ve had to treat multiple patients with injuries so severe that their fingers required amputation or were already missing. It is not easy news to share, and it’s not easy for patients to hear. In a split second, their hand, their life, their employment is changed forever. Listen to my mom, and say ‘no’ to the personal use of fireworks this summer.”

For more information visit:…/…/ASSH-Position-Statement-on-Fireworks