Clinical Briefing:
Orthopaedic Trauma Surgery
May/June 2008
The development of the Orthopaedic
Trauma Service at Penn reflects the coming
of age of the emerging subspecialty of orthopaedic traumatology. Trained to treat
patients with complex polytrauma or abnormal healing processes, the surgeons
of the Penn Orthopaedic Trauma Service specialize in:
- Surgery
for sudden, severe musculoskeletal trauma.
- Reconstruction
for periarticular fractures.
- Long-term rehabilitation for
debilitating post-traumatic sequelae (including fracture
non-union and chronic osteomyelitis).
- Treatment
of complex pelvic and acetabular fractures.
Patient care
at Penn is optimized through the coordination of a multidisciplinary
team of specialists and subspecialists within the departments
of orthopaedic surgery, trauma and surgical critical care,
the Trauma Center at Penn, plastic surgery and neurosurgery.
Hand and upper extremity services (including microvascular
and reconstructive surgery) are offered in partnership with
the Penn Orthopaedic Institute.
In addition to medical and
surgical services, the Penn orthopaedic trauma service embraces
resident education for orthopaedic trauma, and is among the
few orthopaedic trauma departments in the nation engaging
in active research of the biomechanical and orthobiological
aspects of healing.
Case Study
After being struck by an automobile, Mrs. R, a 39-year-old female, was brought
to the Penn Orthopaedic Trauma Service at the Hospital of the University of
Pennsylvania by PennSTAR. The Trauma System was activated
upon her arrival at HUP.
A primary survey at this time indicated hemodynamic instability,
multiple rib fractures to the right rib cage and a vertical
shear pelvic ring injury. A subsequent CT scan of the pelvis
found a right sacroiliac joint fracture dislocation and bilateral
inferior and superior pubic ramus fractures. Mrs. R was intubated
and resuscitated and circumferential pelvic compression was
applied emergently.
3-D rendered inlet view of
the pelvis revealing a right sacroiliac fracture
dislocation with bilateral inferior and superior
pubic rami fractures ("Vertical Shear
Pelvis").
Immediate post-operative
AP "ghost" view revealing reduction of the
right sacroiliac joint and stabilization
of the anterior ring.
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When her hemodynamic status failed to improve, Mrs. R was
sent to interventional radiology for an emergent embolization
of the right superior gluteal artery. She was admitted to
the Trauma Intensive Care Unit, where her right lower extremity
was placed in distal femoral traction and she was stabilized
and cleared for an orthopaedic surgical intervention.
In
the operating room, an open right sacroiliac joint reduction
was performed employing the iliac window of the ilioinguinal
approach. Two plates were applied along the anterior sacroiliac
joint and a percutaneous upper sacral segment screw was placed
to stabilize the posterior ring. To address continued instability
of the anterior ring, a supra-acetabular external fixator
was applied. Intra-operative blood loss was minimal. Mrs.
R was extubated and neurologically intact.
Post-operatively,
Mrs. R was allowed to weight bear fully on the left and to
be 10 percent weight bearing on the right. At six weeks,
Mrs. R’s
external fixator was removed and her weight-bearing was advanced.
Today, Mrs. R is at home recovering from her injury. She
is starting to put some weight on her right leg and is walking
with crutches.
AP pelvis several weeks after
surgery. Pelvic morphology is near anatomic;
fractures are healing. Implants show no signs
of failure or fatigue. The supra-acetabular
external frame provides a less invasive surgical
option than open reduction of the anterior
ring.
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Our Team of Faculty
The Penn Orthopaedic Trauma Service is comprised of an integrated, multidisciplinary
team of surgeons, nurses, social workers, therapists, interventional
radiologists and rehabilitation specialists committed to pre-eminent orthopaedic
surgery and clinical research and excellence in the education of orthopaedic
trauma surgeons. Subspecialties within the Penn Orthopaedic Trauma Service
provide a comprehensive array of surgical and rehabilitative services for the
hand, foot, ankle, spine and joints.
Department of Orthopaedic Surgery
Samir
Mehta, MD
Chief, Orthopaedic Trauma Service
Assistant Professor of Orthopaedic Surgery
Pedro
K. Beredjiklian, MD
Associate Professor of Orthopaedic Surgery
David
J. Bozentka, MD
Associate Professor of Orthopaedic Surgery
John
L. Esterhai, MD
Professor of Orthopaedic Surgery
David
L. Glaser, MD
Assistant Professor of Orthopaedic Surgery
Jonathan
P. Garino, MD
Associate Professor of Orthopaedic Surgery
Nader
M. Hebela, MD
Assistant Professor of Orthopaedic Surgery
R.
Bruce Heppenstall, MD
Professor of Orthopaedic Surgery
G.
Russell Huffman, MD, MPH
Assistant Professor of Orthopaedic Surgery
Craig
L. Israelite, MD
Assistant Professor of Orthopaedic Surgery
Gwo-Chin
Lee, MD
Assistant Professor of Orthopaedic Surgery
Charles
L. Nelson, MD
Associate Professor of Orthopaedic Surgery
Christian
M. Ogilvie, MD
Assistant Professor of Orthopaedic Surgery
Enyi
Okereke, MD, PharmD
Associate Professor of Orthopaedic Surgery
David
R. Steinberg, MD
Associate Professor of Orthopaedic Surgery
Orthopaedic Trauma Nurse Practitioner
Adele Hamilton, CRNP
Division of Trauma and Surgical Critical Care
The Trauma Center at Penn
C.
William Schwab, MD
Chief, Division of Traumatology and Surgical Critical Care;
Professor of Surgery
Benjamin
Braslow, MD
Assistant Professor of Surgery
Forrest
B. Fernandez, MD
Assistant Professor of Surgery
Vicente
H. Gracias, MD
Associate Professor of Surgery
Patrick
Kim, MD
Assistant Professor of Surgery
Jose
L. Pascual, MD
Assistant Professor of Surgery
John
P. Pryor, MD
Assistant Professor of Surgery
Patrick
M. Reilly, MD
Associate Professor of Surgery
Babak
Sarani, MD
Assistant Professor of Surgery
Carrie
A. Sims, MD
Assistant Professor of Surgery
Access
Patient appointments are available at:
Penn Orthopaedic Institute
Hospital of the University of Pennsylvania
2 Silverstein
3400 Spruce Street
Philadelphia, PA 19104
Penn Orthopaedic Institute
Penn Presbyterian Medical Center
1 Cupp Pavilion
38th and Market Streets
Philadelphia, PA 19104
Penn Orthopaedic Institute
Penn Medicine at Radnor
250 King of Prussia Road
Radnor, PA 19087
For urgent access, call 800-543-STAR (7827). The PennSTAR Communications
Center will facilitate any and all requests.
To refer a patient and/or consult with a doctor, call 800-789-PENN
(7366) or you can also refer
a patient online.
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Referring Physicians: To speak with a Penn physician
or refer a patient, contact PennHealth through the secure online
referral form or by calling
1-800-789-PENN
(7366). |
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