Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Pathophysiology and Early Management of Spinal Cord Injury

Introduction Traumatic spinal cord injury (SCI) is a devastating neurologic entity and a life-altering event. SCI affects approximately 1.4 million North Americans, with a disproportionate number of patients who are younger than 30 years of age. Injury results in the development of substantial motor, sensory, and autonomic deficits or even permanent loss of neurologic function. SCI may occur anywhere in the spine, and the location of…

Psychological, Social, and Functional Manifestations of Orthopaedic Trauma and Traumatic Brain Injury

Introduction Psychological stress is a normal human emotion that can be associated with any disease or injury. Most individuals confronting a new diagnosis are able to understand, accept, and move forward. Their ability to do this requires personal inner resources, as well as the support and understanding of their healthcare providers, families, friends, and society. Musculoskeletal injuries often contribute to a gamut of anxiety and fears…

Motorized Intramedullary Lengthening Nail for Limb Reconstruction

Introduction The remote-controlled magnetic intramedullary lengthening nail is a disruptive technology that has changed the surgical approach to limb lengthening and reconstruction surgery. Its availability and use have led to a new paradigm for limb reconstruction with a decreased need for external fixation and the advent of new approaches for complex limb reconstruction. The primary indications for bone lengthening and deformity correction are congenital and posttraumatic…

Nonunions: Evaluation and Treatment

Introduction Fracture nonunions may represent a very small percentage of the traumatologist's case load but can account for a high percentage of a surgeon's stress, anxiety, and frustration. A fracture nonunion may be anticipated after a severe traumatic injury, such as an open fracture with segmental bone loss, but may also appear after a low-energy fracture that seemed destined to heal. Fracture nonunion is a chronic…

Understanding and Treating Chronic Osteomyelitis

History Osteomyelitis can occur for a variety of reasons and is often a result of open fractures. Therefore it is quite obvious that osteomyelitis has accompanied humankind and also animals over thousands or even millions of years. The most likely oldest evidence of osteomyelitis was found in a 250- to 290-million-year-old infected spinal fracture of a dimetrodon Permian reptile. Also, an approximately 500,000-year-old skeleton of a…

Diagnosis and Treatment of Complications

We define a complication as a disease process that occurs in addition to a principal illness. In the lexicon of diagnosis-related groupings, complications are comorbidities. However, a broken implant complicating the healing of a radius shaft fracture hardly seems to fit either of these definitions. In orthopaedic trauma terminology, the term complication has come to mean an undesired turn of events specific to the care of…

Surgical Site Infection Prevention

Introduction Surgical site infection (SSI) is one of the most common and devastating complications of orthopaedic surgical procedures. In its most recent estimate, the Centers for Disease Control and Prevention (CDC) reported that SSIs accounted for 36.4% of all healthcare-associated infections, with orthopaedic surgery responsible for 23.7% of reported SSIs. More than 365,000 SSIs occur annually in the United States, resulting in estimated direct and indirect…

Osteoporotic Fragility Fractures

Demographics of Osteoporotic Fragility Fractures Fragility fracture refers to those fractures that result from a fall from standing height or less and frequently occur in the hip, wrist, and spine. Osteoporosis is characterized by a combination of both a decrease in bone density and microarchitectural defects in bone. Fractures secondary to osteoporosis are, by strict definition, pathologic fractures. They occur in bones whose structural integrity and…

Pathologic Fractures

Introduction Pathologic fractures can be a source of diagnostic and therapeutic challenge to the practicing orthopaedic surgeon. These fractures can be a significant cause of anxiety for patients, who are told they have a tumor, as well as for surgeons, who infrequently encounter this scenario. Pathologic fractures, by nature, occur through bone that is biologically abnormal and where the response to and potential for healing can…

Gunshot Wounds and Blast Injuries

Introduction Although violent crime continues to decline, approximately 74,000 nonfatal gunshot injuries were reported to the Centers for Disease Control and Prevention (CDC) in the United States in 2011, an increase of 10,000 compared with 2004. Estimates of total cost of injury indicate that firearm and gunshot injuries account for 9% or $41.4 billion per year. An unknown but substantial number involved the musculoskeletal system. Gunshot…

Soft Tissue Reconstruction

Introduction and General Principles Introduction The optimal soft tissue characteristics required for coverage of defects involving the upper and lower extremity vary according to the site and location of the defect. Characteristics of interest include pliability, durability, sensibility, the ability to cover large surface areas with minimal thickness, and cosmetic appearance. These features allow the best functional outcome, maximally protect the vital structures of the extremity,…

Open Fractures

Introduction Approximately 6 million fractures and 7.5 million open wounds occur annually in the United States. Extrapolating from European studies, about 4% of all fractures are open, or about 250,000 open fractures annually in the United States. Other studies note that open fracture occurs at a rate of 11.5 per 100,000 persons per year. Open fractures are unique, complex, and emergently presenting injuries that expose the…

Compartment Syndromes

Introduction Acute compartment syndrome (ACS) can be a devastating injury if diagnosis and treatment are delayed or missed. Physicians evaluating patients with acute long bone fractures, especially of the tibia, should keep ACS in the forefront of their mind when examining the traumatized patient. Although the ability to define ACS has become clearer, much controversy and confusion still remain regarding when ACS exists and when intervention…

Evaluation and Treatment of Vascular Injuries

Disclaimer: The views in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US government. I am a military service member. This work was prepared as part of my official duties. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work…

Chronic Pain Management

Introduction Surgeons, and especially trauma surgeons, are often confronted with chronic pain situations that develop subsequent to skeletal trauma. In addition to having a good professional working relationship with a pain specialist, surgeons need to have an in-depth and up-to-date working knowledge of at least three chronic pain topics to apply appropriate preventative measures, correct and timely diagnosis, and appropriate referral. For that reason, this chapter…

The Management of Acute and Perioperative Pain Associated With Trauma and Surgery

Introduction For as long as the practice of medicine has existed, physicians have attempted to develop a tool to accurately measure pain. We now realize that it is not possible to measure pain because pain is not a quantifiable or measurable entity but, rather, a subjective and highly variable perception. The one thing that all skeletal trauma, and all trauma for that matter, has in common…

Disaster Management

Introduction Disasters are large-scale destructive events that disrupt the infrastructure and normal functioning of a community. Disasters are both natural (e.g., earthquakes, tornadoes, hurricanes) and manmade or anthropogenic. Anthropogenic disasters can be either unintentional (e.g., industrial spills, structural collapse) or intentional (e.g., terrorist attacks, mass shootings). Such events present the medical community with many casualties, requiring rapid triage and treatment that is disproportionate to the available…

Damage Control Orthopaedic Surgery: A Strategy for the Orthopaedic Care of the Critically Injured Patient

Introduction Orthopaedic trauma patients presenting with hemodynamic instability and associated multisystem injuries represent challenging cases, particularly with respect to their initial management. Several treatment algorithms exist, yet there is no clear consensus regarding appropriate patient stratification. When confronted with the management of a multiply injured patient (MIP), the treating orthopaedic surgeon must choose from among three currently accepted treatment strategies: early total care (ETC), damage-control orthopaedics…

Initial Evaluation of the Spine in Trauma Patients

Introduction Proper management of trauma patients requires early recognition of spinal trauma to minimize the potential catastrophic sequelae of undetected or underestimated injuries of the spinal column. The epidemiology of spine trauma can be difficult to quantify because most population-level estimates are extrapolations of inpatient or emergency room discharge databases, which rely on accurate diagnosis coding and geographic representations. Furthermore, many spinal cord injury (SCI) patients…

Evaluation and Treatment of the Multi-Injured Trauma Patient

Introduction Each year civilian trauma accounts for 35 million emergency department (ED) visits and 1.9 million hospital discharge admissions across the United States. Leading causes of injury include falls, 40%; motor vehicle crashes, 28%; and firearms, 4.35%. Trauma is the leading cause of death in individuals ages 1 to 44 years (47% of the deaths) and the third leading cause of death overall, covering all age…