The season of trauma
Humpty Dumpty sat on a wall, Humpty Dumpty ….well, we all know how the story ends.
Summer is a particularly busy time in an orthopedic practice for traumatic injuries sustained from falls and accidents associated with warm weather. Alcohol consumption and substance abuse, unfortunately, contribute to many of these trauma cases.
When my phone rings while on trauma call, I know that time can be critical. As part of the Advocate Condell Medical Center Level 1 trauma team, my work frequently involves taking care of patients brought emergently to Condell for injuries sustained in motor vehicle accidents, violent acts or falls from a height, such as ladders or rooftops.
While the surgeons of “Grey’s Anatomy” can resolve complex, traumatic injuries in a one hour episode, real life orthopedic trauma begins when a patient arrives in the emergency department. It is not unusual for care of traumatic injuries to extend for a year or more before maximum medical improvement is reached.
Teamwork is key in successful trauma management. I am often applying an orthopedic appliance on the injured patient while the trauma surgeon works to stop bleeding and controls plummeting blood pressure. We need to work in concert, doing our jobs as quickly and effectively as possible.
Falls from ladders while painting, or from rooftops while gutter cleaning frequently cause devastating fractures of the calcaneus/heel bone or a particularly severe ankle fracture called a pilon fracture. I describe these types of injuries to my patients as dropping an egg from a height. The bone, like the egg, is compressed and flattened, painfully destroying the anatomy of the heel. Pilon fractures, similarly, crush the natural alignment of the ankle, shattering the lower leg.
Both of these injuries, if untreated, will cause chronic pain and disability. Prompt and carefully planned surgeries are necessary to minimize consequences and to somewhat lessen the chances for development of post-traumatic arthritis of the ankle or foot. I remind my trauma patients – even when the fracture is surgically stabilized and heals, they will probably always know that they sustained a serious injury. No surgeon is good enough to restore anatomy to how it was originally created.
I try to stage, or spread out, the surgeries for the patient. At the time of initial injury, I’ll often work with the trauma team and clean out the wound in the operating room to lessen the chance of infection and apply a metal fixation device to help maintain length of the extremity and to minimize contraction of soft tissue.
Over a series of weeks, as the patient stabilizes and the skin heals enough to facilitate successful opening and closing of an incision, I’ll do necessary subsequent surgery and often use plates and screws to repair and stabilize these injuries. We’ve learned that staging of orthopedic trauma surgery results in better outcomes. Breaking a large, complicated surgery into smaller surgeries allows for better planning that minimizes the invasiveness of the surgery.
Once surgery is finished, many trauma patients are immobilized for a significant period of time to allow their fractures to heal. You can imagine the effect on daily life from not being able to weight bear for an extended period. Patients will attend physical therapy to rehabilitate from their injuries – weakness, stiffness and atrophy come with long periods of being unable to ambulate. You don’t realize how much strength and muscular tone are maintained just by moving around on a daily basis.
I would say that one of the most rewarding parts of being an orthopedic surgeon are days when I watch one of my trauma patients walk into the office, returned to mobility and function.
As a surgeon and a resident of Lake County, I am grateful for the outstanding trauma care services available at Advocate Condell Medical Center. We are fortunate to have such state-of-the-art capabilities available in our backyards. Should the unthinkable happen in terms of trauma, we stand ready to provide needed care – orthopedic and beyond.
Here’s hoping that we all enjoy a safe and healthy remainder of the summer.
Gregory G. Caronis, M.D. is a board-certified orthopedic surgeon with Advocate Medical Group at Advocate Condell Medical Center. His practice specialties include disorders of the foot and ankle, fracture care and general orthopedics. Dr. Caronis is currently accepting new patients in his Lincolnshire and Libertyville offices. For more information or for orthopedic questions, he can be reached at firstname.lastname@example.org or at AMG Orthopedics (847) 634-1766.
About the Author
Dr. Gregory Caronis is a board-certified Lake County surgeon with Advocate Medical Group Orthopedics and Advocate Condell Medical Center. A specialist in disorders of the foot and ankle and fracture care, Dr. Caronis sees patients in Gurnee, Lincolnshire and Libertyville.