Orthopaedic Traumatology
An emerging subspecialty

As new knowledge is acquired and technology becomes available, the specialty of orthopaedics continues to grow and include new subspecialties-one of the newest being the field of orthopaedic traumatology. Although all orthopaedic surgeons are trained to treat musculoskeletal injuries, the traumatologist brings a new level of expertise to the handling of complex and cluster (multiple) injuries.

Fred Flandry, M.D., director of The Hughston Clinic's Advanced Reconstruction and Traumatology Service (ARTS), explains it this way: "Whereas we all receive adequate training in treating a patient's individual injury, the traumatologist becomes adept at treating a patient who has suffered multiple injuries, such as fractures, soft tissue injuries, skin wounds, and injuries to other organs. The treatment for any one problem can conflict with that for another, and life-threatening injuries may preclude addressing all problems at once. The presence of multiple injuries also increases the risks of metabolic complications, such as blood clot, fat embolism, compartment syndrome, and uncontrolled bleeding from a condition called DIC. Therefore, the traumatologist must know not only what to do, but in what order to do it, which treatment to put on hold (and how to handle the problems that can arise from delayed treatment), how to reconcile treatment conflicts, and how to anticipate and prevent complications."

Apart from multiple injuries, other conditions, such as pelvic fractures or poorly healed fractures, are gradually becoming a specialty of the traumatologist. Years ago, pelvic fractures were treated by months of bed rest and traction. If the fracture involved the hip joint, the patient was almost certain to suffer crippling arthritis later. Now, surgery by an experienced traumatologist offers the chance to walk sooner, leave the hospital sooner, and have better results. In dealing with the most complex injuries, traumatologists also develop special expertise with problems of fracture healing. Thus, patients who have deformities after a fracture, fractures that don't heal, and bone infections are often sent to the traumatologist by their doctor.

Expertise in treating multiple traumatic injuries requires years of experience as well as additional training. William Terrell, M.D., codirector of Hughston ARTS, has just such a background. After years in practice, he returned for training at the Medical Hospital Hannover in Germany, one of the leading trauma centers in the world. Both Drs. Terrell and Flandry have studied at trauma centers in Europe and Canada, as well as in the U.S. They are on the faculty of an innovative Swiss-based traumatology think tank that carries on trauma research and education worldwide, and they are members of the U.S.-based Orthopaedic Trauma Association.

Because this subspecialty is so new, doctors trained in traumatology are still in short supply. Recognizing this need, The Hughston Clinic established ARTS to provide expertise in orthopaedic traumatology to the Columbus region. The region spans hundreds of miles, and accepts referrals from orthopaedists who have patients with challenging injuries. According to Dr. Terrell, "In this way, cutting-edge techniques are available to anyone virtually anywhere." Dr. Flandry adds, "We want to be a resource that supports but in no way replaces the local community orthopaedist."

To learn more about the Hughston ARTS program, visit their website at www.problemfracture.com.