Innovations in technology and knowledge have transformed medical care in myriad ways, and some of the biggest advances made over the last quarter-century have come in the field of orthopedics.
Injuries as the result of automobile, motorcycle, and all-terrain vehicle (ATV) accidents present orthopedic surgeons with some very complex and difficult challenges. But now more than ever before, minimally invasive surgical techniques, strong and pliable materials, and more targeted rehabilitation methods lead to better recovery for patients, with less loss of limb function.
In this episode of Kentucky Health, host Dr. Wayne Tuckson speaks with a University of Louisville orthopedic surgeon about the latest developments in orthopedics and what sorts of behavior people need to be cautious about when driving motor vehicles.
Dr. Craig Roberts, MD, MBA, is with University of Louisville Physicians and is the K. Armand Fischer Professor and Chair of the Department of Orthopedic Surgery. He has been practicing orthopedics for more than 20 years.
“Unfortunately, motor vehicle accidents are the bread and butter of my practice. I work at the Level 1 Trauma Center, and probably about 80 percent or so of the patients we see come in after motor vehicle accidents, so it’s quite common.”
Automobiles to ATVs: Risk Factors for Injury
“We’ve heard it all,” says Roberts with regard to the different causes for motor vehicle injuries. Roberts and his trauma center team treat a lot of patients brought in from other counties in Kentucky, many of them rural ones. Most of the patients suffering from trauma incurred during all-terrain vehicular accidents come from these outer regions.
Generally, Roberts says the major risk factors for auto vehicle accidents are inclement weather and distracted drivers. The reasons drivers get distracted are manifold, he says: talking on cell phones, texting, drinking from a mug, performing personal hygiene such as applying makeup or shaving, and so on. “Sleep deprivation is a big deal,” he adds. “That is the equivalent to someone having had a drink of alcohol.”
Roberts does not believe that talking via a hands-free device leads to improved concentration. “If you’re going 60 miles per hour, that’s 88 feet per second, so if you look down for three or four seconds, you’ve driven a football field,” he says. “So it’s a lot of distance, and with a lot of things coming quickly, things can change in a second – and they do.”
Roberts says he does not ride a motorcycle, and believes that the smaller scooters and urban cycles are more dangerous than larger, traditional motorbikes. He also says that 3-wheel ATVs are inherently unsafe, but that most of the larger 4-wheel ones are fine, depending on how they are used. The training level and experience of the operator are the most important factors in vehicle safety, Roberts says.
When a person comes into the ER with skeletal trauma to one or more limbs from motor vehicle accidents – or from any encounter – Roberts says that in most cases the injuries to the bone (or bones) are not life-threatening. However, in the most serious cases the recovery process is usually prolonged and the patient may have permanently diminished limb function.
“When patients do see me, I see the whole spectrum of where this is going to be a lifelong issue,” he says. “That might come down to arthritis after injury, post-traumatic arthritis, with a stiff knee, and these may take years, or result in some limitation in their overall function that may impact their work or sports or things they want to do.
“Unfortunately, when we break bones, there is generally scar tissue and pain, oftentimes when the weather changes, so as much as we think the patient is back to normal, it may not be entirely normal.”
Surgery: New Tools and Techniques
Roberts goes through a series of slides with Dr. Tuckson that show various types of orthopedic trauma and the surgical procedures he and his team use to repair broken bones. “One of the nice things about our field is that it is dynamic, not static at all,” he says. “We’re seeing a lot of advances in the implants and materials and approaches that we use.”
The slides include X-rays of injuries to the collarbone, elbow, metacarpals in the hand, ankle, and knee. In each case, implants of varying sizes are inserted and affixed to the injured bone with screws. In some cases, Roberts and his team will have to clear the injured area of bone debris if the bone is broken in many pieces, and may have to reshape the end of the broken bone in order to attach the implant.
“We have certain cutting devices that one might expect even a master craftsman or carpenter to have, so we’ll actually be shaping these things, and we have what we call trial implants for sizing purposes, so it really is, in some ways, jet science,” he says.
Roberts also talks about another device, the external fixator, which is used to stabilize a broken bone or bones by inserting several pins into the bone from the outside, through the skin, and then using bars and clamps to hold the pins in place and stabilize the bone. As his accompanying photograph shows, the device looks like “the old-time Erector set,” and it is especially useful to treat compound fractures and open fractures that occur after serious trauma events.
Roberts also displays a titanium rod used in a knee fracture surgery, which is inserted into the femur bone after the center of the bone has been hollowed out and then attached to the hip at one end and just above the knee at the other end. He also shows the latest iteration of a metal plate used in knee surgery, which is attached to the outer femur and then connected to the knee joint. Patients who receive such implants have far better outcomes than in years past, according to Roberts, with a shorter rehabilitation time and better joint and bone mobility.
“Gone are the days with prolonged immobilization, casting, or traction, where one might get stiffness or what was often termed ‘cast disease’ from adhesions inside the joint, and then muscle weakness and perhaps permanent contractions,” he says. “Those days are gone. We like to move things, joints, bones, extremities, sooner rather than later.”
