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Orthopaedic Perspective of the Boston Marathon Bombing

Orthopaedic Perspective on the Boston Marathon Bombing by Mitch HarrisMitchel Harris, MD Chief of Orthopedic Trauma at the Brigham & Women’s Hospital, Boston, MA.

Michael Weaver, MD is an is an attending traumatologist on the Orthopedic Trauma Service at Brigham & Women’s Hospital, Boston, MA.

First run in 1897, the Boston Marathon is the oldest, continuous running marathon in America. It is generally considered the most prestigious annual running event that is open to the public, once qualifications are met. Prior to its 117th consecutive running, it had not been generally viewed as a target for a “terrorist attack”. However, on April 15, 2013, two brothers allegedly placed explosive filled backpacks with remote detonator switches within yards of each other and the finish line of the Boston Marathon. The following essay will highlight the extraordinary response by the medical community of Boston.

Boston and Patriots’ Day
Boston is well known as a highly resourced and sophisticated academic medical community. It has 6 Academic Medical Centers (AMC’s): Beth Israel Deaconess Medical Center (BIDMC); Boston Medical Center (BMC); Brigham & Women’s Hospital (BWH); Boston Children’s Hospital (CHB); Massachusetts General Hospital (MGH); and Tufts Medical Center (Tufts); each with an American College of Surgeon’s certified level one trauma center. Each of these medical centers provides cradle-to-grave medical services to their respective local communities and function as New England’s regional referral centers. Continue reading

Femoroplasty for Hip Fractures

figure from Femoroplasty for Hip Fractures posted by Arun Shanbhag in Trauma RoundsE Kenneth Rodriguez, MD, PhD is Chief of Orthopaedic Trauma at Beth Israel Deaconess Medical Center, Boston, MA.

Hip fractures in geriatric patients are associated with mortality rates of 20-30% at one year. Many more patients experience significant loss of function and independence (1). The number of hip fractures worldwide was estimated at 1.7 million (1990) and is expected to rise to 6.3 million by 2050 (2). Continue reading

Geriatric Fracture Patient Co-management

Michael Weaver, MD is an Orthopaedic Trauma Surgeon, at Brigham & Women’s Hospital.

In the United States, hip fractures represent a significant medical burden. The annual cost of caring for geriatric patients with hip fractures is $10 – 15 billion. As the Baby Boomer generation continues to age, the number of patients with hip fractures is expected to rise dramatically. The rate of mortality at one year in this patient population runs between 12 and 37% (1). Continue reading

Healing Critical Defects in the Femur

Christopher Evans, PhD, is the Maurice Mueller Professor of Orthopaedic Surgery and Director of the Center for Advanced Orthopaedic Studies in the Department of Orthopaedic Surgery at Beth Israel Deaconess Medical Center.

Vaida Glatt, PhD, is a Senior Research Fellow with the Trauma Research Group of the Institute of Health and Biomedical Innovation at Queensland University of Technology Brisbane, Queensland.

Large segmental defects heal poorly and often present clinical challenges. Approaches used to improve healing include autograft and allograft bone, distraction osteogenesis, vascularized bone grafts and the application of BMP-2 and BMP-7. We wanted to determine whether modulation of the mechanical environment could improve bone healing in a rat femoral segmental defect model. Continue reading

Treating Injuries from the War Zone

George Dyer, MD is a Hand and Upper Extremity surgeon at the Brigham & Women’s Hospital, Boston; Director of the Harvard Combined Orthopaedic Residency Program and a member of the Partners Orthopaedic Trauma Service.

Trevor Owen, MD, is our graduating trauma fellow. He is joining the faculty of the Carilion Clinic in Roanoke, VA, as an orthopaedic trauma surgeon.

In late October 2011, 22 rebels injured during the Libyan Civil War were admitted to Spaulding Hospital in Salem, MA. Our Trauma team provided care to six patients with complex nonunions, malunions, and nerve injuries. This opportunity allowed us to apply techniques we use for more routine care to severe wartime injuries and their sequelae. It showed us how the careful practice of surgical principles can be effective, even when treating devastating injuries. Continue reading

Crush Injuries to the Forefoot

John Kwon Foot and Ankle Surgeon at the Mass General HospitalJohn Kwon, MD is an orthopaedic surgeon at the Massachusetts General Hospital, Boston and a member of the Foot & Ankle Service, as well as the Partners Orthopaedic Trauma Service. Dr. Kwon specializes in foot & ankle fractures, sports injuries and correction of foot & ankle deformities.

Effect of a Steel Toe Cap

Crush injuries to the foot are a common workplace injury, causing significant morbidity, disability and lost wages. A report by the Bureau of Labor Statistics estimated that more than 60% of workplace injuries involve the musculoskeletal system, and 10% of these are foot and ankle injuries (1). Continue reading

Recovering From Injury

David RingDavid Ring, MD, PhD is an Orthopaedic Hand Surgeon at the Massachusetts General Hospital, Boston, specializing in arm fractures, post-traumatic reconstruction, hand surgery and elbow surgery.

Some fractures frustrate us. Adverse events always affect us. But nothing takes the wind from our sails more than a patient who has greater pain and disability than expected. We are used to having answers and knowing what to do. For diagnoses like open fracture, compartment syndrome, or an elbow that will not stay reduced, we feel like we can make a difference. But when our patients have stiff fingers, a stiff elbow, or persistent disabling pain the answers do not always come easily (1). Continue reading