Jason Roberts (left) and Dr. Gregory Schmeling head the
orthopedic trauma service at Froedtert and the Medical College
More than half
of all trauma patients have orthopedic injuries ó many times,
than 10 surgeons specialize in orthopedic trauma, working in Madison
and at Froedtert Hospital and Childrenís Hospital of Wisconsin.
Froedtert Hospital is the only Level I trauma center in the state. Itís
also the busiest, with some 1,500 cases in 2011; patients come from as
far away as the upper peninsula of Michigan.
of Milwaukee was one of those patients after she was taken to
Froedtert last summer following a minivan accident ó the leading
cause of traumatic orthopedic injuries. She was thrown from the
passengerís seat and sustained a complicated hip socket fracture;
the joint was in multiple pieces. Adding to the caseís difficulty:
Tolbert was seven months pregnant.
paramedics tried to extract me from the van, thatís when I knew it
was more than a dislocation. The pain was just excruciating,"
recalls Tolbert, now 29.
was fine. It was just my body wasnít OK at all."
Tolbert spent 12
days in the hospital and needed to use a wheelchair at home for a
month. The last two weeks of her pregnancy, Tolbert used crutches. She
carried her baby to term, and her son was born healthy via a planned
Up to half of
pregnant women who sustain a pelvic fracture end up miscarrying, says
Dr. Jason Roberts, the orthopedic trauma surgeon who treated Tolbert.
It took about
three hours of surgery to set Tolbertís broken hip, about as long as
it would have if she had not been pregnant, Roberts says. To keep tabs
on the babyís health, a nurse from the obstetrics unit and high-risk
anesthesiologists were brought into the operating room. A fetal
monitor was used to detect any fetal distress. The team was prepared
to do an emergency Caesarean section, if necessary.
socket was repaired and now she has a nice, smooth hip joint,"
says Roberts. "We wanted to optimize her long-term function and
try to prevent arthritis in the hip as much as possible, for as long
Roberts and Dr.
Gregory Schmeling head the orthopedic trauma service at Froedtert
& the Medical College of Wisconsin, with a dedicated operating
room and specially trained technicians and nurses available around the
To become an
orthopedic trauma surgeon, Roberts first completed medical school and
a five-year residency in orthopedic surgery. Then, he had an
additional year of orthopedic trauma training that focused on the care
of pelvic fractures, severe joint injuries and patients with multiple
trauma surgeons also work on non-emergency cases, treating patients
whose fractures didnít heal fully or healed out of position.
case is unique because of the variety of injuries ó some severe,
some less so. And, patients can be any age, and come in all shapes and
sizes, with differing underlying medical conditions.
Upon arrival at
a trauma center, patients first are evaluated by general trauma and
critical care surgeons. The bulk of care may be directed by the
orthopedic trauma team because its expertise is in both fractures and
trauma. Later, they may be seen by microvascular, plastic or
reconstructive surgeons, and eventually by rehabilitation specialists.
must prioritize the injuries and carefully schedule surgeries.
"Sometimes fixing that broken leg at the right time can help the
ICU doctors get the patient stabilized more quickly and better,"
injuries, trauma orthopedic specialists need to weigh the pros and
cons of surgery; at times, the patientís age is a major factor in
we advise against surgery because we think it wonít necessarily help
them recover, or they may heal just as well without it," Roberts
Last year, the
Froedtert & MCW team treated approximately 100 patients who needed
surgery to repair pelvic fractures. Most broken hips involve the ball
at the top of the thighbone. Less common ó and more difficult to
treat ó is a fracture of the socket.
injuries can include fractures of the heel bone, knee or ankle. And,
any fracture near a joint can disturb the bone surface and lead to
arthritis. All it takes is an imperfection as small as one millimeter,
according to Roberts.
most severe injuries we treat, even with what we consider a great
outcome and with optimal treatment, oftentimes these can be
life-changing injuries," says Roberts.
sustain organ injuries or other trauma as well. If they develop an
infection in the bone, "it requires an aggressive,
multidisciplinary approach," according to Roberts.
encounter another challenge outside the operating room: helping each
patient understand his or her injuries and what kind of recovery is
"We try to
be encouraging, but at the same time realistic," says Roberts.
"We definitely have patients who beat the odds ó frequently. We
tell them what the expected outcome is for most patients, but we canít
really guarantee thatís going to be their outcome.
"We try to
give our best educated guess what their function will be."
As for Tolbert,
she is back working full-time at a bank and caring for her family ó
"business as usual." She continues to do home exercises in
hopes of eliminating a slight limp. Her hip has healed well, according
wants to get in a car accident, but the whole process made it a
learning experience," says Tolbert. "You appreciate things
more. It tested my strength. Iím grateful."