Combining expertise to treat traumatic injuries

March 20, 2018

Mayo Clinic goes beyond providing typical Level I trauma care to treat complex cases that involve both joint arthroplasty and traumatic injury. Mayo Clinic's orthopedic surgeons have extensive experience treating the growing number of patients with broken bones around joint replacement arthroplasties (periprosthetic fractures).

"We have significant expertise in the gray area where traumatic musculoskeletal injury overlaps with arthroplasty. Our group includes surgeons with the skill set to treat fractures and perform arthroplasty or revision arthroplasty in a single procedure if needed," says Brandon J. Yuan, M.D., a consultant in Orthopedic Surgery at Mayo Clinic in Rochester, Minnesota.

As a Level I Trauma Center, Mayo Clinic has a large volume of patients and 24-hour in-house surgical coverage. Four orthopedic surgeons, including Dr. Yuan, have fellowship training in trauma and focus solely on patients with acute musculoskeletal injuries, allowing for rapid surgery for transferred patients. The surgeons' expertise extends to young patients who have severe accidents or trauma as well as older patients who have a fall or low-energy trauma after joint replacement.

Complex conditions treated by Mayo Clinic trauma orthopedists include:

  • Fracture nonunion and malunion
  • Pelvis and acetabular fractures
  • Correction of limb deformities, both congenital and trauma related
  • Leg-lengthening procedures
  • Periprosthetic fractures
  • Complex periarticular trauma of the upper and lower extremity

Multidisciplinary focus

As a multidisciplinary practice, Mayo Clinic has the resources to manage patients with musculoskeletal injuries who also have multiple medical comorbidities. "We work closely with our colleagues in critical care medicine, anesthesiology, cardiology and internal medicine," Dr. Yuan says.

Older patients with fractures are routinely referred to the W. Hall Wendel Jr. Musculoskeletal Center for assessment of bone health and future fracture risk, as well as outpatient treatment and rehabilitation. The center brings together specialists in physical medicine and rehabilitation, rheumatologists, endocrinologists and radiologists, as well as pediatric orthopedic specialists for younger patients with bone issues. Similar integrated care is available at Mayo Clinic's campuses in Phoenix, Arizona, and Jacksonville, Florida.

"This approach is especially beneficial for people with bone health issues or total joint replacements who then have fractures that impact the joint replacement," Dr. Yuan says. "We have a system for caring for these patients' medical comorbidities and bone health issues."

Patients also benefit from the research undertaken by Mayo Clinic orthopedic surgeons. In a study published in 2017 in The Journal of Arthroplasty, Dr. Yuan and colleagues found that the short-term survivorship of a conversion hip arthroplasty after surgical treatment of an intertrochanteric fracture is excellent, regardless of whether the fracture fixation used an intramedullary or extramedullary device.

"As a major center with clinicians who are involved in research, Mayo Clinic has substantial resources devoted to caring for the multiple needs of trauma patients," Dr. Yuan says. "That care starts with orthopedic traumatologists but continues through all aspects of the patient's medical care and recovery."

For more information

Yuan BJ, et al. Hip arthroplasty after surgical treatment of intertrochanteric hip fractures. The Journal of Arthroplasty. 2017;32:3438.