Trauma Service

The University Hospital is a Level I Trauma Center for the state of Alabama. there is a rich experience in the management of all types of injuries to the musculoskeletal system. There are about 10,000 Emergency Room visits per year with an average hospital census of 45 patients with trauma related injuries. Great emphasis is given to the multiple injured and to patients with pelvic and acetabular trauma. The service is headed by Jorge E. Alonso M.D., with a special interest also in the management of malunions, bone defects and non-unions. Also in the Trauma Service we have James Stannard, M.D. with a special interest in foot trauma, infected non-unions and intra-articular fractures. For additional information you can contact the U.A.B. Orthopaedic Trauma Nurse Coordinator, Jill Moyer,RN,BSN at (1-800-UAB-MIST), or jill.moyer@ortho.uab.edu

• Trauma Fellowship Program

• A.O./A.S.I.F. Program

Trauma Fellowship Program

University of Alabama Hospital; Children's Hospital of Alabama; Cooper Green Hospital for the County Indigent; Veteran's Administration Hospital

Goals and Characteristics

To offer comprehensive training in the aspects of adult and pediatric trauma. Fellows will recieve compreensive training in all aspects of orthopaedics trauma, with special interest in severe multiple trauma and management of complex fractures of the acetabulum and pelvis. Experience with reconstruction of post-traumatic deformities and treatment of non-unions and segmental bone defects are available.

U.A.B. Trauma Center is one of two Level I trauma centers in the Birmingham metropolitan area.

All Orthopaedics Trauma Fellows will be expected to participate in at least one publishable research or clinical project, and be in charge of a Fellow clinic, journal club, and grand rounds.

Our service works closely with other surgical specialties, the Injury Prevention Center, the School of Engineering, and animal research.

A.O./A.S.I.F. Program

The U.A.B. Orthopaedic Trauma Section is one of seven centers in the United States approved by the A.O. International for a fellowship program.

The rotations are up to three months in length and fellows from all over the world rotate at U.A.B. Stipend: $1,700 / month US

For Information and Application please contact A.O. International at:

Clavadelerstrasse
CH-7270 Davos Platz
Switzerland

Telephone: 41(0)81 414-2601
FAX:  41(0)81 414-2238
http: //www.ao-asif.ch

A.O./A.S.I.F. Fellows

• -HEMODYNAMIC UNSTABLE PATIENT:
  • A.P. radiographs
    • Rotatory Instability - EXTERNAL FIXATOR.
    • Rotatory/Vertically Instablity - C CLAMP / EXTERNAL FIXATOR.
  • Rectal Examination.
  • Urethrogram.
  • Possible Arteriogram / Embolization.
  • Laparotomy.
• -HEMODYNAMIC STABLE PATIENT:
  • A.P. / Inlet / Outlet Radiographs.
  • If associated acetabular fractures Judet Views.
  • C.T. scans to evaluate posterior pathology.
    • Rotatory Instablity (+-) EXTERNAL FIXATOR.
    • Rotatory/Vertically Instablity - DISTAL FEMORAL TRACTION (+-) EXTERNAL FIXATION.

• Evaluate Posterior Pathology - C.T. Scans.
• Evaluate Anterior Pathology = A.P. / Inlet / Outlet radiographs.
• Patient in bed more than 3 days:
  • DUPLEX ULTRASOUND
  • GREENFELD FILTER

• If Surgery / Urology is exploring the abdomen.
• EXTERNAL FIXATION - Stable but displaced.
  • Head Injury.
  • Multiple Trauma.
  • Burns.

• Antibiotic ceverage.
• Large Hemovac deep:
  • Anterior - Retzius space.
  • Posterior - Inner table pelvis.
• If EXTERNAL FIXATION secure all clamps.

• Lovenox 30mg. Sq. q 12 hrs.
• D/C drains at 48 hrs. post-op.
• D/C antibiotics at 48 hrs. post-op.
• Dressing Change POD #2.
• OOB POD #2 or #3.
• EXTERNAL FIXATION
  • Start pin care with q-tip and hydrogen peroxide.
  • No betadine soak dressings around the pins.
• Gait training toe touch to affected side POD #3.
• Patient cannot be discharged until they have been cleared from physical therapy.
• Call Dr. Bidez with patients name and M.R. Number (Ext. 4-8460).

• AP / INLET / OUTLET radiographs.
• Staples out and steri-strips.
• NWB to affected side for 10 weeks.
• If anterior EXTERNAL FIXATOR FRAME:
  • Pin care.
  • Fixator in place for 10 weeks.
• Fill out evaluation sheet.
• RTC 3 weeks (Tuesday pelvis and acetabular clinic).

• AP / INLET / OUTLET radiographs.
• Wound check.
• If anterior EXTERNAL FIXATOR FRAME:
  • Remove the fixator.
  • Continue wound care (hydrogen peroxide).
• Check and record ROM.
• Patient to start 50% weight bearing.
• RTC 2 weeks (Tuesday pelvis and acetabular clinic).

• AP / INLET / OUTLET radiographs.
• Wound check.
• Check and record ROM.
• If no change in radiographs start FULL WEIGHT BEARING with no external support.

• AP / INLET / OUTLET radiographs.
• Clinical photographs.
• Patient can return to normal activity.
• RTC 6 months (Tuesday pelvis and acetabular clinic).

• AP / INLET / OUTLET radiographis.
• Check and record ROM.
• RTC in PRN basis

• Distal femoral traction.
• AP/INLET/OUTLET and JUDET radiographs.
• CT Scans.
• 3D Reconstruction.
• Patient in bed more thatn 3 days.
  • DUPLEX ULTRASOUND + GREENFELD FILTER.

• Open Acetabular fractures.
• Acetabular fractures in burn patients.
• Acetabular fractures with associated femoral neck fractures.
• RELATIVE-Fractures with fragments in the joint.

• Extensile approaches DOUBLE antibiotic coverage.
• Pulsa-vac irrigation before closure.
• Anterior and Posterior Hemovac drains.

• Indocin 25mg. TID x 6 weeks or 75mg. SR/Day.POD #1.
• Lovenox 30mg. Sq. Q12 hrs.
• CPM on request (depending on fixation).
• Radiation 700 cGy through opposing fileds POD# 1-3.
• D/C drains at 48 hrs. post-op.
• D/C antibiotics at 48 hrs. post-op.
• Dressing change POD #2.
• OOB POD# 2 or 3.
• Gait training tor touch to affected side POD #3.
  • If affected bilaterally bed to chair transfers.

• AP/JUDET views of the acetabulum.
• Staples out and Steri-strips.
• NWB for 12 weeks.
• PT to start:
  • Quad strenghthening.
  • Flexion to 90 degrees.
• Fill out evaluation sheet.
• RTC 3 weeks (Tuesday pelvic and acetabular clinic).

• AP/JUDET views of the Acetabulum.
• Wound check.
• Check and record ROM.
• RTC 1 month (Tuesday pelvic and acetabular clinic).

• AP/JUDET views of the Acetabulum.
• Wound check.
• Check and record ROM.
• Order CT scans to be done before next visit.
• RTC 1 month (Tuesday pelvic and acetabular clinic).

• AP/JUDET views of the Acetabulum. Wound check.
• Check and record ROM.
• Start PARTIAL WEIGHT bearing (50%).
• RTC 2 weeks (Tuesday pelvic and acetabular clinic).

SIX MONTHS POST OP

• AP/JUDET views of Acetabulum.
• Check and record ROM.
• Check D'Aubigne and Postel Postoperative functional scale.

Postel Postoperative Functional Scale

Postel D'Aubigne

EXCELLENT 18 POINTS.
VERY GOOD 17 POINTS.
GOOD 15-16 POINTS.
FAIR 13-14 POINTS.
POOR < 12 POINTS.

• Schedule for Gait Analysis Lab with Dr. Horn @ 939-6051.
• Patient can return to normal activity.
• Clinical photography.
• RTC 6 months (Tuesday pelvis and acetabular clinic).

• AP/JUDET views of the Acetabulum.
• RTC in PRN basis.

• AP/LAT/OBLIQUE Films of the distal femur (with traction) of the involved side and the contralateral side.
• AP/LAT of the entire femur and the tibia (joint above and below).
• CT with 3D reconstruction on type C3.
• Evaluate for vascular compromise.

• Patient must have a pre-op plan.
• If surgery is going to be delayed more than four days, a tibial traction (10 cm. distal to the tibial tubercle) then is placed in balance suspended traction with 20 to 30 lbs..

• Open Fractures.
• Fractures with vascular compromise.
• Multiple trauma.

• Antibiotic coverage before inflating the tourniquet.
• Large hemovac deep.
• Inject 20 ml of 0.5% Bupivacaine with Epinephrine (1:200,000) in the knee joint.
• Place patient in C.P.M. Post Op..

• D/C drain at 48 hrs. post op..
• D/C IV antibiotics 48 hrs. post-op.
• C.P.M. 0 to 70 degrees - POD #1.
• If the C.P.M. machine is stopped at night, time should be at 90/90.
• Dressing change POD #3.
• Gait training, toe touch to affected side POD #4.
• NWB for 12 weeks.
• Patient cannot be discharged until patient has full control of extremity.

• AP/LAT radiographs.
• NWB for 12 weeks.
• Patient start quad strengthening, flexion to 90 degrees.
• Staples out and steri-strips.
• Fill out evaluation sheet.
• RTC three weeks.

• AP/LAT radiographs.
• Check and record ROM.
• RTC six weeks.

• AP/LAT radiographs.
• Check and record ROM.
• Patient to start 50% weight bearing.
• RTC two weeks.

• AP/LAT radiographs.
• Clinical photographs.
• Start full weight bearing (no external support)
• RTC three months.

• AP/LAT/INTERNAL OBLIQUE/EXTERNAL OBLIQUE views of the injured plateau and the contralateral side.
• AP/LAT views of the entire tibia.
• AP tibial plateau view.
• CT with 3D reconstruction on types B2, B3, C1, C2, and C3.
• Evaluate for vascular compromise.
• The fracture should be reduced, casted, and bivalved.

• Patient must have a pre-op plan.

• Open tibial plateau.
• Tibial plateau fracture with a compartment syndrome.
• Fracture with vascular compromise.
• Multiple trauma (relative).

• Antibiotic coverage before inflating the tourniquet.
• Medium hemovac deep.
• Inject 20 ml of 0.05% bupivacaine with epinephrine (1:200,000) in the joint.
• Apply light dressing.
• Place patient in C.P.M. post-op.

• D/C drain at 48 hrs. post-op.
• D/C IV amtoboptocs 48 hrs. post-op.
• C.P.M. from full extension to 40 to 50 defrees POD #3 full extension to 90 degrees.
• Dressing change POD #3.
• OOB POD #3.
• Gait training toe touch to affected side POD #3.
• NWB for 12 weeks.
• Patient cannot be discharged until patient has full control of the extremity.

• AP/LAT radiographs.
• NWB for 12 weeks.
• Patient starts quad strengthening, flexion to 90 degrees.
• Staples out and steri-strips.
• Fill out evaluation sheet.
• RTC three weeks.

• AP/LAT radiographs.
• Check and record ROM.
• RTC six weeks.

• AP/LAT radiographs.
• Check and record ROM.
• Patient to start 50% weight bearing.
• RTC two weeks.

• AP/LAT radiographs.
• Clinical photographs.
• Start full weight bearing advancing to no external support/.
• RTC three months.

• AP/LAT/MORTICE views of the Distal Tibia with the traction of the involved side and the contralateral side.
• AP/LAT of the entire tibia (joint above and joint below).
• C.T. with 3D reconstruction.
• Evaluate for Neuro-Vascular compromise.

• Patient must have a Pre-Op plan.
• If the patient is ready for surgery and has been less than six hours it should be taken to the operating room.
• If surgery is going to be delayed a calcaneal traction with 10 to 15 lbs. in a Bohler Frame is a must.

• An acute less than six hours Pilon fracture.
• Open fractures.
• Fractures with vascular compromise.
• Multiple trauma (relative).

• Antibiotic coverage before inflating the tourniquete.
• Medium Jackson-Pratt (round).
• Place the ankle in a Sugar Tongue with a foot plate (A.O. Willenegger Splint).

• D/C drains at 48 hrs. post-op.
• D/C antibiotics 48 hrs. post-op.
• Dressing change POD #3.
• Start ROM POD #3.
• OOB POD #3.
• NWB for 12 weeks.
• Gait training foe touch to affected side POD #4.
• Patient can not be discharged until patient has full control in crutches.
• Place patient in a Moon Boot before discharge.

• AP/LAT, MORTICE Radiographs.
• NWB for twelve weeks.
• Staples out and Steri-Strip.
• Fill out evaluation sheet.
• RTC three weeks.

• AP/LAT, Mortice radiographs.
• Check and record ROM.
• RTC six weeks.

• AP/LAT, Mortice radiographs.
• Check and record ROM.
• Patient to start 50% weight bearing.
• RTC two weeks.

• AP/LAT, Mortice radiographs.
• Clinical photographs.
• Start full weight bearing (no external support).
• RTC three months.

• AP/LAT, Mortice radiographs.
• Ankle Scoring System (RAIRD R.A. ET. AL. JBJS 69A 1347, 1987).
• RTC six months.

Ankle Scoring System

Results