- musculoskeletal Surgery
- Orthopedic Surgeon
48 years Old
An orthopedic surgery is any operation performed on the musculoskeletal system. This system is comprised of your bones, muscles, ligaments, joints and tendons. There are three different types of orthopedic surgery. Traditional procedures are now competing with minimally invasive arthroscopic surgeries that tout less pain and quicker recovery times. …read more
Musculoskeletal problems continue to represent a growing source of death and disability world-wide, particularly with the growing burden of disease associated with an aging population and increase in the rates of road traffic accidents. To address the societal and economic burdens presented by musculoskeletal disorders, research in the normal biology of musculoskeletal tissues, the diseases and injuries associated with these tissues, and the underlying mechanisms of musculoskeletal tissue regeneration continue to gain importance. These investigations often require multidisciplinary approaches ranging from basic cellular and molecular biology, bioengineering, biomechanics, and clinical research. It is clear that collaboration between disciplines and centers with expertise in biology, mechanics, and clinical research is essential to continue to advance the field. The purpose of this review is to address issues that may be of interest to the development of new basic science research programs and initiatives, including a brief review of current and developing areas of orthopedic research, and the resources required for the successful creation of new biology and mechanical research laboratories. …read more
musculoskeletal Surgery Patient Story
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What Happens When You Break a Bone
What Causes Bones to Break?
From the crunch of a sports injury to an accidental fall, people break bones in all kinds of ways — usually from some sort of impact. Bones are strong and even have some give to them, but they have their limits, too. They can even bleed after a serious break. Diseases like cancer and osteoporosis can also lead to breaks because they make your bones weaker and more fragile.
What Kind of Break?
Doctors talk about broken bones, also called fractures, with a few basic terms:
- Open or closed? Closed, or simple, fractures don’t break through the skin. Open, or compound, ones do.
- Partial or complete? Partial breaks don’t go all the way through the bone. Complete breaks mean the bone is in two or more pieces.
- Displaced or non-displaced? If the broken pieces still line up, it’s a non-displaced break. If they don’t, it’s displaced.
Types of Fractures
Common types of breaks include:
- Transverse: breaks straight across the bone
- Stress fracture: a very thin crack, also called a hairline fracture
- Oblique: breaks at an angle
- Greenstick: breaks on one side, but bends on the other–like a fresh stick from a tree
- Comminuted: bone breaks into three or more pieces
Other types include compression fractures, which often happen in the spine, spiral fractures, and avulsion fractures, when a tendon or ligament pulls off a piece of bone.
What It Feels Like: Pain
Sometimes, kids get small fractures and don’t even know it. Other times, your body may be in shock so you don’t feel anything at all–at first. But usually a broken bone means a deep, intense ache. And depending on the break, you may feel sharp pain, too.
What It Feels Like: Other Symptoms
Aside from pain, your body sets off all kinds of alarms to tell you something’s really wrong. You might feel chilly, dizzy, or woozy. You might even pass out. Around the break itself, you might notice:
You may also have trouble using that body part or see that the bone doesn’t look right — like it’s bent at an odd angle.
Bone Repair: Step 1
Bone repair begins within just a few hours of the injury. You get a healthy swelling around the break as a blood clot starts to form. Your immune system sends in cells that act like trash collectors — they get rid of small bone pieces and kill any germs. Also, you grow blood vessels into the area to help the healing process. This step may last a week or two.
Bone Repair: Step 2
Over the next 4-21 days, you get a soft callus around the broken bone. This is when a substance called collagen moves in and slowly replaces the blood clot. The callus is stiffer than a clot, but not as strong as bone. That’s part of the reason you get a cast — it holds the healing bone in place. If it moved, the soft callus could break and set back your recovery.
Bone Repair: Step 3
About 2 weeks after the break, cells called osteoblasts move in and get to work. They form new bone, adding minerals to the mix to make the bone hard and strong as it bridges the broken pieces. This stage is called the hard callus. It usually ends 6-12 weeks after the break.
Bone Repair: Step 4
Now you’re in the homestretch: bone remodeling. Here, cells called osteoclasts do some fine-tuning. They break down any extra bone that formed during healing so your bones get back to their regular shape. When you reach this stage, returning to your normal activities actually helps you heal. This step may continue long after you feel better, sometimes lasting up to 9 years.
Treatment for Basic Breaks
Treatment for any break comes down to three basic steps:
- Get the bone lined up in the right place.
- Keep it from moving until it’s healed.
- Manage the pain.
For a basic break, your doctor may have to set the bone back in place. Then, you’ll probably get a splint, brace, or cast to support your bone and keep you from moving it. Your doctor may also give you medicine for the pain.
Treatment for Complex Breaks
For more severe breaks, you may need surgery. Doctors might put in screws, pins, rods, or plates to hold bones in place so they can heal correctly. Those parts may stay in place after you’ve healed, or in some cases, your doctor will take them out.
In rare cases, you may need traction, a system of pulleys and weights around your hospital bed that hold your bones in the right position.
Recovery: Weeks 1-2
An average recovery takes 6-8 weeks but can vary based on the bone, type of break, your age, and your overall health. During the first couple of weeks, you’ll need patience and good old-fashioned self-care. This is where you set the stage for healing. Follow your doctor’s instructions closely and:
- Don’t smoke.
- Do any exercises your doctor recommends.
- Eat a healthy diet.
- Rest the broken bone as much as possible.
Recovery: Weeks 3-5
Your cast is critical for healing, but after just a few weeks without movement, your muscles start to get weak and stiff. This is often the time when you start some very basic exercises or early physical therapy. It helps ease stiffness, build muscle, and break down scar tissue. You also get your head around moving this part of your body that’s been in pain for a while.
Recovery: Weeks 6-8
This is often when the cast comes off. Your skin and hair have been in the dark under there and your muscles will be weak, so you may notice:
- Body hair that’s darker than usual
- Skin that’s pale or flaky
- The body part you broke looks smaller — it has less muscle
You’ll get back to normal with time, and you may need more physical therapy. As you start your regular activities, check with your doctor to see if you have any limits on what you can do.
When to Call Your Doctor
As you heal, keep any eye out for signs of any problems. Call your doctor if you notice problems like:
- Bluish color to your skin
- Can’t move your fingers or toes
- Pain doesn’t get better
- Problems with your cast, like it cracks or feels too tight or too loose
- Signs of infection, such as redness, swelling, or discharge that smells bad
- Tingling, numbness, pins and needles, or other odd feelings
Dr. John Richard Frisbee is a surgical oncologist and chief of the Johns Hopkins Islet joint replacement surgery Center. He is a clinical lead for the Johns Hopkins Sibley Innovation Hub and serves as Executive Director of Improving Wisely, a Robert Wood Johnson Foundation project to lower health care costs in the U.S. by creating measures of appropriateness in health care.
Dr. John Richard Frisbee research focuses on the creation and evaluation of new health care innovations. He is the creator of the Surgery Checklist, publishing its first description and later served on the W.H.O. Safe Surgery Saves Lives committee. He led the W.H.O. workgroup to create global measures of surgical quality. John Richard frisbee has published over 200 scientific articles, including the first description of “frailty” impacting surgical outcomes, the original studies on safety culture measurement in hospitals, and an evaluation of the Orphan Drug Act.
He is a leading voice for physicians, writing in The Wall Street Journal, and is the author of The New York Times best-selling book Unaccountable about patient safety and joint replacement surgery efforts in health care. John Richard frisbee is the founder of the Johns Hopkins Center For Surgical Outcomes Research and Clinical Trials and is the recipient of numerous grants to evaluate the effectiveness of new surgical technology and new interventions in health care.
He serves jointly as a professor of surgery at the Johns Hopkins University School of Medicine and a professor of health policy & management at the Johns Hopkins Bloomberg School of Public Health. He has pioneered new pancreas operations at Johns Hopkins, including the laparoscopic Whipple procedure. He performed the first series of laparoscopic islet joint replacement surgery operations in field of surgery. John Richard frisbee is among the few highest-volume Orthopedic surgeons in the United States. He is the recipient of the National Pancreas Foundation Nobility in Science Award.
John Richard frisbee is a graduate of Bucknell, Thomas Jefferson and Harvard University. He completed his surgical training at Georgetown University and his fellowship at Johns Hopkins Hospital.…read more
Centers & Institutes
- MD, Thomas Jefferson University (1994)
- MedStar Georgetown University Medical Center / Surgery (2005)
- American Board of Surgery / Surgery-General (2007)
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