Illustration by Noah Woods
SKELETON CREW
The Department of Orthopaedic Surgery is at the forefront of efforts to reduce the human suffering caused by damaged joints and bones.
by Phil DavisThe musculoskeletal system is a magnificent combination of bones, joints, muscles and nerves that keep humans running and lifting and hiking and moving. But when it breaks or fails or is attacked by disease the results are often torturous.
For Greg Willis, 45, a studio driver from Pacific Palisades, Calif., the sparks of agony began the instant he lost his balance carrying a 60-pound bag of mortar and slammed into the ground, shattering his lower left leg.
He suffered seven complete breaks in his tibia and fibula and soon after developed osteomyelitis, a severe infection of the bone that is often extremely difficult to eradicate and potentially limb-and life-threatening. His physicians operated twice, placing a rod into the leg, but the injury barely healed. They offered little hope that he would ever walk without crutches.
Months later, in February 1997, Willis sought help from Michael J. Patzakis, M.D., an internationally known expert on osteomyelitis and head of the USC Department of Orthopaedic Surgery. Willis underwent two operations by Patzakis to repair the injury, which involved controlling the infection and transplanting bone from his pelvis. He then had a third operation, performed by Randy Sherman, M.D., professor of surgery, to transfer and muscle from his stomach to his leg.
His treatment and subsequent care by Patzakis was a success-so much so that by April 1998, Willis was able to complete a 50-mile bike marathon.
"Not to be able to walk or run was devastating because it's such an essential part of my life. But now, I'm able to do everything I could before-with no pain. That's a really big deal to me," Willis says. "I get emotional when I think about Dr. Patzakis. He literally saved my life."
Patzakis and his fellow physicians at the USC Department of Orthopaedic Surgery are at the forefront of efforts to curb the pain and eradicate the diseases that can make the lives of active people a living hell. Under his direction, the 29 clinicians and seven basic scientists in orthopaedics use the latest medicine and science to bring relief from the pain and diseases of the musculoskeletal system.
Included in the Department's priority list:
Three USC orthopaedic research laboratories work to further understand arthritis, infectious diseases and human biomechanics. Tom Hedman, Ph.D., USC assistant professor of research and director of the orthopaedic research laboratory, is unraveling the inner workings of the musculoskeletal system. Understanding the intricate mechanics of the human body will lead to new treatments or innovations like tissue regeneration.
The doctors and nurses in USC's orthopaedic trauma unit at LAC+USC Medical Center are masters at repairing the damage a hard world can inflict on bones and muscles. At the top-rated trauma center, USC emergency medicine orthopaedists treat most of the serious cases. When Los Angeles County Firefighters Dennis Silgen and Steven L. Robinson suffered severe injuries in a helicopter crash last March, Jackson Lee, M.D., associate professor of clinical orthopaedics and co-chief of orthopaedic trauma at LAC+USC, led the team that tackled the firefighter's myriad injuries. And, if the President were to break his ankle in a spill off Air Force One at a Los Angeles area airport, USC's physicians are the designated First Surgeons.
A leader in sports medicine, USC's Center for Athletic Medicine provides excellent orthopaedic care for members of the university's athletic teams and also runs a free clinic that takes care of injured athletes from area high schools. Orthopaedic surgeons James Tibone, M.D., C. Thomas Vangsness, M.D., and John Itamura, M.D., ensure that the latest innovative techniques are available for all patients.
The USC orthopaedic faculty members are carefully selected for their unique skills and knowledge. Robert Watkins, M.D., professor of clinical orthopaedics and chief of the USC Orthopaedics Spine Center, is a leader in the fight against lower back pain, a serious affliction that strikes four out of five Americans. According to the American Academy of Orthopaedic Surgeons, lower back pain is second only to the common cold in terms of lost workdays. An expert in the field of spine and minimally invasive surgery, Watkins uses instruments that permit him to perform micro disk surgery through incisions far smaller than traditional techniques allow. Avoiding the drawbacks of traditional surgery, which can be expensive and risky, he can use this surgical technique to fuse the spine and eliminate chronic back pain. Watkins is nationally known for treating injured professional athletes and helping them continue their careers.
"We're a full service orthopaedic department," says Patzakis, the Vincent and Julia Meyer Chair in Orthopaedic Surgery. "We have an outstanding group of faculty who are nationally and internationally known in their areas of expertise."
Those kind of bragging rights come only through hard work-backed by the testimonials of patients cared for by the USC orthopaedics doctors and support from grants and gifts. The USC Orthopaedics Department has $5 million in grants and endowments that fund research in the treatment of everything from debilitating bone disease to crushed knees. Two years ago, Patzakis' work on osteomyelitis won the recognition of Julia Meyer, who created the endowed chair that Patzakis now holds. Recently, Hal and Edna LaBriola established an endowed chair in genetic orthopaedic research as a joint effort between the Department of Orthopaedics and the Institute for Genetic Medicine at the USC School of Medicine.
On the treatment side, patients run the gamut from a homeless man with a broken wrist to USC athletes who brought home a national championship title in college baseball last year.
An opportunity to learn the fine art of orthopaedic medicine from respected physicians is what prompted Olympic gold medallist Dot Richardson, M.D., a fifth-year resident in orthopaedic surgery, to compete with 400 other doctors for admission to USC's orthopaedic residency program, the largest in the country.
"Dr. Patzakis has brought the program to new heights. It's great to be a part of it," says Richardson.
A world-champion softball player-among the first women in the world to win an Olympic gold medal in the sport in 1996-Richardson compares her colleagues at USC to the professional athletes they often treat. "Like athletes, surgeons rely on sharp wits and physical dexterity to succeed," Richardson says.
USC's reputation also attracted the attention of respected researcher Baruch Frenkel, M.D., Ph.D., assistant professor and director of the Bone Molecular Biology Lab, who is trying to determine why long-term use of steroids causes bone loss. His work with osteoblasts-cells that make bones-recently resulted in a $150,000 grant from the Donald E. and Delia B. Baxter Foundation.
Frenkel says he chose USC because of a creative environment in which physicians and scientists freely exchange information. "I was very lucky to be recruited here," he says. "There is a very fruitful interaction. We are really a basic research laboratory in a clinical department. That creates conditions that lead to good research."
That kind of enthusiasm is common in the Department of Orthopaedic Surgery, along with the realization that the limitations of their work bind them together.
At the trauma center, surgeon Jackson Lee cannot get inside a patient for a firsthand look at the subtle reaction of a spine under pressure, nor can he control the forces on his patient's spine. But his research laboratory colleague Tom Hedman can-thanks to generous people who donate their bodies to science.
Hedman can put a cadaver's spine into his servohydraulic materials testing system and subject it to forces that-in life-might cause a minor backache or, when the pressure in his testing machine is turned up, cause "total failure" of the spine. The machine allows him to observe and measure precisely the biomechanics of the human body. Knowing what causes tissue to degenerate will ultimately lead to a method of regenerating tissue, Hedman says. "Obviously, when you're working with dead tissue there are limits," he says, "but we can make measurements that absolutely cannot be made in a live human body."
Still, Hedman realizes that his work with cadavers needs integration with the work of physicians like Lee who have practical experience treating the living. "That clinical experience is vital in having pertinent research," Hedman says.
The work is technical, but the mission is simple and universal: "We're working to reduce human suffering," Hedman says.
For more information about the USC Department of Orthopaedics, or to learn about The Doctors of USC, call 1-800-USC-CARE (1-800-872-2273).
Jon Nalick contributed to this article.
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