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Acute Fractures: From Treatment to Prevention

Acute Fractures: From Treatment to Prevention

What initially attracted orthopaedic surgeon and traumatologist Babar Shafiq to join The Johns Hopkins Hospital were the challenge of complex cases and the opportunity to care for patients with severe injuries, often with multiple comorbidities. As a Level 1 trauma center, the Johns Hopkins facility attracts patients with some of the most difficult fractures to manage. Some patients come to Johns Hopkins from the local and regional area via ambulance or by air after acute injury, while many others are transferred from other hospitals when their injuries or medical problems necessitate advanced care.

Shafiq accepts referrals of patients with severe, acute traumatic injuries of the pelvis and extremities, and those who have failed fracture management, nonunions, malunions or deformity. In addition, he is able to manage patients with these injuries who also have severe medical comorbidities that put them at higher surgical risk. “I routinely receive referrals from other doctors in our hospital system and from other local and regional hospitals for patients who have a fracture but are also very sick,” says Shafiq.

The complexity of these cases requires Shafiq to team with specialists from other disciplines. “A patient may also have severe cardiac disease or have undergone an organ transplant. They may have kidney failure or a more obscure comorbidity, like osteogenesis imperfecta,” says Shafiq. The multidisciplinary team may include specialists from interventional radiology, cardiothoracic surgery, endocrinology, transplant medicine, neurosurgery and general trauma surgery.

To offer patients the best possible treatments, Shafiq performs minimally invasive pelvic, acetabular and extremity surgeries whenever possible. He also participates in numerous research efforts to improve surgical technique and patient outcomes.

Teamed with fellow orthopaedic trauma surgeon Erik Hasenboehler, the two lead biomechanical cadaver studies to investigate the treatment of complex pelvic and ankle fractures. They are studying minimally invasive treatments for tibial plateau fractures and alternative techniques for the management of injuries to the syndesmosis.

During the past year, Shafiq has led the effort to design and implement a clinic to support bone health in patients over 50. The Bone and Joint Decade, a network of organizations that position musculoskeletal conditions as a public health issue and is promoted by the American Academy of Orthopaedic Surgeons, encourages orthopaedists to promote cost-effective prevention and treatment of musculoskeletal injuries and disorders. Shafiq and physician assistant Andra Love have partnered with Kendall Moseley, a bone health endocrinologist specializing in metabolic bone disease. Together, they have created a clinic that is focused on preventing secondary fractures and promoting bone health.

“Our clinic has been running for about six months now,” says Shafiq. “We are identifying patients with fragility fractures and osteopenia or osteoporosis, and we’re taking them through a diagnostic and treatment pathway to reduce their risk of future fractures.”

When a patient needs a bone health examination, Love reviews the patient’s risk factors for osteoporosis and fracture history to determine the risk of secondary fracture. Education is provided to help the patient understand the roles that calcium, vitamin D and exercise play in supporting bone health. Patients are given guidance concerning fall prevention and medication options. Dual-energy X-ray absorptiometry is used to evaluate bone density and, if necessary, patients are referred to Moseley for further treatment. Together, this bone health team constitutes a fracture liaison service that offers an individualized care plan for each patient. 

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