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Fall 2007

Trauma's Past and Future at UCSF

UCSF has a long history of excellence and innovation in trauma care. UCSF physicians, who have long been at the forefront of new techniques and technology, took part in the development of the first complete program for trauma care in the nation.

The UCSF orthopaedic trauma team provides highly integrated, comprehensive care. All surgeons on the team are on the staff of San Francisco General Hospital (SFGH), a level 1 trauma center and the city's only trauma hospital. Four of the five surgeons have completed yearlong orthopaedic trauma fellowships, and four of the five have completed two fellowships, a ratio that is one of the best in the nation. Patient care is enhanced by the multidisciplinary team that includes physiatrists, podiatrists, nurse practitioners, orthotists and prosthetists, all of whom have expertise in treating post-traumatic conditions.

Now, the program is expanding in ways that will allow UCSF physicians to transfer their skills to other orthopaedic surgeons throughout the region. The program will promote the basic research that may fundamentally alter orthopaedic trauma care in the future.

In the late 1960s, San Francisco was a place of tumult, where protests against the war in Vietnam and a volatile social climate led to a threefold spike in trauma. UCSF physicians at SFGH realized that many fatal traumatic injuries would be survivable if approached systematically.

They developed a new trauma system that addressed communication from the field during an emergency, transportation of patients to the hospital and evaluation and resuscitation of those patients in the hospital. In 1977, UCSF physicians formed a group — which would later become the Orthopaedic Trauma Association — dedicated to the care of trauma patients with musculoskeletal injuries.

Today, the fellowship-trained UCSF faculty continues to provide comprehensive, expert care at the UCSF/SFGH Orthopaedic Trauma Center. They are nationally recognized leaders in all aspects of orthopaedic trauma, including education, research, and the comprehensive care and rehabilitation of patients with musculoskeletal injuries.

"One of the major efforts we are making is to create facilities to help train orthopaedic surgeons throughout the region in trauma care," says Theodore Miclau, M.D., director of orthopaedic trauma and chief of Orthopaedic Surgery at SFGH.

To that end, UCSF is creating a state-of-the-art orthopaedic surgical training center that will foster the transfer of knowledge UCSF faculty have gained about best practices in orthopaedic trauma care. UCSF is also creating an orthopaedic trauma simulator similar to the anesthesia simulators that have boosted education and training in that field.

The university is also expanding post-trauma care. Many complex trauma cases require treatment by both orthopaedic surgeons and plastic surgeons. Studies have shown that outcomes are significantly improved when surgeons from both specialties work together, which is why UCSF has created a special clinic built around this collaboration.

Finally, UCSF puts a high priority on research that will produce the clinical treatments of the future. Such research ranges from clinical research such as limb lengthening to basic research such as stem cell work that is likely to dramatically transform the field in the future.

For more information, call Theodore Miclau, M.D., at (415) 206-8812.

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