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Treatments for Open Fracture and Injury Complications

In This Video

  • R. Malcolm Smith, MD, chief of the Orthopaedic Trauma Center, is interested in open fractures
  • In this video, he discusses his work in reconstructing open fractures and managing the complications of the bone healing process
  • He correlates a greater understanding of the way bones heal and proven techniques with high success rates

R. Malcolm Smith, MD, PhD, chief of the Orthopaedic Trauma Center at Massachusetts General Hospital, reconstructs open fractures and manages the complications of the bone healing process. In this video, he explains how in recent years researchers have developed a greater understanding of complications such as nonunions and malunions, along with nonchemical approaches to treatment such as implants and realignment.


For years, I've worked on open fractures. I feel very strongly that open fractures are dealt with by highly specialized teams. And they should have very early, within a day or two, bony reconstruction and soft tissue reconstruction. And the delay in them, in doing them after a long period of time, only increases the chance of infection. That's based on work I did many, many years ago and have continued to do since then.

Over more recent years, I've been involved in the treatment of a lot of the complications of injury and specifically in nonunions and malunions, bones that haven't joined or bones that have joined bent. The essence of nonunion care is an understanding of the way the bones heal and why they don't heal. 

Over very recent years, I think we've increased our understanding a great deal. Some of the older reasons that bones don't heal, I think have been not helpful in understanding, it's not been very helpful in the care. It's got a lot better recently, and without going down the lines of using industrial doses of chemicals that aren't required, like BMPs, we can get bones to heal by just doing appropriate treatment with appropriate implants. Straightening them and putting the right sort of compression across the bone healing area makes things a great deal better.

Without using bone graft and using specific techniques, we can get nonunions to join in well over 95% of cases. And then the other side is malunions, so limbs that have healed bent. We have the ability and technology to straighten them or lengthen them or correct positions if we need to, which is always difficult and highly specialized.

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