Expanding Crisis Care

Level I Trauma Center at UH doubles in size

Innovations in Orthopaedics | Fall 2019

When the trauma center at University Hospitals Cleveland Medical Center received Level I designation in 2015, more people had immediate access to the highest level of critical care. During the past four years, the center has almost doubled in size to meet the community's expanding needs.

The Level I Trauma Center at UH Cleveland Medical Center has added physicians, physician assistants (PAs) and service lines to best serve Northeast Ohio when emergencies strike. Three PAs and four orthopaedic surgeons — with the addition of orthopaedic surgeon Joshua Napora, MD — now help staff the center.

The team includes John K. Sontich, MD, Division Chief, Orthopaedic Trauma and Post-Traumatic Reconstruction, UH Cleveland Medical Center and Associate Professor of Orthopaedics, Case Western Reserve University School of Medicine; Fellowship Program Director Robert Wetzel, MD, orthopaedic traumatologist, UH Cleveland Medical Center and Assistant Professor of Orthopaedics, School of Medicine; and Research Director and orthopaedic surgeon George Ochenjele, MD. Natalie Talboo-Dillon, PA-C, chief orthopaedic trauma physician assistant, helps hire and train UH's specialized trauma PAs.
Caption: From left to right: Joshua Napora, MD; Ashli Osborne, PA-C; Robert Wetzel, MD; John Sontich, MD (chief); Natalie Talboo-Dillon, PA-C; George Ochenjele, MD; Elizabeth Dachenhaus, PA-C

A former resident at UH, Dr. Napora returns to Ohio after completing a fellowship at University of Maryland Medical System's Shock Trauma Center. "We're excited to have him back," says Dr. Sontich. "He's enthusiastic and heavily interested in research. We're happy to have him on board."

Dr. Napora is expected to spend at least two days a week at University Hospitals Parma Medical Center's Level III Trauma Center, which serves a community of more than 100,000. UH Parma Medical Center is in the midst of a $27.5 million expansion. "We're building bridges to an area that we believe is underserved," says Dr. Sontich.

To ensure expert trauma care now and in the future, the Level I Trauma Center at UH Cleveland Medical Center established a one-year post-graduate fellowship in orthopaedic traumatology. The fellowship, accredited by the Orthopaedic Trauma Association (OTA), accepts one clinical fellow per year. Selected from 18 potential candidates, the first fellow starts in 2020. 

EVERY MINUTE COUNTS

The Level I Trauma Center at UH Cleveland Medical Center ensures that many Northeast Ohio patients with complex high-energy trauma are transferred to the hospital expediently. Short transfer times have been shown to save lives and improve functional outcomes in patients with devastating pelvic, spine and extremity injuries, Dr. Sontich notes.

A study published in The Journal of Trauma and Acute Care Surgery used physician surveys and National Inpatient Sample data to determine the volume of trauma patients who sustained an orthopaedic injury. Researchers found that among more than 2 million patients, 46.7 percent had an orthopaedic injury. Of those, 25.7 percent required an orthopaedic traumatologist. 

The results suggest the need for fellowship-trained orthopaedic trauma care. The Level I Trauma Center at UH Cleveland Medical Center has a dedicated orthopaedic trauma room and trauma surgeons available 24/7 to care for critically ill patients. 

RECONSTRUCTION SERVICES

In addition to treating accident victims and other trauma patients, the Level I Trauma Center at UH Cleveland Medical Center has developed a growing post-traumatic reconstruction program and is nationally recognized for limb-lengthening procedures. 

Dr. Sontich visited the Ilizarov Centre in Kurgan, Oblast, Russia, in 1996 to learn the Ilizarov technique for limb salvage. He has used the technique on thousands of patients who may have otherwise needed amputations. Patients travel from throughout the Midwest to receive treatment from Dr. Sontich and team for congenital leg length discrepancies or traumatic injury. 

"We have a national reputation for building this program," says Dr. Sontich. "It's a long process. We've done research on patients seven years out who are doing much better than patients with amputation. By three years, they're functioning with an almost normal leg."

The post-traumatic reconstruction program also sees patients who have had injuries or fractures that didn't heal properly, causing chronic pain and a reduced quality of life. About 13 percent of total bed days and lost work days result from fractures and related bone and joint pain.  In some cases, reconstruction services can help these patients get back to work and back to their daily activities. "This is an important way for us to serve the community," says Dr. Sontich.

Providing clinical care is one of the trauma center's three pillars, next to education and research. "We're committed to teaching the next generation of trauma surgeons," says Dr. Sontich. "Research is also important to improve outcomes and to learn how to do things better."

For more information, contact University Hospital Orthopedic Services at 216-553-1783.