Caring for Patients on Their Worst Days

Physician Highlight: Joshua Napora, MD

Innovations in Orthopaedics | Summer 2021

The patients who meet Josh Napora, MD, usually aren’t thrilled about it — and he knows it. Many have just experienced a serious accident or injury, and a trauma center is the last place they expected to end up that day.

Joshua Napora, MD

 James Voos, MD

“One thing that really motivates me about my job is that most of my patients don't choose me,” says Dr. Napora, an orthopedic trauma surgeon at University Hospitals Cleveland Medical Center and assistant professor of orthopedic surgery at Case Western Reserve University School of Medicine. “They are meeting me on one of their worst days, and I can start the process of trying to return them to their quality of life.”

Dr. Napora was immediately drawn to the field of orthopedics when attending medical school at Pennsylvania State University College of Medicine. He liked that orthopedic trauma surgery, specifically, offered diverse challenges for surgeons, who have the opportunity to treat many types of conditions and cases. “Instead of performing one or two surgeries, we operate all over the body,” he explains.

Trauma surgeons also play an important role in easing fear and uncertainty for patients who may face a long recovery. Some reconstruction surgeries can take years to complete.

“There is an emotional or mental component involved, beyond the physical,” he says. “It's a long road, so we have to form a relationship quickly to ensure that they are willing and able to go down that road.”

A happy homecoming

For his residency in orthopedic surgery, Dr. Napora chose UH Cleveland Medical Center — the flagship hospital of a health system with a national reputation and hands-on approach to orthopedics. His experience there inspired him to return as a full-time faculty member in 2019.

Dr. Napora is the fourth orthopedic traumatologist to join the fast-growing Level I trauma center, the busiest in Northeast Ohio.

“There's something special that happens here, and I wanted to be a part of it,” he recalls. “I’m proud to be part of the teaching and training of future leaders in orthopedics, which is special to me. It’s also important to me to be in a Level I trauma center, because those are the types of cases I want to be involved with — helping people with the highest-level acuity injuries.”

Before rejoining UH, Dr. Napora completed his orthopedic trauma fellowship at R A Cowley Shock Trauma Center at University of Maryland Medical Center and trained in complex limb deformity at the Hospital for Special Surgery in New York City. Today, as an orthopedic trauma surgeon, he primarily sees adults and children who have experienced acute trauma, including complex fractures or other injuries resulting from car accidents, sports injuries, gun shots or other trauma. In many cases, patients are dealing with long-term challenges from trauma, such as a fracture that didn’t heal correctly.

“Dr. Napora’s expertise allows us to take care of those complex problems,” says James Voos, MD, Chair of the Department of Orthopedic Surgery at UH Cleveland Medical Center. “We’ve had a very large demand from patients to develop a coordinated trauma program that connects all our hospitals across the region, which we’ve done in a short period of time.

Dr. Napora routinely partners with general surgeons, plastic surgeons and vascular surgeons to deliver trauma care for patients. He also works closely with UH orthopedic trauma surgeon, and his mentor, John Sontich, MD, to treat patients with limb deformities, including limb length discrepancy, where one arm or leg is longer than the other, and limb malalignment.

Patients with a limb deformity usually follow a referral pattern, meaning they have often had multiple surgeries at other institutions without success. The goal for surgeons in these cases is to salvage the limb and avoid amputation.

One innovative technique Dr. Napora uses to treat limb length discrepancy involves a magnetic nail that goes inside the patient’s body paired with an external magnet. He can adjust the nail to “squeeze” a bone that needs to heal or extend a bone so that it can grow slowly. He also has specialized training in circular ring external fixation correction, a computer-assisted technique to progressively correct the alignment, rotation or length of the leg. “On an acute basis, the bone and soft tissue around it can’t handle big adjustments without injuring blood vessels and nerves,” he explains. “So, this process allows you do it more gradually.”

Advancing the field

Dr. Napora enjoys collaborating with UH residents on research, as well as in academic and clinical settings.

As an assistant professor at the School of Medicine, he leads lectures on various trauma-related topics and runs an anatomy course for students. He also makes it a point to include residents on almost all of his cases.

“He is not only committed to taking care of our patients, but also educating the future generation of orthopedic surgeons and moving the specialty forward with research,” Dr. Voos says. “It takes a unique individual to cover all three aspects successfully.”

The field of orthopedic surgery is also ripe for innovation, and Dr. Napora is excited about continued advances for patients and clinicians.

“With orthopedics, implant design is always advancing,” he says. “Every year, they are coming out with new and more innovative ways to do surgeries. If you think about what we were doing 20 years ago and how far it's come, there have been many advances in technology and minimally invasive approaches. It's truly remarkable.”

From tibial plateau fractures, long bone nonunions and pathology of metastatic bone, lesions and fractures, Dr. Napora’s clinical research spans a wide range of topics. “I'll do any research that advances orthopedic trauma, in general,” he says. “If someone has a good idea or I find a good idea, I'll work on that.”

He is particularly interested in research around nonunions, or fractured bones that fail to heal even with medical treatment and/or surgery. These may be caused by infection, smoking, metabolic reasons and sometimes, just bad luck.

“Sometimes the bone just didn’t heal, but why? And what are the risk factors of that?” Dr. Napora says. “Then, what are treatment options and success rates of getting that bone to eventually heal?”

To refer a patient to Dr. Napora, call 216-553-1783.

Contributing Experts:

Josh Napora, MD
Orthopedic Trauma Surgeon
UH Cleveland Medical Center
Associate Professor
Case Western Reserve University School of Medicine 

James Voos, MD
Professor and Chair, Department of Orthopaedic Surgery
Jack and Mary Herrick Distinguished Chair
Orthopaedics and Sports Medicine
University Hospitals
Head Team Physician, Cleveland Browns
Medical Director, Cleveland Ballet
Charles H. Herndon Professorship and Chair
Case Western Reserve University School of Medicine