Saint Louis University’s orthopaedic traumatology fellowship offers a diverse experience incorporating four full-time traumatologists all with designated areas of interest and expertise.
SSM Health Saint Louis Hospital
The trauma service at SSM Health Saint Louis Hospital has a chief resident, a senior resident, three junior residents, an orthopaedic intern, a surgical rotator, and varying numbers of medical students from SLU. Additionally, a trauma nurse practitioner and clinical trauma nurse help manage the service.
An American College of Surgeons designated Level 1 trauma center for Missouri and Illinois, the hospital also sees the largest number of patients of any trauma center in Missouri.
SLU’s orthopaedic traumatology fellowship is accredited by the Orthopaedic Trauma Association and participates in the orthopaedic trauma SF match for the selection of candidates.
An optional active pediatric trauma, microvascular hand service and adult reconstruction experience is also available if the fellow has an interest but not required.
Role of the Fellow
Fellows assume a crucial role in the management of patients at SSM Health Saint Louis University Hospital and help coordinate the trauma service in conjunction with the chief residents on the service. Daily census ranges between 35 and 45 patients with 2-3 orthopaedic trauma operating rooms every day so the number of cases to choose from is substantial.
There is no assigned fellow service. Fellows can select the cases that they feel will benefit their interests and future goals. This is a surgical fellowship and fellows are expected to take full advantage of all the operative opportunities afforded. One fellow is selected per year so cases are not divided amongst multiple fellows.
During the day, the fellow is scrubbed as the operating surgeon with the faculty scrubbed as the first assistant and providing direct supervision. For more subspecialized, complex trauma or reconstruction cases, the attending will be the primary surgeon with the fellow as the first assistant (or primary surgeon depending on the skill level).
Fellows are free to pick the most appropriate case throughout the day and is not tied to a particular staff surgeon. If necessary or available, fellows may be asked to staff a routine trauma case if additional rooms become available during the day (e.g., washout, ankle fracture, femoral nail, etc.) but not in lieu of a primary trauma case of interest to the fellow.
Our trauma fellows are expected to be able to actively teach residents basic tenets of trauma care, the evaluation and management of trauma patients and operative principles of long bone fracture fixation. Fellows coordinate clinic participation and are encouraged to attend at least one specialty trauma clinic per per month but are not expected to forego opportunity to scrub interesting cases.
- Total number of emergency room orthopaedic trauma admissions for the combined institutions for the 2017-2018 academic year: 2,055 admissions.
- Total operative procedures performed by the orthopaedic trauma service during 2017-18: 1,050 procedures.
The most recent case numbers for 2017-2018 are as follows:
- Pelvic and Acetabular surgery: 169 cases
- Humerus and Elbow: 80 cases
- Femur and Knee: 219 cases
- Leg and Ankle: 238 cases
- Foot and Toes: 46 cases
Average fellow case logs range from 650-800 cases per year
In addition to the large numbers of acute polytrauma and monotrauma patients treated, a large volume of post-traumatic reconstruction surgery is performed including Ilizarov reconstruction for nonunions, malunions, post-traumatic osteomyelitis, leg length discrepancy, and hip related osteotomies.
Our specialty clinics are designed to give a concentrated clinic experience in a select area of orthopedic traumatology. They include the Trauma Foot and Ankle Clinic, Nonunion/Deformity/ Ilizarov Clinic, Pelvis and Acetabular Fracture Clinic and the General Trauma Clinic. Our fellows participate with the appropriate faculty where surgical indications are emphasized and the subtleties of management are reviewed.
There is no call for the first month, supervised call for the second month and then the call is under monitored supervision beginning the third month of the fellowship.
After the second month, the fellow will take independent night call as an attending on the trauma service with full operative privileges. There is always a backup faculty member on call if the fellow has questions or problems and fellows can call the faculty in at any time deemed necessary. Call averages approximately five to seven times per month depending on trauma staff schedules.
In addition to the vast clinical experience offered in the course of this fellowship, there are many basic science research opportunities in the areas of fracture biomechanics and orthobiologics. Our biomechanics and cellular biology labs are staffed by full-time Ph.D.s and their master’s and doctoral candidates. The labs are dedicated to collaborative orthopaedic research projects.
Our previous fellows have obtained a wide variety of positions, including academic traumatologists running trauma services at the Naval Medical Center in San Diego, State University New York in Buffalo, Louisiana State University in New Orleans, University of Colorado in Denver and University of Missouri- Springfield.
Other previous fellows are heading Level One or Two trauma services for large orthopaedic groups practicing in community-based institutions nationwide.