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Accelerating Fracture Healing

Emil Schemitsch
Emil Schemitsch

Segmental bone loss at fracture sites continues to be one of the most vexing and resistant problems for orthopaedic and trauma surgeons. Though healing can be accomplished by resection of damaged and devascularized segments, shortening the extremity to heal the fracture in a healthy soft-tissue envelope results in deformity that is not generally acceptable to patients. Grafting is inappropriate in traumatic injuries because of the risk of infection. Secondary approaches following initial shortening include the use of distraction frames complemented with the use of pro-osteogenic factors. About 10% of traumatic injuries result in segmental defects requiring a long period of repair. The combination of the injury and its correction frequently takes a year of the patient's life.

St. Michael's Orthopaedic Division Head Emil Schemitsch has been working on this problem since he was an orthopaedic resident at the University of Toronto. His research project with Robin Richards examined the effectiveness of muscle flaps to accelerate fracture healing. He later completed a fellowship in arthroplasty at Brigham and Women's Hospital in Boston and a trauma fellowship at Harbourview Hospital in Seattle. When he returned to Toronto he added bone blood-flow techniques learned in Seattle to the fracture healing model. As his study of this problem evolved and deepened, Emil added molecular and cellular interventions in collaboration with cardiologist Duncan Stewart. Recent work with vascular endothelial growth factor in transfected fibroblasts, and endothelial progenitor cells led to national and international awards for his advances toward a solution to this difficult problem.

In studies with Bob Byrick, Emil showed that fat embolism results not from the intramedullary nailing of femoral fractures, but from the initial trauma. More recently, with

research engineer Rad Zdero he has applied finite element modeling to fracture healing in the biomechanics lab and computer navigation to perfect the positioning of hip prostheses during resurfacing. Only 2% of surgeons in North America use computer navigation in the resurfacing operation. His current resident in the surgeon-scientist program, Aaron Nauth, is working on cell-based gene therapy. Aaron has won five grants. Emil is conducting multi-centre randomized clinical trials on orthopaedic trauma with his partner Michael McKee, Mo Bandari from Hamilton and other surgeons across Canada. The Canadian Orthopaedics Society is a world leader in orthopaedic randomized clinical trials. Their recent 1300 patient Sprint trial showed the value of limited intramedullary reaming for internal fixation of tibial fractures.

Emil is married to Maureen, a former intensive care nurse at Sunnybrook. Their daughter Laura is at McMaster. Their 17-year-old son Geoffrey is billeted in Owen Sound where he plays for the Owen Sound Attack. Daughter Christine is at deLaSalle Academy and son Thomas is a Triple A hockey player for the Northrup Rangers. There is a lot of hockey commuting in the Schemitsch family.

During the week of my interview, Emil spent Monday in the fracture clinic, Tuesday in the operating room performing two hip resurfacings and one total hip replacement, Wednesday was spent doing three revision joint replacements, Thursday in orthopaedic clinic and Friday chairing a course for community orthopaedic surgeons at the Hotel Intercontinental. In addition to his research and busy practice, Emil hopes to strengthen and unify the practice of arthroplasty surgery in Toronto where 6000 joint replacements are performed each year. He is grateful to his mentors, principally Robin Richards and Jim Waddell, and looks forward to mentoring additional residents in clinical and laboratory research.

See a related story in the Winter 2009 issue of the Spotlight.


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