Sonoran Orthopaedic Trauma Surgeons is an Orthopedic Surgery practice dedicated solely to the treatment of complex fractures. All of our surgeons are fellowship trained in orthopedic trauma. We were all trained at the leading orthopedic residencies and trauma fellowships in the United States, and we all have completed international fellowships as well. We attend and lecture at both local and national meetings and courses related to orthopedic trauma, and we actively publish scientific and educational literature in our specialty.
Trauma is a life changing event that is devastating for the individual and for society. We are passionate about our role in the management of the traumatized patient. If you or a loved one has suffered a major orthopedic trauma, please call our office to arrange a transfer to our facility or for a consultation if you are an outpatient.
We firmly believe that orthopedic trauma is a sub-specialty that requires expertise and dedication to manage complex injuries of the Clavicle, Shoulder, Humerus (Upper Arm), Ulna (Lower Arm), Radius (Lower Arm), Pelvis, Hip, Femur (Upper Leg), Fibula (Lower Leg), Tibia (Lower Leg), Knee, Wrist, Ankle and Foot. It is our objective to establish a world class center for excellence here in Scottsdale and the Phoenix metro area; our staff is proud to serve the Arizona public.
We are contracted with Medicare, Health Net and Blue Cross Blue Shield (BCBS). We are currently not contracted with any other private health insurance companies. If you see us in consultation, you will be expected to pay for your visit (unless you have a workers' compensation claim) and it will be your responsibility to seek reimbursement from your carrier. If you are seen in the hospital as an emergency, we will provide you with services, but you will be expected to help facilitate payment by your carrier. SOTS will bill your insurance company as a courtesy but patients will likely have to facilitate the process with their carrier.
We recommend paying your balance in full within 60 days to avoid penalties or collections. Most insurance plans have provisions for out of network services in emergency scenarios. If you receive a check from your insurance company as payment for our services, you should endorse it to our practice immediately. We accept Visa and Mastercard as well. Please do not hesitate to contact us, our team of Billing Representatives are here to answer any questions you might have.
An orthopaedic surgeon is a physician who has completed four years of college, four years of medical school and five years of orthopaedic surgery residency. He or she must also complete three written examinations and pass a state board for medical licensure. An orthopedic surgeon becomes board certified by taking a written exam after residency and then passing a stringent oral examination two years after beginning practice. The American Board of Orthopaedic Surgeons has very strict rules for admission to the board. An orthopedic trauma surgeon is a surgeon who has completed all of the requirements above and also has completed a one year fellowship in orthopedic trauma surgery. Orthopedic trauma surgeons are specialists in management of pelvis fractures, fractures of the acetabulum and peri-articular fractures. Peri-articular fractures are fractures that are very complex and involve the joints such as the knee and ankle (tibial plateau and tibial pilon). There are very few fellowship trained orthopedic trauma surgeons in the United States, and even fewer in Arizona. All of the surgeons at SOTS are fellowship trained and maintain a 100% trauma practice. Orthopedic trauma can affect your mental well-being as well as your physical health. It is important to speak with your doctor regarding any conditions that may adversely affect your ability to heal.
Total hip replacement involves replacing both the proximal femur and the acetabulum (hip socket). The anterior approach to total hip replacement at our Phoenix-area practice utilizes a natural interval between muscles and does not remove tendons or muscles from either the pelvis or femur. This approach is facilitated with the use of the Pro-Fx table designed specifically with this procedure in mind.
The traditional posterior approach to the hip requires removal of tendon and muscles from the bone. This destabilizes the hip and requires adherence to hip precautions after surgery that effect the way you sit, stand, use the bathroom and sleep. With the anterior approach, no hip precautions are necessary and dislocation rates are reduced. Other advantages of the anterior approach include decreased postoperative pain and quicker recovery. Use of an x-ray intra-operatively, which is not possible with traditional approaches, allows the surgeon to more accurately control leg length and make small changes during the operation.
Dr. Brian Miller is one of only two orthopaedic surgeons in Arizona who has fellowship training in the anterior approach to total hip replacement. He has been trained in all three approaches to performing total hip replacements and has chosen the anterior approach because he has seen firsthand its advantages. His experience and training with pelvic and acetabulum fractures, considered by many the most challenging fractures to treat, gives him a comprehensive understanding of the anatomy and workings of the hip joint.
Dr. Gil Ortega performed his first anterior hip replacement in 2002. He learned the anterior hip approach techniques while training at Yale under a pioneer of the approach, Dr. Kristaps Keggi. In the late 1970s,, Dr. Keggi was the first in the United States to present and publish his results using the anterior hip approach for total hip replacements. Dr. Ortega values the mentorship he shares with Dr. Keggi. Although experienced in all approaches to the hip, Dr. Ortega prefers to use the anterior approach for his partial and total hip replacements as he has recognized improved patient outcomes using the anterior approach.
Fractures of the pelvis are extremely complex injuries that occur after high energy trauma like a fall from a height or a motor vehicle crash. The pelvis is made of three large bones and some of the most powerful ligaments in the body. It is full of major arteries, veins, nerves and organs. An injury to this region requires a huge amount of force and can be extremely damaging to all of these structures. A patient with a pelvis fracture may for example injure the nerves at the bottom of the spinal cord, rupture their bladder or damage the intestines. Recognizing these associated injuries and working with our colleagues in general surgery and urology is part of our expert approach to pelvic fracture management.
Pelvis fracture surgery is highly specialized, and should be done by surgeons who have special training in this field and do several of these procedures a year. Our surgeons were both trained by the world's leading pelvic fracture surgeons, and they are constantly learning about new techniques and methods.
The acetabulum is often referred to as the socket part of the hip joint. It is the cup part of the pelvis that wraps around the ball or head portion of the femur to create the hip joint. Fractures of the acetabulum are very complex and severe injuries that occur after high energy trauma such as fall from a height or a motor vehicle crash. These injuries have significant relevance both initially and long term. Many patients with a fracture of the acetabulum also have other major trauma including injuries to the head, chest and abdomen. The orthopaedic trauma surgeon plays a critical role in the initial management of these injuries and the initial stabilization of the patient. The doctors at Sonoran Orthopaedic Trauma Surgeons have extensive experience with critically injured patients.
It has clearly been demonstrated that accuracy of reduction (the quality of the repair of the actual joint surface) is predictive of the patient's long term outcome. Acetabular fracture surgery is very complex with long arduous dissections and difficult bone work. These procedures should only be done by experienced surgeons who do several a year and have specialized training in pelvic fracture surgery. Our surgeons are trained with some of the world's leading pelvic fracture surgeons, and they continue to remain up to date on the latest techniques in acetabular fracture management.
Perhaps the most important facet of fractures of the acetabulum to understand is the many complications of both the injury and the surgery to fix them. Patients with acetabular fractures have a high risk of developing arthritis after the injury. This may become so severe that a total hip replacement is necessary. A portion of patients may have nerve or arterial injuries that cause weakness, numbness and pain. We identify these associated injuries as soon as possible and use a multidisciplinary approach to treat these difficult problems. Many patients with these injuries are at risk for other medical problems such as infection or blood clots in the veins of the pelvis and legs. Furthermore, the acetabulum is situated in one of the most eloquent parts of the body. There are numerous large blood vessels, nerves and visceral structures within millimeters of the operative site. Therefore, the importance of an experienced pelvic fracture surgeon can not be underscored enough. Even the hands of the most skilled orthopaedic trauma surgeons, fractures of the pelvis can be complicated by severe bleeding and neurologic injury.
Pelvic and acetabular fractures can be fixed up to 3-4 weeks after the initial injury. It is easier to fix them in the first ten days, but stabilization of a multiply injured patient is of utmost importance. If you or a family member are at another facility and wish to be transferred to the care of Sonoran Orthopaedic Trauma Surgeons, please have your surgeon call our office to arrange a transfer.
A "pilon" fracture is a complex fracture of the end of the tibia or shin bone. This injury is very severe because it involves the ankle joint. Long term complications include infection, crooked ankles and debilitating arthritis. The most important factor in treating a pilon fracture is respecting the horrible soft tissue injuries of the skin that occur around them and attempt to get an anatomic reduction of the joint surface that has been disrupted. Years of experience by trauma surgeons around the world have shown that respecting the soft tissue is of utmost importance; therefore, if you have a pilon fracture, you will likely have at least two operations. The first will be to "span" the ankle joint with an external fixator. This keeps the bones in their original length while the bruising subsides. About ten days later the external fixator is removed and the joint itself is opened and repaired.
The tibial plateau is the upper surface of the tibia or shin bone that makes up the bottom half of the knee joint. Fractures of this joint surface are very common in high energy trauma such as auto accidents and pedestrian versus auto. Meticulous management of the skin, muscles, tendons and ligaments is crucial to the successful healing of a tibial plateau fracture. Like all fractures involving joints, plateau injuries should be managed by experienced trauma surgeons who understand the nuances of these complex injuries. Severe plateau fractures are often complicated by compartment syndrome, a condition that results in uncontrolled swelling of muscle and decreased blood flow to the leg. Compartment syndrome is a surgical emergency. Our surgeons have extensive training in the management of tibial plateau fractures. They utilize the latest techniques in minimally invasive surgery and early motion to help patients recover from these severe fractures.
Compartment syndrome is a surgical emergency that is not an uncommon occurrence in orthopedic trauma. This condition results when an extremity is crushed or injured and bleeding and swelling occurs in the muscle. Each muscle in our body is wrapped in a compartment. As the swelling increases, the pressure in the compartment rises. If the pressure exceeds the patient's blood pressure, then blood can no longer get into the muscles and the extremity can die. Compartment syndrome can result in limb loss and even death if not treated quickly. The compartments are opened with a knife and the muscle is decompressed. The wounds are closed at a later date or they are covered with a skin graft. Compartment syndrome is most common in the leg, but also occurs in the thigh, arm, forearm and the buttock.
The calcaneus is the large spongy bone that makes the heel of your foot. Fractures of the calcaneus are rare and often devastating injuries. They occur most often when patients have a fall from a height or are in high energy car accidents. They can be associated with other lower extremity trauma and spinal injuries. A calcaneus fracture changes the shape of the back of the foot, making it difficult to wear shoes. Furthermore, severe calcaneus fractures involve an important joint in the back of the foot called the subtalar joint. The subtalar joint is very important for walking, especially on uneven surfaces.
The calcaneus is a complex bone, and surgery in this region is equally demanding. Even in the most experienced hands the complication rate is as high as 10%. Our surgeons are trained with the world's leading expert on fractures of the calcaneus, Dr. Roy Sanders. Not all calcaneus fractures are amenable to surgery. The surgeons at SOTS will help you understand your injury and whether or not surgery is needed.
A nonunion is a bone that was fractured and did not heal. There are many types of nonunions. Some bones do not heal because they were not fixed appropriately. Others fail to unite because the bone is infected, the patient is not healthy or perhaps did not follow instructions. Some examples of health risks for nonunion are vascular disease, diabetes, patients with cancer or immune diseases and especially SMOKERS! Cigarette smoke directly inhibits bone healing and has been scientifically shown to prevent healing in all types of surgery. Many patients develop a nonunion for unknown reasons. Orthopaedic surgeons can become frustrated with nonunions and their complexity. We enjoy treating these difficult problems and welcome the most challenging cases.
Nonunions often are complicated by broken hardware and deformity of the bone. This makes these procedures very complex because they require removal of hardware and deformity correction on top of the treatment of the nonunion.
Our surgeons use a methodical approach to treatment of non-unions with collaboration on the behalf of infectious diseases, hyperbaric oxygen, plastic surgery and internal medicine. Nonunion is a biological problem and requires a whole system approach. We use the latest scientifically proven technologies to tackle these challenging problems. If you have a nonunion please call our office for a consultation.
Osteomyelitis is the medical term for infection of bone. This is not an uncommon occurrence after orthopaedic trauma, particularly bad open fractures. Osteomyelitis is a strange diseases and has often been called the great imitator because of its ability to appear like other illnesses. Bone infection can lie dormant for years only to spring back into action later in life. Bone infection often results in bone loss and even amputation. There are many techniques, old and new, for salvage that the surgeons at Sonoran Orthopaedic Trauma Surgeons are capable of utilizing. We have a close relationship with the hyperbaric unit at Scottsdale Healthcare. Hyperbaric oxygen has been shown to be effective in the treatment of osteomyelitis.
We do not treat osteomyelitis associated with diabetic neuropathy or the diabetic foot.
Post-Traumatic Bone Infection
Open fractures of the tibia had a 50% mortality during the civil war of the United States. Imagine, if you had an open shin bone fracture in 1864 there was a 50% chance you would die! Modern antibiotics and surgical techniques have changed this outcome dramatically . . . but the fact still remains that a tibia fracture that penetrates the skin is a serious injury.
Humans of the 21st century enjoy exciting activities like sky diving, bungee jumping, parasailing and motorsports. Unfortunately sometimes these activities lead to life changing injuries. There are many armed conflicts happening around the globe resulting in devastating injuries of the extremities too. Open fractures that occur in high energy situations or in theaters of combat are highly susceptible to chronic infection.
The Doctors at Sonoran Orthopaedic Trauma Surgeons have significant expertise in dealing with chronically infected bones after trauma. We employee the most up to date techniques in surgical, metabolic, hyperbaric and molecular medicine. Osteomyelitis, or bone infection after trauma, is a horrible condition that in many cases is totally debilitating. Patients with these problems must seek experts like our surgeons who have extensive experience in the treatment of chronic bone infection and access to all of the necessary specialists to treat all aspects of the infection.
Often bone infection requires excision of dead and infected bone. In these scenarios, one needs a surgeons who can grow new bone through bone transport mechanisms using the method of ilizarov or modern bone grafting techniques.
The hip joint is one of the most important joints in the human body. It allows us to walk, run, and jump. It bears our body’s weight and the force of the strong muscles of the hip and leg. Yet the hip joint is also one of our most flexible joints and allows a greater range of motion than all other joints in the body except for the shoulder.
The hip joint is a ball-and-socket synovial joint formed between the os coxa (hip bone) and the femur. A round, cup-shaped structure on the os coax, known as the acetabulum, forms the socket for the hip joint. The rounded head of the femur forms the ball of the joint.
The bones of the shoulder consist of the humerus (the upper arm bone), the scapula (the shoulder blade), and the clavicle (the collar bone).
The elbow and the forearm are made up of only three bones and two joints. Half of the elbow is formed by the humerus, the lone bone of the arm. The forearm contains two bones; the radius is on the lateral side of the forearm and the ulna is on the medial side.
The elbow is where the two bones of the forearm – the radius on the thumb side of the arm and the ulna on the pinky finger side – meet the bone of the upper arm -- the humerus.
The bones of the ankle and foot form the most distal region of the lower limb in the appendicular skeleton. These bones are responsible for the propulsion, balance, and support of the body’s weight through many diverse activities, such as standing, walking, running, and jumping.
The bones of the hand and wrist provide the body with support and flexibility to manipulate objects in many different ways. Each hand contains 27 distinct bones that give the hand an incredible range and precision of motion.
The knee is one of the largest and most complex joints in the body. The knee joins the thigh bone (femur) to the shin bone (tibia). The smaller bone that runs alongside the tibia (fibula) and the kneecap (patella) are the other bones that make the knee joint.
Located in the lower torso, the pelvis is a sturdy ring of bones that protects the delicate organs of the abdominopelvic cavity while anchoring the powerful muscles of the hip, thigh, and abdomen. Several bones unite to form the pelvis, including the sacrum, coccyx (tail bone), and the left and right coxal (hip) bones.
A broken ankle is also known as an ankle "fracture." This means that one or more of the bones that make up the ankle joint are broken. Three bones make up the ankle joint: Tibia - shinbone, Fibula - smaller bone of the lower leg, Talus - a small bone that sits between the heel bone (calcaneus) and the tibia and fibula.
The femur, or thigh bone, is the longest, heaviest, and strongest bone in the entire human body. All of the body’s weight is supported by the femurs during many activities, such as running, jumping, walking, and standing. Extreme forces also act upon the femur thanks to the strength of the muscles of the hip and thigh that act on the femur to move the leg.
The tibia, sometimes known as the shin bone, is the larger and stronger of the two lower leg bones. It forms the knee joint with the femur and the ankle joint with the fibula and tarsus. Many powerful muscles that move the foot and lower leg are anchored to the tibia. The support and movement of the tibia is essential to many activities performed by the legs, including standing, walking, running, jumping and supporting the body’s weight.
The fibula is the long, thin and lateral bone of the lower leg. It runs parallel to the tibia, or shin bone, and plays a significant role in stabilizing the ankle and supporting the muscles of the lower leg. Compared to the tibia, the fibula is about the same length, but is considerably thinner. The difference in thickness corresponds to the varying roles of the two bones; the tibia bears the body’s weight from the knees to the ankles, while the fibula merely functions as a support for the tibia.
A broken collarbone is also known as a clavicle fracture. This is a very common fracture that occurs in people of all ages. The collarbone (clavicle) is located between the rib cage (sternum) and the shoulder blade (scapula), and it connects the arm to the body.
The clavicle lies above several important nerves and blood vessels. However, these vital structures are rarely injured when the clavicle breaks, even though the bone ends can shift when they are fractured.
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Our primary objective is a practice dedicated solely to complex fracture management, both acute and reconstructive. We strive to be a resource to the community to help offload orthopaedic sub-specialists who focus on arthroplasty, arthroscopy or other fields that may be disrupted by the unpredictable ebb and flow of complex trauma. We are available 24 hours a day, 365 days a year. Please call our office to speak with the trauma surgeon on call. We will help facilitate a transfer to our facility in Scottsdale if warranted. We also see patients with post-traumatic deformity and non-unions at our office. Please see our section regarding methods of payment when referring patients on an outpatient basis.