Dr. Tarkin

Dr. Ivan Tarkin, Chief of Orthopaedic Traumatology at UPMC discusses the collaborative and cutting-edge approaches to treating patients dealing with everything from simple fractures to complex traumatic injuries.

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– [Presenter] This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider. From simple fractures to complex injuries, offering new advancements in care. Welcome to the UPMC HealthBeat Podcast. I’m Tonia Caruso, and joining us right now is Dr. Ivan Tarkin. He is the chief of Orthopaedic Traumatology at UPMC. Dr. Tarkin, thanks for joining us.

– It’s my pleasure.

– Doctor, so let’s begin there. What exactly is orthopaedic traumatology?

– An orthopaedic traumatologist takes care of people with injuries of the lower extremities, upper extremities, pelvis, and hip socket. Most commonly we take care of fractures, but we also take care of patients who need post-traumatic reconstruction, meaning people who have nonunions, bones that have failed to heal, malunions, when someone heals crooked, or when someone has arthritis from a fracture which involves a joint.

– And so UPMC’s orthopaedic unit consistently ranks top in the country among the top hospitals. And why would you say that is? Talk about the multidisciplinary approach

– We take incredible pride in taking care of the patient with both simple and severe musculoskeletal injury, injuries to both the bone and joints. We have a team which is innovative, meaning that we perform both translational and clinical research to be able to figure out what is the best way to treat any individual injury. Further, we don’t work in isolation; we work as a huge team. We emphasize overall wellness of the patient. When the patient is well, they heal faster, and certainly they rehabilitate much better.

– Who might be some of those other people around the table when you are talking with a patient and coming up with an approach to care?

– It depends on the individual patient. All care is suited towards that individual person and their specific injury pattern. So for instance, if a patient has multiple medical comorbidities, we certainly get the internal medicine doctors involved. If the patient needs help with their nutrition, we get the nutritionist involved. Certainly a fair amount of the patients we treat have other injuries, and the general trauma surgeons may be involved. There’s sometimes soft tissue components to the fractures that we see, and we always need a plastic surgeon in that regard. So we really bring in anyone necessary to make that patient well and whole to promote best outcomes for any individual patient and/or injury.

– And part of being connected with a university and a research hospital is that there are always new advancements in care. And talk a little bit about that, beginning with the commitment to that.

– So certainly the goal, the mission of the orthopaedic trauma service, is to vastly improve the outcomes after both routine as well as complex orthopaedic trauma. As the years go by, we use different techniques. We study them intensely, both from a translational research standpoint, as well as clinical research, and we’re always striving to do our best year after year and improve outcomes as time goes on. When a patient makes an appointment with an orthopaedic trauma doctor, typically their presentation is straightforward. They have a fracture or a significant joint injury, and their pain is severe. In terms of a lower extremity injury, they would have a very difficult time walking, and an upper extremity injury, certainly they would have an equal amount of pain and dysfunction. Certainly for the pelvis and hip socket fractures we see, usually those patients are coming in through the ER just because of the severity of their injury.

– And what about when it comes to joint replacements? Knee replacements, hip replacements, what are typically the symptoms, or when do you say to folks it’s really time to come in for a consultation?

– So certainly in the world of orthopaedic trauma, we’re taking care of folks who have arthritis in the setting of having a previous injury. So perhaps you had a hip socket fracture, and now you have hip arthritis. You had a significant knee fracture, and now you have knee arthritis. You had an ankle fracture or a fracture of the shin bone down by the ankle, and now you have significant disabling arthritis. Certainly if you’re very disabled, that would be a time to come into the office to get evaluated, and hopefully we’d have a treatment option which would suit you best.

– So let’s talk now a little bit about treating patients in the middle of COVID-19. And I guess in the beginning, when cases first began to emerge in western Pennsylvania, we were sort of dialing things back a little bit, correct?

– Safety is our first priority. And certainly during the COVID-19 pandemic, we’re very careful about what patients we want to either see in the office or certainly take care of in the hospital. As an orthopaedic trauma doctor, there were just cases that could not wait. So someone who had a severe fracture who was involved in a bad motor vehicle accident, for instance, we would take care of all those patients and certainly take all the necessary precautions. But also, as I mentioned at the beginning, an orthopaedic traumatologist also takes care of people with sometimes chronic conditions, such as a post-traumatic nonunion, the bone didn’t heal; a post-traumatic malunion, the bone healed crooked; or alternatively, a joint fracture that went on to arthritis. For those patients who need pseudo-elective surgery, we asked them to wait until we saw exactly how safe it would be to be in a hospital during this pandemic.

– And now we’re at a time where we are saying to patients, come back in. And why is that?

– Well, there are certain people who just need care, who are suffering, who have severe debilitating pain and dysfunction, secondary to a chronic musculoskeletal condition, a problem involving the bone or the joints.

– And so then let’s tell people a little bit about the safety precautions that are in place.

– We protect the patients and ourselves using personal protective equipment. We have liberal screening at the hospital, as well as increased availability of preoperative testing. And certainly we’re always respecting social distancing.

– Right. And really, we started out talking about how all the care is individualized, and even more so in this case, you do have conversations with patients before they come in and on a case-by-case basis, decide who should come in for care.

– For those patients, which are especially vulnerable, we’re attempting to provide telemedicine and other remote services to try and ease their suffering and their conditions without bringing them into a hospital. But those who do come in, as you mentioned, is screening right off the bat and actually you do testing before any procedure, correct?

– We’re making sure that that patient gets tested so we can A, prove that that patient is safe to undergo anesthesia and have a procedure, but also to protect the other patients we have in the hospital.

– And so then finally, what is your message to patients about getting their health care back on track?

– It’s becoming safer to come into the hospital to have surgeries which have a level of urgency. And while you’re, before you reach this hospital and certainly while you’re in the hospital, we take every precaution to make sure that your care is both safe and effective.

– Dr. Ivan Tarkin, thanks so much for your time today. We certainly do appreciate it.

– It’s my pleasure. I’m Tonia Caruso, thank you for joining us. This is UPMC HealthBeat

Editor's Note: This article was originally published on , and was last reviewed on .

About UPMC Orthopaedic Care

When you are dealing with bone, muscle, or joint pain, it can affect your daily life. UPMC Orthopaedic Care can help. As a national leader in advanced orthopaedic care, we diagnose and treat a full range of musculoskeletal disorders, from the acute and chronic to the common and complex. We provide access to UPMC’s vast network of support services for both surgical and nonsurgical treatments and a full continuum of care. Our multidisciplinary team of experts will work with you to develop the treatment plan that works best for you. Our care team uses the most innovative tools and techniques to provide better outcomes. We also are leaders in research and clinical trials, striving to find better ways to provide our patients care. With locations throughout our communities, you can find a provider near you.