Under Pressure

In this episode, Dr. Blair joins us to talk about what limb salvage actually requires when the bone itself is gone, why he's argued there's no such thing as a "golden hour" in damage control orthopaedics, and why he thinks compartment syndrome needs to be understood as a continuous, dynamic process rather than a single moment you either catch or miss. We also get into the shift toward automation in bone transport and what changed when orthopaedic surgeons started doing their own soft tissue coverage instead of always calling plastics.____________________Dunn JC, et al. There Is No Role for Damage Control Orthopedics Within the Golden Hour, Military Medicine, Volume 187, Issue 1-2, January/February 2022, Pages e17–e21.Blair, J. A., et al. (2016). Infection and Nonunion After Fasciotomy for Compartment Syndrome Associated With Tibia Fractures: A Matched Cohort Comparison. Journal of Orthopaedic Trauma, 30(7), 392–396.

Dr. Alex Trompeter joins Under Pressure to challenge one of orthopaedics' most entrenched dogmas: the six-week non-weight-bearing rule after tibial fracture fixation. He also discusses the evidence, patient outcomes, and how modern practice is evolving.____________Visit our landing page!

What happens to the human body in the most extreme environments?In this episode, we’re joined by Dr. Scott Parazynski – physician, innovator and former NASA astronaut – for a conversation that goes far beyond the operating room. Dr. Parazynski shares insight from his time at NASA, his medical training, and his work at the intersection of tech and human performance. We discuss decision-making in high-stakes environments, how teams operate when there’s no room for error, and what clinicians can learn from spaceflight about resilience, monitoring, and pushing the limits of what’s possible.______________Visit our landing page!

Dr. Samir Mehta joins Under Pressure for a conversation on orthopaedic trauma, surgical judgment, innovation, and the evolving role of data in medicine. From teaching residents and building expertise in high-pressure environments to advancing personalized approaches for predicting fracture healing, Dr. Mehta shares insights from decades of experience in trauma care and education. We also explore how orthopaedic surgery has changed over time, what separates technical skill from true clinical judgment, and why some of the most important lessons in medicine happen outside the operating room.

In this episode, Dr. William Obremskey joins us for a discussion on how compartment syndrome actually presents in practice, the realities of surgical decompression, and the difficult scenarios surgeons rarely talk about, including what happens when a compartment is no longer viable. We also explore knee dislocations, scapula fractures, and infection prevention strategies with MSK implants.__________________Comparing the Effects of Age, Sex, and Extremity Fracture Location on Continuous Intra-compartmental Pressure (ICP) Measurements in Trauma PatientsVisit our landing page!

Acute compartment syndrome is one of the most feared diagnoses in orthopaedic trauma, yet despite decades of teaching, controversy and uncertainty remain. In this episode, Dr. Andrew Schmidt joins us for a thoughtful and refreshingly candid discussion on why compartment syndrome continues to generate anxiety among surgeons, the limitations of traditional diagnostic thinking, and how dogma, research challenges, and medicolegal pressures have shaped the field. We explore what fasciotomy truly represents, why defining a diagnostic “gold standard” remains elusive, and what the future of multimodal treatment strategies might look like.________________Visit our landing page!

When surgeons talk about compartment syndrome, the focus is often on diagnosis and surgical urgency. Far less attention is given to what happens next for the patient. In this episode, Dr. Christopher Doro joins us for a conversation on the downstream realities of acute compartment syndrome, recovery timelines, functional challenges, and the physical and psychological hurdles patients face following fasciotomy or limb loss. We also discuss real cases, the implications of false-positive pressure findings in ACS, and how multidisciplinary care impacts patients’ lives._____________________Do one-time intracompartmental pressure measurements have a high false-positive rate in diagnosing compartment syndrome?Intracompartmental Pressure Monitoring Using a Handheld Pressure Monitoring System_____________________Visit our landing page!

Trauma care doesn’t happen in a vacuum, and neither does innovation.In this episode, Dr. Jonathan Sackier sits down with Dr. Sandip Tarpada, orthopaedic trauma surgeon at Harlem Hospital Center, to explore how cutting-edge science meets real-world constraints. From his work on DNA methylation as a predictor of trauma outcomes to implementing new technologies in underserved communities, Dr. Tarpada shares what it actually takes to move the needle on patient care.Blood and Bone-Derived DNA Methylation Ages Predict Mortality After Geriatric Hip Fracture: A Pilot StudyVisit our landing page!

Pediatric trauma brings a unique set of challenges, from subtle clinical signs to children who can’t always articulate what hurts, and injury patterns that behave differently than those of adults. In this episode, Dr. Jonathan Sackier sits down with Dr. Kristin Livingston, pediatric orthopaedic surgeon at Boston Children’s Hospital and faculty at Harvard Medical School, to explore the complexity of acute compartment syndrome in kids, why it’s so different, and what makes timely diagnosis so difficult. Visit our landing page!

In this episode of Under Pressure, Dr. O’Toole takes us inside landmark studies like VANCO and PREVENT CLOT, explaining what they mean for infection prevention, VTE prophylaxis, and real-world surgical protocols. He also shares why research consortia like METRC are so critical for answering big clinical questions and discusses emerging topics like continuous compartment pressure monitoring, perfusion data, and evolving tools for trauma decision-making.VANCO Trial PREVENT CLOT_______________Visit our landing page!