On the Team that Never Sleeps

Duke orthopaedic surgeon David S. Ruch, MD, specializes in the repair of hands and arms and is part of a trauma team that's always available.

What does it mean for Duke to have a Level 1 trauma service?

Level 1 refers to the fact that we get transfers of the most critically injured patients from all over the country at any time day or night, 365 days a year. Duke's orthopaedic trauma program is a key component of our level 1 care services.

What are your biggest concerns when it comes to repairing severed or highly damaged extremities?

The timing is critical. The injured extremity is often without any blood supply, and irreversible damage occurs with the passage of minutes. Duke is one of a handful of centers in the country that offer 24-hour coverage seven days a week. Thus, we receive patients from all over the eastern half of the United States.

David S. Ruch, MD

What is microscopic surgery and when is it used?

In the treatment of degenerative conditions or the repair of severed or damaged extremities, we're mending not only the limb itself but the delicate blood vessels and nerves. The use of the operating room microscope allows the surgeon to see these vessels and nerves, which could not be repaired with normal vision. The stitches used to make these repairs are literally smaller than your eyelashes, and some are impossible to see without magnification.

What are the advantages to the patient of minimally invasive surgery?

Hand surgeons at Duke have learned that in some cases the size of the incision used to repair a problem can directly affect the amount of time that it takes a patient to recover from the surgery. The use of the arthroscope, which relies on small incisions, allows the surgeon to obtain the same results as with a large cut, thereby minimizing the time away from work and sports.