D E F I N I N G
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The prison of discomfort
oseph Fernandez-Moure wants to free you. He wants to get you out of jail. But he’s not baking a cake with a file in it; he wants to get you out via injection. So, no, he’s not talking about the I’ve-committeda-crime jail, of course. The metaphorical jail this trauma surgeon is talking about comes from the limitations people face when they suffer one of the least-studied injuries people encounter: rib injuries. “A lot of people have become really complacent with rib care, saying we have nothing to offer,” he says. “I refuse to accept that as an answer for anything in this modern age of surgery.” You can’t splint a rib injury—the patient wouldn’t be able to breathe. And invasive surgery to implant a plate or screw, except in the most extreme cases, is often more traumatic than the injury itself. So, often physicians, at a loss for what else to do, prescribe pain-management techniques and send patients home: It’ll feel better in a few months. “But people don’t have six months to be jailed up for. Because rib fractures are like a jail sentence at times,” says Fernandez-Moure, a trauma specialist and assistant professor of surgery at Duke School of Medicine. More serious rib injuries may require hospital care because of extreme pain, possibly resulting in drug dependence. And much like spinal injury, “rib injury impairs people significantly when they get home.” Breathing is hard; picking up a child or bag of groceries is hard; twisting for shower or bathroom care is hard. “So I have envisioned my role as trying to give people back their function. It’s serendipitous that freedom is the word selected, because you’re really giving people back the freedom of mobility, the freedom to go home.” With his partner-scientist Matthew Becker, Hugo L. Blomquist Distinguished Professor of chemistry, he’s working on a project to free rib-injury patients from their prison of immobility and discomfort. The project involves the development of an adhesive that can be injected into ribs to stabilize fractures, both to decrease pain and to improve healing.
Becker had done research into an adhesive based on a material produced by the caddisfly larvae for use underwater. The adhesive doesn’t impair cell functions and shows possibility for use in bones. They’re currently at work “to optimize its mechanical and biological functions to target fractures”—so that it can eventually be injected into fractured ribs, where it would stabilize them as they naturally heal. “The next steps will be testing it on stem cells to understand whether it will allow for cell osteodifferentiation.” That is, to make sure that the cells in the area of the adhesive can turn into bone cells. Next will come testing in an animal model, and then ultimately testing on people. “But again, not a lot of [researchers] are in this space. Most people focus on long bones. Because for the longest time, everyone was like, ‘You can’t do anything about ribs. Why do you want to focus on them?’ There isn’t a lot of study that has been done on it from a mechanical standpoint.” There’s a long way to go, but he is hopeful he and Becker will make progress and that, within a decade, doctors will be able to inject an adhesive into your fractured ribs, and you’ll be able to breathe and rotate and pick up your kids while you heal. For more severe cases, he’s also at work on ways to apply the screws and stabilizers without having to perform major surgery. “We can do thoracoscopic surgery,” he says: small incisions in the chest, through which the lab is designing special tools that will allow surgeons to, say, turn screwdrivers in any direction. Not unlike the tools you wish you had when you’re working under the sink, only for inside the chest of someone with severe rib injuries. Those tools, too, will take several years before they’re ready for use, but anything that diminishes the sentence of people with rib injuries is, for Fernandez-Moure, a win. “If I tell someone who relies on working with their hands that they can’t do that anymore, and it’s gonna take them six months to get back to normal,” he says, “you’re taking food off people’s plates. That to me is completely unacceptable.”—Scott Huler
It’s serendipitous that freedom is the word selected,
40 www.dukemagazine.duke.edu
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