Under Pressure

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.

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Comparing the Effects of Age, Sex, and Extremity Fracture Location on Continuous Intra-compartmental Pressure (ICP) Measurements in Trauma Patients

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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.

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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.

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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 Study

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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.

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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

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In this episode of Under Pressure, host Dr. Jonathan Sackier speaks with Mr. Dafydd “Taff” Edwards, Consultant Orthopaedic Trauma Surgeon, Clinical Director, and former Army surgeon whose career spans conflict zones, UK major trauma centres, and cutting-edge elective upper limb surgery. Mr. Edwards shares powerful real-world experiences, from managing polytrauma patients in austere environments to leading teams at one of the busiest trauma centers in the UK, and dives into the evolving role of continuous pressure monitoring, training the next generation, and what it takes to make the right call when seconds count.

Award-winning journalist and pilot Miles O’Brien has spent over three decades bringing science, space, and technology stories to the public through CNN, PBS NewsHour, NOVA, and more. In this episode of Under Pressure, Miles shares his remarkable career journey, from covering shuttle launches to flying planes, and the story of how a seemingly minor injury turned into acute compartment syndrome, ultimately costing him his left arm.

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Follow Miles' Podcast on Spotify: Miles To Go

In this episode, Dr. Jonathan Sackier sits down with Dr. Jeff Gadsden, Professor of Anesthesiology and Chief of Orthopedic, Plastic, and Regional Anesthesiology at Duke University Medical Center. Together, they explore the ongoing controversy around using nerve blocks in patients at risk for acute compartment syndrome, the importance of timing and pressure monitoring, and how technology is reshaping the safety profile of these interventions.

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Read the studies discussed in this episode:

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In this episode of Under Pressure, host Dr. Jonathan Sackier sits down with Dr. Niloofar Dehghan, orthopaedic trauma surgeon, educator, and research powerhouse. From her pioneering work on weight-bearing protocols and flail chest fixation to her leadership in randomized trials and DEI initiatives, Dr. Dehghan shares what it means to challenge norms, both in and out of the OR. We cover the fundamentals of compartment syndrome, the evolving role of continuous pressure monitoring, her vision for a more inclusive future in orthopaedics, and the mindset needed to lead through evidence.

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Read the study reviewed in this episode:

Operative vs Nonoperative Treatment of Acute Unstable Chest Wall Injuries: A Randomized Clinical Trial

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In this episode of Under Pressure, Dr. Jonathan Sackier is joined by Dr. Charles Moon, Director of Orthopaedic Trauma at Cedars-Sinai Medical Center. Educator, researcher, and surgeon, Dr. Moon shares how structured protocols and objective data are transforming compartment syndrome diagnosis — and improving trauma care at every level.

Whether you’re in trauma surgery, acute care, or just curious about how innovation actually gets adopted in high-stakes medicine, this one’s for you.

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In this episode of Under Pressure, host Dr. Jonathan Sackier welcomes Dr. Hans Van Lancker, Network Chief of Orthopedics at Cambridge Health Alliance, to discuss how standardization, data, and real-time monitoring are reshaping the future of trauma care. From protocolized pathways in compartment syndrome to cutting length of stay by 150%, Dr. Van Lancker shares actionable strategies for improving patient outcomes while scaling system-wide efficiency.

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In this episode of the Under Pressure podcast series, we're joined by Pr. Mohamed (Mo) Imam, Consultant Trauma, hand, wrist, and upper limb surgeon at Rowley Bristow Orthopaedic Unit, Ashford and St Peter’s Hospitals. Pr. Imam discusses his pioneering work in digital health, his experience with sports medicine, and how various technologies can improve clinical care.

Read the paper reviewed in this episode:

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In this episode of Under Pressure, host Dr. Jonathan Sackier sits down with Charles Allan, founder and CEO of MY01. From growing up in an entrepreneurial family to launching a groundbreaking medical device, Charlie shares the full origin story of MY01 and the journey of bringing continuous pressure monitoring to life. Tune in to hear lessons learned, challenges faced, and what the future holds for medtech innovation.

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Welcome with us Pr. Peter Giannoudis, Professor and Chair of Trauma and Orthopaedics at the University of Leeds. With over 800 peer-reviewed publications, Pr. Giannoudis is a leader in orthopaedic trauma research and clinical practice. We’ll be discussing his latest study on risk factors for acute compartment syndrome, insights into treating open fractures, acute bone loss, and the impact of compartment syndrome in athletes. Join us as we explore how his passion for running ties into his research on trauma and compartment syndrome.

Read the article discussed during this episode:

Risk factors for acute compartment syndrome in one thousand one hundred and forty seven diaphyseal tibia fractures

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Join us for a captivating conversation with Mr. Ash Vasireddy, orthopedic and trauma surgeon at King's College Hospital and Cleveland Clinic London. Mr. Vasireddy shares insights on improving trauma care through lessons from aviation, the complexities of diagnosing compartment syndrome, and the role of patient education apps in reducing complications. Listen in on an in-depth discussion, practical guidance, and innovative perspectives on enhancing trauma care.

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In this episode of Under Pressure, we are joined by Angie Chisolm, President and Managing Partner of Optimal Healthcare Advisors. With a deep background in trauma program management and healthcare consulting, Angie brings her expertise to the forefront as we explore the complexities of trauma care. We'll dive into the leading causes of trauma-related deaths, the impact of funding on care quality, and how performance improvement initiatives can help reduce costs and improve patient outcomes. Don’t miss this insightful conversation!

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In this episode of the Under Pressure podcast, host Dr. Jonathan Sackier sits down with Dr. Mark Slaughter, a leader in cardiovascular and thoracic surgery. Dr. Slaughter shares insights on ECMO (Extracorporeal Membrane Oxygenation) and its role in managing limb ischemia, especially in high-stakes situations involving critical care and trauma. They discuss the challenges of early detection in compartment syndrome, the importance of continuous monitoring, and how proactive approaches can transform patient outcomes.

Read the article discussed during this episode:

⁠⁠Proactive or reactive? Best approach to limb ischemia in peripheral venoarterial extracorporeal life support⁠⁠

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Explore the nuanced debate surrounding peripheral nerve blocks (PNB) in trauma anesthesia with Dr. Richard Dutton. As a distinguished expert in critical care anesthesia, Dr. Dutton delves into the effectiveness and potential risks of PNB, especially in patients at risk for compartment syndrome.

Read the paper discussed during this episode:

Pro-Con Debate - Peripheral Nerve Blockade Should Be Provided Routinely in Extremity Trauma, Including in Patients At Risk for Acute Compartment Syndrome

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Dive into the realms of data science, machine learning, and their impact on surgical care in this riveting episode. Our guest, a seasoned data scientist with a unique background in pharmacy, epidemiology, and biostatistics, shares insights on the intersection of data, technology, and trauma care.

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Dive into the latest breakthroughs in basic science and acute compartment syndrome (ACS) research with our insightful podcast series!

Discover why continuous pressure monitoring is crucial for early detection and explore paradigm-shifting findings in ACS epidemiology.

Compartment Pressure Monitoring Instructions:

https://youtu.be/sX3dcjW6TwA

Comparison of Three Devices to Measure Pressure for Acute Compartment Syndrome:

https://my01.showpad.com/share/SrcXTc0tMJUzhWh6ciZ33

In collaboration with the Orthopaedic Trauma Society (OTS), this insightful session features esteemed faculty members who will explore the latest advancements in compartment syndrome diagnostics and management.

Speakers:

Moderator: