Specializing in complexity: Trinity surgeon brings new orthopedic expertise to Minot

Jill Schramm/MDN Dr. Cody Pehrson holds a model of a pelvis in explaining the complexities of traumatic pelvic and acetabular surgery.

Complex bone fracture surgeries are Dr. Cody Pehrson’s specialty. Recently joining the orthopedic staff at Trinity Health, Pehrson brings an expertise that’s new to the area with his fellowship training in orthopedic trauma.

“That’s my passion. That’s what I enjoy doing,” he said.

Pehrson, who also has introduced anterior hip replacement to Minot, is giving area residents options that enable them to stay closer to home for their medical care.

Previously, Trinity had referred patients to other centers, often in Minneapolis, when they presented with trauma-related fractures to the pelvis or acetabulum, the cup where the femur meets the pelvis. Trauma might result from a vehicle crash or major fall, such as might occur with oil field or sports and playground injuries, although an elderly person might sustain a traumatic injury from less force.

Unless trained in trauma, orthopedic surgeons typically do not want to address these injuries because of the complexity with larger blood vessels and other factors that make the surgical approach into the pelvic region difficult. Pehrson describes it as “recreating a structure you can’t see, through deep, dark holes with a lot of dangerous structures surrounding it.”

His role as a trauma-trained surgeon is to bring bones back into anatomical alignment and stimulate healing without sacrificing all the surrounding structures that allow healing to take place, he said.

He developed an appreciation and interest in trauma care from exposure during his residency in a busy hospital in Fresno, Calif. He concluded he would not be bored in providing trauma care. He went on to complete his Orthopaedic Trauma Fellowship with Sonoran Orthopaedic Trauma Surgeons in Phoenix, Ariz., where he provided orthopedic trauma care at the four Level I trauma centers in the Phoenix area.

“Everything is different. No two fractures are the same,” he said. “I prepare for each case. I plan on fixing each fragment of each fracture in a different way. You use basic concepts for each fracture, but that’s where the art of medicine comes in – to try to recreate anatomy from the broken pieces of a puzzle.”

Pehrson also trained in Phoenix in reconstructive and revision surgery of the hip, with an emphasis on using the anterior approach.

“What makes the anterior approach different is it’s more of a muscle-sparing approach. In order to access the hip from the back or the side, you actually have to release muscles from their origin or insertion,” Pehrson said, explaining the frontal approach leaves muscles intact by going between them.

Studies show reduced post-operative pain and enhanced early mobility with the anterior method, he said. His goal is to have patients walking the same day as surgery and walking out the door the next day.

“Another benefit is that it does not have the same precautions that the other approaches have,” he said. “Those precautions being certain positions that put yourself at very high risk for dislocation. The anterior approach has a lower dislocation rate long-term. I find that to be very helpful for patients not to have to worry about the position they are in.”

From a technical standpoint, he appreciates that he can assess the placements of implants using fluoroscopy, a type of medical imaging that shows a continuous X-ray image on a monitor, much like an X-ray movie. It gives a high sense of accuracy to the procedure.

Pehrson is trained in each of the different hip replacement approaches and can perform the other surgery types when necessary. For instance, the anterior approach is more difficult with morbidly obese patients because of a higher risk of infection so a different approach is likely to be used.

Each of the various procedures for replacing hips result in the same functional outcomes in the long term, Pehrson said.

“The other approaches are great. They are standard approaches that are utilized all over the country still. The anterior is also becoming more and more common,” he said.

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