2010 Alumnus of Merit

Orthopedic surgeon did it his way and set the standard for trauma care

Dr. Sigvard “Ted” Hansen Jr. ’57

As Dr. Sigvard “Ted” Hansen Jr. ’57 extolled the virtues of the late Whitman biology professor Dr. Art Rempel — “the greatest guy I ever knew and such a great teacher” — he paused in mid-thought.

“Maybe. Subconsciously. Everything I’m talking about I learned from him.”

Hansen, a pioneering orthopedic surgeon lauded as the “father of traumatology” and the Alumni Association’s 2010 Alumnus of Merit, was describing Rempel’s keen powers of observation and knowledge of every bird and every plant, and recalling with fondness class trips to Malheur Lake. Dr. Rempel “was not the classic scientist; he was absolutely honest, and that was his basis for everything,” Hansen said.

Hansen doesn’t consider himself a “classic scientist” either. Or much of an academic, for that matter, although by definition he is a pioneer in the study of wounds and injuries caused by accidents or violence. And just as Rempel mentored and inspired generations of young Whitties, Hansen has guided generations of young doctors in his roles as a University of Washington School of Medicine professor of orthopedics and a Harborview Medical Center trauma, foot and ankle surgeon.

“I’ve gotten by just fine doing things my own way,” said Hansen, a farm boy turned Navy doctor, then orthopedic surgeon. “People shake their heads, but I’m totally objective and observant and critical of my own work.”

Take research, for example: A proponent of the “lies, damn lies and science” view of research, he finds little appeal in drawing conclusions from artificially created circumstances. Why break a rat’s leg to see what happens when a leg breaks? “What the hell does that mean?” He believes valuable knowledge can only come from studying what actually happens when a human breaks a leg or gets hit by a truck, and by documenting how the body reacts to that specific circumstance and how the patient responds to specific treatment.

Administration isn’t high on his list of favorite things to do either, despite his having served for decades as orthopedic chief of service at Harborview and a department chair at UW. “Sitting in meetings when I could be outside or operating becomes more unbearable with each passing year.”

Hansen is more of an up-to-your-elbows-in-it kind of guy, whether he’s building an industrial-strength wall and terracing the bluff below his Puget Sound home or using his revolutionary techniques to reconstruct a mangled ankle in the operating room at the Sigvard T. Hansen Jr. M.D. Foot and Ankle Institute.

Concrete, he enthuses, has a chemical composition like bones. “I love concrete and bones equally.”

He also loves to perform surgery, a realization that dawned in the midst of his rotating internship at Harborview. “It was the first time I realized I had chosen the right field.”

An engineer in scrubs

Hansen wanted to be an engineer. He enrolled in Whitman’s 3-2 program (three years at Whitman followed by two at a graduate school). The high school math whiz encountered his first taste of math theory at Whitman.

“I like to deal with what I can touch and feel and see,” he said. So out with the theoretical math and in with Dr. Rempel’s natural history course, which changed Hansen’s own life course to biology and pre-med. This development thrilled his mother, Beverley Means Hansen ’29, who always wanted him to be a doctor. Her son was less enthusiastic. His first childhood experience with a doctor involved his tonsils, his uncle’s doctor’s office and ether. “I hated the smell of ether,” he said. And he wasn’t wild about being a doctor.

Still, in the 1960s few people were applying to medical school, so he enrolled. To his great satisfaction, he learned he could employ his engineering interest and abilities there, too. “The feet are the most interesting part of the body from an engineering standpoint,” Hansen said. “My grandmother had the most god-awful feet, and a friend in high school had club feet, so I was always interested in feet.

“Trauma, and foot and ankle surgery were two areas of focus that nobody at that time seemed to be interested in. I found out early that I could operate; it’s an easy thing for me. These two areas had the longest way to go in modern advancements.”

An internship in England working at a hospital that specialized in congenital paralysis in children — mostly related to feet — fueled his passion to specialize in foot and ankle surgery. “It was fascinating. Muscles, essential motors and just moving the motors around until you get the right balance.”

The years that followed at Harborview cemented his reputation as the “father of traumatology”; although, that distinction wouldn’t come until much later.

“We were just beginning to treat trauma patients aggressively in the early 1970s,” Hansen said. “With the advent of Medicare and Medicaid, county hospitals thought they might not survive because patients could go to private hospitals.” To stay competitive, Harborview started the first paramedic program in Seattle, and suddenly Hansen and other doctors were faced with ambulances rolling up to the door with patients who had suffered severe trauma, people who before would never have made it to the hospital. This, coupled with the arrival of prophylactic antibiotics and Hansen’s meteoric rise to the position of chief of orthopedic services, set the stage for radical changes in trauma care.

“Wild things” are in the eye of the beholder

Hansen’s confidence and creativity in the operating room grew exponentially during his military service and residency. He was pretty much left to his own devices during a three-year tour of duty in the Navy, primarily as medical officer in charge at the Naval Ammunition Depot Dispensary in Lualualei, Oahu. The district medical officer later explained that he never checked up on Hansen because visits usually followed complaints, and no one ever complained about the young doc. Hansen, meanwhile, didn’t feel like he was busy enough, so he offered extra clinics, including the first to offer birth control on the island.

After his Navy service came four years of orthopedic residency at Harborview and a stint at Shriner’s Children’s Hospital in Spokane, Wash. Years of experience honed his surgical skills, but more importantly, taught him to trust his own judgment. “Instead of doing what I knew I was supposed to do, I did what I thought I should do.”

Of course, doing what he thought he should do landed him on probation “a lot” during orthopedic residency, but none of his patients were any the worse for his nonstandard surgical techniques and treatments, “so instead of kicking me out, the chairman of the orthopedics department hired me on the UW faculty.”

Hansen became chief of orthopedic surgery at Harborview soon after. He approached the new challenge of trauma care much like he had run the family farm outside Spokane as a teenager. Dad was a high school principal, football coach and athletic director with little time to spare, so Ted manned the plow and found creative ways to keep the temperamental farm machinery running.

The lessons learned on the farm, and later as a star nose guard on the Whitman football team, proved instrumental in Hansen’s ability to deftly maneuver through deeply entrenched medical dogma. To do so, he employed cutting-edge equipment and tools pioneered by the Swiss and Germans and not yet in use in the United States. And he tried what some considered “wild things” in the operating room. He developed creative, aggressive — and, at the time, controversial — techniques that would eventually be considered the gold standard in trauma care.

Put a metal rod into an open fracture?

The Doctor's In

“Cheap high heels are better for your feet than flats.”

It’s long been thought that high heels damage a woman’s feet, says orthopedic surgeon Dr. Ted Hansen ’57.

Not so.

“If you take a look at history, women wear high heels — aside from cosmetic reasons — because they feel better.”

It helped that Hansen and others took advantage of new hardware being developed by Swiss doctors who were “working on a system of internal fixation. We got some of their equipment early on. In addition to plates and screws, they gave me a set of special instruments to use.”

“Thought to be total malpractice,” Hansen said.

Standard practice was to cast, splint and traction a patient’s bones, then leave the patient in bed until he healed. Metal rods in open fractures equaled serious infection, or so conventional wisdom held.

Hansen tried something new. He began operating on patients shortly after they arrived in the emergency room. “Based on my theory of evolution — which I learned at Whitman — the skeleton is there to protect soft tissues. If you have a severe crush, the best thing is to re-establish the skeleton. If you can get inside and repair the bones, then the soft tissue is immediately protected.” Ultimately, this new procedure proved “exceptionally safe,” and patients healed faster and more anatomically.

Being a pioneer can be a pain

Hansen’s heretical techniques created more than a little consternation among surgeons in the American Academy of Orthopaedic Surgeons, whose members, Hansen said, at one time considered booting him out. In the late 1960s, “I would be on panels with guys 10 years my senior, very famous surgeons,” Hansen said. Their antagonism toward his techniques was clear, and fairly long-lived. It was the mid-1980s before one of these same surgeons, when asked if he were to break his leg skiing, where would he want it to happen, answered “Snoqualmie Pass, so they’d take me to Harborview.”

During the 1980s, Hansen’s surgical techniques and trauma treatments began to gain favor. The academy selected him as a junior member of its board and asked him to head a committee on trauma. “They were beginning to realize that trauma care was a really big deal.”

In a 1981 letter in support of an alumni award for Hansen, Dr. Rempel noted with pride his pupil’s achievements. “Sig is clearly an artist in the performance of his operations, and he also has a deep commitment to his patients. Not only has Sig’s approach now become standard procedure at the University of Washington, but students come from far and wide to learn this new technique and procedure.”

Hansen’s willingness to look outside the United States for surgical solutions garnered him what he considers his greatest career honor, the Swiss AO Foundation’s Award for Innovation in 2006, its lifetime achievement award. “Even though they thought I was a little wild, too, they were more prone to agree very quickly that what I was doing was right,” Hansen said. He is one of a few lifetime members of the foundation, through which he has “met all kinds of fantastic people and been invited to teach and operate all over the world.”

Among his other accolades: In 1994, the Sig T. Hansen Jr. Endowed Chair for Traumatology Research was dedicated at UW; in 1997, Whitman awarded him an honorary doctor of science degree; in 2000, Harborview dedicated the Sigvard T. Hansen Jr. M.D. Foot and Ankle Institute. It is there that he continues to operate on patients with challenging foot and ankle issues — the waiting list is long — and to mentor orthopedic residents in sought-after fellowships.

Hansen, a Whitman overseer emeritus, and those he has trained are mentors to the next generation of foot and ankle surgeons around the world. Medical school faculty teach the theories and techniques he pioneered.

Still, the “father of traumatology” sees his son, Dr. Eric Hansen ’85, as his greatest legacy. Eric quite literally followed in his father’s footsteps: After earning his medical degree from UW, he served in the Navy, becoming an orthopedic surgeon and practicing in that field while in the Navy and after. Later, he did a fellowship with his father for further study of the foot and ankle.

Taking care of the Whitman family

While the elder Dr. Hansen’s work continues to be in high demand in the surgery suite, today he is less focused on pioneering new techniques and more on using his perfected craft to improve the quality of life for patients other surgeons have turned away. His colleagues honored him for this work in February 2010 with the Mission of Caring Award at the UW Medicine Salute Harborview Gala.

Jim and Joan Fegan Coulson ’57

His Whitman classmate Sheila Bird Ralston ’57 nominated him for the Alumnus of Merit award. And in a 2009 letter in support of that nomination, Joan Fegan Coulson ’57 shared her personal testament to Hansen’s compassion and surgical skill.

At the Class of 1957’s 50th reunion in May 2007, Hansen noticed that Coulson’s husband, Jim, was wearing an unwieldy cast.

In her letter, Joan described her husband’s condition:

“Jim and I had been married 48 years and during the last 10 years, he had developed diabetes. One of the side effects was Charcot fractures — fractures in the feet when the bones turn soft or like cottage cheese, become misaligned and often lead to amputation. During the last three years he had had an open sore on the bottom of one of his feet where one of the bones had protruded through the bottom of his foot. He needed to wear a very large, heavy plastic boot that held his foot in suspension. The dressing was changed daily, and he had been on crutches and in and out of a wheelchair several times. Our biggest fear was the wound becoming infected — it was sure to mean amputation.”

During a reception at the reunion, Hansen inquired about Jim’s foot. “I was really surprised,” Joan wrote. “He had never met Jim, and I had only seen Ted at a couple of Whitman gatherings. What followed was an incredible experience.”

Hansen, moved by empathy for Joan, who had to dress the wound daily, and Jim, who faced the almost inevitable loss of his foot if the condition wasn’t resolved, asked the couple to go to dinner with him and his wife, Dalia. At dinner, Hansen suggested a plan to move forward with “fixing” Jim’s foot.

“Every doctor we had talked to about Jim’s foot knew Dr. Hansen, and every podiatrist we had ever seen in past years had studied under him,” Joan wrote. “But no one was willing to undertake an operation rebuilding the foot of a diabetic who had no feeling in his feet and an open wound.”

“A lot of surgeons don’t like to do this type of surgery,” Hansen acknowledged. “It’s medically legally risky and hard to do. But if you do anything enough, it’s not very hard anymore. For most patients, I’m a last resort. I have operated on people from all over the country. These patients get in line and wait. Often, several doctors have already told them nothing can be done.

“Before I know others have turned them down, they ask me if their problem can be fixed.

“I say, ‘Yeah, sure.’

“It’s simpler for me because I’ve done it a lot and I have lots of help” from a talented operating team he has worked with for many years and young orthopedic residents “eager to see these things and learn.

“Some surgeries don’t work, and the patients are back where they started. But 80 to 90 percent of the time, they live a much better quality of life.”

The Coulsons happily fall into the latter category. Jim’s foot is completely healed and “the quality of life for both of us is as good as it gets,” Joan wrote. Since the operation, they have traveled extensively. In a recent update, Joan said that Jim continues his woodturning hobby and even began teaching in his spare time.

Joan, eternally grateful to her classmate, sums up Hansen’s life work this way: “His dedication to helping folks regain their mobility and his caring and professionalism have gained him worldwide recognition, as an example of the best of the best orthopedic surgeons, and a true humanitarian.”

— Lana Brown