UAB Insight Orthopaedics Volume 1 - Page 2

Sticks, Stones, and STORMS Will Break Bones! The UAB Orthopaedic Response to the 2011 Alabama Tornado Disaster UAB Medicine News Director Thomas R. Hunt III, MD When dozens of aggressive tornadoes struck Forearm Surgery Alabama on April 27, 2011, the UAB Division Adult Reconstruction K. David Moore, MD, section head Richard A. Sanders, MD Stuart X. Stephenson, MD Division Director Thomas Hunt III, MD, is editor of Operative Orthopaedic Trauma as assistant professor. Min earned his of Orthopaedic Surgery readied its faculty for Techniques in Hand, Wrist, and Forearm Surgery (Lippincott, MD from the University of Medicine and Dentistry of New a torrent of action. As the only Level 1 Trauma Williams & Wilkins, 2010) from the Sam W. Wiesel series Jersey and completed an orthopaedic residency at the New Center in the state, UAB Hospital expects to be Operative Techniques in Orthopaedic Surgery. The book York University Hospital for Joint Diseases and an orthopaedic called on in times of disaster. contains nearly 1,000 pages in 120 chapters by 187 contributing trauma fellowship at the University of California, Davis. He has Fa c u lty Listin g Foot and Ankle John S. Gould, MD, section head Nilesh M. Chaudhari, MD John S. Kirchner, MD Mark W. Kunkel, DPM Ashish B. Shah, MD Hand and Upper Extremity Thomas R. Hunt III, MD, section head Nilesh M. Chaudhari, MD Richard D. Meyer, MD Jean E. Oakes, MD Brent A. Ponce, MD Musculoskeletal Oncology Herrick J. Siegel, MD, section head Orthopaedic Trauma Rena L. Stewart, MD, section head Jeffrey T. Leary, MD Jason A. Lowe, MD William Min, MD, MBA Pediatric Orthopaedics J. Scott Doyle, MD, section head Michael J. Conklin, MD Shawn R. Gilbert, MD Joseph G. Khoury, MD Sports Medicine William P. Garth, MD, section head Marshall J. Crowther, MD A. Reed Estes, MD Spine Steven M. Theiss, MD, section head Firas M. Chamas, MD, PhD Donald A. Deinlein, MD Research Jack E. Lemons, PhD The action came fast and furious. In the first Hunt Edits Operative Techniques in Hand, Wrist, and Three New Physicians Join UAB Orthopaedics Faculty William Min, MD, MBA, has joined the Section of P ub l i c ations of N ote authors. It provides full-color, step-by-step explanations of many a research interest in fracture healing to complement his clinical day, orthopaedic trauma chief Rena Stewart, MD, operative procedures, focusing on mastery of techniques and practice and re ceived the Jack McDaniel AO Fellowship Award, says the team provided 58 consults, performed a thorough understanding of how to select the best procedure, through which he was able to study in Hanover, Germany. 19 major operative procedures, staffed eight how to avoid complications, and what outcomes to expect. The operating suites at one point, and utilized nearly format enables quick preoperative review of procedures, with as assistant professor. A graduate of the University of Texas every available clinical faculty member, fellow, intraoperative photographs and drawings that demonstrate how Medical School, San Antonio, he completed an orthopaedic to perform each technique. residency at UAB and a pediatric/adolescent/young adult sports and resident. “Disaster situations can bring out the best in trauma teams, and we are extremely proud of The 2011 tornado necessitated a collaborative effort by orthopaedic surgery, not only because of the number of injuries but also the complexity of many of them. Here, surgeons and others strain to align a major leg fracture. An elite U.S. Air Force Special Ops Surgical Team-Special Ops our response to these horrific tornadoes,” says Stewart. “We frequently see difficult cases, but to grossly contaminated and gangrene is imminent without early, be confronted with so many at once requires organization and aggressive surgical debridement and broad-spectrum antibiotics. planning.” Early amputation can be a life-saving procedure. Have a high Many patients had multiple fractures or crush injuries, some index of suspicion for compartment syndrome and perform early of them open wounds. Surgeons encountered major comorbid fasciotomy to release compartment pressure, particularly in non- conditions as well, some necessitating delayed surgeries or staged examinable patients. surgeries. One 18-year-old female suffered 25 injuries, including UAB Helps Air Force Develop Trauma Teams “We also learned that while older, medically, and Critical Care Evacuation Team is stationed at UAB’s Level 1 Trauma Center to help hone their medical readiness. Air Force orthopaedic trauma surgeon Jeffrey Leary, MD, and UAB’s Rena Stewart, MD, are among the members of this partnership. The AF team is based at Hurlburt Field. Lt. Col. Jon Winkler, MD, an AF trauma surgeon and team commander, says, “I performed more trauma surgeries in just a few months [at UAB] than I did during the previous year. When we deploy next, our traumatic toe amputation, foot fractures, and an open pelvic-ring immunocompromised patients are at high risk, young, healthy injury with periurethral tear. She was discharged 33 days later. patients can survive a staggering amount of trauma, recover trauma skills and team skills will be top-notch.” excellent function, and demonstrate remarkable resilience in the Reed Estes, MD, has joined the Section of Sports Medicine medicine fellowship at Children’s Hospital Boston/Harvard Medical School. He has become known for his interest in dance medicine, on which he lectured at the 2012 Alabama Dance Festival, and also has a clinical interest in pediatric and adolescent hip arthroscopy and the management of anterior cruciate ligament tears in skeletally immature patients. Firas Chamas, MD, PhD, has joined the Section of Spine Garth WP, et al. “Patellar Subluxation at Terminal Knee Extension: Isolated Deficiency of the Medial Patellomeniscal Ligament.” Journal of Bone and Joint Surgery. 2011 May; 93(10);954-962. Ponce BA, et al. “Biomechanical Evaluation of 3 Arthroscopic SelfCinching Stitches for Shoulder Arthroscopy: The Lasso-Loop, Lasso-Mattress, and DoubleCinch Stitches.” American Journal of Sports Medicine. 2011 Jan;39(1):188-94. Stewart, R, Gilbert, SR, et al. “Increasing Vascularity to Improve Healing of a Segmental Defect of the Rat Femur.” Journal of Orthopaedic Trauma. 2011 Aug;25(8):472-6. Surgery as assistant professor. He received both his MD and his PhD from New York Medical College, Valhalla. Chamas completed an orthopaedic surgery residency at Lenox Hill Total Ankle Arthroplasty Lessons learned include the following: Recognize the need for a great deal of help and call for it early. Even medical personnel face of tragedy,” Stewart says. get tired—they need to take breaks for sleep and sustenance. Tornado victims are dirty—even simple open wounds are To view a presentation on UAB orthopaedic trauma’s tornado response, visit www.uabmedicine.org/physician. Hospital, New York, and a spine surgery fellowship at Johns Hopkins University, Baltimore. UAB is one of the primary centers in the Southeast for the treatment of ankle arthritis with total ankle arthroplasty (TAA). M easures of S u c c ess Orthopaedics Operative Volume Since 1998, John Gould, MD, chief of the Section of Foot and Ankle, and John Kirchner, MD, have performed 491 TAAs, including 110 revision arthroplasties. From 2007 to 2011, they continued from front page His team has published results of a large, automated multidisciplinary laboratory, the Center for Translational performed 260 such procedures, utilizing primarily the Salto healing during distraction osteogenesis. (Proc Natl Acad screen looking for compounds with this activity. Out of Research in Surgery. In another collaboration, approximately 300,000 compounds, they have found researchers are evaluating whether the HIF pathway is of the largest in the country (averaging 52 cases annually) with and are developing two that are about 10 times more important in Perthes, the pediatric hip condition. the longest follow-up evaluations. To earlier work on insertion OUTPATIENT INPATIENT 2007 vs. 2011 Inpatient Volume increased 17.1% Talaris and the InBone prostheses. Their Salto experience is one Sci USA. 2008 Jan 15;105[2]:686-691.) 6,000 “Subsequently, we tried this same approach in routine 5,000 4,000 Outpatient Volume increased 9.6% 3,000 TOTAL volume increased 13.8% equipment design, Gould and Kirchner have added new revision fractures in mice and in bone defects too l arge to heal effective than DFO at stimulating the key HIF pathway. spontaneously in rats,” says Gilbert. “In both cases we (Bioorg Med Chem Lett. Available online 28 November the NIH to investigate pharmacologic activation of jigs for reshaping the distal tibia, recutting the posterior chamfer found that DFO increased blood vessel growth and 2011, ISSN 0960-894X, 10.1016/j.bmcl.2011.11.077.) the HIF pathway in bone healing and identification of on the talus, and remilling the anterior talar neck. “In prototype subsequent bone healing.” He is looking for other applications for these findings, Gilbert’s research has been supported by grants from molecular probes to activate the pathway, and by the phase, these advancements already have proved their worth in revision surgeries,” says Gould. 2,000 VA Medical Center Children's University Highlands 1,000 including one in collaboration with Rena Stewart, MD, Kaul Center for Research and Innovation at Children’s Metabolic Bone Disease and BioMatrix Engineering director of orthopaedic trauma. They are investigating of Alabama hospital to improve healing of segmental and Regenerative Medicine Center, now seeks to whether these drugs could improve outcomes of severe defects. The Department of Defense supports the effort to UAB Hospital acquired Highlands, a former orthopaedic hospital on the perimeter of campus, in 2006 and made it the locus of elective develop better drugs and methods of application to infected leg wounds similar to those encountered in war. promote angiogenesis in contaminated open fractures. orthopaedic surgery and outpatient visits. Orthopaedic trauma and certain other surgeries are still performed at the hospital’s main stimulate blood vessel growth and promote bone growth. For this work, they are utilizing the resources of a new Gilbert, who also is a scientist in UAB’s Center for 2 F or Ref err a l s: 1- 8 0 0 - 8 2 2- 6 47 8 0 FY 2007 FY 2011 FY 2007 FY 2011 (University) facility. Both Children’s hospital and the Birmingham VA Medical Center are physically connected to UAB. M o r e I n f o r ma t i o n : u a b m e d i c i n e . o r g / p h y s i c i a n 3