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.
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