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Access Statistics 2013 | July-June | Issue 1


Cameron Ledford MD, Grant E Garrigues MD, Robert D Fitch MD

Ilizarov: The Man, The Myth, The Method: An Orthopaedic Inspiration

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:104-107]


There are many orthopaedic pioneers whose impact continues to live on today, teaching us valuable lessons, inspiring us to greatness, and touching the lives of generations of future patients. Professor Ilizarov, a nonsurgically trained general practitioner, represents such an important orthopaedic forefather for his instruction on how to grow bones and soft tissues that would otherwise face catastrophic deformity and dysfunction. A simple look at his life, his innovation, and astonishing legacy serves as an inspiration to all involved in the amazing field of orthopaedics.

Keywords: Gavril Ilizarov, Distraction osteogenesis, External fixation.

How to Cite: Ledford C, Garrigues GE, Fitch RD. Ilizarov: The Man, The Myth, The Method: An Orthopaedic Inspiration. The Duke Orthop J 2013;3(1):104-107.


Stephanie W Mayer MD, Patrick W Joyner MD, Louis C Almekinders MD, Selene G Parekh MD MBA

Stress Fractures about the Foot and Ankle in Athletes

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:8-19]


Stress fractures of the foot and ankle are a common problem encountered by athletes of all levels and ages. This review summarizes the history and physical exam findings, radiographic imaging, diagnosis and treatment of stress fractures of the foot and ankle in those participating in athletic activities.
These injuries can be divided into low- and high-risk based upon their propensity to heal without complication. A wide variety of nonoperative strategies are employed based on the duration of symptoms, type of fracture, and patient factors such as activity type, desire to return to sport and compliance. Operative management has proven superior in several high risk types of stress fractures. Evidence on pharmacotherapy and physiologic therapy such as bone stimulators is evolving.
A high index of suspicion for stress fractures is appropriate in many high-risk groups of athletes with lower extremity pain. Proper and timely workup and treatment is successful in returning these athletes to sport in many cases. Education of athletes as well as their families, training and coaching staff is important. Attention to training regimens, technique, equipment and proper nutrition is paramount in the prevention of these injuries.

Keywords:Stress fracture, Athlete, Foot, Ankle.

How to Cite: Mayer SW, Joyner PW, Almekinders LC, Parekh SG. Stress Fractures about the Foot and Ankle in Athletes. The Duke Orthop J 2013;3(1):8-19.


William R Mook MD, James A Nunley MD

Allograft Reconstruction of Irreparable Peroneal Tendon Tears: A Preliminary Report

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:1-7]


Background: Peroneal tendon injuries represent a significant but underappreciated source of lateral ankle pain. Partial thickness tears of the peroneus brevis amenable to direct repair techniques are common. Irreparable tears are uncommon and require more complex surgical decision-making. Intercalary segment allograft reconstruction has been previously described as a treatment option; however, there are no reports of the outcomes of this technique in the literature. We present our results utilizing this technique.

Materials and methods: A retrospective chart review was conducted to identify all patients who underwent intercalary allograft reconstruction of the peroneus brevis. Mechanism of injury, concomitant operative procedures, pertinent radiographic findings, pre- and postoperative physical examination, intercalary graft length, medical history, visual analog scores (VAS) for pain, short form-12 (SF-12) physical health survey, lower extremity functional scores (LEFS), and complications were reviewed.

Results: Eight patients with eight peroneus brevis tendon ruptures requiring reconstruction were indentified. Mean follow-up was 15 months (range, 10-31). The average length of the intercalary segment reconstructed was 12 cm ± 3.9 (range, 8-20). The average postoperative VAS decreased to 1.0 ± 1.6 from 4.0 ± 2.2 (p = 0.01). No patient had a higher postoperative pain score than preoperative pain score. Average postoperative eversion strength improved from 3.5 ± 1.2 to 4.81 ± 0.37 (p = 0.03). The average SF-12 survey improved from 41.1 ± 12.3 to 50.2 ± 9.31 (p = 0.06). The average LEFS improved from 53.3 ± 17.0 to 95.25 ± 10.0 (p = 0.02). Four patients experienced sensory numbness in the sural nerve distribution, and two of these were transient. There were no postoperative wound healing complications, infections, tendon reruptures or reoperations. No allograft associated complications were encountered. All patients returned to their preoperative activity levels.

Conclusion: Allograft reconstruction of the peroneus brevis can improve strength, decrease pain, and yield satisfactory patientreported outcomes. Importantly, this can be successfully performed without incurring the deleterious effects associated with tendon transfer procedures. Our results suggest that allograft reconstruction may be a safe and reasonable alternative in the treatment of irreparable peroneal tendon ruptures.

Level of evidence: Therapeutic level IV.

Keywords: Peroneal tendon, Tendon rupture, Allograft, Tendon reconstruction.

How to Cite: Mook WR, Nunley JA. Allograft Reconstruction of Irreparable Peroneal Tendon Tears: A Preliminary Report. The Duke Orthop J 2013;3(1):1-7.


Marc J Richard MD, Leonid I Katolik MD, Douglas P Hanel MD, Daniel A Wartinbee MD, David Ruch MD

Distraction Plating for the Treatment of Highly Comminuted Distal Radius Fractures in Elderly Patients

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:93-98]


Purpose: To evaluate the use of internal distraction plating for the management of comminuted, intra-articular distal radius fractures in patients over 60 years of age at two level one trauma centers. Our hypothesis was that distraction plating of comminuted distal radius fractures in the elderly would result in acceptable outcomes regarding range of motion, disabilities of the arm, shoulder and hand (DASH) score, and radiographic parameters and would thereby provide the upper extremity surgeon with another option for the treatment of these fractures.

Materials and methods: A retrospective review was performed on 33 patients over 60 years of age with comminuted distal radius fractures treated by internal distraction plating at two level 1 trauma centers. Patients were treated with internal distraction plating across the radiocarpal joint. At the time of final follow-up, radiographs were evaluated for ulnar variance, radial inclination, and palmar tilt. Range of motion, complications and DASH scores were also obtained.

Results: Thirty-three patients with a mean age of 70 years were treated with distraction plating for comminuted distal radius fractures. At final follow-up, all fractures had healed and radiographs demonstrated mean palmar tilt of 5° and mean positive ulnar variance of 0.6 mm. Mean radial inclination was 20°. Mean values for wrist flexion and extension were 46° and 50° respectively. Mean pronation and supination were 79° and 77° respectively. At the final follow-up, the mean DASH score was 32.

Conclusion: In the elderly, distraction plating is an effective method of treatment for comminuted, osteoporotic distal radius fractures.

Level of evidence: Therapeutic, Level IV (Retrospective case series).

Keywords: Distal radius fracture, ORIF, Bride plate, Spanning fixation.

How to Cite: Richard MJ, Katolik LI, Hanel DP, Wartinbee DA, Ruch D. Distraction Plating for the Treatment of Highly Comminuted Distal Radius Fractures in Elderly Patients. The Duke Orthop J 2013;3(1):93-98.


Constantine A Demetracopoulos MD, James K DeOrio MD, James A Nunley II MD

Posterior Tibial Tendon Excision and Postoperative Pain in Adult Flatfoot Reconstruction: A Preliminary Report

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:20-24]


Background: Posterior tibial tendon insufficiency plays a large role in the pathogenesis of adult acquired flatfoot deformity (AAFD) in select patients. Transfer of the flexor digitorum longus is indicated to compensate for the loss of posterior tibial tendon function; however the role of resection of the degenerated posterior tibial tendon remains unclear. The aim of this study was to determine the effect of posterior tibial tendon resection on pain relief following surgical treatment of stage II AAFD.

Methods: All patients who underwent surgical treatment for stage II AAFD and posterior tibial tendon insufficiency were retrospectively reviewed. Patients were divided into two groups based on whether the degenerated posterior tibial tendon was resected or left in situ. Twenty-seven patients with a mean follow-up of 13.3 months were included in the study. A visual analog scale (VAS) score for pain was recorded for each patient pre-operatively and at final follow-up. Concomitant surgical procedures and the incidence of postoperative medial arch pain were also reported. Preoperative deformity and postoperative deformity correction were assessed by measuring the anteroposterior talar-first metatarsal angle, the talonavicular (TN) coverage angle, the lateral talar-first metatarsal angle, and the calcaneal pitch onstandard weight bearing radiographs.

Results: Eleven patients underwent FDL transfer and resection of the posterior tibial tendon (PTT resection group), and 16 patients underwent FDL transfer without resection of the posterior tibial tendon (PTT in situ group). A greater percentage of patients in the PTT resection group underwent lateral column lengthening (100 vs 18.8%, p < 0.001), and a greater percentage of patients in the PTT in situ group had a medial displacement calcaneal osteotomy performed (93.8 vs 18.2%, p < 0.001). There was no difference in preoperative VAS pain scores between groups, and all patients demonstrated excellent pain relief postoperatively. No patient in either group reported medial arch pain postoperatively. Radiographic assessment revealed similar deformity preoperatively in both groups, and patients in the PTT resection group demonstrated a greater correction of the TN coverage angle (9.8 ± 4.6 vs 6.0 ± 4.1 degrees, p = 0.041).

Conclusion: Resection of the PTT did not significantly affect postoperative VAS scores at final follow-up. It did however, correlate with a slightly greater correction of the TN coverage angle. There were no instances of pain along the medial ankle or medial arch of the foot in either group postoperatively. Future prospective studies are needed to determine whether resection of the PTT is necessary at the time of surgery for stage II AAFD.

Keywords: Adult acquired flatfoot deformity, Posterior tibial tendon insufficiency, Talonavicular coverage, Postoperative pain, Tendinopathy.

How to Cite: Demetracopoulos CA, DeOrio JK, Nunley JA II. Posterior Tibial Tendon Excision and Postoperative Pain in Adult Flatfoot Reconstruction: A Preliminary Report. The Duke Orthop J 2013;3(1):20-24.


Nicholas A Viens MD, E Grant Sutter MS, Daniel S Mangiapani MD, Samuel B Adams MD, Robert D Zura MD

Unstable Ankle Fractures in Older Patients: A Consecutive Series with Modern Internal Fixation Techniques

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:25-31]


Background: Ankle fractures are among the most common injuries sustained by older patients. Management of these fractures remains both controversial and challenging. Clinical outcomes from a series of older patients treated surgically for unstable ankle fractures were reviewed to determine the effects of patient, injury and fixation factors on postoperative outcomes.

Materials and methods: A retrospective series of 58 consecutive patients age 60 years and older with 63 unstable ankle fractures treated surgically by a single surgeon over a 5- year period was reviewed. Forty-seven females (81.0%) and 11 males (19.0%) with a mean age of 72.6 (range, 60 to 88.4) years made up the sample.

Results: The most common injuries were OTA type 44-B2 (66.7%) or Lauge-Hansen supination-external rotation type-4 (76.2%) fractures. Forty-seven (74.6%) fractures were due to a low energy mechanism. Nineteen (30.6%) injuries were fracturedislocations and seven (11.1%) fractures were open. Augmented techniques were used in 31 (49.2%) cases overall. Ten (17.2%) patients experienced postoperative complications. Males, patients with fracture dislocations, high energy fractures, and open fractures experienced significantly worse outcomes (p < 0.05). Age, fracture type and the use of augmented technique were not predictive of clinical outcomes.

Conclusion: Overall in this series, older patients treated surgically for ankle fractures experienced good clinical outcomes. Further investigations are required in order to find patient and injury factors that can assist preoperative planning and predict outcomes.

Keywords:Ankle fracture, Elderly, Osteopenia, Augmented fixation, Locked plating.

How to Cite: Viens NA, Sutter EG, Mangiapani DS, Adams SB, Zura RD. Unstable Ankle Fractures in Older Patients: A Consecutive Series with Modern Internal Fixation Techniques. The Duke Orthop J 2013;3(1):25-31.


Walter H Wray III MD, J Mack Aldridge III MD, James A Nunley II MD, David S Ruch MD, Fraser J Leversedge MD

Restoration of Shoulder Abduction after Radial to Axillary Nerve Transfer following Trauma or Shoulder Arthroplasty

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:99-103]


Purpose: A loss of active shoulder abduction due to axillary nerve dysfunction may be caused by brachial plexus or isolated axillary nerve injury and is often associated with a severe functional deficit. The purpose of this study was to evaluate retrospectively the restoration of deltoid strength and shoulder abduction after transfer of a branch of the radial nerve to the axillary nerve for patients who had sustained an axillary nerve injury.

Materials and methods: We retrospectively reviewed all patients who underwent transfer of a branch of the radial nerve to the anterior branch of the axillary nerve at our institution, either alone or in combination with other nerve transfers, between 2004 and 2011. We identified, by chart review, 12 patients with an average follow-up of 16.7 months (6-36 months) who met inclusion criteria.

Results: Active shoulder abduction significantly improved from an average of 9.6° (0-60°) to 84.5° (0-160°) (p < 0.005). Average initial deltoid strength significantly improved from 0.3 (0-2) on the M scale to an average postoperative deltoid strength of 2.8 (0-5) (p < 0.005). Five of 12 (41.7%) achieved at least M4 strength and eight of 12 (66.7%) achieved at least M3 strength. No statistically significant difference was seen when subgroup analysis was performed for isolated nerve transfer vs multiple nerve transfer, mechanism of injury with MVC vs shoulder arthroplasty, age, branch of radial nerve transferred, or time from injury to surgery. No significant change in triceps strength was observed with an average of 4.9 (4-5) strength preoperatively and 4.8 (4-5) postoperatively (p = 0.34). There were three patients who achieved no significant gain in shoulder abduction or deltoid strength for unknown reasons.

Conclusion: Transfer of a branch of the radial nerve to the anterior branch of the axillary nerve is successful in improving deltoid strength and shoulder abduction in most patients. Our series, the largest North American series to our knowledge, has not shown outcomes as favorable as other series. Larger multicenter trials are needed.

Type of study/Level of evidence: This is a retrospective case series representing a level IV study.

Keywords: Brachial plexus, Axillary nerve, Radial nerve, Shoulder abduction, Neurotization.

Funding: No outside funding was received and the authors have no conflicts of interest to disclose.

How to Cite: Wray WH III, Aldridge JM III, Nunley JA II, Ruch DS, Leversedge FJ. Restoration of Shoulder Abduction after Radial to Axillary Nerve Transfer following Trauma or Shoulder Arthroplasty. The Duke Orthop J 2013;3(1):99-103.


Patrick N Siparsky MD, Matthew G Kanaan DO, William E Garrett Jr MD PhD

Bilateral Proximal Tibial Stress Fractures at the Epiphyseal Scar

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:71-73]


Tibial stress fractures are a common cause of pain in athletes including runners and are the most common stress fracture in athletes. The underlying pathoanatomy is microscopic cracks in the bone that never fully heal as a result of continued strain on the bone coupled with insufficient rest. The typical presentation is pain that initially begins with the onset of athletic activity, but eventually becomes persistent pain throughout the day with any loading of the bone. We present a case report of a 36-year-old male with bilateral proximal medial tibia stress fractures along the epiphyseal scar.

Keywords:Stress fracture, Stress reaction, Tibial stress fracture.

How to Cite: Siparsky PN, Kanaan MG, Garrett WE Jr. Bilateral Proximal Tibial Stress Fractures at the Epiphyseal Scar. The Duke Orthop J 2013;3(1):71-73.


Patrick W Joyner MD, William J Mallon MD, Donald T Kirkendall PhD, William E Garrett Jr MD PhD

Relative Age Effect: Beyond the Youth Phenomenon

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:74-79]


The relative age effect (RAE) refers to the oversampling of youth born in the first quarter of the birth year when auditioning for selected age-restricted sports. This advantage conferred to the older athlete is the result of the older athlete being more physically and emotionally mature and, therefore, assumed to be a more advanced player. Chosen players will be exposed to better coaching, competition, teammates, and facilities in their respective sport. This RAE was first described in 1988 for ice hockey, and has since been described in numerous other sports, with a vast majority of the literature demonstrating an RAE in small cohorts, as well as in team sports and sports that incorporate a ball (i.e. soccer, basketball, hockey, etc). We extended the exploration of an RAE beyond specific sports by examining the birth quarter of over 44,000 Olympic athletes birth dates, born between 1964 and 1996. Our hypothesis is that not only did an RAE exist in Olympic athletes, but that it existed across selected categories of athletes (by gender), such as team vs individual sports, winter vs summer athletes, and sports using a ball vs those not using a ball. The fractions of births in the first vs the fourth quarter of the year were significantly different (p < 0.001) from each other for the summer and winter Olympians, ball and nonball sports, and team as well as individual sports. This significant difference was not gender specific. We found the general existence of an RAE in Olympic athletes regardless of global classification.

Keywords:Relative age effect, Olympic, Athletes.

How to Cite: Joyner PW, Mallon WJ, Kirkendall DT, Garrett WE Jr . Relative Age Effect: Beyond the Youth Phenomenon. The Duke Orthop J 2013;3(1):74-79.


John S Lewis Jr MD, Daniel S Mangiapani MD, Bridgette D Furman BS, Virginia B Kraus MD PhD, Farshid Guilak PhD, Steven A Olson MD FACS

Post-traumatic Arthritis: An Update

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:32-35]


Post-traumatic arthritis (PTA) is a frequent cause of disability following trauma of weight-bearing joints and is associated with significant physical impairment and loss of function. The development of PTA often occurs after an articular fracture. Currently, the only treatment option available to orthopaedic surgeons in the management of an acute articular fracture is anatomic fracture reduction. The complex pathway involved in the development and progression of PTA after articular injury, however, remains unknown and largely unstudied. Proinflammatory cytokines, such as interleukin-1 (IL-1) and tumor necrosis factor-α (TNF-α) are upregulated in injured and degenerative joints and may play an important role in the pathogenesis of PTA. The central goal of ongoing research is to understand the sequence of biologic events-distinct from mechanical disruption of the joint surface-that cause progressive joint degeneration and ultimately the development of PTA. Promising new interventions on the molecular level have been shown to slow or halt the progression of these adverse events in animal models.

Keywords:Post-traumatic, Arthritis, Interleukin-1, Tumor necrosis factor-alpha.

How to Cite: Lewis JS Jr, Mangiapani DS, Furman BD, Kraus VB, Guilak F, Olson SA. Post-traumatic Arthritis: An Update. The Duke Orthop J 2013;3(1):32-35.


Special Interest
Jonathan A Godin MD MBA

Duke Orthopaedics Opens Page Road Clinic

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xxvii]


Duke Orthopaedics has identified new opportunities to serve patients in the Triangle region while expanding its geographic reach. In July 2011, the Duke Medical Plaza at Page Road opened its doors. Located just off of I-40 and 54, close to Raleigh/ Durham International Airport, the plaza is strategically located in the middle of population growth in the Triangle area, thereby increasing access to Duke Orthopaedic care for many patients in the area.


Jared Kroger BS, Pierre Beaufond BS, Serkan Inceoglu PhD, Victoria Maskiewicz PhD, Wayne Cheng MD, Justin Eugene Brier-Jones BS

Setting Time Comparison of Four Antimicrobial Laden Calcium Sulfate Plasters

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:36-40]


Background: The surgeon may implant calcium sulfate pellets (aka gypsum) as a resorbable antimicrobial vehicle at the surgical site in severe cases of osteomyelitis. Gypsum setting times with or without antibiotic additives are found scattered throughout the literature, but often factors known to alter setting time are either not disclosed or not held constant between experiments. To our knowledge, no prior study compares the setting time of calcium sulfate plaster mixed with the four commonly used antibiotics under constant conditions as presented here.

Purpose: To compare the setting times of calcium sulfate hemihydrate mixtures containing vancomycin, cefazolin, tobramycin, or amphotericin B.

Materials and methods: Groups consisted of samples comprised of 6.3 gm calcium sulfate hemihydrate (CSH) mixed with approximately 1/4th a vial of lyophilized antimicrobial (vancomycin, cefazolin, tobramycin or amphotericin B) with CSH powder to normal saline ratio of 1.7 gm/ml and mixed for 30 seconds at controlled speed and humidity. Each sample initial setting time (Ti) and final setting time (Tf) were established by Gillmore needles method according to ASTM standard C266- 08 apparatus specifications.

Results: Kruskal-Wallis one-way analysis of variance by ranks revealed that antibiotic type affected the initial and final setting times of gypsum (p < 0.05). Post hoc analysis using Dunn's multiple comparisons indicated that there was no difference between control Ti (7.2 ± 1.1 min) and that of vancomycin or cefazolin group (9.8 ± 1.7 or 14.2 ± 1.3 min, respectively, p > 0.05), but the Ti of the tobramycin and amphotericin B groups (31.8 ± 5.7 and 140.4 ± 18.0 min) differed from the control Ti (p < 0.05). Likewise, there was no difference of control Tf (p > 0.05, 12.2 ± 1.1 min) when compared to vancomycin or cefazolin groups (22.2 ± 6.9 or 25.7 ± 4.1 min), but that the Tf of tobramycin and amphotericin B groups (76.3 ± 5.9 and 200.0 ± 21.1 min) each differed from the control group (p < 0.05).

Conclusion: This experiment is aimed to help surgeons plan when they should begin preparing their calcium sulfate antibiotic beads during surgery. As a general guideline, allow 15 minutes to set when adding a 1 gm vial of vancomycin or cefazolin, 30 minutes for adding a 1.2 gm vial tobramycin, and 2.5 hours for adding a 50 mg vial of amphotericin B.

Keywords:Calcium sulfate plaster, Antibiotic cement, Setting time.

How to Cite: Kroger J, Beaufond P, Inceoglu S, Maskiewicz V, Cheng W, Brier-Jones JE. Setting Time Comparison of Four Antimicrobial Laden Calcium Sulfate Plasters. The Duke Orthop J 2013;3(1):36-40.


Special Interest
Stephanie W Mayer MD, Braden K Mayer MD, Todd E Bertrand MD, MBA, Mark G Hamming MD, C Thomas Haytmanek MD, Jordan F Schaeffer MD, Donald E Fowler III MD, Karl M Schweitzer Jr MD

Tribute to Dr James Nunley

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xxv]


As we, the Duke Orthopaedic Residency Class of 2013, round the corner into the last few months of our training, many emotions arise. We cannot believe we have been here this long, and we cannot believe it went by so fast. We reflect back on why we decided on Duke in the first place and hope that we have made those who chose us 5 years ago proud. We have had many meetings as a class this year regarding how we wanted to lead, what our policies would be, what we would try to teach and engrain into the minds and hearts of our fellow residents. At each of these meetings and in countless e-mail exchanges, the overriding theme was that we all wanted those who come after us to have as much pride in the program as those who came before us. Our program has been built on the shoulders of exceptional leaders, each of whom has sacrificed for the good of our department as well as contributed much to education and the advancement of the field during their careers.


Steven J Svoboda MD, Dean C Taylor MD, Robert A Magnussen MD

The Anatomic Variability of the ‘Rotator Interval Capsule’: A Comparison of Arthroscopic and Open Investigations

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:54-60]


Introduction: Variably present rotator interval capsular openings (RICOs) complicate anterior shoulder capsular anatomy. Open and arthroscopic approaches may lead to differences in the appearance and size of RICOs. The purposes of this study are to: (1) Confirm that RICOs viewed from inside and outside the joint are the same structures, and (2) compare the size of RICOs when approached in an open manner vs arthroscopically.

Materials and methods:Twelve fresh cadaveric shoulders were randomized to two different approaches in order to identify and mark RICOs. In the first group, the superior glenohumeral ligament (SGHL) and middle glenohumeral ligament (MGHL) were marked arthroscopically. Sutures were placed in these structures in an open fashion. Repeat arthroscopy was then performed to determine whether the sutures penetrated the marked SGHL and MGHL. In the second group, these steps were reversed and arthroscopically placed sutures were evaluated in an open manner. Dimensions of the RICOs were measured both arthroscopically and open in each shoulder.

Results: All specimens had a RICO visualized both arthroscopically and open. Five of 12 specimens had an additional second RICO. RICO size measurements were similar for the arthroscopic and open techniques. Sutures placed via both the arthroscopic and open technique were noted to penetrate the marked structures in all cases. In addition, sutures placed through the SGHL while viewing arthroscopically always captured the coracohumeral ligament (CHL). Sutures placed through the SGHL with an open technique never engaged the CHL.

Conclusion: The capsular openings in the rotator interval were confirmed to be the same structures when observed arthroscopically and through an open approach.

Keywords: Rotator interval, Shoulder instability, Foramen of Weitbrecht, Foramen of Rouviere.

How to Cite:Svoboda SJ, Taylor DC, Magnussen RA. The Anatomic Variability of the 'Rotator Interval Capsule': A Comparison of Arthroscopic and Open Investigations. The Duke Orthop J 2013;3(1):54-60.


Robert A Magnussen MD, Evrard Gancel MD, Elvire Servien MD PhD, Matthias Jacobi MD, Guillaume Demey MD, Philippe Neyret MD, Sebastien Lustig MD PhD

Simultaneous Unicompartmental Knee Arthroplasty and Lateral Patellar Facetectomy for Bicompartmental Degenerative Disease

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:61-66]


Introduction:Unicompartmental knee arthroplasty (UKA) is a treatment option in patients with unicompartmental degenerative disease. Compared to total knee arthroplasty (TKA), the advantages of UKA include accelerated recovery and cruciate ligament retention. These advantages, along with emerging evidence that mild patellofemoral joint osteoarthritis does not compromise results of UKA have encouraged expansion of the indications for UKA. Symptomatic lateral patellofemoral joint degenerative disease is a common cause of UKA revision. Partial lateral patellar facetectomy can provide relief from symptoms of lateral patellofemoral degenerative disease. We hypothesize that simultaneous UKA and lateral patellar facetectomy provides durable pain relief and functional improvement in a patient population with degenerative disease of one tibiofemoral compartment and the lateral patellofemoral joint.

Materials and methods:Between 2004 and 2008, 11 lateral UKA's were performed in association with partial lateral patellar facetectomy in 11 female patients (mean age: 66.7 years) with degenerative changes in one tibiofemoral compartment and the lateral patellofemoral joint. Patients were followed clinically and radiographically for a mean of 5 years.

Results: No patient underwent revision surgery in the followup period. The mean international Knee Society (IKS) knee score improved from 64.9 ± 11.2 points preoperatively to 87.5 ± 12.6 points at final follow-up (p = 0.01). The mean IKS functional score improved from 65.9 ± 23.5 points preoperatively to 83.2 ± 23.3 points at final follow-up (p = 0.012). The mean Kujala score was 84.3 ± 13.5 points postoperatively. Progression of patellofemoral OA was observed in one patient.

Conclusion: Simultaneous UKA and partial lateral patellar facetectomy is a viable treatment option for symptomatic degenerative disease involving one tibiofemoral compartment and the lateral patellofemoral joint. This treatment approach may be a useful alternative to TKA or bicompartmental arthroplasty in a carefully selected patient population.

Level of evidence: Case series-Level IV.

Keywords: Bicompartmental osteoarthritis, Unicompartmental knee arthroplasty, Lateral patellar facetectomy.

How to Cite:Magnussen RA, Gancel E, Servien E, Jacobi M, Demey G, Neyret P, Lustig S. Simultaneous Unicompartmental Knee Arthroplasty and Lateral Patellar Facetectomy for Bicompartmental Degenerative Disease. The Duke Orthop J 2013;3(1):61-66.


Jocelyn Wittstein MD, Charles Spritzer MD, William E Garrett MD PhD

MRI Determination of Knee Effusion Volume: A Cadaveric Study

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:67-70]


Background: There is currently limited literature on quantitative determination of knee effusion volume using magnetic resonance imaging (MRI).

Purpose: To describe a method of knee effusion volume determination using MRI generated models and to demonstrate accuracy of this technique.

Materials and methods: Using axial T2-weighted turbo spin echo and sagittal SPACE sequences, MRIs of three cadaver knees with multiple saline loads were obtained. Effusions models were created and effusion volumes were estimated using the Rhinoceros software. Estimated and known effusion volumes were compared using a bivariate correlation analysis.

Results: The SPACE sequence and T2WTSE estimates were highly correlated with the known volumes (R = 0.996 and 0.993 respectively, p < 0.001).

Conclusion: MRI-generated models of knee effusions provide accurate estimates of knee effusion volumes.

Clinical relevance: MRI determination of knee effusion volume may provide a useful clinical outcomes tool.

Keywords: Effusion, Magnetic resonance imaging, Knee.

How to Cite: Wittstein J, Spritzer C, Garrett WE. MRI Determination of Knee Effusion Volume: A Cadaveric Study. The Duke Orthop J 2013;3(1):67-70.


Special Interest
Steven A Olson MD

Proceedings from the Research Colloquium on Post-traumatic Arthritis

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xliv]


The colloquium was attended by more than 40 participants from across Duke University Hospital, including Members of the Departments of Medicine, Orthopaedic Surgery, Physical Therapy and Radiology. This unique opportunity allowed investigators working in the area of arthritis after joint injury to share their own work, and learn of the ideas and efforts of others interested this growing area of clinical interest.


Kyle P Kokko MD PhD, Qian K Kang MD, Xuejun Wen MD PhD, Yueheui H An MD, William R Barfield PhD, Langdon A Hartsock MD

Novel Rabbit Model for the Evaluation of Open Tibia Fractures: Effect of Delayed Surgery on Infection Rate

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:48-53]


Introduction: The objective of this investigation was to evaluate the effects of delayed surgery on infection rates of open tibia fractures in a rabbit model. Our hypothesis was that delaying irrigation and debridement (I&D) would increase the risk of bony and soft tissue infection when antibiotics were withheld.

Materials and methods: A drill hole was created in the rabbit tibia and inoculated with Staphylococcus aureus. Animals underwent I&D at controlled delayed times of 6 hours (n = 11), 12 hours (n = 9) and 24 hours (n = 10). A stainless steel pin was inserted to mimic definitive fracture fixation with a metal prosthesis. No antibiotics were administered. Animals were sacrificed at 4 weeks and evaluated for infection.

Results: The percent of soft tissue infections with I&D delays of 6, 12 and 24 hours were 18, 22 and 40%, respectively [p = 0.59; odds ratio (OR) = 3]. The percentage of animals with osteomyelitis with I&D delays of 6, 12 and 24 hours were 9, 22 and 50%, respectively (p = 0.12; OR = 10).

Discussion: In the current model, delaying I&D from 6 to 24 hours may increase the rate of postoperative osteomyelitis and further investigation is warranted.

Keywords: Infection, Open tibia fracture, Irrigation and debridement, Delayed surgery, Natural history.

How to Cite:Kokko KP, Kang QK, Wen X, An YH, Barfield WR, Hartsock LA. Novel Rabbit Model for the Evaluation of Open Tibia Fractures: Effect of Delayed Surgery on Infection Rate. The Duke Orthop J 2013;3(1):48-53.


Anil K Gupta MD MBA, Alison P Toth MD

Management of Massive Rotator Cuff Tears in Active Patients with Minimal Glenohumeral Arthritis: A Prospective Observational Study with Clinical and Radiographic Analyses of Reconstruction using Dermal Tissue Matrix Xenograft

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:80-87]


Objectives: To evaluate the clinical and radiographic outcomes of patients undergoing interposition reconstruction of massive, otherwise irreparable rotator cuff tears through a mini-open approach with the use of a porcine dermal tissue matrix.

Materials and methods: We performed a prospective observational study of 26 patients (27 shoulders) who underwent reconstruction of massive rotator cuff tears using dermal tissue matrix xenograft. Pain level (scale 0-10, 10 = severe pain), active range of motion, and supraspinatus and external rotation strength were assessed. Additional outcome measures included modified American shoulder and elbow score (MASES) and short form-12 (SF-12) score. Clinical and radiographic analyses were performed at an average 32 months follow-up period (minimum 2-year follow-up). Ultrasound imaging (static and dynamic) of the operative shoulder was performed at final followup to assess the integrity of the reconstruction.

Results: Mean patient age was 60. Mean pain level decreased from 5.1 to 0.4 (p = 0.002). Mean active forward flexion, abduction, and external rotation motion improved from 138.8 to 167.3 (p = 0.024), 117.9 to 149.3 (p = 0.001) and 57.7 to 64.7° (p = 0.31), respectively. Supraspinatus and external rotation strength improved from 7.2 to 9.4 (p = 0.001) and 7.4 to 9.5 (p = 0.001), respectively. Mean MASES improved from 62.7 to 91.8 (p = 0.0007) and mean SF-12 scores improved from 48.4 to 56.6 (p = 0.044). Twenty-one patients (twenty-two shoulders) returned for a dynamic and static ultrasound of the operative shoulder at a minimum 2-year follow-up. Sixteen (73%) demonstrated a fully intact tendon/graft reconstruction. Five (22%) patients had partially intact reconstructions, and one (5%) had a complete tear at the graft-bone interface due to suture anchor pullout as a result of a fall. There were no cases of infection or tissue rejection.

Conclusion: We present a reproducible surgical technique for the management of massive irreparable rotator cuff tears. In our series, patients demonstrated a significant improvement in both subjective and objective clinical outcomes. Radiographic analysis demonstrated that the majority of patients had a fully intact reconstruction at a minimum 2-year follow-up.

Keywords: Massive rotator cuff tear, Xenograft, Augmentation, Repair.

How to Cite: Gupta AK, Toth AP. Management of Massive Rotator Cuff Tears in Active Patients with Minimal Glenohumeral Arthritis: A Prospective Observational Study with Clinical and Radiographic Analyses of Reconstruction using Dermal Tissue Matrix Xenograft. The Duke Orthop J 2013;3(1):80-87.


Special Interest
William R Mook MD

Emily Berend Adult Reconstructive Symposium Update

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xliii]


This past year marked the fourth annual Emily Berend Adult Reconstructive symposium held at Duke University Medical Center hosted by brothers Keith R Berend, MD, and Michael E Berend, MD. The symposium is held in honor of their late mother who had great respect for the Duke Orthopaedic Residency Program and truly appreciated the training that both of her boys received. The symposium covered the latest topics pertaining to reconstruction of the hip and knee, and provided a forum for scholarly discussion, cadaveric demonstrations and fellowship.


Special Interest
Robert D Fitch MD, Ralph Coonrad MD

On the Shoulders of Giants: Eugene E Bleck MD

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xxix]


Gene Bleck was a well-known pediatric orthopaedist of my age. In 1983, my first year in practice, he was president of POSNA, I had studied his classic textbook Orthopaedic Management of Cerebral Palsy; and Duke's Chairman, J Leonard Goldner frequently and fondly spoke of him!


Special Interest
William R Mook MD

Update from the John A Feagin Jr MD Leadership Program

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xxxiv]


The Duke Sports Medicine Feagin Medical Scholars Program and Endowment, created in honor of Dr John A Feagin Jr, Duke University Emeritus Professor of Orthopaedic Surgery, has had another exciting and productive year. Now in its fourth year, the program continues to attract highly motivated medical students and residents from across the Duke Medicine community interested in honing their skills in preparation for assuming leadership positions in their respective medical professions and communities. The foundation of the leadership program's curriculum remains constant, emulating and cultivating the qualities that characterize the program's namesake: Professionalism, dedication, passion, enthusiasm and ingenuity. This year's curriculum evolved in exciting ways to meet the demands brought about by the changes to the domestic and international health care landscape.


Bret C Peterson MD, Daniel S Mangiapani MD, Ryan Kellogg MD, Fraser J Leversedge MD

Hand and Microvascular Replantation Call Availability Study: A National Real-time Survey of Level 1 and 2 Trauma Centers

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:88-92]


Purpose: The inconsistency of subspecialty emergency call services is a growing concern as declining reimbursements, increased legal risk, and challenging social and professional issues present a deterrent to call panel participation. This study assessed call availability of hand and microvascular replantation surgery at all level I and II trauma centers in the US.

Materials and methods: Between May and December 2010, all level I (n = 137) and level II (n = 153) trauma centers across the US were contacted by telephone. Phone contact was unannounced; responders were invited to participate in our IRBapproved anonymous survey regarding hand and microvascular replantation emergency coverage specific to their hospital.

Results: Level 1 centers: 117 of 137 (85%) participated, of which 64 (54.7%) had immediate access for hand surgery and microvascular replantation services. Six hospitals provided services 15 to 31 days per month and 3 hospitals supported 1 to 15 days per month. Ten hospitals indicated an inconsistent coverage which was difficult to estimate and 34 hospitals reported no coverage.
Level 2 centers: 132 of 153 (86.3%) participated, of which 38 (29%) had immediate access for hand surgery and microvascular replantation services. Seven hospitals provided services 15 to 31 days per month and 3 hospitals for 1 to 15 days per month. 84 hospitals reported no specific coverage protocol.

Conclusion: Consistent on-call availability for emergency hand and microvascular replantation services remains a challenge across the US:

  • 54.7% of level I trauma centers had immediate access to emergency hand and microvascular replantation services although many hospitals had intermittent coverage;
  • 29% of level II trauma centers had immediate access to emergency hand and microvascular replantation services although many hospitals had intermittent coverage. Over 50% had no specific coverage protocol;
  • Many hospitals indicated the presence of subspecialty hand surgery coverage, however microvascular replantation resources were not available consistently;
  • While not confirmed, the current study findings suggest that a more clearly defined and coordinated system of hand surgery and microvascular replantation emergency call coverage will likely improve the efficiency of a limited resource and, ultimately, improve patient care.

Keywords: Microvascular replantation, Orthopaedic surgery call, Trauma centers, Hand surgery.

How to Cite: Peterson BC, Mangiapani DS, Kellogg R, Leversedge FJ. Hand and Microvascular Replantation Call Availability Study: A National Real-time Survey of Level 1 and 2 Trauma Centers. The Duke Orthop J 2013;3(1):88-92.


Special Interest
William R Mook MD

ORS/AAOS Annual Meetings

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xxxviii]


The Duke Department of Orthopaedic Surgery had a proud showing at both the 2013 Orthopaedic Research Society (ORS) annual meeting held from January 26th to 29th, 2013, in San Antonio, Texas, as well as the American Academy of Orthopaedic Surgeons (AAOS) annual meeting held from March 19th to 23rd, 2013, in Chicago, Illinois. Many members of the Duke Orthopaedic Surgery family were able to gather for the Piedmont Orthopaedic Society Mid-Winter reception held on March 22nd, 2013, at the Sheraton in downtown Chicago. Listed below is a summary of the podium presentations, posters, demonstrations, and invited lectures from the current faculty and residents at these meetings.


Brian A Mata MD, Robby Bowles PhD, Timothy K Mwangi BS, Lori A Setton PhD

Impaired Function and in vivo Imaging of NF-?B Activation in a Mouse Model of Knee Joint Inflammation

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:41-47]


Objective: Osteoarthritis (OA) is a consequence of not only mechanical events such as joint instability, but also biological events that result in the upregulation of proinflammatory and catabolic mediators. The intra-articular injection of monoiodoacetate (MIA) has been widely used to induce OA. NF-κB activity has been linked to increased expression of proinflammatory cytokines (IL-1β, TNF-α, IL-6, etc), metalloproteinases (MMPs), chemokines and inducible enzymes, which all contribute to cartilage degradation and subsequent OA. The goal of this study was to use in vivo imaging (IVIS) of NF-κB activation to track longitudinal changes due to inflammation in a rodent model of OA.

Design: Twenty-four (24) NF-κB-luc reporter transgenic mice [BALB/C-Tg (NF-κB-RE-luc)-Xen, age 7-8 weeks] were given intra-articular knee injections with either MIA (n = 12) or normal saline (n = 12) to serve as a control. IVIS and ex vivo imaging of NF-κB and tactile allodynia measurements were performed, and correlations were recorded preoperatively and on days 1, 3, 7, 14, 21 and 28. Animals were euthanized on days 3 and 28 for ex vivo imaging, and tissues were stored for future immunohistochemical evaluation.

Results: NF-κB activity was significantly elevated in the MIA group on days 1 and 3 (p < 0.05) when compared to preoperative levels and was significantly elevated compared to the normal saline group on day 3 (p < 0.05). There was a significant increase in tactile allodynia in the MIA group compared to preoperative levels, as well as compared to the normal saline group at all time points (p < 0.05). in vivo NF-κB luminescence correlated with tactile allodynia (p < 0.0001) and with ex vivo imaging (p < 0.0001).

Conclusion: This study validates the use of IVIS imaging of NF-κB activity in a MIA rodent model of arthritis and provides evidence for the use of NF-κB luminescence imaging as an imaging biomarker of pain sensitivities. This can be utilized in the future to further elucidate NF-κB's role in inflammation and OA. In addition, it can help evaluate potential therapeutic agents that target NF-κB.

Keywords:Osteoarthritis, Inflammation, in vivo imaging.

How to Cite: Mata BA, Bowles R, Mwangi TK, Setton LA. Impaired Function and in vivo Imaging of NF-κB Activation in a Mouse Model of Knee Joint Inflammation. The Duke Orthop J 2013;3(1):41-47.


Special Interest
Donny Fowler MD

The Bassett Society Update

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xxxiii]


The Bassett Society was founded in 1985 by Dr Frank H Bassett III, legendary orthopaedic surgeon at Duke University Medical Center. Dr Bassett served as the team physician for Duke Athletics from 1966 to 1993, but remained a prominent figure within the department even after retirement. He was known for his warmth and charisma, and inspired everyone he came into contact with-students, athletes and doctors alike.


Special Interest
Jonathan C Riboh MD

The Atlanta Experience

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:lviii]


Each year, half of the fourth year residents spend 6 months away from Duke furthering their experience in pediatric orthopaedics. For the fourth straight year, these residents have been working under the guidance of the attending staff at Children's Healthcare of Atlanta's Scottish Rite campus.


Special Interest
Karl M Schweitzer Jr MD

Indo-US Foot and Ankle Surgery Conference 2013

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xli]


The 4th annual Indo-US Foot and Ankle Surgery Conference, founded and sponsored by The Parekh Family Foundation was held from January 18th to 20th, 2013 in Kolkata, India. Since its inception, the aim of the conference was to disseminate and share techniques in foot and ankle surgery with surgeons from India, South Asia, the United States and beyond. Faculty from these respective countries run educational sessions and workshops, along with leading live surgeries.


Special Interest
Jonathan C Riboh MD

Resident Awards

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xxxi]


Best Junior Resident Award

Every year, the graduating chief residents elect the third year resident that they feel best embodies the intangibles that make the Duke Orthopaedics residency special. In June of 2012, Dr T Matt Chapman was chosen for this special honor. Dr Chapman has a long history of excellence. His higher education started at Davidson College, where he was a stellar student. He then travelled down the road to Wake Forest School of Medicine, where he established himself as a diligent, hard working student with a passion for Orthopaedics. This is also where he met his wife, Jenny. They were married after his final year of medical school in Kiawah Island, SC.


Jonathan C Riboh MD, William R Mook MD, Jonathan A Godin MD MBA

Letter from the Editors

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xxi]


Dear Colleagues,

This year marks the third issue of the Duke Orthopaedic Journal. This has been a year of transition. No longer in its infancy, the Journal has taken on an important role in the Duke Orthopaedic tradition. The result has been a phenomenal interest among residents, faculty, and alumni in contributing to the Journal. We have expanded every section of the Journal, for which we have relied on a growing group of dedicated reviewers. We have created a rigorous peer-review process, and a Journal of the Duke family can be proud of.


Faculty Advisor
Selene G Parekh MD MBA

2013 Faculty Advisor's Corner

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xxii]


2012 to 2013 has once again been a busy year for Duke Orthopaedics. One of the biggest and most exciting announcements was the appointment of Dr Benjamin Alman as the Chairman of the Department. Dr Alman has been internationally recognized as a clinician, researcher and teacher. We look forward to his arrival and the opportunities it will bring.


Chairman's Corner
Benjamin Alman MD

From the Chairman’s Corner

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xxiii]


Alfred Shands Jr's Vision in 2013: Inventing the Future of Orthopaedics at Duke

We live in an era of fast paced changes in health care, affecting all clinical specialties, but these changes will have much more of an impact in resource intense clinical areas, such as orthopaedics. These changes are a special challenge for academic departments, which need to not only provide excellent care and be financially responsible but also have a mandate to educate the next generation of clinicians and undertake research that will improve the health of the population they serve.


Special Interest
Donna Roman

Annual Uganda Spine Surgery Volunteer Trip

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xlii]


In 2008, Dr William Richardson, MD, Associate Chief Medical Officer and Professor of Surgery at Duke University Hospital was asked to join a medical trip into eastern Africa with Neurosurgical colleague Michael Haglund, MD, PhD to assist with operative spine needs. This began a lasting relationship between Duke and Mulago Orthopaedics. Richardson returned in 2009 with donated orthopaedic supplies, equipment and a small volunteer team and with local Ugandan Orthopaedics headed by Dr Mallon Nyatti opened a dedicated operating area in back of the spine patient ward. This allowed spine surgeons the opportunity to do surgery without having to await the long queue of patients in the main operating area of the hospital which could result in as much as a 2- to 6-month delays for spine patients regardless of urgency.


Special Interest
Dan Wartinbee MD

Faculty Teaching Award

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xxxii]


This past year Marc Richard was honored with the Bassett teaching award. Each year the Bassett teaching award is given to the attending whom the chief class feels has had the greatest impact on resident training. Considering the sheer number of gifted surgeons that exist in the orthopaedic department at Duke, should signify just how special of an honor this award really is for Dr Richard to receive.


Special Interest
Matt Chapman MD

NCOA Update

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xxxvii]


The 2012 North Carolina Orthopaedic Association Annual Meeting convened in beautiful Pinehurst, NC for 3 days of education, fellowship and 'gimme' putts. The scientific portion of the meeting featured several Duke residents, Drs Tom Hershmiller, John Lewis, Matt Chapman, Adam Caputo, Tommy Haytmanek, Will Mook and Cameron Ledford as well as chairman Dr James Nunley. The highlight of the weekend, however, was the tribute to Dr William S Ogden. The moving presentation of the Honored Surgeon Award by Dr Edward Lilly took attendees through the life and practice of an orthopaedic surgeon dedicated to his family, his patients, and the physicians who had the privilege to spend time learning our trade from him.


Special Interest
Jason Jennings MD DPT

Asheville Rotation Update

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:lvii]


Residents receive a diploma after completing their 6 months rotation in Asheville that reads 'Having graciously and dutifully endured excessive amounts of fatherly advice, ancient wisdom and guidance…..a distinguished graduate of the Asheville VA Over the Hill Gang School of Orthopaedic Surgery.' The Asheville VA has been the 'farm team' for our residents since 1969. We leave this rotation gaining experience in adult general orthopaedics with special emphasis on the following five surgeries: TKA, THA, rotator cuff repair, knee arthroscopy and carpal tunnel releases.