Orthopaedic Grand Rounds 2011-2012

June 4, 2012 Grand Rounds Video: Making the Subjective Objective: Outcome Measures in Clinical Orthopaedic Research

Frederick Matsen III, MD, Professor
Elizabeth Dailey, MD, Orthopaedic Surgery Resident
Darin Davidson, MD, Assistant Professor
Michael Lee, MD, Assistant Professor

In this Grand Rounds, Dr. Elizabeth Dailey discusses the definition of outcomes research and its historical and contemporary contexts. Dr. Michael Lee then discusses the significance of orthopaedic complications and how the nature of complications has a large impact on outcomes. Through the use of a case study, Dr. Lee shows the challenging nature of guiding our patients through complications and what the implications are on their health care costs. Finally, the doctors discuss the difficult topic of which outcomes to use in our patient populations and what this means for health care policy. Dr. Darin Davidson draws from his extensive outcomes research background in sarcoma patients to describe and explain quality of life, then uses this premise to guide us through clinical decision-making in a case study using quality of life as a guiding principle.

Making progress in Orthopaedic Trauma care. New insights from major multicenter studies

May 2, 2012

Michael Bosse, M.D., Ortho Carolinas in Charlotte NC and Ellen MacKenzie, Ph.D., Johns Hopkins, Baltimore

April 4, 2012 Grand Rounds Video: Compartmental Syndromes: Are they still a problem?

David P. Barei MD, FRCSC, Professor
Kyle F. Chun, MD, Orthopaedic Surgery Resident
Benjamin W. Starnes MD, FACS, Professor of Surgery
Sigvard T. Hansen Jr., MD, Professor
Frederick A. Matsen III, MD, Professor

A compartmental syndrome is a condition where increased pressure within any closed space compromises the circulation and function of the tissues within that space. These syndromes are rare, but they rank high in terms of impact, patient outcomes, and medical liability. UW Orthopaedic resident Kyle Chun along with UW Medicine physicians Benjamin Starnes and David Barei open the program with a review of the clinical diagnosis, pathophysiology, and surgical approaches to comparmental syndromes. In the second half, they are joined by UW Medicine Drs. Sigvard T. Hansen and Frederick Matsen for a discussion centered on case studies and questions from an audience of peers and colleagues.

March 7, 2012 Grand Rounds Video: Complex Distal Humerus Fractures, Current Concepts

Daphne M. Beingessner, MD, Associate Professor
Jerry I. Huang, MD, Assistant Professor
Emily R. Squyer, MD, Orthopaedic Surgery Resident

UW attendees Daphne Beingessner and Jerry Huang along with resident physician Emily Squyer take us through a discussion of Distal Humerus Fractures. The lecture covers anatomy, historical treatments, early surgical outcomes, and modern treatment with maximized recovery. The discussion concludes with complex elbow reconstruction and salvage options for patients whose initial treatments failed.

February 1, 2012 Grand Rounds Video: ACL Graft Selection: From Wide Receivers to Weekend Warriors

Carol C. Teitz, MD, Professor
Brian B. Gilmer, MD, Orthopaedic Surgery Resident
John R. "Trey" Green III, MD, Associate Professor
Jason J. Wilcox MD

ACL (anterior cruciate ligament) reconstruction is one of the most common procedures in orthopedic surgery. This lecture reviews the historical development of ACL reconstruction, the technical details of graft harvest, and benefits and limitations of grafts commonly used in modern ACL reconstruction. Current literature and future directions of study are explained. Finally, patient specific and surgeon dependent considerations are discussed with a UW Medicine faculty panel.

January 4, 2012 Grand Rounds Video: Controversies in Management of Metastatic Disease

Joshua Lindsey, MD, UW Orthopaedic Surgery Resident
Darin J. Davidson, MD, Assistant Professor
Ernest "Chappie" Conrad, MD, Professor, Chairman of Pediatric Orthopaedics, Seattle Children's

Metastatic disease of the axial skeleton is on the rise as patients are living longer with their disease through advances in cancer treatment. UW Medicine physicians Ernest Conrad, Darin Davidson, and Joshua Lindsey discuss how the ideal treatment is a balance between providing surgical stability that allows for maximal functional outcome, while minimizing morbidity. Humeral and femoral lesions can be treated with plates, intramedullary nails or reconstructive implants. Each metastatic lesion provides a unique challenge to the treating surgeon and the diagnosis must be certain prior to definitive fixation. With patients with metastatic disease, each lesion is a complex problem that requires a patient-centered approach to optimize the outcome.

December 7, 2011 Grand Rounds Video: Orthopaedic Responsibilities in Child Abuse

Mark Miller, M.D., Orthopaedic Surgery Resident
Thomas Jinguji, M.D., Assistant Clinical Professor
Kenneth Feldman, M.D., Clinical Professor

Child abuse is a ubiquitous social and medical problem that remains a prime cause of disability and death among children. As one third of all abused children are eventually seen by an orthopaedic surgeon, this lecture serves to outline the medical and legal responsibilities of surgeons in the evaluation and management of child abuse patients. After an overview of the epidemiology and medical management presented by UW Medicine Orthopaedic Surgery resident, Dr. Mark Miller, Dr. Tom Jinguji from Seattle Children’s discusses specific fracture patterns in child abuse and gives insight into their traumatic mechanisms. Concluding the lecture, Dr. Kenneth Feldman, a pediatrician at Seattle Children’s and child abuse expert, reviews the legal and ethical responsibilities of physicians.

November 2, 2011 - Patients that Bite and Scratch

Patients that bite and scratch: What humans can learn from them

Prof. Jorg Auer, University of Zurich
Dr. George Bagby


October 5, 2011 Grand Rounds Video: Stress Fractures following Osteoporosis Management

Jennifer Hagen, MD, Orthopaedic Surgery Resident
James C. Krieg, MD
Susan M. Ott, MD, Professor

There is some evidence that atypical femur fractures could be linked to prolonged use of oral bisphosphonate therapy drugs, which are prescribed to inhibit the loss of bone mass in patients with osteoporosis. While these drugs have done a great deal of good for many, there could be some unintended consequences of their use. This episode of Grand Rounds looks at all causes of these fractures and their potential link to bisphosphonate usage.

UW Medicine physician, Jennifer Hagen, with the Department of Orthopaedics and Sports Medicine, opens with a history of the development of bisphosphonates and their efficacy, the initial studies that discussed atypical femur fractures, and two case examples of these fractures. UW Medicine physician, Susan Ott, then presents the clinical characteristics of patients with atypical femur fractures along with a review of epidemiology and medical therapy. Finally, James C. Krieg, UW associate professor of Traumatology, presents issues regarding surgical management of atypical femur fractures.

September 7, 2011 Grand Rounds Video: Clearing up controversies in Ankle Fracture Management

David P. Barei M.D., FRCSC, Professor
Greg Blaisdell, M.D., Orthopaedic Surgery Resident
Robert P. Dunbar, M.D., Associate Professor

In this Grand Rounds presentation, UW Medicine physicians Greg Blaisdell, David Barei, and Robert Dunbar discuss current issues in the treatment of ankle fractures, one the most commonly operatively treated injuries in adults. Although often referred to as simple injuries requiring routine fixation, debate continues about how to determine ankle stability in even the simplest patterns. Orthopaedic specialists continue to rely on classification systems that help with pattern recognition, but provide little help in developing treatment algorithms. The speakers present a number of case studies to the audience of health care professionals, who are then polled on how they would treat a given patient. Standard procedures for diagnosis, treatment, and management of ankle fractures soon lead to controversy when one considers individual patients and their complicating host factors.

August 3, 2011 - New Approaches to Ankle Arthritis

This Grand Rounds covers the concept of tissue, or allograft, transplantation as a treatment option for ankle arthritis. Dr. David Patterson, UW Medicine physician, begins the lecture with an overview of the changes in function and mechanics of ankle arthritis, as well as current strategies for treatment. Dr. Chappie Conrad, a UW Medicine Orthopaedic tumor surgeon and a pioneering developer of the Northwest Tissue Bank, offers a historical perspective of allograft transplantation. Finally, Dr. Michael Brage, a UW Medicine Foot and Ankle surgeon, discusses the surgical indications, outcomes, and reasons for failure.

Michael E. Brage, MD, Associate Professor
Ernest "Chappie" Conrad, MD, Professor
David Patterson, MD, Orthopaedic Surgery Resident

July 27, 2011 - Quarterback Trauma

Orthopaedic Special Grand Rounds
Combined Departments of Surgery, Neurological Surgery, and Orthopaedics & Sports Medicine

Dr. Brent Eastman
N. Paul Whittier Endowed Chair of Trauma
Scripps Memorial Hospital
Chairman, Committee on Trauma
American College of Surgeons

Dan Fouts
Former NFL Quarterback
San Diego Chargers, 1973-1987
Inducted into the Pro Football Hall of Fame, 1993

July 6, 2011 - The Mechanobiology of Bone Health: In Vivo, In Silico, and In Spaceflight

Ted Gross, Ph.D., Professor and Sigvard T. Hansen Jr. Endowed Chair
Sundar Srinivasan, Ph.D., Research Associate Professor
Peter Cavanagh, Ph.D., Professor and Endowed Chair in Women's Sports Medicine and Lifetime Fitness, Vice Chair for Research

The Department of Orthopaedic Surgery and Sports Medicine presents three of its basic science researchers in a broad-ranging review of the mechanisms by which mechanical loading modulates bone health. Dr. Gross will discuss novel rodent experiments demonstrating the importance of muscle forces and distributed loading in developing bone; Dr. Srinivasan will report on computer models of preventing bone loss in the aging skeleton; and Dr. Cavanagh will present the results of his experiments examining bone loss during long-duration space flight.