Orthopaedic Grand Rounds 2013-2014

June 4, 2014 Grand Rounds: Orthopaedics & Palliative Medicine: Opportunities for Collaboration

Wayne C. McCormick, MD, MPH
Director, Palliative Medicine Fellowship Program
Professor of Medicine, Harborview Medical Center

Caroline J. Hurd, MD
Acting Clinical Instructor
Palliative Medicine & Hospitalist Services
Harborview Medical Center & University of Washington Medical Center 

Kenneth Gundle, MD, Orthopaedic Surgery Resident

May 7, 2014 Grand Rounds: Finger Replantation: When, Where, and What to Expect

, Associate Professor
, Assistant Professor
, Assistant Professor
, Orthopaedic Surgery Resident

April 2, 2014 Grand Rounds: ICD 10 Coding

M. Bradford Henley, M.D., Professor

March 5, 2014 Grand Rounds: Balancing AO Principles in Calcaneous Fractures

Timothy B. Alton, MD
Stephen K. Benirschke, MD
Bruce J. Sangeorzan, MD

The calcaneus, also known as the heel bone, is responsible for transmitting the majority of the body's weight from the talus bone to the ground. Nearly every aspect of the management of complex calcaneus fractures is controversial. The anatomy of the calcaneus is complicated and treatment of fractures in this bone requires a comprehensive understanding of its anatomy, common fracture patterns, and displacement. An accurate reduction is essential to good patient outcomes. Treatment options include closed management, an extensile lateral open approach and the mini-open technique. This presentation highlights the indications for each technique, compares and contrasts their strengths and weaknesses, and provides case examples with discussion from some of the leaders in the field of calcaneus fracture management.

February 5, 2014 Grand Rounds: Checklists and pathways in perioperative care: The new norm

Michael J. Goldberg, M.D.
Amanda C. Roof, M.D.

January 8, 2014 Grand Rounds: Surgical Navigation in Orthopaedic Oncology: Promise or Peril?

Ernest U. "Chappie" Conrad III, M.D., Professor
Randal P. Ching, Ph.D., Research Associate Professor & Lab Director, Applied Biomechanics Laboratory
Kenneth R. Gundle, M.D., Orthopaedic Surgery Resident

Orthopaedic oncologists help care for patients with tumors of the bones and soft tissues, which are generally called sarcomas. Surgical treatment often consists of accurate tumor removal with an appropriate margin of uninvolved tissue, followed by a reconstruction that maximizes patient function. So-called 'surgical navigation', these are developing technologies which allow 3D intraoperative localization, based on advanced imaging studies. In this Grand Rounds, orthopaedic surgeons from the University of Washington and Seattle Children's Hospital explain this technology and discuss their experience utilizing surgical navigation in patient care, as well as their collaboration with researchers from the Applied Biomechanics Laboratory to study the accuracy and impact of these systems.

December 4, 2013 Grand Rounds Video: Collagen and the Aging Skeleton

, Professor & Ernest M. Burgess Endowed Chair for Orthopaedic Investigation
Professor and Vice Chair

In this episode, David Eyre, PhD presents the latest research from the Ernest M. Burgess Chair Laboratories of the UW Dept. of Orthopaedics and Sports Medicine.

In vertebrates the collagen scaffolding of different skeletal tissues has evolved a complex range of molecular variations. Largely through genetic studies in the last decade the functional significance of such molecular variations is being understood more clearly. Examples include new genes identified in which mutations cause recessive osteogenesis imperfecta, some of which can produce brittle bones combined with joint contractures through tendon/ligament collagen abnormalities.

The broader clinical implications of these molecular insights from rare genetic diseases include the potential to develop new therapeutic targets and strategies for treating or preventing common degenerative disorders of the aging skeleton. These include osteoporosis, osteoarthritis, degenerative spine disorders and tendon/ligament pathobiologies.

Special Grand Rounds: Combined Departments of Surgery & Anesthesiology and Pain Medicine

November 6, 2013 Grand Rounds

Andrew Gurman, MD
Speaker of the House of Delegates
American Medical Association

October 2, 2013 Grand Rounds: Osteogenesis imperfecta

Michelle S. Caird, MD
Assistant Professor, Orthopaedic Surgery
Pediatric Orthopaedic Surgery
University of Michigan
C.S. Mott Children's Hospital and Von Voigtlander Women's Hospital

September 4, 2013 Grand Rounds Video: Why are we still discussing Bunions? = Revisited

, Associate Professor

, Professor
, Orthopaedic Surgery Resident

Drs. Sigvard T. Hansen, Michael Brage, and Paul Kim discuss current research into treating bunions along with various surgical techniques for more serious cases. Medical professionals define bunions as a lateral deviation of the great toe, a complex-dynamic deformity. In assessing a patient to determine if surgery is needed, the physician will first look at the history of the condition with a focus on foot pain, the progress of the condition, the occupation of the patient, how active they are, and what kind of shoes they wear. If necessary, a comprehensive physical exam will follow along with X-rays and ultrasound.

August 7, 2013 Grand Rounds Video: Common Stress Fractures: Etiology, Diagnosis and Management

Orthopaedic Surgery Resident
, Professor

Drs. Carol Teitz, Bruce Twaddle and Daniel Patton as they explore current research and treatment for stress fractures in sports medicine. Stress fractures generally present as a gradually worsening boney ache. They can occur in any athletic population and can be debilitating for months.

Prevention of stress fractures is achieved by a careful training schedule built around an understanding of normal bone physiology. Diagnosis is made by history, physical examination, and in persistent cases imaging which can include Xrays, bone scan, or MRI. The majority of cases are managed by rest and modification of training schedule to allow bone healing. Underlying medical risk factors must be addressed including nutrition (e.g. Vit. D), bone density, and mechanical limb alignment. The goals of surgery are to prevent a complete fracture, speed healing, and give the patient a return to activity.

July 3, 2013 Grand Rounds: Is Preoperative Testing in Elective Orthopaedics Medically Cost Effective?

Howard Chansky, M.D., Professor
Paige Mallette, M.D., Orthopaedic Surgery Resident
Gail Van Norman, M.D., Professor, Department of Anesthesiology