Residency Information
Last updated Tuesday, December 04, 2007
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Hand and microvascular surgery
About the rotation
The hand service is a region specific orthopedic rotation that covers all aspects of hand surgery.
The hand service is directed by Dr. Trumble and includes faculty from the VAH (Dr. Sack), HMC Dr’s Allan, Hanel, Sack, Vedder)
and the University Medical Center (Sack, Trumble and Vedder). The hand
service is seamlessly coordinated with the section of Plastic Surgery
(Dr. Vedder). The educational goals are the same in each location.
The specific details are listed below but the overall goal is for
the residents to gradually develop the skills necessary to function
independently and be able to handle those cases which would be managed
by a general orthopedist or plastic surgeon. Graduated responsibility
is afforded to each resident dependent upon their skills, knowledge of
orthopedics and level of confidence.
An R-2 at HMC assists with clinic one day per week and is in the OR
one day per week. The remainder of the week this R2 is part of the
general HMC Orthopedic Team. An R-4 is a full time "hand resident",
operating on Mondays, Tuesdays, Thursdays and Fridays. This resident is
in the University hand clinic on Wednesdays. Call for this service is
shared amongst the plastic residents (2) and the hand fellows (3).
Although call covers the University, Children’s and Harborview, 95%+ of the call time is spent at Harborview.
Goals & objectives
Our goals are to teach the essentials of the specialty relevant to a
general orthopedic practice as well as the foundation for fellowship
training.
Residents are expected to achieve a sound knowledge base, including
reading the standard texts of Operative Hand Surgery, reviewing the
ASSH video entitled Examination of the Hand, reviewing ASSH video
regarding nerve decompression, learning to draw and label a schematic
of the hand intrinsic mechanism in the digits, achieving an
understanding of the segmental innervation of the upper extremities,
and using the List of Selected Readings to prepare of surgical cases
and to answer other clinical questions.
In the clinical arena, residents learn to synthesize a management
plan for patients with hand problems by conducting a thorough and
efficient clinical history and physical examination, understanding the
implications of systemic, emotional, and situational factors to the
treatment of hand disorders, understanding the indications for and
interpretation EMG/NCV and SSEP, understanding the indications for and
interpretation of standard radiographs, CTs, MRIs, and sonograms of the
hand understanding the relevant basic science and anatomy (gross and
arthroscopic) related to the hand and wrist, and presenting basic
treatment options, including home exercises, medications and surgery
along with the alternatives and risks of each.
Residents develop an understanding of the diagnosis and treatment
for a core group of traumatic lesions (including fractures, tendon
injuries, dislocations and instability problems, nerve injuries, soft
tissue loss, reflex sympathetic dystrophy and amputations),
non-traumatic disorders (including arthrosis, compression neuropathies,
tendinitis, contractures, ganglions, tumors, and palsies).
Finally, residents learn the elements of efficient and safe hand
surgery, including preoperative planning, positioning and preparation,
surgical approaches, and the techniques of tendon repair, fracture
fixation, nerve repair, nerve decompression, the management of
tendinopathies, and soft tissue coverage.