Partners Othopaedic Trauma Service Year in Review, 2011-2012

By: Mark S.Vrahas, M.D.

Academic year 2011-12 marked our thirteenth as a combined Partners service.  The year, itself, was marked by some notable achievements, service expansions, additions, and productivity in our established programs.

We always begin our OJHMS articles with information and updates about our colleagues, as they are truly the ones who keep us producing at a high level year after year.  We first would like to congratulate the Chief of our BWH service, Mitch Harris, MD, for his promotion to Professor of Orthopedic Surgery.  Mitch’s dedication to teaching, clinical acumen, and continuous pursuit of excellence are indeed examples to us all.  Bravo and congratulations, Professor Harris, on this honor well-deserved!

Our combined fellowship program continues to attract top talent from recognized residencies both in the United States and Canada.  Our 2011-12 fellows, Trevor Owen, MD, and Stéphane Bergeron, MD, came to us from The Oschner Clinic and McGill University respectively.  Dr. Owen will be heading to the International Center for Limb Lengthening to complete a one-month fellowship prior to starting fulltime work as a traumatologist at the Carilion Clinic in Roanoke, VA. Dr. Bergeron has accepted a position in his home town of Montreal, in a practice affiliated with McGill University, which he will start in September.  This Summer, he will be at the Harvard School of Public Health, beginning coursework toward a Masters of Public Health degree.

Our fellowship curriculum was bolstered this year with the addition of quarterly journal clubs feature lectures and cadaveric labs run by experts in the subject area.  We look forward to continuing this important educational endeavor in the months and years ahead, and would like to thank the educational division of Stryker Orthopaedics for their sponsorship assistance.

This Spring, our BWH team welcomed Caitlin Eagen, PA-C, as our first ever physician assistant.  Caitlin recently graduated from the Physicians Assistant Masters Program at Chatham University, and has a personal passion for Orthopaedics. Caitlin will serve a vital role as our point person for patients, staff, and faculty to ensure high quality of care and communication for our patient population.  Welcome aboard, Caitlin!

In my past reports, you have read about our humanitarian efforts both here and abroad. The past two years these pages have spoken to the work that many of us – most notably that of Malcolm Smith, MD, and George Dyer, MD – have done in Haiti. This past year, both Dr. Smith and Dr. Dyer made several more trips to Haiti in their continuing efforts to improve the quality of care provided by orthopaedic surgeons.  In May, Mitch Harris spent two weeks at the Landstuhl Regional Medical Center in Landstuhl, Germany serving members of the United States military through the American Academy of Orthopaedic Surgeon’s Distinguished Visiting Scholars Program. Landstuhl is a “halfway hospital” between the battlefields of Iraq and Afghanistan and definitive treatment in the United States.

We are always very proud and pleased when our residents decide to pursue careers in our subspecialty.  This year’s outstanding graduating class features two residents – Conor Kleweno, MD, and Kanu Okike, MD – who will be completing their fellowship year at Shock Trauma under the tutelage of HCORP alumni Bob O’Toole, MD, and Christina Boulton, MD.  Natalie Casemyr, MD, of the Class of 2013 has just matched at the Level I Trauma Center, Denver Health. Congratulations to Kanu, Conor, and Natalie. We know that you will make us all proud.

Without a doubt, the most exciting and notable programmatic change of the year was the launch of Orthopaedic-Geriatric co-management services at both of our hospitals.  Both services now have geriatric physicians from (respectively) the Senior Health Services (MGH) and Division of Aging (BWH), taking care of admitted elderly patients with orthopaedic injuries.  The main goal of these services is to provide consistent age-appropriate clinical care on the orthopaedic units and throughout the hospitals for this patient population. Both programs have been well-received by patients and staff alike, with initial data review showing positive influences on hospital metrics like length of stay and time from admission to the operating room.  I want to welcome and thank our geriatricians, Drs. Joel Bauman, Houman Javedan, and Bernardo Reyes, for really helping these programs get off to such a good start. Our future plans include smoothing the many processes associated with the care of these patients and conducting robust research about important subject topics like hospital-acquired delirium and outcomes in patients with non-operative pelvic fractures to determine optimal care.

Our Harvard Orthopaedic Trauma research program – otherwise known as “HOT Trauma,” – is now in its third year. This year, we had two noteworthy accomplishments. In the Spring, our MGH and BWH Services became the AO Foundation’s first ever Certified Study Center.  The AO’s general goal in promoting these Centers is to improve and promote the quality of clinical research conducted while providing training to perform clinical investigations.  In early June, we hosted our first Harvard Orthopaedic Trauma Research Day, featuring presentations by trauma faculty, fellows, colleagues from the orthopaedic labs, and residents.  The event was a great success and we look forward to developing the program in the years to come.

Mike Weaver, MD, and I are particularly excited about a new protocol we have devised with the assistance of Drs. Malchau and Bragdon from the Harris Orthopaedic Lab which uses a technology called radiostereometric analysis (RSA). In short, RSA uses round tantulum markers ranging from 0.5 - 1mm and specialized radiographic equipment to track motion and displacement over time in vivo.  In our study, we will be implanting these markers in subjects with distal femur fractures and then tracking their movement over a one-year period to determine, we hope, fracture healing and bone union.  While our colleagues at the Harris Orthopaedic Lab have used this technique to analyze joint replacements, this study is one of the first of its kind using RSA technology in fractures.

As we close, we want to recognize and thank Diane Sheehan both for her contributions to the Residency Program and the advice and assistance she has given us throughout the years. My colleagues and I are truly grateful to Diane and wish her the very best in her new position within the Graduate Medical Education office.