Handbook> Selectives > Surgery > Orthopaedic Surgery

Surgery Subspecialties

Orthopaedic Surgery

Number: (Oasis - S56m) 2116

Rotation Supervisor: Dr. Aaron Freilich

Coordinator: David Craig

Available: all Rotations

Duration: 2 weeks

Report to: Resident will be identified in assignment email

Time to Report: 6:15am (unless noted otherwise in assignment email)

Place to Report: Moss Auditorium, Univ. Hosp. (unless noted otherwise in assignement email)

Suggested preparatory reading:

  1. Netter’s Concise Orthopaedic Anatomy
  2. Surgical Exposures in Orthopaedics: The Anatomic Approach
  3. Hoppenfeld’s Surgical Exposures in Orthopaedics (several copies available in the library)
  4. http://www.orthobullets.com/
  5. http://www.wheelessonline.com/

Number of students per rotation: 4

Course Description: The goal of the Selective is to provide an introduction to Orthopaedic outpatient, inpatient and operative care. The student will shadow the Orthopaedic Residents in daily activities and duties. This includes inpatient rounds, conferences, clinics, and surgery. The student is expected to learn basic orthopaedic concepts and techniques. Basic understanding of orthopaedic concepts should lead to the ability to develop an initial treatment plan. Energetic, self-initiated contribution to the orthopaedic team is expected and questions and active participation are encouraged.

The student will be assigned to ONE of seven Orthopaedic subspecialty services. They are:

  1. Adult Reconstruction: provides in- and out-patient exposure to major joint replacement, reconstructive osteotomies and oncology.
  2. Foot & Ankle Surgery: provides exposure to foot and ankle reconstruction as well as the surgical and nonsurgical care of the foot.
  3. Spine Surgery: provides exposure to the non-surgical and surgical treatment of both acute and chronic conditions involving the adult spine.
  4. Sports Medicine: provides exposure to the operative and non-operative treatment of sports-related injuries for the recreational and competitive athlete.
  5. Trauma: provides exposure to the management of complex pelvic and peri-articular fractures, as well as upper extremity fractures.
  6. Hand: provides exposure to the management of traumatic and non-traumatic conditions affecting the upper extremity.
  7. Pediatric Orthopaedics: provides in- and out-patient exposure to the care of the pediatric orthopaedic patient.

Learning Objectives:

Medical Knowledge

Learning Objective #1: The student will develop a basic level of pertinent basic science knowledge as it pertains to orthopaedic surgery.

Learning Objective #2: The student will acquire understanding of implications of patients’ illnesses, including prognosis and follow-up plan.

Patient Care

Learning Objective #1: The student will develop the ability to take a complete orthopaedic history and a pertinent physical examination focusing on goals of completeness, accuracy, directing an exam to the patient’s problems, and eliciting and interpreting findings.

Learning Objective #2: The student will correlate exam and history with imaging including XR, CT, and MRI.

Communications

Learning Objective #1: The student will develop the ability to engage and communicate with orthopaedic patients in clinical, operative, and post-operative settings.

Learning Objective #2: The student will keep appropriate written clinical records with goals of completeness, accuracy, organization and appropriateness.

Practice Based Learning & Improvement

Learning Objective #1: The student will acquire the ability to access and apply literature resources in order to utilize current medical information in the care of their patients.

Learning Objective #2: The student will develop an inquisitive attitude towards patient care with regards to orthopaedic illnesses and their treatments.

Systems Based Practice

Learning Objective #1: The student will acquire the ability to select, justify, and interpret basic diagnostic studies including lab tests that are in the best interest of the patient.

Learning Objective #2: The student will integrate medical knowledge with clinical information in the care of patients and weigh the risks and benefits of treatment options.

Professionalism

Learning Objective #1: The student will assume responsibility in a professional way and demonstrate dependability.

Learning Objective #2: The student will develop the ability to interact cooperatively with other members of the health team including staff and colleagues.

Subspecialty-Specific Learning Objectives

Adult Reconstruction

Learning Objective #1: The student will be able to discuss the indications for total joint arthroplasty of the hip and knee and recognize the characteristic signs of end-stage osteoarthritis on XR imaging.

Learning Objective #2: The student will demonstrate an understanding of the relevant anatomy involved in the anterolateral surgical approach to the hip.

Learning Objective #3: The student will display knowledge of the basic operative steps involved in total hip and total knee arthroplasty as well as the post-operative precautions that must be taken in these surgical patients.

Foot & Ankle Surgery

Learning Objective #1: The student will be able to discuss common complications of the diabetic foot, including ulcers and Charcot neuropathy, as well as management options for these common conditions.

Learning Objective #2: The student will describe the classic clinical presentations and non-operative and operative management methods for the following common tendon injuries: Achilles tendon rupture, Achilles tendonitis, and plantar fasciitis.

Spine Surgery

Learning Objective #1: The student will demonstrate the ability to perform a thorough neurologic exam of the upper and lower extremities, and indicate potential findings that require urgent/emergent action to be taken.

Learning Objective #2: When presented with a patient with back pain, the student will be able to create a differential diagnosis, identify indications for imaging, describe associated findings on imaging in anatomic terms, and delineate management options.

Sports Medicine

Learning Objective #1: The student will distinguish among the clinical presentations and physical exam and imaging findings of the following kinds of knee injury: Meniscal tears, ACL injury, PCL injury, MCL injury, LCL injury, and knee dislocation. The student will additionally be able to perform the Anterior and Posterior Drawer, Lachman, and McMurray tests.

Learning Objective #2: The student will differentiate between impingement and rotator cuff disease by clinical presentation and physical exam findings. The student will also be able to discuss the medical and surgical management options for these conditions.

Trauma

Learning Objective #1: In the evaluation of an orthopaedic trauma patient, the student will be able to identify associated findings on imaging in anatomic terms and describe when urgent surgical intervention is necessary.

Learning Objective #2: The student will explain the pathophysiology of compartment syndrome and the types of injuries that most likely cause this condition. The student will be able to discuss classic physical exam findings associated with compartment syndrome and the required surgical intervention as well.

Hand

Learning Objective #1: In the evaluation of a patient with carpal tunnel syndrome, the student will be able to characterize the classic presentation, perform Durken’s, Tinel’s, and Phalen tests on exam, and discuss the medical and surgical management methods for the condition.

Learning Objective #2: The student will be able to discuss the pathophysiology of and management options for the following conditions commonly seen in hand clinic: Trigger finger, Mallet finger, Depuytren’s contracture, and Ganglion cyst.

Pediatric Orthopaedics

Learning Objective #1: The student will explain the classic symptoms, physical exam findings, and radiographic appearance of the following conditions: slipped capital femoral epiphysis, developmental dysplasia of the hip, and Legg-Calve-Perthes disease.

Learning Objective #2: The student will display understanding of the physical exam and radiographic evaluation of the pediatric spine, and will discuss indications for bracing versus surgical intervention.