Beyond the Bone
Department of Orthopaedic Surgery
Summer 2018
Contents
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On the Cover: The 2018 Graduates with Dr. David Ruch (center), chief of hand surgery at Duke University (from left: Drs. Matthew Delarosa, Rabun Fox, David Ruch, Patricia Fox, and Thomas Royals)
Message from the Chair
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Faculty Spotlight
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Faculty News
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Research News
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Newsroom
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Resident News
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Calendar
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Alumni
Acknowledgements WRITERS Elizabeth Hofheinz, M.P.H., M.Ed. Lori Green EDITOR Lisa Stang, BSN, RN CONTRIBUTORS Linda Flot Shawn Bosby Vinod Dasa, M.D.
Message from the Chair
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s we welcome Summer 2018 we are reflecting on a year of dynamic clinical and programmatic advances in the LSU Department of Orthopaedic Surgery.
Michael Hartman, M.D., associate professor of orthopaedic surgery, has been named assistant team physician for the beloved New Orleans Saints. In addition to those responsibilities, Dr. Hartman remains at the helm as our program residency director; Abhishek (Abe) Kumar will contribute his talents in the role of assistant program director. This year’s residency match was very rewarding as we were able to secure four outstanding residents into our program: Drs. Scott Barnett, Rocio Crabb, Stuart Schexnayder, and Patrik Suwak . They will hit the ground running on July 1, actually earlier at boot camp in Texas, while at the same time our department undertakes the ambitious goal of expanding our residency capacity to five—and perhaps six— positions. Further expanding the dimensions of our programs are the new faculty we have brought on board. The pace of our departmental growth is picking up while the capabilities of our specialists continue to grow. In addition, we retain a strong commitment to diversity. Among our new faculty are Meredith Warner, M.D., M.B.A., a foot and ankle surgeon, Anna Cohen-Rosenblum, M.D., a total joint surgeon, and Carter Clement, M.D., a pediatric orthopedic surgeon. Kim Mix, Ph.D. is joining us on sabbatical from Loyola University, Luis Marrero, Ph.D. joins our department as research professor of orthopedics, and Jennifer Simkin, Ph.D. joins the department as an assistant professor of research. March was an especially lively month as New Orleans was the host of the 2018 American Academy of Orthopaedic Surgeons. Many of our faculty and students took to “the podium” to showcase their research projects. As this newsletter is being written, the Louisiana legislature is debating the issue of funding for private/public partnerships. While we anticipate that things will be resolved in our favor, this is a challenging environment in which to function. Recruiting, retention, planning, new initiatives—to a great extent, all stand at the mercy of the legislature. Given our stable growth and the thoughtful planning of our faculty, however, the department is well-positioned to advocate for continued support. Alas, graduation is upon us and we must send four terrifically talented residents off into their futures. They will be greatly missed.
Robert Zura M.D. Robert D’Ambrosia Professor & Chair Department of Orthopaedic Surgery LSU Health Sciences Center New Orleans
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Faculty Spotlight Alex Betech, M.D.
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hose who know two cultures and two languages are arguably better prepared to take on the challenges life puts before them. Alex Betech, M.D., an assistant professor in the LSU Department of Orthopaedic Surgery, was blessed with those gifts and has used them well. Dr. Betech says, “I was born in Mexico City and my dad, a pediatrician, brought me along on rounds at the hospital and I was fascinated. When it came time to decide on a field of study, I knew that the medical field was for me because I saw the opportunity to make a real difference in patients’ quality of life.” Fast forward several years and Alex Betech was stepping out of the Anahuac School of Medicine in Mexico City with an M.D. in hand. “I wanted to go straight into orthopedics and do my residency in the U.S., but because the field was so competitive, I knew I had to do further training and boost my CV. I did a general surgery internship at Mayo Clinic, followed by a research fellowship at the University of Texas in Houston, and finally a deformity correction fellowship in Baltimore, all the while ‘knocking on the doors’ of an orthopedic residency.” “I decided to return to Mexico City to do my orthopedic residency at the American British Cowdray Medical Center and then headed back to the U.S. for a fellowship in pediatric orthopedics at Baylor. “Even though I loved to work with kids, my true interest was in joint replacements and being able to help patients return to thieir fully functional lives. So I then took on the challenge of a joint replacement fellowship at the University of Chicago.” And what was so alluring about orthopedics?
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“I knew I wanted to be in a surgical field because peering inside the human body and getting to make a difference in a body’s condition was thrilling. And I enjoyed the thought of being able to help people get up and moving again…and I just lived in the OR.” Now a three-year veteran of LSU in Baton Rouge, Dr. Betech has caught the academic bug. “I am relishing LSU Orthopaedics because working with residents and teaching them is a superb way to help future generations of surgeons. It’s great to work with junior residents because they are so eager to learn and are fascinated by pretty much all aspects of orthopedics.” In the beginning it was difficult because I went from no teaching experience to, ‘OK, this is how you do it.’ But it turns out that being an instructor is a good fit for me.” And he has a substantial amount to teach. Dr. Betech has the clinical expertise needed to manage the most severe cases of avascular necrosis of the femoral head (AVN). He states, “Most of the patients I see are at advanced stages with severe arthritis, so unfortunately, the only treatment option is a total hip replacement. AVN can have multiple causes, ranging from idiopathic, infectious (HIV and hepatitis C), traumatic, hematologic (sickle cell disease) or rheumatologic conditions, such as rheumatoid arthritis, lupus. Patients with these conditions may be forced to undergo total hip replacement at a younger age.” “Occasionally, I do see patients in the early stages, on which I have performed a smaller surgery called core decompression. In addition, I inject their own bone marrow aspirate, with the goal of stimulating new bone formation. Such a procedure, if successful, can avoid or postpone the total hip replacement, which is particularly desirable in younger patients.” “I have multiple patients who are younger than 30 and have developed advanced AVN. My youngest hip replacement patient was 19 years old. I have another patient, a 20-year-old girl who has lupus and subsequently developed AVN of both her hips. Because she presented in already advanced stages, I was forced to do bilateral hip replacements on her. It was the only way for her to return to a normal functional lifestyle. In order to preserve bone, I used a shorter version of the femoral stem, called mini stems or bone preserving stems. Today, she is very happy with her hips, has a job and leads a full, functional life.”
Faculty Spotlight
And for me, this downtime is a perfect way to recharge my batteries.”
Above: X-ray of the 20 year old patient with bilateral hip replacements with mini stems or bone preserving stems.
Lauding the university’s efforts to care for underserved populations, Dr. Betech says, “I am struck by how deeply LSU cares for those who have poor access to healthcare and am so proud to be part of this team. We see quite a bit of chronic injuries that received no initial treatment; if we don’t help these people no one will.” “This is especially true for arthritis patients. Before my arrival, local people in need of joint replacements were not getting them. I was able to grow the clinic and now a multitude of people are experiencing the relief of joint replacement surgery.” And on the research front, Dr. Betech says, “We have one study looking at outcomes of people undergoing knee replacement and comparing people with Medicaid to those with private insurance. Another study examines knee arthritis patients and their outcomes after cortisone injections.” Looking to the future, says Dr. Betech, “My goal is to continue to work and train residents to help them become future orthopedic surgeons. I would like to grow the service such that we can treat more people with arthritis and offer them joint replacement. A dream I’ve always had since I was a medical student is to go on mission trips to underdeveloped countries and help people in need of joint replacements that otherwise cannot get treated. I haven’t had the opportunity yet, but I’m really looking forward to that day.” When not devoting his energies to those in need, Dr. Betech takes out his bike and hits the trails with his wife and two young boys. “Our children are 3 and 5 years old and I love introducing them to the peaceful beauty of the lakes here in Baton Rouge.
Above: (top) Dr. Betech and his wife at the graduation ceremony in June. (bottom) Dr. Betech and his two sons at a soccer game in Baton Rouge.
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Faculty Spotlight Michael Hartman, M.D.
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s a young boy growing up in Kaplan, Louisiana, Michael Hartman spent his fall Sundays like just about everyone else in the state—watching the Saints do their best to topple their opponents.
“As a lifelong Saints fan, it is an honor to work with the organization,” says Dr. Hartman, now Associate Professor of Orthopaedic Surgery at LSU. Dr. Hartman, recently named Assistant Team Physician for the Black and Gold, developed an interest in medicine while in college and was drawn to working with athletes, in part due to their formidable determination to recover. “I am a former athlete and found it so moving to see my injured teammates work their way back to full strength. I knew I wanted a surgical specialty and orthopedics was the most natural fit.” In 1997 Dr. Hartman received his undergraduate degree from the University of Southwestern Louisiana in Lafayette, then attended the LSU Health Sciences Center in Shreveport to obtain his medical degree. From 2001-2006 he was at the Mayo School of Graduate Medical Education in Rochester, Minnesota where he completed his internship and residency training. To further refine his expertise, Dr. Hartman completed fellowship training in orthopaedic sports medicine at the American Sports Medicine Institute in Birmingham in 2007.
And on Game Day? “The medical team typically arrives at least three hours before kickoff. We are available as needed for any last minute issues. As the kickoff time approaches—usually an hour before the game—we have a meeting with the medical staff from the other team. Whether at home or away, the referees know who are the doctors and the medical personnel. As you can imagine, there is a substantial amount of preparation for games. All of the details are worked out prior to the game. For example, contingency plans are made to identify the nearest Level 1 Trauma Center, cell numbers for opposing medical personnel, location of ambulances on the field, etc. The NFL does a superb job of providing us with the necessary information prior to games in case there is an emergency.” As for what he most wants the Saints players to know, Dr. Hartman states, “I heard one of the players say, ‘You’re a 24-hour football player. It’s not just what you do here, but what you do outside of this facility is critical as well.’ That resonated with me. Their livelihood is in essence all about their bodies, fitness level, and keeping the edge.” Asked about his philosophy of care, Dr. Hartman notes, “I strive to treat my patients like family. I do my best to speak to them in a manner that is down to earth and thorough.” Michael Hartman also runs a small team at home … co-runs, that is. “My wife, a pediatrician, is my high school sweetheart. We have the same high school diploma, college diploma, and Mayo Clinic diploma. Our four children are heavily involved in athletics and seem to have an event every evening. It’s a fun, rewarding life here in New Orleans.”
“I first practiced in Springfield, Missouri with a colleague who also trained at Mayo. I helped establish a sports medicine practice within that group and began an athletic trainer network for the local high schools.” But nostalgia for the colorful life of Louisiana drew him home and in 2011 Dr. Hartman accepted a position at LSU in New Orleans. And now Dr. Hartman is providing his specialized care, as well as leading the sports medicine division of the LSU Healthcare Network and serving as orthopedic residency program director. Of his work with the Saints, Dr. Hartman details the regimented schedule that is in place. “The week is spent covering games and taking care of players as needed. The care of the athletes is a collaborative effort among various medical personnel including athletic trainers, physical therapists, dietician, etc.”
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Above: Dr. Michael Hartman (third from left) and Dr. Larry “Chip” Bankston (far right) at a New Orleans Saints game versus the Carolina Panthers in November. Photo Credit: Baton Rouge Orthopaedic Clinic
Faculty News
Clinical Staff Introductions Carter Clement, M.D.. Assistant Professor Orthopaedics/Pediatrics
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Clinical
Pediatric orthopaedic surgeon Dr. Carter Clement is returning to his native New Orleans. A graduate of New Orleans’ Isidore Newman School, Dr. Clement received an undergraduate degree in architecture and engineering from Princeton University. He later decided he wanted to practice medicine, and returned to school to take some necessary pre-med courses, including organic chemistry and biology. After spending a year as a healthcare consultant in Cape Town, South Africa, he decided the best way to pursue his greatest passions was through a five-year program combining an MD at the University of Pennsylvania School of Medicine with an MBA from Wharton School of Business. With this background, he now is well-prepared to examine how recent healthcare policy changes have affected the practice of orthopaedics. “I am interested in researching healthcare costs and effectiveness,” Dr. Clement said. He believes that a healthcare system with the right incentives can simultaneously improve treatment quality, reduce costs, and expand access to care for patients. “I’m very excited to be working at Children’s Hospital of New Orleans,” he said. He looks forward to being part of a great group of orthopaedic physicians and surgeons who provide exceptional care for patients. “It’s important to me that there is shared decisionmaking,” he added. By ensuring parents and children are informed and prepared, they can, together, determine the best treatment decisions for the child. Having spent 18 years away, he is thrilled about bringing his new family home to his city – and the food. “I missed all of the food here, but mostly the crawfish,” he said. Dr. Clement met his wife, Meredith Clement, M.D., in medical school. She is an infectious diseases physician with a specialty in HIV prevention who will be working with LSU Health New Orleans. They have two daughters: two-and-a-half year old Clara, and Alexandra, aged four months.
Anna Cohen-Rosenblum, MD
Assistant Professor Orthopaedics
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Clinical
Dr. Anna Cohen-Rosenblum is excited about joining the staff at LSU Health in the Department of Orthopaedics. Her educational path created the perfect background for her current specialty: hip and knee replacement. Dr. Cohen-Rosenblum’s Bachelor of Arts in classical archaeology from Harvard University fostered a deeper interest in anatomy, and sparked her desire to become a doctor. Her master’s degree in skeletal archaeology from University College London provided her with a deeper study of skeletal pathology – and that’s when she noted a lot of joints had arthritis. Her studies at Albany Medical College provided an array of medical learning opportunities, but her interest in orthopaedics, and seeking solutions to joint arthritis, continued. “I wanted to take what I’d learned and apply it to people, to learn how we could help them move around better,” she said. After a residency at the University of Chicago in orthopaedic surgery, she now is completing a fellowship at the University of Virginia with a focus on hip and knee replacement. She is eager to start a comprehensive joint program for hip and knee replacement at LSU Health. Dr. Cohen-Rosenblum explained: “The faculty and staff are a great group of people. I’m excited to work with them to create a standardized care for patients, from clinic through discharge.” Shared decision-making with the patient is important to Dr. Cohen-Rosenblum. “The physician and patient are investing in this treatment together,” she said. “All people with arthritis can benefit from a replacement,” she added, “from the person who wants to get back to skiing to the grandparent who wants to walk down the street with friends.” LSU Health’s home in New Orleans also provides the potential for Dr. Cohen-Rosenblum to pursue a unique opportunity for collaborative research with LSU archeology faculty. “I think it would be really interesting to engage in some comparative anatomy research,” she noted. Dr. Cohen-Rosenblum, a native of San Jose, Ca., will begin work in September. She has a husband and twoyear-old daughter.
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Faculty News (continued from page 5)
Research Staff Introductions Kimberlee Mix, PhD
Associate Professor of Biological Sciences, Loyola University
Dr. Kimberlee Mix is excited about the work she is doing in her sabbatical with the Department of Orthopaedics at LSU Health New Orleans (LSUHNO). “This is a great opportunity to work with a dedicated team on some translational research that could have a profound impact on producing better patient outcomes following surgery,” she explained. Dr. Mix’s investigation is aligned with precision medicine, as it examines molecular features within individual patients in conjunction with demographic factors. In the future, results from the study may lead to customized treatments for patients recovering from joint replacement. Her work benefits from the tissue repository created by Dr. Vinod Dasa in the Department of Orthopaedics, and colleagues from across the LSUHNO system. The repository, funded by the Louisiana Clinical & Translational Science Center (LA CaTS), is a translational research effort meant to apply science research in order to move discovery and knowledge into a clinical testing environment with patients. The tissue samples are examined by Dr. Mix and the basic science research team, while the clinical team monitors patient health and outcomes after joint replacement. This approach will allow the interdisciplinary group to better understand how patients with osteoarthritis recover after joint replacement surgery. Her research examines specific molecular factors involved in inflammation and cartilage degradation. “We’re seeing results that align with other research indicating that race, age, and gender can predict some outcomes, like increased pain,” she said. “What we’re trying to understand is which biological factors also may be contributing to these disparities.” “We hope to use these findings and information to help customize treatment for each patient,” Dr. Mix said. “The results of this research can help physicians better manage treatment, and improve outcomes and health quality for every patient.” As an associate professor of biological sciences in the College of Arts and Sciences at Loyola University New Orleans, Dr. Mix involves her students not only in the discussion of disease mechanisms in the classroom, but also encourages them to participate in research as well. “Engaging students in health disparities research increases their awareness about the complexities of research and the practice of medicine,” she explained. “Findings by these students interested in pursuing a medical degree helps improve understanding of how health disparities coupled with molecular mechanics can impact patient outcomes.” Dr. Mix is a graduate of Worcester Polytechnic Institute, and
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received her PhD in biochemistry from Dartmouth College. She has collaborated on translational research projects related to arthritis at New York University Hospital for Joint Diseases and University College Dublin in Ireland. She has taught at Loyola University New Orleans since 2009. She lives in New Orleans with her husband, Ram, and children, Kiran (7) and Priya (4).
Jennifer Simkin, Ph.D.
Assistant Professor of Research
“I will be joining the department as an Assistant Professor of Research. My goal is to make sure everyone, regardless of their sex, ethnic background, and economic class, has the best opportunity for positive long-term outcomes after surgery. To accomplish this, my work seeks both new and supplemental clinical therapies tailored for the individual and will help uncover the molecular basis behind disparate health outcomes.”
Luis Marrero, Ph.D., HTL (ASCP)
Assistant Professor, Orthopedic Surgery Director, Morphology and Imaging – School of Medicine
“The overarching goal of our research team is to bridge the gap between basic science and orthopedic medicine in an effort to address musculoskeletal disease, trauma, and patient disparities during recovery from surgical intervention against osteoarthritis. My work as a Research Professor of Orthopedics will focus on manipulating the inflammatory response, extracellular microenvironment remodeling, and cellular metabolic crisis during traumatic limb injury to encourage salvage, repair, and regeneration of damaged soft tissue and bone. I plan to conceptualize projects and design experiments in strategic synergy with the rest of our research team of scientists and clinicians while using established collaborations with researchers at Tulane Medical School, Texas A&M, Fort Gordon, and the Medical University of South Carolina.”
Harel Schwartzberg
Chair-Elect, LSU Musculoskeletal Research Committee
“My main goal for the coming year as chair-elect is to learn as much as I can from my senior members Jacob Neary and Hunter Starring so when it is my turn to fill the position of committee chair we can continue to publish a large volume of high quality orthopedic research projects. Another big goal for us moving forward is the institution of a system in which older students with research experience are paired with younger students on research projects so that we create a cycle of older medical students orienting their less experienced peers as to how we accomplish quality research through the musculoskeletal research committee.”
Faculty News
Jacob Neary
Acting Chair, LSU Musculoskeletal Research Committee
“I will monitor all progression of research including submission to conferences, publications, and collective coordination within the committee. In addition, I will script and present all quarterly meetings while introducing available resources, providing an outline for research development, as well as communicate the present status and future of our committee.”
Hunter Starring, M.D.
Senior Advisor to Chair, LSU Musculoskeletal Research Committee
“Now that I have ascended in the role from chairman, I will now provide counsel to the chairman and chair-elect regarding past research experiences, in addition to serving as a mentor to younger students and acting as a liaison to upper-level medical students with all aspects of research. I will continue to provide guidance from my experiences thus far to help my fellow committee members to refine the research process as well to make it more streamlined for students so that recruitment is at a maximum.”
Jacob Davis
Student Research Associate
“I am a 4th year medical student at Ross University School of Medicine and am thrilled and honored to be doing a 1-year orthopaedic surgery research fellowship with Dr. Dasa. I attended Tulane University where I played wide receiver for the football team and received a BS in cell and molecular biology and a minor in business. I also received a Masters degree in cell and molecular biology from Tulane. During graduate school, I shadowed my team doctor, Dr. Felix Savoie, while I played football at Tulane, and it was there I solidified my interest in orthopaedic surgery. Working with Dr. Savoie allowed me to see how I could fulfill both my passions - sports and medicine - into one profession. I will be applying to the 2019 NRMP Match for orthopaedic surgery.
Visiting Professors On March 16, 2018 the distinguished William M. Mihalko, M.D., Ph.D. brought his deep knowledge of biomedical engineering to LSU as a visiting professor. Dr. Mihalko, chair of the Joint Graduate Program in Biomedical Engineering at the Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering, lectured on one of his specialties: Soft Tissue Balancing in TKA. Speaking of his time at LSU, Dr. Mihalko stated, “During my visit to LSU I thoroughly enjoyed my interactions with the residents. The Journal Club on Thursday night was highlighted by many
discussions concerning how to optimize primary TKA outcomes and on many ways to align and balance a TKA.” “The cadaver session on Friday allowed for one-on-one teaching time to show how to implement these techniques and provide teaching in a step-by-step manner to perform a primary TKA. LSU has a very unique setup that allows an enhanced learning experience for the residents and is an excellent model for other programs to follow. As part of department’s Research Day on June 16, 2018, the department hosted the esteemed Dr. David S. Ruch, MD as the guest lecturer for the event. Dr. Ruch is an expert in traumatic conditions of the hand, wrist, and elbow and has extensive experience in the management of avascular necrosis in young adults. He conveyed his vast knowledge in his lecture titled “The Top 20 Questions Treating Distal Radius Fractures.” Dr. Ruch was also priveleged to take part in the inauginal “In the Hot Seat” segment, where rapid fire questions were asked of him, ranging from professional to personal, with many of his responses ending up very entertaining and humorous. “The LSU program has become one of the power houses in the south. The combination of academics and strong emphasis on practical orthopedic trauma make it the ideal program. I especially enjoyed my time with the residents. The “hot seat” is a fantastic opportunity to share experiences with the residents. I came away from the experience having learned more than I taught,” says Ruch. He adds, “Upper extremity trauma surgery has been a very rewarding career. It was a great pleasure to share some of my experiences with the faculty and residents at LSU.” Dr. Ruch is the Chief of Hand and Microsurgery at Duke University Department of Orthopaedic Surgery and in 2016 assumed the role of the first combined Division Chief of Hand Surgery at Duke. He currently serves as Chairman Membership Committee and on the executive board of the American Orthopedic Association. He also is currently Executive Director of the Duke Hand Club, through which he has chaired the Duke Residents and Fellows Upper Extremity Review Course for the past nine years.
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Research News Trauma Induced Heterotopic Ossification
Disparities in TKA Outcomes
Vinod Dasa, M.D., associate professor of clinical orthopaedics and the Irvin Cahen Chair of Orthopaedic Research, has co-authored a study titled, “Trauma induced heterotopic ossification patient serum alters mitogen activated protein kinase signaling in adipose stem cells.” His co-author, Jeffrey Gimble, M.D., Ph.D. is with the Tulane University School of Medicine, Center for Stem Cell Research and Regenerative Medicine. He commented on their research, saying, “Heterotopic ossification (HO), or the formation of ectopic bone in soft tissues, has been a major complication of high energy orthopedic trauma for military personnel injured in combat. The Department of Orthopaedic Surgery at LSUHSCNO, in partnership with the Center for Stem Cell Research & Regenerative Medicine at Tulane University, the Department of Surgery at the Uniformed Services University of Health Science, and Ohio State University, have recently completed studies exploring the mechanisms and potential serum biomarkers of HO. Over 60% of orthopaedic injuries in the Afghanistan and Iraq conflicts were noted to display evidence of HO.”
Christopher E. Marrero, M.D. is associate professor in the LSU Department of Orthopaedic Surgery. Of his new study, he notes, “The Department of Orthopedics at LSU Health performs nearly one hundred total knee arthroplasties (TKA) each year on patients of various races and socioeconomic status. We have found that African Americans report aggravated symptoms of the disease prior to surgery as well as more post-surgical difficulties, consistent with published data. We propose to investigate whether poor outcomes following TKA stem from inherent biological differences between races or from environmentally induced health deficiencies caused by socioeconomic disadvantage. We hypothesize that the cause of disparities in the outcome of TKA stems from race-specific biological variations in the dynamics of synovial joint inflammation and repair, exacerbated by factors related to socioeconomic disadvantage. To test this hypothesis, we will screen tissues and/or fluids, harvested during surgery and recovery, for molecular changes specific to joint inflammation and repair. These biological data will then be pooled by race and matched to pre- and post-operative patient-reported survey scores and information on demographics, nutrition, and socioeconomic status to determine whether there is a biological basis for skewed surgical outcomes. These experiments will integrate objective, quantitative biological profiles with clinical data to define the role they play in causing differences in the outcome of TKA.”
“In a prospective study exploring the incidence of HO in civilian orthopaedic patients admitted to the UMC, the LSUHSC-NO team determined that nearly 40% of patients with trauma scores >16 developed HO within 12 months of injury based on radiographic evidence. Analyses of serum samples from both civilian and military subjects determined that AP-1 transcriptional regulatory pathway in adipose, bone, and muscle derived stromal/stem cells contributed to the fundamental mechanism underlying HO formation. Candidate biomarker proteins in the serum were further identified by mass spectroscopy. These findings determine that HO may occur more frequently than formerly considered and could provide clues for intervention to prevent or treat this complication.”
CartiHeal IDE Study LSU is augmenting our knowledge of joint surface lesions in the knee with a new multicenter, prospective, randomized controlled trial of Agili-CTM, a porous, biocompatible and resorbable scaffold. Nir Altschuler is founder and CEO of Israel-based CartiHeal, the manufacturer of Agili-CTM. Altschuler says, “LSU has begun screening subjects for inclusion in our investigational device exemption study, an effort that aims to evaluate Agili-CTM for the treatment of a wide range of cartilage and joint surface lesions. The first surgeries at LSU are expected to take place during Q2-Q3, 2018. The study assesses Agili-CTM versus surgical standard of care (SSOC), microfracture or debridement. The patient population involves different kinds of joint surface lesions: focal lesions, osteochondral defects, and mild-to-moderate osteoarthritis, including multiple defects. We look forward to collaborating with the Principal Investigator, Dr. Vinod Dasa, and his team.”
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Newsroom Study with Implications for Opioid Crisis Finds Opioids Raise Risk of Fracture Nonunion
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r. Robert Zura, Professor and Chair of Orthopaedic Surgery at LSU Health New Orleans School of Medicine, was part of a research team reporting that not only may opioid use increase the risk of bone fractures, but opioids may also impair healing. The authors also question their effectiveness in controlling pain. Dr. Zura is a coauthor of the “Article in Press” available online in the journal, Injury. The authors suggest that chronic use of certain medications may be a significant and substantial risk factor for fracture nonunion. Overall, 49.2% of opioid-naive patients receive an opioid prescription for post-operative pain control at hospital discharge after major surgery. Yet they report there is no evidence that opioids are more effective than non-opioids for acute extremity pain in the Emergency Department. The authors add that their data suggest that there is an inherent risk in use of most opioid analgesics and emphasize the importance of multimodal, non-opioid analgesic techniques at fracture. The team studied 309,330 of the 18 most common bone fractures, as well as medication use, including antibiotics, anticoagulants, diabetes medications, osteoporosis medications, cardiac medications, diuretics, immunosuppressants, steroids, anticonvulsants, and nonopioid analgesics in addition to opioid analgesics. They found that opioid medications as a class significantly increased the risk of fracture nonunion following both acute and chronic administration. “Chronic opioid use roughly doubled the risk of nonunion among all patients, and this effect was fairly consistent across all ages and both genders,” noted Dr. Zura. The researchers report that Schedule II opioids, as a group, create a greater nonunion risk than non-opioid
analgesics. Certain of these medications produce a significant risk, including acetaminophen/oxycodone, hydromorphone, acetaminophen/hydrocodone, oxycodone and meperidine. Of the Schedule III-V opioids, tramadol and naloxone/ pentazocine were also associated with increased risk. Acetaminophen/codeine and buprenorphine were not associated with increased risk of nonunion. Prescription NSAID use also increased the risk of nonunion among chronic users. “It is interesting that recent opioid policy discouraging the use of highpotency opioids appears to be increasing use of lower-potency opioids such as tramadol, a Schedule IV opioid,” says Zura. “Our data suggest that this trend may not increase medication safety to the degree desired. It is critical that trauma surgeons and other practitioners be aware of the nonunion risk created by medication use.” The team also included researchers from Duke University Medical Center, North Carolina State University, Hospital of the University of Pennsylvania and the University of Missouri. The study was supported by Bioventus, LLC, and Zura and two other co-authors are paid consultants to Bioventus.
*Reprinted with permission from “Louisiana State University Health Sciences Center. “Study with implications for opioid crisis finds opioids raise risk of fracture nonunion.” © Copyright 2018 LSU Health Sciences Center New Orleans Journal reference: Thomas Buchheit, Robert Zura, Zhe Wang, Samir Mehta, Gregory J. Della Rocca, R. Grant Steen. Opioid exposure is associated with nonunion risk in a traumatically injured population: An inception cohort study. Injury, 2018; DOI: 10.1016/j. injury.2018.05.004
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Resident News
Congratulations, Residents, On Your Fellowships! Dr. Matthew Delarosa – Hand and Upper Extremity Fellowship at OrthoCarolina Hand Center in Charlotte, NC Dr. Patricia Fox – Hand Fellowship at The Philadelphia Hand to Shoulder Center at Thomas Jefferson in Philadelphia, PA Dr. Rabun Fox – Foot and Ankle Fellowship at The Rothman Institute at Thomas Jefferson in Philadelphia, PA Dr. Thomas Royals – Hand and Upper Extremity Fellowship at Florida Orthopaedic Institute in Tampa, FL
Welcome, New Residents!
Scott Barnett – University of Texas Southwestern Medical Center, Dallas, TX Rocio Crabb – Hofstra Northwell School of Medicine, Hempstead, NY Stuart Schexnayder – LSU Health Sciences Center, New Orleans, LA Patrik Suwak – A.T. Still University School of Osteopathic Medicine, Mesa, AZ
Residency Match Resident applications are now being accepted through the Electronic Residency Application Service (ERAS). Last day to apply is November 15th. Interview dates will be in January. 10
Graduation
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Calendar Grand Rounds Grand rounds are held on Fridays from 7-8am at the Lion’s Building, 6th Floor Conference Room with didactic lectures and lab follow. August 3 Sports/Upper Extremity September 21 Adult Reconstruction October 12 Spine November 9 Hand
Important Dates August 18-19 ATLS Course (Tulane School of Medicine) September 13-15 ASSH Annual Meeting Boston, MA September 25-28 OTA Annual Meeting Denver, CO September 26-29 NASS Annual Meeting Los Angeles, CA October 10-12 MSTS Annual Meeting New York, NY November 1-4 AAHKS Annual Meeting Dallas, TX G. Dean MacEwen Lectureship (CHNOLA) 1pm – 5pm November 2 Dr. Tony Herring – Texas Scottish Rite Hospital for Children
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Alumni We are grateful for those who have supported Tiger Bones, the Resident Educational LSU Orthopedic Resident Fund. Your generosity benefits the the LSU Orthopedic Residency Training Program - having a direct impact on its residents through expanded access to training experiences, technology updates, and educational opportunities that are necessary in a residency training program. Your online donation can be made at https://give.lsuhealthfoundation.org/tigerbones OR if you prefer, please mail your check made payable to: LSU Tiger Bones c/o LSU Health Foundation 2000 Tulane Avenue, 4th Floor New Orleans, LA 70112 Questions: 504-568-5717 We thank you for your support!
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LSU Health Sciences Center Department of Orthopaedic Surgery 1542 Tulane Avenue, Box T6-7 New Orleans, LA 70112 Phone: (504) 568-4680 Fax: (504) 568-4466 https://www.medschool.lsuhsc.edu/orthopaedics/