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InsideOI

Volume 5: Issue 1

2010

Also in this issue Doc Talk:

Dr. Dicke on Basilar Thumb Arthritis

Work Comp:

The latest in Work Comp

Q u a rt e r ly P u b l i c at i o n

Expanding Our Care

OrthoIndy physicians now at new locations


Editor’s Note: Everyone in the OrthoIndy and Indiana Orthopaedic Hospital (IOH ) community is dedicated to providing the highest quality care for patients and their families. We will continue to offer our services to those who matter most in our practice: the patients. TM

TM

In this issue you will have the opportunity to learn more about a new study the OrthoIndy trauma department is participating in with the Orthopaedic Extremity Trauma Research Program of the Department of Defense. As a member of our team, please let us know if you have any suggestions on how we can improve our relationship by contacting us at suggestions@orthoindy.com or by contacting one of our staff directly (please see staff contact information on the next page). We appreciate your feedback in advance. Thank you for choosing OrthoIndy and IOH for all of your orthopaedic needs.

ON THE COVER OrthoIndy Trauma Department to participate in Extremity Trauma Clinical Research Consortium. For more information see the story on page 6.

Sincerely,

Kasey Prickel Editor Public Relations Manager

Taking care of your orthopaedic needs....

from pediatrics to geriatrics! ÂŽ


OrthoIndy Trauma Department involved in new research study

[Inside OI Staff]

New OrthoIndy速 Outreach Locations

La Porte

South Bend

Valparaiso

Auburn

R

65

Angola

Goshen

Plymouth

e ano pec Ti p

80

90

Elkhart

Michigan City

Gary Portage

Warsaw

Fort Wayne

Rochester

Huntington

Logansport

Decatur

Wabash

Peru

West Lafayette

Kokomo

Lafayette

Elwood

74

Noblesville

Crawfordsville

Carmel

Richmond Lawrence Greenfield Greenwood Franklin

Greensburg

W hi t e

Columbus

Ri ver Wab ash

64

Evansville

Work Comp Representative John Orr jorr@orthoindy.com (317) 802-2131

Madison 65

Jasper

io Oh

74

9

Seymour

Shoals

Washington

OrthoIndy physicians now at new locations

Bloomington

Bedford Vincennes

Princeton

Shelbyville

Martinsville

Monroe Lake

Linton

Muncie

Anderson

Fishers

Indianapolis Greencastle 70

Brazil Terre Haute

69

Ri ve r

Frankfort

4

Expanding Our Care

Marion

Referring Physician Representatives North/East Territories Jennifer Nair jnair@orthoindy.com (317) 802-2074 South/West Territories Amy Klesk aklesk@orthoindy.com (317) 884-5228

Patoka Lake

New Albany

Jeffersonville

er Ri v

Work Comp

The latest updates in the Work Comp Department

4 year old receives trauma care from Dr. Weber

Doc Talk

Editor Kasey Prickel

Dr. Dicke discusses Basilar Thumb Arthritis

Graphic Design Kim Connett

8450 Northwest Boulevard Indianapolis, IN 46278

Indiana Orthopaedic Hospital (IOH速)

8400 Northwest Boulevard Indianapolis, IN 46278

1st Quarter 2010

]

OrthoIndy速

10 13

Rave Review

Contributing Writers Kasey Prickel Dr. Timothy Dicke

Marketing Director Jennifer Fox

3

Trauma Research

TM

Learn more about OrthoIndy chat with us at:

]

(800) 223-3381 or (317) 802-2000 or visit us on:

email us at suggestions@orthoindy.com

2


E

: e r a C r u o g n i d cations o L n w e a N t a p x vailable A w o N s n a i ndy Physic OrthoI

To provide more access to bone, joint, spine and muscle care, OrthoIndy has expanded to four underserved areas in Indiana. OrthoIndy physicians are now available in Brazil, Greenfield and Shelbyville, Indiana.

Brazil

Dr. Chris Bales is now accepting patients at the St. Vincent Clay Hospital, located at 1206 East National Avenue. Dr. Bales is available at the clinic on Wednesdays from 8 am to noon. Dr. Chris Bales Orthopaedic Specialties: Knee, Shoulder, Sports Medicine To schedule an appointment with Dr. Bales, please call (317) 268-3632.

Fishers

Dr. Michael Thieken is now accepting patients at the St. Vincent Medical Center Northeast, located at 13914 E. State Road 238, Suite 301, Fishers, Indiana. Dr. Thieken is available on Fridays from 8 am to noon. Dr. Michael Thieken Orthopaedic Specialties: Sports Medicine, Shoulder, Hip, Knee To schedule an appointment with Dr. Thieken, please call (317) 802-2442.

Greenfield

Three OrthoIndy physicians are now practicing in Greenfield. Drs. Matthew Lavery, Benjamin Justice and Gregory Reveal are now accepting patients three days a week at the new location, located at One Memorial Square, Ste. 2000, Greenfield, Indi-

4

ana. The Greenfield location is open Monday and Wednesday, 8 am to 12 pm and Friday, 1 to 4 pm. Dr. Matthew Lavery Orthopaedic Specialties: Sports Medicine, General Orthopaedics To schedule an appointment with Dr. Lavery, please call (317) 884-5170. Dr. Benjamin Justice Orthopaedic Specialties: Total Joint Replacement, General Orthopaedics To schedule an appointment with Dr. Justice, please call (317) 884-5169. Dr. Gregory Reveal Orthopaedic Specialties: Trauma, Upper Extremity To schedule an appointment with Dr. Reveal, please call (317) 917-4389.

Shelbyville

Dr. Michael Coscia is now accepting patients at the Renovo Building, located at 275 West Bassett Road, Suite 4, Shelbyville, Indiana. Dr. Coscia is available at the clinic on Mondays from 8 am to 5 pm. Dr. Michael Coscia Orthopaedic Specialties: Spine To schedule an appointment with Dr. Coscia, please call (317) 802-2874. Inside OI


New OrthoIndy速 Outreach Locations

Gary Portage

La Porte

South Bend

Valparaiso

Auburn

R

65

Angola

Goshen

Plymouth

e ano c e p Ti p

80

90

Elkhart

Michigan City

Warsaw

Fort Wayne

Rochester

Huntington

Logansport

Decatur

Wabash

Peru

Marion West Lafayette

Kokomo

Lafayette

Elwood

74

Noblesville

Crawfordsville

Carmel

Richmond Lawrence Greenfield

Franklin

Greensburg

W hi t e

Columbus

Monroe Lake

Ri ver

Vincennes

Wab ash Ist Quarter 2010

Shelbyville

Martinsville

Seymour Madison

Shoals

Washington

65

Jasper

64

74

Bloomington

Bedford

Princeton

Anderson

Greenwood

Greencastle 70

Linton

Muncie

Fishers

Indianapolis Brazil Terre Haute

69

Ri ve r

Frankfort

Patoka Lake

New Albany

er v i R

Jeffersonville

Evansville

io h O 5


OrthoIndy, will serve as one of 12 core clinical centers in a newly established Extremity Trauma Clinical Research Consortium. Funded by the Orthopaedic Extremity Trauma Research Program (OETRP) of the Department of Defense for $18.4 million over 5 years, the Consortium will work closely with several major military treatment centers and the U.S. Army Institute of Surgical Research (USAISR) to conduct multi-center clinical research studies relevant to the treatment and outcomes of severe orthopaedic trauma sustained on the battlefield. These studies will help establish treatment guidelines and facilitate the translation of new and emerging technologies into The staff and clinical practice.

cally problematic,” said Ms. Dana Musapatika, MSC, Trauma Research Manager at OrthoIndy. “This grant will provide the resources necessary to accomplish this type of research in a relatively short period of time.” Critical needs to be addressed include the reconstruction of significant bone defects and the management of musculoskeletal infections. Over time it will expand and leverage its infrastructure to address many other priority topics relevant to the long-term management of severe extremity trauma, including the prevention of osteomyelitis, chronic pain and disability.

surgeons are very excited about the opportunity to work with the other top centers in the country on these research projects. We are hopeful that the findings will result in better treatment for both civilian and wartime injuries.”

“The need for such a consortium is evident,” said Ellen MacKenzie, PhD, Director of the Coordinating Center for the Consortium, located at the Johns Hopkins Bloomberg School of Public Health. “Eightytwo percent of all service members injured in Opera- Dr. Renn Crichlow tion Iraqi Freedom and Operation Enduring Freedom sustain significant extremity trauma. Many sustain injuries to multiple limbs. The research “The staff and to be conducted by the Consortium will help us better surgeons are very understand what works and what doesn’t in treating excited about the these injuries and ensure that our service members are opportunity to provided with the best care possible.” work with the other top centers Initial funding of the consortium will help establish in the country on the network and provide the resources to address some these research of the critical needs in acute clinical care identified by projects,” the military. “Obtaining adequate funding to supsaid Dr. port these types of research studies has been historiRenn


Crichlow, an orthopedic trauma surgeon at OrthoIndy and the IOH. “We are hopeful that the findings will result in better treatment for both civilian and wartime injuries.”

wounded warrior and ultimately improve the clinical, functional and quality of life outcomes of both service members and civilians who sustain major limb trauma”.

An important feature of the Consortium will be its ability to expand the number of clinical sites participating in any one clinical study. Over 30 trauma centers around the country have pledged support for the Consortium and are eager to participate in one or more of the studies sponsored under its umbrella.

The twelve core clinical centers currently participating in the Consortium include:

“We are thrilled to be partnering with the Consortium and the incredible team of investigators they have assembled,” says Dr. Joseph Wenke of the USAISR. “Together we will develop the infrastructure critically needed to address some of the most pressing issues in orthopedic trauma care. Without a large multi-center effort such as this, many of these issues would never be solved.” MacKenzie concludes, “The Consortium is all about providing the scientific evidence needed to establish treatment guidelines for the optimal care of the

• Boston University Medical Center • The Florida Orthopedic Institute • Carolinas Medical Center, Denver Health and Hospital Authority • OrthoIndy® and the Indiana Orthopedic Hospital™ • Orthopedic Associates of Michigan • The Orthopaedic Trauma Institute at the University of California at San Francisco • San Francisco General Hospital • The University of Maryland Medical Systems R Adams Cowley Shock Trauma Center • The University of Mississippi Medical Center • The University of Texas Southwestern Medical Center • The University of Washington Harborview Medical Center • Vanderbilt University Medical Center

Dr. Renn Crichlow Specialties: Trauma Dr. Crichlow received his medical degree from Harvard Medical School in Boston, MA after receiving a degree in Kinesiology from Simon Frasier University in Vancouver, British Columbia. Following his medical degree, he completed an internship in general surgery at the Beth Israel Deaconess Medical Center in Boston. Dr. Crichlow subsequently fulfilled an orthopaedic surgery residency at the Harvard Combined Orthopaedics Program which is based at the Massachusetts General and Brigham and Women’s hospitals in Boston. He pursued his subspecialty training in Orthopaedic Traumatology at the world renowned Shock-Trauma Center in Baltimore, Maryland. Dr. Crichlow was a member of the Canadian Olympic Canoe Team and participated in the Seoul 1988, Barcelona 1992 and Atlanta 1996 Olympic Games. In 1991, Dr. Crichlow was the World Champion in Kayak Singles; he holds multiple other World Championship and World Cup Medals. Dr. Crichlow’s research interests include pelvic fractures in multiply injured patients and the psychological effects of traumatic injuries.

To schedule an appointment, please call (317) 917-4384

Ist Quarter 2010

6


Orthopaedic Research Foundation OI Seeks Patients for Research Studies

The Orthopaedic Research Foundation, Inc. (ORF) supports various research and educational interests of the physicians at OrthoIndy. Founded in 1986, its mission is “to advance the scientific body of knowledge associated with musculoskeletal disorders, for the scientific and public communities, through research and education.�

Study Title

Brief Description Criteria

Enrollment Contact Deadline or Person Enrollment Goal

Contact

A Multicenter, Randomized, Pivotal Study Dr. J. Farr to Evaluate the Safety and Efficacy of the Cartilage Autograft Implantation System (CAIS) for the Surgical Treatment of Articular Cartilage Lesion of the Knee

Articular Cartilage Defects of the Knee Visit www.clinicaltrials.gov for inclusion and exclusion criteria.

Open

Vicki Snodgrass CCRC

vsnodgrass@ orthoindy. com

Evaluation of the Composit of Cancellous and Demineralized Bone Plug(CR PLUG) for Repair of Focal Cartilage Lesions of the Femoral Condyle

Dr. J. Farr

Articular Cartilage Defects of the Knee Visit www.clinicaltrials.gov for inclusion and exclusion criteria.

After 10 patients enrolled

Vicki Snodgrass CCRC

vsnodgrass@ orthoindy. com

A Post Market Study of the ABS OrthoGlide Arthroplasty Device for OsteoArthritis of the Knee

Dr. J. Farr

Osteoarthritis of the knee

Vicki Snodgrass CCRC

vsnodgrass@ orthoindy. com

A Post Market Study of Articular Cartilage Defects of the Knee Treated with Denovo NT, Natural Tissue Graft

Dr. J. Farr

Articular Cartilage Defects of the Knee Visit www.clinicaltrials.gov for inclusion and exclusion criteria.

After 10 patients enrolled

Vicki Snodgrass CCRC

vsnodgrass@ orthoindy. com

Rgeneration Technologies, Inc. Registry of Biocleanse Meniscus Transplants

Dr. J. Farr

Meniscal Transplantation Candidates Visit www.clincialtrials.gov for inclusion and exclusion criteria

After 10 patients enrolled

Vicki Snodgrass CCRC

vsnodgrass@ orthoindy. com

Collection of Specimens from Joint Replacement Surgery for In-Vitro Osteoarthritis Research

Drs. J. Farr, Kolisek, and Monesmith

Total Knee Replacement Candidates

Vicki Snodgrass CCRC or Nenette Jessup

vsnodgrass@ orthoindy. com or Njessup@ orthoindy. com

Trial to Evaluate Ultrasound in the Treatment of Tibial Fractures (TRUST)

Dr. Maar

Study of low-intensity pulsed ultrasound treatment vs. placebo treatment in IM nailed tibial fracture healing.

After 15 patients enrolled

Dana Musapatika

(317) 9174117

Reamed Irrigation Aspirator (RIA) for Bone Graft Harvest for Segmental Defect

Dr. Weber

A study focused on the use of reamed irrigation of the tibia or femur as a technique for bone graft harvesting.

After 15 patients enrolled

Dana Musapatika

(317) 9174117

Musculoskeletal Injuries Associated with Moped and Motorized Scooter Accidents

Dr. Jelen

A study of the factors involved in moped and motorized scooter accidents and the treatment methods utilized.

After 15 patients enrolled

Dana Musapatika

(317) 9174117

Fixation using Alternative Implants for the Treatment of Hip Fractures (FAITH)

Dr. Baele

A trial comparing sliding hip screws and cancellous screws on revision surgery rates and quality of life in the treatment of femoral neck fractures.

After 15 patients enrolled

Dana Musapatika

(317) 9174117

Post-operative Knee Rehabilitation: Comparing the Conventional Approach to the Use of a Music Rehab Video

Drs. Fisher, Hellman, Kunkel, Randolph,

This is a randomized controlled blind study to determine whether patients who use a music exercise video for their physical therapy after knee replacement surgery have outcomes and satisfaction scores equivalent to patients who undergo a conventional physical therapy protocol.

April, 2010

Deborah Robinson, PA-C

drobinson@ orthoindy. com

7

Participating Physicians

Inside OI


Study Title

Participating Physicians

Brief Description Criteria

5 – Year Prospective,Post-Market Pilot Study of Biolox Delta 36 mm and Larger Femoral Heads with Trident X3 Polyethylene Inserts

Dr. Kolisek

A single center study evaluating patients 18-month with Biolox delta femoral head with an X3 period polyethylene insert hip implants for wear rate, clinical results, radiographic stability and quality of life.

Nenette Jessup

(317) 8845232 njessup@ orthoindy. com

10 - Year Retrospective/Prospective RaDr. Kolisek diographic Analysis of Secur-Fit Hip Stem

A single center study comparing radiographic remodeling of the Secur-Fit stem to the Omnifit HA stem through 10 years and evaluating the group for quality of life and clinical results.

Nenette Jessup

(317) 8845232 njessup@ orthoindy. com

Osteocel® Plus in Anterior Lumbar Fusion (ALIF): Evaluation fo Radiographic and Patient Outcomes

Drs. Schwartz, Riina, Trammell, Dietz, Huler

One or two level lumbar fusion using Osteocel® Plus as a bone graft substitute.

July 2010

Kim Fitzpatrick

spineresearch@ orthoindy. com

A Prospective, Randomized, Controlled Pivotal Clinical Investigation of DIAM™ Spinal Stabilization System in Patients with Lumbar Degenerative Disc Disease

Drs. Riina, Schwartz, Trammell, Dietz

Mild to moderate degenerative disc disease from L1-L5. Randomized study into either DIAM (surgical) or conservative care group.

September 2009

Kim Fitzpatrick

spineresearch@ orthoindy. com

A comparison of INSORB™ staples and traditional wound closure in posterior spinal surgery.

Dr. Trammell

Randomized study comparing use of staples versus sutures on surgical incision.

July 2010

Kathy Flint

spineresearch@ orthoindy. com

Linkage analysis and gene mapping of familial spinal disorders (scoliosis, Scheuermann’s kyphosis, spondylolisthesis, lumbar disc disease, osteoporosis).

Drs. Schwartz, Riina, Trammell, Dietz, Huler, Coscia

DNA (saliva) testing of patients with scoliosis.

N/A

Kathy Flint

spineresearch@ orthoindy. com

Epidemiology, Process, and Outcomes of Spine Trauma

Drs. Schwartz, Riina, Dietz, Coscia, Huler, Trammell

Any spinal cord trauma patients

N/A

Kathy Flint

spineresearch@ orthoindy. com

Surgical Treatment for Acute Spinal Cord Injury Study

Drs. Schwartz, Riina, Dietz, Coscia, Huler, Trammell

Any spinal cord trauma patients

N/A

Kathy Flint

spineresearch@ orthoindy. com

Management of Type II Odontoid Fractures

Drs. Schwartz, Riina, Dietz, Coscia, Huler, Trammell

Cervical spine trauma patients

N/A

Kathy Flint

spineresearch@ orthoindy. com

Incidence of Dysphagia after Anterior Cervical Fusion Procedure with Various Types of Anterior Cervical Plates: A Short and Long Term Follow-up Study

Drs. Joesph Patients (>18 years of age) who undergo Riina, Michael anterior cervical surgery with plating Coscia, John Dietz, Robert Huler, Gabriel Jackson, David Schwartz, Terry Trammell

N/A

Kathy Flint

spineresearch@ orthoindy. com

Magnetic Resonance Imaging and the Posterior Ligamentous Complex

Drs. Riina, Dr. Schwartz, Dietz, Huler

Spine trauma patients

N/A

Kathy Flint

spineresearch@ orthoindy. com

A Comparison of INSORB Staples and Metal Staples in Bilateral Knee Replacement

Dr. Fisher

Patients 18 years of age or older who present 11/11 wiith the need for a bilateral knee replacement will be considered for participation. Those patients who fulfill the inclusion criteria and do not meet any of the exclusion criteria will be evaluated. Patients being able to provide a written personal signature on the consent/authorization form for enrollment in the study.

Mary Burgess

(317) 8022853

4th Quarter 2010

Enrollment Contact Deadline or Person Enrollment Goal

Contact

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Work Comp Update Through marketing and operational initiatives, OrthoIndy® is continuously working to improve the Worker’s Compensation Department and how it services the WC industry. OrthoIndy’s WC department handles all referrals of WC patients, starting the process with the initial request for an appointment and stays involved through the medical reporting, work status, return to work orders and finally until a patient is released and reaches MMI (Maximum Medical Improvement). We understand that the customer is not only the patient, but the Nurse Case Manager, Claims Adjuster and the employer as well. Operational processes for the department have been streamlined, making the initial appointment process shorter, more efficient and customer service driven. Nan Millikan is the manager of the WC Department. Nan uses her previous position as a Worker’s Compensation Adjuster, as well as 15 years of Worker’s Compensation knowledge and experience to help implement user-friendly processes in the department. Nan also provides her staff with a training manual to train and educate the staff on the Worker’s Compensation process. In an effort to better serve our customers, we now have additional locations in Brazil, Greenfield, Shelbyville and at St. Vincent’s location at Exit 10 off of I-69 in Noblesville. The new locations will allow quicker, closer treatment options and will help the patients receive the treatment they need closer to home. More outreach locations are being identified as we continue to expand throughout central Indiana. OrthoIndy now offers Walk-in clinics at our OrthoIndy West and OrthoIndy Northwest locations, with the goal to eventually offer this program at all of our locations. The clinics will offer immediate care to

orthopaedic injuries that are acute in nature. We are working internally to make this an easier process for the WC community. Ideally, we would like to treat the patient from date of injury until MMI. At OrthoIndy, we have physicians who specialize in spine, upper extremity, lower extremity, foot and ankle, hand and joint replacement surgery. We also have physiatrists and of course, our own physicianowned specialty hospital, the Indiana Orthopaedic Hospital (IOH). We understand how frustrating it must be when patients suffer a work related injury, and the desire of the employer to get the injured employee back to work and the sense of urgency of the adjusters to monitor costs, treatment and return to work status. The WC Department appreciates the responsibilities of the Nurse Case Manager in attending the appointments and reporting back to the employer or insured, as well the Nurse Case Manager’s busy schedule. We look forward to continued service to the WC industry and will strive to continue to be educated on changes in the worker’s compensation world, as well as work hard to provide top-notch customer service, quality care and prompt response time.We want to treat the patient’s injuries, get the patient to maximum medical improvement as quickly as the healing allows, and get the patient back to work. For more information on OrthoIndy’s WC Department, please contact John Orr. John is the WC Marketing Representative for OrthoIndy. He has been with OrthoIndy since August of 2007. Prior to that John worked for 18 years in the insurance industry as a WC Claims Specialist. Please feel free to contact him at (317) 802-2131 or jorr@orthoindy.com.


Rave Review

OrthoIndy Provides Such Great Service, the Patients Can’t Help But to Rave About it! One of the scariest trips to the doctor’s office is when a serious accident has occurred, especially when your child is involved. Shannon Humphrey had to rush her daughter to the emergency room and was fortunate that an OrthoIndy physician was there to help. Shannon’s daughter, Morgan is four years old. On Thanksgiving weekend, at 5:30 pm, an ATV hit Morgan. She had a right humerus and clavicle fracture with two large gaping wounds over the humerus fracture. Morgan was stabilized in the emergency room at Washinton County memorial Hospital. As an employee of the Indiana Orthopaedic Hospital, Shannon knows the OrthoIndy Trauma physicians. She asked the ER to transfer Morgan to Methodist after calling to ensure an OrthoIndy physican was on call. “I had never dealt with a true trauma situation so I wasn’t really sure what to do,” said Shannon. “We were in Washington County, which is a long way from

our home in Columbus. Because we were so far away, the trauma physician assistant, Julie Gebhart and I had to play phone tag because my cell phone wasn’t getting good coverage. Julie was very patient and very kind and instructed the emergency room on what to do to stabilize her and to get her transferred up to them at Methodist so OrthoIndy Trauma could handle it.” After examining Morgan, Julie came down to the emergency room to talk to Shannon and her family. She answered all their questions and said that Dr. Timothy Weber, an orthopaedic trauma surgeon at OrthoIndy, would talk to the family prior to Morgan’s surgery. The ER at Methodist was very busy and Morgan’s surgery did not happen until 2:30 am on Sunday morning. Dr. Weber talked to Shannon and her family before taking Morgan to surgery. “He was very kind and patient with our questions and reassured our fears,” said Shannon. “I remember him

Dr. Weber checks on Morgan at her post operative appointment.


putting his hand on my shoulder, giving it a squeeze and letting me know everything was going to be ok. He came out after surgery, brought pictures with him and explained the injuries and what he had done.” Dr. Weber was able to get the humerus fracture reduced and put a rod in to stabilize it and he got one of the two open wounds closed. He was concerned about closing the other wound due to the amount/ size of the wound and due to a secondary piece of skin that he wasn’t sure would live so he placed a wound vac over this wound. He also wanted a plastic surgeon consult for a potential skin graft.

ing the second surgery I could see the smile on their faces,” said Shannon. Dr. Weber was able to get the second wound closed without the skin graft and the other piece of skin in question had survived. After surgery, Dr. Weber personally followed up with Morgan’s progress and informed her family that she was recovering and would be able to go home soon. “I cannot say enough good things about Dr. Weber, his NP Danielle and the trauma PA Julie. He was wonderful with Morgan. She would only let Mommy and Daddy look at her wound, but Dr. Weber convinced her to let him look at it. He was gentle with her and took his time again answering our questions. I never felt rushed or hurried and truly felt like our family had his undivided attention. He was wonderful not only with Morgan but also to my husband and me. I would highly recommend him.”

“I remember him putting his hand on my shoulder, giving it a squeeze and letting me know everything was going to be okay.”

Morgan was scheduled for another procedure on Tuesday to remove the dressings under anesthesia, as he felt Morgan would be most comfortable with this, and to change the wound vac. In the meantime, Dr. Weber asked plastic surgeon, Dr. Sando to attend Morgan’s next procedure to observe and perform a skin graft if necessary. “When Dr. Weber and Dr. Sando came out follow-

To learn more about Dr. Weber, please visit OrthoIndy.com/findadoc.

Dr. Timothy Weber Orthopaedic Trauma Surgeon Practice Focus • • • • •

Acute Orthopaedic Trauma Fractures both Adult and Pediatric Foot and Ankle Trauma Ankle Replacement Nonunions and Malunions

• • •

Bone Defects Osteotomies and Joint Fusions Joint preservation surgery as an alternative to joint replacement for young adults with early arthritis

Locations OrthoIndy Downtown 1801 N. Senate Boulevard Suite 200 Indianapolis, IN 46202

OrthoIndy Northwest 8450 Northwest Boulevard Indianapolis, IN 46278

To schedule an appointment with Dr. Weber, please call (317) 917-4369.


Doc Talk

this quarter’s Physician:

Timothy E. Dicke, MD

Basilar Thumb Arthritis Joint pain and stiffness in the hands are common complaints, especially as we age. One of the most common areas of the hand to develop arthritis is at the base of the thumb. The basilar thumb joint or carpalmetacarpal joint (CMC) is where the thumb originates off of the wrist. The thumb metacarpal rests on the trapezium bone of the wrist forming a “saddle” joint which has a great degree of freedom of motion to rock back and forth. This allows flexion, extension, adduction, abduction and circumduction to place the thumb where it needs to be for pinch and grasp. Along with this degree of motion comes significant shear stress on the cartilage which can lead to cartilage thinning and joint arthritis. Joint surface cartilage can typically accept compressive force much better than shear stress, so the thumb CMC joint frequently “wears out” at an accelerated rate compared to surrounding joints in the hand and wrist. The thumb needs a stable base for

13

opposition to the fingers for pinch and grasp. When the basilar thumb joint becomes painful, simple tasks such as holding a book, turning a key or writing become difficult. It is hard to open jars or use

hand tools or scissors. Symptoms frequently begin spontaneously, but may be aggravated by an injury or increased use of the hand. If a job requires frequent thumb grasp, the activity can become more and more difficult to tolerate. The risk of developing arthritic changes in the thumb base is not related to certain job types, but the job can be a

factor in provoking symptoms. It is common to have deterioration of the basilar thumb joint on both hands, although symptoms are frequently but not always worse in the dominant hand. The condition is more common in women, especially if there is an underlying natural laxity of the CMC joint which allows more translation and shear stress to the joint. Patients usually present at a younger age than other forms of arthritis, as the thumb is more symptomatic in those who still have near normal motion of the joint despite the wear of the cartilage. In the older population, the radiographic appearance can be more severe with joint narrowing, subluxation and bone spurring but this does not correlate well with increased pain. It is common for the basilar thumb joint to stiffen over time and the reduced motion can limit the pain and grind. Sometimes those with asymptomatic arthritic changes can have onset of significant basilar thumb pain after a fall or trauma to the thumb which “awakens” the underlying condition.

Inside OI


Patients usually present with localized symptoms at the thumb base. This can be sharp with pinch and can radiate proximally into the forearm. Usually, the other joints in the thumb (inter-phalangeal and metacarpal-phalangeal) are not specifically painful and the wrist usually has normal painless motion. A provocative test for basilar thumb arthritis is called the “grind test” which recreates symptoms when the base of the thumb is rotated while applying gentle compression down the thumb. Instability of the thumb base can also be assessed by gentle translation of the CMC joint. After localizing symptoms on examination, the best test is an xray series of the hand. Joint narrowing, osteophyte formation, subchondral sclerosis or cysts and subluxation of the trapeziometacarpal joint are hallmarks of the condition. Usually MRI and other imaging modalities are not necessary if symptoms are well localized. Treatment of basilar thumb arthritis usually begins with nonsteroidal anti-inflammatory medication,

splinting and activity modification. Splinting can be confined to the thumb base to allow normal wrist and finger mobility and there are a variety of basilar thumb splints available. Cortisone injection is not routine as it typically does not have any lasting value, but can be considered with more intense or acute symptoms. Persistent or advanced basilar thumb pain frequently will progress to surgical repair. Historically, there have been a variety of surgical options for basilar thumb arthritis including fusion, joint implant and partial of full resection of the thumb CMC joint, with or without tendon interposition or suspension. My personal preference for surgical intervention for basilar thumb arthritis is a resection of the trapezium with a suspension of the thumb metacarpal using a tendon transfer. This is a “natural” approach using the patients own tissue and usually does not have the need for later revision for implant failure, mechanical loosening or “wearing out.” Removing the tra-

Timothy Dicke, MD

Orthopaedic Surgeon, Hand Surgery Practice Focus • • • • • • •

Fracture Care Tendon and Nerve Injuries Work Related Injuries Arthritis Arthroscopy Sports Medicine Microvascular Reconstruction

Locations • OrthoIndy Fishers • OrthoIndy Northwest

To schedule an appointment with Dr. Dicke, please call (317) 802-2808.

pezium bone, which is the base of the joint, prevents the symptomatic bone on bone grind and the thumb metacarpal is “suspended” in place by using a tendon transfer to recreate a ligament to maintain position and stability of the thumb base. The thumb maintains a natural appearance and motion as the normal muscles continue to control the thumb as usual. It typically takes 4 to 6 months to gain confidence in the thumb, but long term function is usually excellent. There can be residual weakness of thumb pinch, but function generally improves due to the reduced pain. Potential complications can include residual instability, swelling, neuralgia and pain in a small percentage of individuals.


8450 Northwest Blvd. Indianapolis, IN 46278


/Inside_OI_Volume_5_Issue_1