Campbell Orthopaedic Journal, Vol. 11

CAMPBELL

ORTHOPAEDIC JOURNAL

2025 VOLUME 11

2025 CAMPBELL ORTHOPAEDIC JOURNAL

VOLUME 11

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VOLUME 11

Transforming Pain Management Through Innovation

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2025 CAMPBELL ORTHOPAEDIC JOURNAL

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CAMPBELL

ORTHOPAEDIC JOURNAL Volume 11, May 2025 A JOINT PUBLICATION OF

Campbell Clinic Orthopaedics • Campbell Clinic Foundation University of Tennessee Health Science Center-Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering

EDITORIAL BOARD

Editor-in-Chief Frederick M. Azar, MD Editorial Advisors Kathy Brooks • Linda Jones • Anne Tipton Editorial Support Staff Tracy Henry • Margaret Knack, RN, MS • Jenny Koltnow, MBA, MEd • Becky Williams Graphics/Design Chris Strain

2025 CAMPBELL ORTHOPAEDIC JOURNAL

VOLUME 11

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Your Surgery Deserves It In the demanding world of orthopedic surgery, maintaining a sterile environment is paramount. Be sure with BD Surgiphor™ Irrigation Solution.

The Surgiphor™ Antimicrobial Irrigation System is a pre-mixed, terminally sterile dilute povidone-iodine (PVP-I) surgical irrigation solution.

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Terminally Sterile: Surgiphor™ Irrigation System is a terminally sterile povidone-iodine (PVP-I) solution reducing the risk of contamination.+

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Standardized and Simple: Eliminate variability and complexity in preparing irrigation solutions. Surgiphor™ Irrigation System is ready-to-use, ensuring consistency and compliance with best practices and guidelines.

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+ PVP-I is an antimicrobial preservative contained within the bottled solution. The Surgiphor™ solution is not indicated for use as an antimicrobial at or within the wound site.

Product description. Surgiphor™ Antimicrobial Irrigation System is an antimicrobial irrigation system containing 0.5% povidone-iodine (PVP-I) in phosphate-buffered saline, potassium iodide and Vitamin E TPGS. PVP-I acts as a preservative to help inhibit microbial growth in the irrigation solution. Indication for use. BD Surgiphor™ Antimicrobial Irrigation System is intended to mechanically loosen and remove debris, and foreign materials, including microorganisms, from wounds. Contraindications. BD Surgiphor™ Antimicrobial Irrigation System should not be used in patients with known allergic reaction to any of the ingredients in the solutions. BD Surgiphor™ Antimicrobial Irrigation System should also not be combined with other irrigation or antiseptic solutions due to potential reactions and reduction in the effectiveness of the system. Not for use in neonates. Warnings. Do not use or mix with other cleansers, soaps, lotions, or ointments. Do not use for injection or infusion. Do not swallow. Do not use in eyes or ear canals. Discontinue use immediately if irritation or an allergic reaction occurs. Do not use if packaging is damaged or if seal integrity is compromised. Do not reuse BD Surgiphor™ solution after 24 hours. Precautions. BD Surgiphor™ solution may cause a temporary irritation and/or burning sensation on exposed skin in very rare cases. BD Surgiphor™ solution may cause allergic reactions such as rash or skin irritation in patients with iodine allergy. Anaphylaxis with the use of BD Surgiphor™ solution may occur in patients with severe iodine allergy. Federal law restricts this device to sale by or on the order of a licensed physician. Single patient use only. Not for at-home use. Please consult product insert for complete indications, contraindications, warnings, precautions, safety information and instructions for use.

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2025 CAMPBELL ORTHOPAEDIC JOURNAL

BD and the BD Logo and Surgiphor are trademarks of Becton, Dickinson and Company or its affiliates. © 2025 BD. All rights reserved. BD-144332 (02/25)

VOLUME 11

TABLE OF CONTENTS LETTER FROM THE EDITOR

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Frederick M. Azar, MD

CAMPBELL CLINIC CORE CORE VALUES

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CAMPBELL CLINIC PHYSICIANS TRIBUTES

Linda Jones...................................................................................................................................................................................................................................................................................................................................................................................................... 16

CAMPBELL CLINIC FOUNDATION CAMPBELL CLINIC FOUNDATION STAFF

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CAMPBELL FOUNDATION BOARD OF TRUSTEES

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OUTREACH ORTHOPAEDIC OUTREACH

ORTHOPAEDIC EDUCATION ORTHOPAEDIC EDUCATION

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FELLOWSHIP PROGRAM

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2025 INGRAM MEMORIAL LECTURE

Wilford K. Gibson, MD.................................................................................................................................................................................................................................................................................................................................................................... 36 Thomas A. Russell, MD............................................................................................................................................................................................................................................................................................................................................................... 36

2025 CAMPBELL ORTHOPAEDIC JOURNAL

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Copyright © 2025 DJO, LLC MKTIS00-12618-Rev B SOURCE

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Individual results may vary. Neither DJO, LLC nor any of the Enovis companies dispense medical advice. The contents of this document do not constitute medical, legal, or any other type of professional advice. Rather, please consult your healthcare professional for information on the courses of treatment, if any, which may be appropriate for you.

RESIDENCYRESIDENCY EDUCATION EDUCATION CAMPBELL CLINIC-LED CAMPBELL ORTHOPAEDIC CLINIC-LED ORTHOPAEDIC SURGERY RESIDENCY SURGERY PROGRAM RESIDENCY PROGRAM CELEBRATES 100 CELEBRATES YEAR ANNIVERSARY 100 YEAR ANNIVERSARY

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2024-2025 RESIDENTS 2024-2025 RESIDENTS

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CLASS OF 2025CLASS RESIDENT OF 2025 RESEARCH RESIDENT RESEARCH 44Total Knee Arthroplasty Smoking Cessation and Relapse Effects Patient-Reported Outcomes Total Knee Arthroplasty Smoking Cessation Smoking andon Relapse Cessation Effects andon Relapse Patient-Reported EffectsFollowing on Patient-Reported Outcomes Following Outcomes Total Knee Following Arthroplasty 44 ............................

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Couture AJ • Derefinko KJAJ • Ford MC • Crockarell JR • Guyton • Harkess JW •JL Roberts C • JW Mihalko WM C • JW Couture • Derefinko Couture KJAJ • Ford • Derefinko MC • Crockarell KJ • JL Ford JR MC • Guyton • Crockarell • Harkess JR • Guyton •JL Roberts • Harkess Mihalko • Roberts WM C • Mihalko WM

Autograft Reconstruction Volar Ulnar Corner Insufficiency After Distal Corner Radius Fractures Autograft for Reconstruction Autograft for Reconstruction Volar Ulnar Corner for Volar Insufficiency Ulnar After Insufficiency Distal Radius After Fractures Distal Radius46 Fractures

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Effectiveness of Weight Loss Treatment inLoss Total Arthroplasty Effectiveness of Weight Effectiveness Treatment ofJoint Weight inLoss Total Treatment Joint Arthroplasty in Total Joint Arthroplasty

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Farrell ND • Mansour KLND • Weller WJ Farrell • Mansour Farrell KLND • Weller • Mansour WJ KL • Weller WJ

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Gailey AD • Leonard EHAD • Funderburg KMAD Ford MC • Mihalko WMMC • Mihalko Gailey • Leonard Gailey EH •• Funderburg • Leonard EH KM •• Funderburg Ford KM • Ford WMMC • Mihalko WM

Clinical and Radiographic Outcomes of Hybrid Glenoid Fixation with of a Central Post: Clinical and Radiographic Clinical and Outcomes Radiographic of Hybrid Outcomes Glenoid Hybrid FixationPorous Glenoid with aTitanium Central FixationPorous with aTitanium Central Porous Post: Titanium Post: Analysis of 713 Consecutive Shoulders 50 Analysis of 713 Consecutive Analysis of 713 Shoulders Consecutive Shoulders 50 ......................................................................................................................................................................................................................................................................................... .........................................................................................................................................................................................................................................................................................

Marigi EM • Lenartowicz KA •• Lenartowicz Jennewine BR Throckmorton • Sperling JW Marigi EM Marigi EM KA •• Lenartowicz Jennewine BR KATW • Jennewine Throckmorton BRTW • Throckmorton • Sperling JWTW • Sperling JW

Incidence and Risk Factorsand Associated withand Anterior Shoulder Pain Shoulder Incidence Risk Incidence Factors Associated Risk Factors with Associated Anterior with Anterior Pain Shoulder Pain Following Reverse Total Shoulder Arthroplasty Following Reverse Following Total Shoulder ReverseArthroplasty Total Shoulder Arthroplasty

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Engineered TypeEngineered II CollagenType Chimeric Antigen Receptor (CII CAR) Engineered II Collagen Type Chimeric II Collagen Antigen Chimeric Receptor Antigen (CII CAR) Receptor (CII CAR) T Regulatory Cell the Treatment ofthe Arthritis T for Regulatory Cell T for Regulatory Treatment Cell for ofthe Arthritis Treatment of Arthritis

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Internal RotationInternal Measurements: Correlation between Vertebral Body Level RotationInternal Measurements: Rotation Correlation Measurements: between Correlation Vertebral between Body Level Vertebral Body Level and Goniometerand Measurements Functional Outcome ScoresOutcome Goniometeron and Measurements Goniometer on Measurements Functional on Functional ScoresOutcome Scores

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Comparing Safety of Ambulatory Total Hip Arthroplasty andArthroplasty Total Total Knee Hip Arthroplasty Comparing Safety Comparing of Ambulatory SafetyTotal of Ambulatory Hip andArthroplasty Total Knee Arthroplasty and Total Knee Arthroplasty between Medicare-Insured and Privately Patients Insured 58 between Medicare-Insured between Insured Medicare-Insured and Privately and Privately Patients Insured Patients

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Nahr AD • HanishNahr SJ • AD Coble TJ • Hunter MC• Hanish • TJ Throckmorton • Brolin TJ MCTW • Hanish Nahr SJ • AD Coble • Hunter SJ • Coble MCTW • TJ Throckmorton • Hunter • Throckmorton • Brolin TJ TW • Brolin TJ

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Porter ER • Ponnuchetty MV• •Ponnuchetty Silva V • Beda •Silva Hasty • Cho •Hasty Radic Porter ER Porter ER MV•N•Ponnuchetty V •KBeda MVN•H•Silva V •KMZ Beda • ChoNH• •Hasty RadicKMZ • Cho H • Radic MZ

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West EJ • Dixon DT • Throckmorton TW • Bernholt ••Azar FM • Brolin West EJ • Dixon DT West • Throckmorton EJ • Dixon DL DTTW Throckmorton • Bernholt DLTW • TJ Azar • Bernholt FM • Brolin DL • TJ Azar FM • Brolin TJ

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Zalewski JT • Hou N • Eason •Zalewski Diltz •JT Mihalko WM • Ford MC• Diltz Zalewski JT RR • Hou N • ZR Eason RR • Hou • Diltz N • ZR Eason • Mihalko RR WMZR • Ford • Mihalko MC WM • Ford MC

RESEARCH RESEARCH CAMPBELL CLINIC CAMPBELL FOUNDATION CLINIC FOUNDATION RESEARCH PROGRAM RESEARCH PROGRAM

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RESEARCH PARTNERS/SPECIALTY RESEARCH PARTNERS/SPECIALTY MAP MAP

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CONTINUING MEDICAL CONTINUING EDUCATION MEDICAL OPPORTUNITY EDUCATION OPPORTUNITY Oblique Trans-syndesmotic Screw to Augment Fixation of Distal Fibular Fractures: Oblique Trans-syndesmotic Oblique Trans-syndesmotic Screw to Augment Screw Fixation to Augment of DistalFixation Fibular of Fractures: Distal Fibular Fractures: 62 A Retrospective A Cohort Study and Technique Retrospective A Cohort Retrospective StudyGuide and Cohort Technique StudyGuide and Technique Guide

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Richardson DR • Foropoulos Richardson LA DR • Foropoulos Richardson LA DR • Foropoulos LA

WILLIS C. CAMPBELL WILLIS C. CAMPBELL CLUB ALUMNI CLUB ALUMNI LETTER FROM ALUMNI LETTER FROM PRESIDENT ALUMNI PRESIDENT

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CAMPBELL CLUB CAMPBELL – IN MEMORIAM CLUB – IN MEMORIAM

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John Priddy, MD, Class of 2002MD, Class John Priddy, John Priddy, of 2002MD, Class of 2002

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2025 CAMPBELL2025 ORTHOPAEDIC JOURNAL VOLUME 11 JOURNAL CAMPBELL2025 ORTHOPAEDIC CAMPBELL ORTHOPAEDIC JOURNAL VOLUME 11

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Frederick M. Azar, MD Chief of Staff, Campbell Clinic Orthopaedics Professor, University of Tennessee Health Science CenterCampbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering

Letter from the Editor-in-Chief

Campbell Clinic Foundation Family and Friends, Over the past 12 months we have experienced a number of landmark events in the Campbell Clinic family. We were able to honor three distinguished colleagues who retired from Campbell Clinic: Robert H. Miller III, William C. Warner, and Santos F. Martinez. Each of these individuals served our Mission with excellence and commitment, and we were blessed to have had them as a part of Campbell Clinic throughout their careers.

We welcomed four new physicians to our staff, all of whom are superb individuals dedicated to compassionate patient care, education, and research. Stephanie N. Chen specializes in pediatric orthopaedics, and Austin T. Hardaway specializes in orthopaedic sports medicine. Both were former residents with us and have a strong interest in clinical research and resident training. We also added two primary care sports medicine physicians, Kristina M. Quirolgico and Mariam E. Mansour.

In an effort to continue to improve patient care and access, we have continued to offer our best practices to other orthopaedic and neurosurgical groups in the region to help them enhance their services. We recently welcomed Appalachian Orthopedics and Highlands Neurosurgery to our family. As you recall, in the summer of 2022, we announced a similar alliance with an orthopaedic group located in Cookeville, Tennessee Tier 1 Orthopaedics and Neurosurgical Institute. Appalachian Orthopedics is headquartered in Johnson City, Tennessee with three satellite clinics in East Tennessee and southwestern Virginia. The group has 12 physicians and 18 advanced practice providers (APPs). Located in Bristol, Tennessee, Highlands Neurosurgery has three neurosurgeons, a physiatrist, and three APPs. With both practices combined, we welcomed 150 new employees to our Campbell Clinic family.

We also added another satellite office to our Mid-South locations, this one in Millington, Tennessee. We now employ 1,200 dedicated employees at 22 locations across Tennessee, Mississippi, and Virginia. The healthcare environment is constantly changing, and having a larger geographical

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2025 CAMPBELL ORTHOPAEDIC JOURNAL

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footprint will help us compete in the marketplace in the years to come. These new partnerships are positive and exciting next steps for the Campbell Clinic family.

The Campbell Clinic Foundation has also experienced tremendous growth. We expanded our clinical trials initiative, producing more than 200 presentations, publications, and posters to share the results of our research with the orthopaedic community. Additionally, the second edition of Campbell’s Core Orthopaedic Procedures was published, and work on the 15th edition of Campbell’s Operative Orthopaedics is well underway. We also continue to serve as the editors of Orthopedic Clinics of North America.

These achievements highlight the strides we are making in advancing our mission of providing unsurpassed orthopaedic patient care—a goal we strive to achieve through our research and education programs. The ongoing support from our patients, alumni, industry partners, staff, and donors worldwide has been vital in helping us continue this journey into the next 100 years. We are deeply grateful for your generosity and passion.

We are pleased to introduce our 2025 Graduating Class of Residents and Fellows, all of whom are exceptional surgeons. This edition of the Campbell Orthopaedic Journal features abstracts of the research they completed during residency.

Campbell Clinic remains committed to education and to our mission of excellent patient care—a standard set by our founder, Willis C. Campbell, MD, more than a century ago. While the healthcare landscape has changed significantly, our Core Values of Excellence, Integrity, Compassion, Innovation, Commitment, Legacy, and Unity continue to guide us. We remain steadfast in our priorities of faith, family, and patient care.

We look forward to gathering at the Alvin J. Ingram Lectureship on May 2, 2025 to celebrate our shared accomplishments and chart the future of orthopaedic excellence.

Thank you for all that you do for our patients and our profession.

Together, we are Moving Lives.

Best regards and God Bless, Frederick M. Azar, MD Campbell Clinic Chief of Staff

2025 CAMPBELL ORTHOPAEDIC JOURNAL

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CAMPBELL CLINIC MISSION

The mission of the Campbell Clinic is to provide unsurpassed patient care while being recognized as a leader in teaching and research in the profession of orthopaedic surgery.

CAMPBELL CLINIC VISION STATEMENT

Another century of world-class orthopaedic care restoring function and quality of life.

CAMPBELL CLINIC CORE VALUES EXCELLENCE We aim to exceed expectations by providing an exceptional patient experience through accessible & efficient quality care, a comfortable and safe environment, and effective communication.

INTEGRITY We embrace, expect, and exhibit honesty, accountability and professionalism toward patients, each other, and outside partners.

COMPASSION We commit to cultivating an environment of compassion for each patient and family member through sensitivity, sincerity, and empathy.

INNOVATION We commit to delivering innovative technologies, products, and services through our rich orthopaedic heritage and a strong research foundation.

COMMITMENT We commit to each other, to excellent patient care, to education, to innovation and research, to community service, and to orthopaedic leadership.

LEGACY We will do what is right for the Campbell Clinic, our patients, and our employees.

UNITY Everything we do, we do together.

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2025 CAMPBELL ORTHOPAEDIC JOURNAL

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When you’re hurt, we’re there.

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• Break, sprain, and injury care

ARLINGTON

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S GERM ANTOW N RD

The region’s top orthopaedic specialists are available near you when you need them most.

MILLINGTON

SAM COOPER BLVD

MIDTOWN

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EAST MEMPHIS (MENDENHALL & POPLAR)

• Outpatient hip, shoulder, ankle, and knee surgery

WOLF RIVER

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• Physical therapy • Entire family musculoskeletal care

GERMANTOWN

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SOUTHAVEN

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Campbell Clinic has kept the Mid-South healthy for more than 100 years. Wherever you are, we’ve got a convenient clinic nearby.

Midtown | East Memphis | Germantown | Wolf River | Oxford Arlington | Collierville | Southaven | Olive Branch | Millington

Find walk-in and availability 2025after-hours CAMPBELL ORTHOPAEDIC JOURNAL at campbellclinic.com.

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Frederick M. Azar, MD

Nahum M. Beard, MD

Michael J. Beebe, MD

David L. Bernholt, MD

Clayton C. Bettin, MD

Joshua R. Brandon, MD

Christopher T. Cosgrove, MD

John R. Crockarell, MD

Gregory D. Dabov, MD

Dee Dockery, MD

Matthew J. Gilbert, MD

Benjamin J. Grear, MD

Joseph D. Lamplot, MD

Jimmie Mancell, MD

Mariam E. Mansour, MD

Anthony A. Mascioli, MD

Omar Medina, MD

Marc J. Mihalko, MD

Barry B. Phillips, MD

Kristina Quirolgico, MD

David R. Richardson, MD

Carson M. Rider, MD

Carlos E. Rivera, MD

Matthew I. Rudloff, MD

Norfleet B. Thompson, MD

Thomas W. (Quin) Throckmorton, MD

John C. Weinlein, MD

William J. Weller, MD

A. Paige Whittle, MD

Keith D. Williams, MD

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2025 CAMPBELL ORTHOPAEDIC JOURNAL

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Tyler J. Brolin, MD

James H. Calandruccio, MD

Chad E. Campion, MD

Douglas T. Cannon, MD

Stephanie Chen, MD

Kevin B. Cleveland, MD

James L. Guyton, MD

Austin T. Hardaway, MD

Robert K. Heck, MD

Christopher T. Holland, MD

John C. Hyden, MD

Derek M. Kelly, MD

William M. Mihalko, MD, PhD

G. Andrew Murphy, MD

Austin B. Murphy, MD

Keith J. Orland, MD

Wesley M. Owen, MD

Ashley L. Park, MD

Andrew Samborski, MD

Jeffrey R. Sawyer, MD

Benjamin W. Sheffer, MD

Henry L. Sherman, MD

David D. Spence, MD

Kirk M. Thompson, MD

FIND A WORLD-CLASS PHYSICIAN TO MEET ANY ORTHOPAEDIC NEED.

2025 CAMPBELL ORTHOPAEDIC JOURNAL

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TRIBUTE

A pillar of excellence, integrity, and dedication at Campbell Clinic and the Campbell Clinic Foundation for nearly four decades:

LINDA JONES Since 1986, Linda Jones has shaped orthopaedic education in countless ways, supporting thousands of papers, presentations, and book chapters. She has helped produce seven editions of Campbell’s Operative Orthopaedics as well as Campbell Orthopaedic Journal, Current Orthopaedic Practice, Foot and Ankle International, and Orthopedic Clinics of North America. In addition, she has mentored generations of surgeons, staff, and researchers, placing integrity and precision above all else.

As Foundation Editor since 2021, she has been a steady leader, a trusted partner, and a voice of reason. Her passion for producing quality information

Linda’s remarkable talent for transforming ideas and fragmented words into clear, compelling text has ensured that we uphold the gold standard in publishing. She has faithfully and tirelessly edited and refined many aspects of our publications, from manuscript preparation to final proofing.

Her work serves as a testament to her unwavering dedication to excellence in writing and education.

Fred Azar, MD is second to none. More than a colleague, she is a confidante and an irreplaceable friend.

Linda is planning to retire in the Fall of 2025, and this is the last edition of Campbell Orthopaedic Journal under her watch. Her presence will be deeply missed, but her legacy will continue for generations.

Linda, from your entire Campbell family – past, present, and future – congratulations on your upcoming retirement!

It is difficult to envision the Campbell Clinic Foundation without Linda Jones. As our lead editor, she has been the steadfast, unassuming, yet resolute, presence whose exceptional talent has guided our editorial department to national recognition as one of the finest teams in the country.

Her kindness, endless patience, and attention to detail took much of the stress out of writing chapters and articles. I genuinely enjoyed our sessions together in the Foundation library reviewing projects whose deadlines were imminent – a testament to her calm demeanor, subtle humor, and incisive intellect. Linda will be sorely missed, but her influence will endure.

Thank you, Linda, for your immeasurable contributions to the Campbell Clinic Foundation and to the advancement of orthopaedic knowledge. Your legacy of precision, grace, and wisdom will remain an inspiration.With utmost admiration and wishing you joy in this next chapter of life, David Richardson, MD

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Steady, calm, responsive, dedicated, efficient, and talented. She is simply really good at her job.

Derek Kelly, MD

Of all the great people at the Campbell Clinic Foundation, Linda Jones is an unsung hero. For decades, she has been the steady, behindthe-scenes key player that has guided our textbook and editorial program. She has never once called attention to herself or asked for the spotlight. Instead, she has steadily and consistently come to work and produced excellent content. From a personal standpoint, she is one of the most important pieces of our research program, which has grown from a non-presence in 2009 to a well-respected, high-level original research machine. It would not have been possible without her, and I am forever grateful. Best wishes on your retirement, LMJ! Thomas Throckmorton, MD

Linda, dear Linda, I can see you and Kay working together day after day on the next edition of “The Book,” never getting ruffled. You are an exceptional person and have earned – so earned – a time you can pick what your day will be like.

With great admiration and affection, Greer (Dr. R) Richardson, MD

No one is more reliable and quietly dedicated to the Campbell Clinic Foundation and orthopaedic education than Linda Jones.

She has been the motor that has kept Campbell Clinic’s education program running. She has a level of commitment and determination that is apparent in every conversation. I’ve loved asking her for help because I know she knows how to get just about anything done.

David LaVelle, MD

2025 CAMPBELL ORTHOPAEDIC JOURNAL

Linda has been an incredible support for me, the adult reconstruction team, as well as for grad students in my lab. Her expertise in editing manuscripts, book chapters, and presentations is unmatched, and she will be missed every day! I wish her all the best in her retirement.

William Mihalko, MD, PhD

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STAFF

Rosemary Bankston Fellowship Coordinator

Kathy Brooks Editorial Assistant

Lucy Del Mar, MD, MS Clinical Research Coordinator

Tracy Henry Development Officer

Emily Holmquist, BS, MBA Clinical Research Coordinator

Nuanqiu Hou, MS, NREMT Clinical Research Coordinator

Linda Jones Editor

JoAnn Jones, RN, BSN Clinical Research Coordinator

Daniel Kallaher Foundation Office Administrator

Margaret Knack, RN, MS Senior Research Manager

Jenny Koltnow, MBA, MEd Executive Director

Jada Laws, BA Research Scholar

Jennifer Lowrey Gift Officer

Ev Nichol, BA Research Scholar

Ginae Owens Residency Program Coordinator

Tonya Priggel Medical Librarian

Karen Romer, RN, BSN Clinical Research Coordinator

Angie Smith Nora Tillmanns, BS, MS Senior Accountant Research Scholar

Anne Tipton Deputy Editor

Rebecca Williams Senior Coordinator, Foundation Operations

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Development Chair Retired, International Paper

JAMES H. BEATY, MD

President UTHSC Department of Orthopaedic Surgery

MEMBERS CHAD E. CAMPION, MD

FRANK T. NAVARRA

Campbell Clinic Orthopaedics

Retired, Smith+Nephew Orthopaedics

DEREK M. KELLY, MD

DAVID POPWELL

DAVID G. LAVELLE, MD

JEFFREY R. SAWYER, MD

WILLIAM M. MIHALKO, MD, PHD

NORFLEET B. THOMPSON, MD

WILL MOORE

THOMAS W. THROCKMORTON, MD

G. ANDREW MURPHY, MD

BARBARA WILLIAMSON

Campbell Clinic Orthopaedics

First Horizon Bank

Retired, Campbell Clinic Orthopaedics

Campbell Clinic Orthopaedics

Campbell Clinic Orthopaedics

Campbell Clinic Orthopaedics

Atkins Capital Management

Campbell Clinic Orthopaedics

Campbell Clinic Orthopaedics

GARY K. WUNDERLICH, JR. PNFP Capital Markets, Inc.

EMERITUS JACK R. BLAIR

BUZZY HUSSEY

LARRY W. PAPASAN*

S. TERRY CANALE, MD*

JOSEPH ORGILL, III*

JOSEPH C. WELLER* *Deceased

EX-OFFICIO DANIEL H. SHUMATE Chief Executive Officer Campbell Clinic

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JENNY TURNER KOLTNOW Executive Director Campbell Clinic Foundation

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ORTHOPAEDIC OUTREACH Community outreach is a top priority for the Campbell Clinic Foundation and Campbell physicians.

Together, we play to our strengths and provide critical leadership, orthopaedic expertise, and educational opportunities to improve lives in our community.

Center of Excellence for Cerebral Palsy Care and Research Since January 2018, the Campbell Clinic Foundation has led a comprehensive, multidisciplinary outpatient clinic focused on children with cerebral palsy in partnership with Le Bonheur Children’s Hospital. On average, more than 500 children and families are served each year, thanks to many specialty physicians, therapists, mobility specialists, donors and allies, as well as a $1 million grant from the Children’s Foundation of Memphis (CFOM).

In the summer of 2024, CFOM made an additional $900,000 donation to expand CP Center services and access. We are deeply grateful to CFOM’s generosity and the partners who work together to help children thrive in the midst of a very challenging, debilitating condition.

Foot Health Outreach Clinics The foot health of Memphis Union Mission clients is the focus of Our Hearts to Your Soles, an annual outreach program led by Campbell Clinic foot and ankle specialist Dr. David Richardson each fall. A spring program for Hospitality Hub of Memphis clients was added, as well. At each event, Campbell Clinic physicians, advance practice providers, and residents provide foot and nail care, address special issues such as bunions, and distribute new shoes and socks.

UTHSC medical students volunteer, offering additional care and encouragement to participants.

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Future of Orthopaedic Talent Campbell Clinic Foundation is committed to creating experiences that introduce careers in orthopaedic surgery and accompanying fields to young people. Exposure is the first step in a student’s career exploration process – if students do not realize opportunities exist, they are unlikely to pursue them.

The Campbell Clinic Foundation held its first Orthopaedic Exploration Day on November 1 for 100 STEM and health care-minded students from White Station and Collierville High Schools. The Clinic’s surgeons, residents, fellows, physical therapists, and industry partners facilitated immersive stations that focused on the tactile operations of each facet of orthopaedic care.

“I really enjoyed each of the stations, there was something to learn from each professional there, and it was eye opening to see the technology used every day to care for others,” one student shared.

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CCF Research Scholars Since 2019, the Research Scholar Program has provided a “gap year” experience for young professionals interested in medical careers. During the paid, year-long program, scholars work across subspecialties and participate in clinical research, including study design, data collection and analysis, literature review, regulatory compliance, and abstract/manuscript preparation.

Renn Eason, currently an M3 at UTHSC, says, “The research scholar position has been the most beneficial experience I could have asked for. It helped me achieve my dream of going to medical school. It is through that wonderful experience that I fell in love with orthopaedics.”

Memphis Thanksgiving Turkey Trot On Thanksgiving morning, November 28, Start2Finish Racing hosted the annual Memphis Turkey Trot, benefiting the Campbell Clinic Foundation. More than 2,500 people of all ages walked and ran the 4-mile course and 2-mile relay at Shelby Farms Park. Campbell Clinic staff, surgeons, and friends were among the volunteers and participants. The 2024 event was particularly special as the Campbell Clinic Foundation celebrated the 100th anniversary of its Campbell Clinic Orthopaedic Surgery Residency program. Thanks to our generous partners and participants, we raised more than $25,500 for health outreach!

Save the date: We’ll be back even bigger for the >2,000 participants on November 27, 2025!

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Campbell Celebrates “Havana Nights” The Foundation’s highly anticipated annual gala in September, presented by Gentleman Orthopedic Solutions and Mid-South Imaging and Therapeutics, “Campbell Celebrates ~ Havana Nights” drew more than 300 attendees, adorned in tropical attire, to the FedEx Event Center.

"We host this event to support our community health outreach programs. this includes our Cerebral Palsy Center, residents' international medical mission trips, and outreach to inspire the next generation of orthopaedic professionals, " explained Jenny Koltnow, Foundation Executive Director.

One of the night’s highlights was the impressive live auction, hosted by Pete Pranica, the “voice” of the Memphis Grizzlies. A private wine dinner for eight, catered by Tennessee Restaurateur of the Year, Ernie Mellor; a Pappy Van Winkle Tasting for Ten, donated by Buster’s; and a Louis Vuitton handbag were among the big-ticket items.

“Why Havana Nights?” Dr. Fred Azar, Campbell Clinic Chief of Staff, asked as the program opened.

“The Campbell Clinic alumni group… hosted a meeting that took place in Havana, Cuba in 1955. The Cuban hospitality… and the participation of prominent Cuban orthopaedists – made it immensely successful and memorable. While things have changed considerably in Cuba since then, our Campbell worldwide impact continues to go strong.”

Outreach has always been and continues to be a team effort. “Our programs’ success is a testament to the generosity of our volunteers, donors and partners,” said Koltnow.

“Thank you for moving lives.”

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ORTHOPAEDIC EDUCATION Celebrating 100 Years of Teaching and Worldwide Impact 2024 Alvin J. Ingram Memorial Lecture Surgeon education has always been the cornerstone of the Campbell Clinic Foundation. One of 2024’s educational highlights was the Alvin J. Ingram Memorial Lecture program, which coincided with the 26th Campbell Club Triennial – the reunion of graduates of the University of Tennessee Health Science Center-Campbell Clinic Residency and Fellowship Programs and Campbell Clinic staff.

The April 4-6 Ingram program featured two distinguished visiting professors: Dr. John D. Kelly, IV, second vice-president of AANA and Director, Sports and Shoulder and Co-Director, Sports Medicine Fellowship and Professor of Clinical Orthopaedic Surgery at the University of Pennsylvania; and Dr. Javad Parvizi, President of AAHKS and James Edwards Professor of Orthopaedic Surgery, Sidney Kimmel Medical College at Rothman Institute.

The program also included five expert panels and, to honor tradition, eight graduating residents’ research presentations. Presenters addressed the latest advancements in orthopaedic surgery, sports medicine, and musculoskeletal health, and offered perspectives on emerging trends and future directions. The annual lecture honors the memory of a former Campbell Clinic Chief of Staff and Department Chairman who was an international authority on polio treatment.

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American Orthopaedic Association “American-BritishCanadian” (ABC) Fellows Campbell Clinic Foundation’s global leadership in medical education was further evidenced last summer when the foundation hosted seven American-BritishCanadian (ABC) Traveling Fellows, who came from the United Kingdom, South Africa, Australia, and New Zealand.

Campbell Clinic was one of only five U.S. programs selected to host this prestigious American Orthopaedic Association flagship program. The visit included surgical observations, guest lectures, staff and resident case discussion, and sightseeing, in addition to a considerable dose of Southern hospitality.

The Campbell Clinic Foundation has hosted five sets of international fellows in the last two years, representing more than a dozen countries and myriad subspecialties, including pediatric orthopaedics, foot and ankle, shoulder and elbow, sports medicine and oncology.

Inaugural Mid-South Spine Symposium In September, Campbell Clinic’s Dr. Kirk Thompson and Dr. Chad Campion collaborated with Dr. Byron Stephens, a spine subspecialist at Vanderbilt University Medical Center and Campbell Clinic alum, to present the first Mid-South Spine Symposium. More than 50 practicing surgeons, fellows, residents, advanced practice providers, and industry partners gathered to discuss challenging spine cases, decision-making, and current research. The inaugural symposium featured faculty from Campbell Clinic, Vanderbilt University Medical Center, the University of Arkansas for Medical Sciences, and the University of Iowa.

Industry partners included Arthrex, BioGennix, Globus, J&J MedTech, Kolosis Bio, Medtronic, OrthoFix/SeaSpine, Shukla Medical, and Stryker Spine/Ignite Medical.

“This is a terrific model of collaboration,” said Keith Williams, MD, an orthopaedic spine specialist at Campbell Clinic.

The Mid-South Spine Symposium represents an exciting new chapter in orthopaedic spine care collaboration. All faculty will return for the second annual MSSS October 23-24, 2025 and will include morning didactic sessions and afternoon cadaveric labs. Details and registration will be available on Campbell-Foundation.org.

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ORTHOPAEDIC EDUCATION

FELLOWSHIP PROGRAM The Campbell Clinic Foundation offers exceptional training and experience to newly minted orthopaedic surgeons through five distinct 12-month subspecialty fellowships each year: Foot and Ankle (2 Fellows), Hand, Trauma, Pediatric Orthopaedics, and Shoulder and Sports Medicine. The Foundation and Campbell Clinic also partner with the University of Tennessee Health Science Center to offer a Primary Care Sports Medicine Fellowship program.

“In our programs, you are not a ‘cog in the wheel,’” explains Carson M. Rider, MD, Program Director of the UTHSC-Campbell Clinic Orthopaedic Foot & Ankle Fellowship. “The fellowship is about maximizing your education. We have [clinic support] to facilitate robust learning opportunities at our busy Level 1 trauma center, pediatric hospital, or with one of the other staff. We are quite flexible in helping you learn during this important year of training.”

courses, visiting professor lectures, cadaveric labs, and mentorship opportunties augment the hands-on and didactic experience.

Fellows are encouraged to pursue research during their training year with support from the Campbell

Fellows gain significant operative and clinical experience, thanks to considerable time spent with subspecialty faculty members and both junior and senior residents throughout the year.

Each team has a weekly conference, where attending surgeons, the fellow, all the residents on that service, advanced practice providers, research staff, and medical students participate for case review, research discussion, and collaboration. Subspecialty

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Clinic Foundation, including research scholars, clinical research coordinators, a full-time librarian, a statistician, and editorial support. This allows them to study important aspects of orthopaedic research and collaborate. From retrospective record reviews to prospective, randomized clinical trials, fellows engage in myriad musculoskeletal studies and innovations.

The Campbell Clinic Foundation is grateful to receive fellowship funding from Arthrex, Medartis Inc., Skeletal Dynamics, Smith + Nephew, Arthroscopy Association of North America, and American Orthopaedic Foot and Ankle Society, in addition to generous local partners. To learn more, check out https://campbell-foundation.org/surgeon-education

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FOOT AND ANKLE SURGERY FELLOWSHIP Carson M. Rider, MD, Director Two fellows spend five days each week with the foot and ankle staff, gaining exposure to acute and reconstructive surgery of the foot and ankle and advanced knowledge about clinical nonsurgical problems. They also work at the evening “after hours” clinics in Germantown and Southaven. The fellowship is focused on education, with ample time for surgery, reading, and research. Fellows are active participants in all procedures, and the training locations include Baptist Memorial Health Care, Methodist Le Bonheur Healthcare, Regional One Health, and Campbell Clinic Surgery Centers.

2024-2025 FOOT AND ANKLE FELLOWS PAUL SCHROEDER, MD

A native of Reading, PA, Dr. Schroeder graduated from the Uniformed Services University, then completed a residency at Brooke Army Medical Center.

He and his wife, Meagan, met while he was on medical school rotation at Tripler Army Medical Center in Hawaii and she was stationed there as an active-duty engineer in the U.S. Army.

She now works for the U.S. Army Corps of Engineers in Memphis as a Congressional Liaison and Engineering Chief Strategist. The Schroeders are expecting their first child in July.

Dr. Schroeder’s hobbies include cooking, watching Philadelphia sports teams compete, and hiking with his wife and dogs.

Witnessing close family members be diagnosed with life-altering medical conditions prompted me to pursue a career that would let me make a difference in someone’s life when he or she needs help the most. I chose orthopaedics because it merged sports, engineering, and the ability to acutely fix a specific problem to improve someone’s functionality and quality of life.

His favorite memory during fellowship occurred when Dr. Schroeder was participating in the Heart to Soles event and he heard a patron tell on of my attendings that he should really be wearing gloves while cleaning everyone’s feet. After graduation, Dr. Schroeder will serve in the U.S. Air Force at the Air Force Academy and at Fort Carson in Colorado Springs, CO. This past year has been an incredible experience. I had the honor of learning from a great group of foot and ankle surgeons who I know will be lifelong friends and mentors. The residents have been great to get to know and work with. Dean, my co-fellow, has become a great friend, and I look forward to seeing the accomplishments he will achieve.

DEAN CONSTANTINE WONAIS , MD

Dr. Wonais is a native of Naperville, IL, who graduated from the University of Minnesota-Twin Cities and University of Illinois at Chicago Medical School, where he also completed an orthopaedic residency.

He and his wife Jacqueline, an IT consultant, met when they were undergraduate freshmen; they have one child, Constantine Jack.

Dr. Wonais’s hobbies include basketball, football, weightlifting, traveling, hiking, and watching Chicago sports.

His father is an internist and has been a major role model. As a child I always wanted to follow in his footsteps.

I found being a doctor is intellectually stimulating and allows me to help others.

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Dr. Wonais enjoys the hands-on nature of orthopaedics and the ability to provide treatments that tangibly improve people’s lives.

His favorite memory of fellowship is tailgating at an Ole Miss football game with co-fellows and attendings. After graduation, Dr. Wonais plans to practice in Chicagoland.

The Campbell Clinic is a warm, family-oriented institution. I will always cherish my time here and will forever be a part of the Campbell Clinic family.

HAND FELLOWSHIP PROGRAM Norfleet B. Thompson, MD, Director This fellowship focuses on hand surgery and hand conditions, with extensive exposure to surgical management of acute and reconstructive upper-extremity procedures as well as education about clinical nonsurgical problems. Hospital and surgical experiences span various facilities, including Methodist-Le Bonheur Healthcare, Regional One Health, Campbell Clinic Surgery Centers, and Baptist Memorial Health Care.

2024-2025 HAND FELLOW ANDREW WATKINS, MD

Dr. Watkins grew up in Bossier City, LA, and graduated from Louisiana State University and the LSU Health Sciences Center-Shreveport, followed by an orthopaedic residency at the University of Missouri-Kansas City.

He and his wife, Madelynn, met in high school, and she is a general surgeon. The Watkins have two daughters, 5-year-old Lillian Grace and 4-month-old Ella Kate.

Dr. Watkins’s hobbies include hunting, fishing, cooking, and playing golf.

He chose a medical career because medicine was a good combination of my interest in science/technology and helping others.

Dr. Watkins went into orthopaedics because he liked the variety of cases and patients and the ability to restore function and improve a patient’s quality of life.

His favorite memory of fellowship? I enjoyed getting to work with different hand staff and seeing how each one did things differently. I also enjoyed getting to work with the residents and hopefully taught them something.

Dr. Watkins’s research activity was working on the study, “Improving Patient Care in Hand Surgery Through Non-Narcotic Postoperative Pain Control Regimens.”

After graduation, he plans to go on active duty in the U.S. Air Force.

Thank you to all four hand surgeons for a great year and for supporting my growth as a surgeon and physician.

Also, thank you to my wife who took care of our two young children while completing her residency in a different state – you’re a rock star.

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PEDIATRIC ORTHOPAEDIC FELLOWSHIP Derek M. Kelly, MD, Director This ACGME- and POSNA-accredited fellowship program combines clinical training and research, preparing surgeons for a career in both private practice and academic settings. The fellowship offers extensive exposure to trauma, scoliosis, clubfoot, hip diseases, limb deformities, tumors, hand and upper-extremity conditions, sports orthopaedics, metabolic and genetic conditions, neuromuscular disorders, cerebral palsy, myelomeningocele, degenerative diseases, congenital conditions, and other conditions that affect the spine, hip, foot and ankle, and hand. Training locations include Le Bonheur Children’s Hospital and Campbell Clinic Orthopaedics.

2024-2025 PEDIATRIC ORTHOPAEDIC FELLOW AARADHANA JIVENDRA JHA, MD

Dr. Jha is a native of Kathmandu, Nepal. She graduated from St. Xavier’s College and Tribhuvan University Teaching Hospital, then completed a residency at B. P. Koirala Institute of Health Sciences, all of which are in Nepal.

Her older brother is a cardiac surgeon.

Dr. Jha’s hobbies include hiking, cooking, traveling, trying new foods, reading, and listening to music.

Since childhood, the intricate workings of human biology have fascinated me. The philanthropic aspect of medicine is also alluring.

She chose to specialize in orthopaedics because the very different nature of this specialty, along with the ability to put things together in real time was very intriguing. Then when everyone kept telling me “women can’t do orthopaedics,” I was curious, which fueled my intent to pursue ortho.

Her research has focused on a systematic review of brace wear after serial Ponseti casting for clubfeet.

Dr. Jha’s favorite memory has been the genuine investment of all the attendings to hand down surgical skills.

After graduation, Dr. Jha hopes to work at a university-related hospital, where she would be involved with residents and scholarly activities.

My most sincere gratitude to all the attendings (especially Dr. Kelly), the residents, the staff at Le Bonheur and Campbell Clinic (Germantown, Midtown) for their invaluable help in making this a very fruitful and productive year. I’m going to miss Campbell Clinic and this year of fellowship, which will form the basis of my career ahead.

Thank you!

SPORTS MEDICINE FELLOWSHIP David L. Bernholt, MD, Director Tyler J. Brolin, MD, Assistant Program Director The Sports Medicine, Shoulder and Elbow Surgery Fellowship combines six months of Sports Medicine education with six months of Shoulder and Elbow training. This hybrid program exposes each fellow to a breadth of pathology of the knee, shoulder, and elbow and focuses on all aspects of arthroscopic shoulder, knee, and elbow surgery with special emphasis on shoulder arthroplasty, open shoulder instability, multi-ligamentous knee reconstruction, as well as complex patellofemoral reconstruction. Fellows also gain training in hip arthroscopy, hip preservation, pediatric sports medicine and are exposed to all aspects of practice management including

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formal training in billing and coding. A major part of the fellowship is the opportunity to participate in clinics, team, and event coverage for the United Football League (UFL), Memphis Redbirds (AAA baseball), Division I, II, and III collegiate teams, and high school teams.

2024-2025 SPORTS MEDICINE, SHOULDER AND ELBOW FELLOW MARC SCHATZ, MD

Dr. Schatz grew up in Weston, FL, graduated from the University of Miami and its School of Medicine, then completed an orthopaedic residency at Louisiana State University in New Orleans.

Dr. Schatz’s mother is a hospitalist, and his father is an anesthesiologist.

He met his wife, Jessica, through mutual friends in Miami; she works as a CRNA. Dr. Schatz’s hobbies include weightlifting, working on cars, and spending time with his wife.

I was always interested in science and its application to better lives. Growing up with physicians in the family, medicine seemed like an obvious career choice.

He got into orthopaedics because he found it to be a problem-focused, goal-oriented specialty. I was particularly interested in the way a surgeon can alter anatomy to address pathology and improve function.

His favorite memory of fellowship has been the wide variety of surgical cases and the complex pathology that is addressed daily. Dr. Schatz’s research has included the paper “SLAP repair, tenodesis, or both?” Preoperative comorbidities, and machine learning in shoulder arthroplasty.

After graduation, he plans to practice in Fort Lauderdale, FL.

TRAUMA FELLOWSHIP John C. Weinlein, MD, Director The trauma fellow receives comprehensive experience at Regional One Health, a high-volume Level 1 trauma center that serves as a referral facility for Tennessee, Arkansas, Mississippi, Missouri, and Kentucky, with four orthopaedic traumatologists on staff. This program is primarily focused on the management of complex polytrauma, including pelvic, acetabular, and periarticular fractures; reconstructive fracture management, including nonunions, malunions, and deformity correction.

The fellowship provides extensive operative exposure of complex fractures, and the fellow consistently experiences some of the highest volume of pelvic and acetabular injuries in the country. The fellow interacts with two orthopaedic trauma teams including daily morning report/fracture conferences, after which the fellow has first choice of operative cases. More recently, the fellow has had increased opportunities to pursue arthroplasty for hip and acetabular trauma as well as soft-tissue coverage procedures.

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2024-2025 TRAUMA FELLOW ROCK HWANG, MD

Dr. Hwang is a native of Irvine, CA, who graduated from Tufts University and Drexel University College of Medicine, then completed an orthopaedic residency at Cooper University Hospital.

His fiancée, Amy Olinzock, is a pediatric nurse practitioner at Children’s Hospital of Philadelphia.

Dr. Hwang’s hobbies include watching the Philadelphia Eagles and Phillies compete, running, and drinking whiskey.

He chose a medical career because of the variety of people he would meet, and orthopaedics specifically because it would let him help patients return to their lifestyles after sustaining an injury.

Patients are young, old, athletic, and weekend warriors. Medicine provides an opportunity to help people who come from all walks of life.

His favorite memory of fellowship? Being around the interns as they try their best (with varying degrees of success) to navigate the early parts of residency.

After graduation, Dr. Hwang will work as an orthopaedic trauma surgeon at Cooper University Hospital, a Level 1 academic trauma center.

Thank you to the trauma staff for contributing to my growth as a surgeon and a person. Special thanks to all of the residents for being so welcoming and helpful. Finally, congrats to the graduating senior residents. This is a huge achievement! You guys have been incredibly helpful, and I look forward to seeing how you do in fellowships and beyond.

PRIMARY CARE SPORTS MEDICINE FELLOWSHIP John C. Hyden, MD, Director The Campbell Clinic/UTHSC Primary Care Sports Medicine Fellowship’s mission is to train physicians from primary specialties in the art and science of musculoskeletal and sports medicine, encompassing the science and clinical application of exercise physiology, kinesiology, nonoperative orthopaedics, cardiology, and general medicine applied to the care of the active person. It also trains physician specialists who understand, advance, and apply evidence-based medicine in the psychosocial, environmental, and physiologic milieu of athletic training and competition from the pediatric to the elite.

2024-2025 CAMPBELL CLINIC-UTHSC PRIMARY CARE SPORTS MEDICINE FELLOW RYAN MATTHEW WENDT, MD

Dr. Wendt is a native of Ankeny, IA, who graduated from the University of Arkansas and University of Iowa’s Carver College of Medicine before completing a family medicine residency at the University of Nebraska Medical Center.

Dr. Wendt met his wife Madison, who is an attorney, through mutual friends while they were attending undergraduate school in Fayetteville. She stays at home with their daughters, 4-year-old Bonnie and 2-year-old Eleanor.

Dr. Wendt’s hobbies include woodworking, watching football, and hunting. He chose a medical career to help people live fulfilling lives that are not limited due to their health or injuries and chose primary

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care sports medicine specifically to gain the skills needed to care for all levels of athletes.

Dr. Wendt’s favorite memory of his fellowship has been working the St. Jude marathon and providing care for the runners after they finished the race. A close second was traveling with the University of Memphis Tigers football team to Frisco, TX and being on the sideline for a Frisco Bowl victory.

He has a case report abstract that was accepted for presentation at the American Medical Society for Sports Medicine’s annual conference and has co-authored a review article with Dr. John C. Hyden that is being considered for publication. In addition, Dr. Wendt is collecting data for an article about the cost effectiveness of contrast injection via ultrasound guidance versus fluoroscopy guidance for magnetic resonance angiography, which was to be submitted for publication this spring with Dr. Nahum M. Beard.

After graduation, he hopes to continue practicing nonoperative sports medicine and researching nonoperative musculoskeletal treatments.

I want to thank all of the orthopaedic faculty for allowing me to learn the clinical care of orthopaedics while working in their clinics. I want to thank the primary care sports medicine faculty for the mentorship and teaching they have provided, especially Dr. Hyden and Dr. Beard, for their immense role in my development as a primary care sports medicine physician.

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For more information on the Ingram lectures scan this code:

MAY 5, 2025 The annual Alvin J. Ingram Memorial Lecture honors the memory of a former Campbell Clinic Chief of Staff and Department Chairman who had a larger-than-life presence among his colleagues.

Two renowned orthopaedic surgeons are the keynote speakers for the Ingram Memorial Lecture this year.

Dr. Wilford K. Gibson is a partner at Atlantic Orthopaedic Specialists in Virginia Beach, Virginia. In addition, he is currently the 1st Vice President of the AAOS and is dedicated to advancing orthopaedic practices and modeling values of leadership, service, and excellence.

Dr. Gibson graduated cum laude from the University of Richmond and received his medical degree from the Medical College of Virginia. He completed his surgery internship at Naval Medical Center Portsmouth and served on the USS Nassau, earning several military awards.

He returned to Portsmouth for his orthopaedic surgery residency and completed fellowships in orthopaedic trauma and pelvis and acetabulum surgery.

Dr. Gibson focuses on adult hip and knee reconstruction, specializing in minimally invasive approaches, robotics, and patient-specific systems. He volunteers as a team physician for Old Dominion University football and basketball programs, and has been actively engaged in AAOS leadership for over a decade, serving in various roles including Board of Councilors Secretary, Chair, and Advocacy Council Chair. Dr. Gibson has received multiple awards, including the Virginia Orthopaedic Society President’s Award and Career Lifetime Achievement Award and the AAOS Congressional Ambassador of the Year Award.

Dr. Thomas A. Russell, better known as “Toney,” is an internationally recognized inventor and surgeon. He earned his medical degree from the University of Tennessee Health Science Center (UTHSC) and completed his orthopaedic residency at the UTHSC-Campbell Clinic.

He is Professor Emeritus of Orthopaedic Surgery at the UTHSC-Campbell Clinic and a past President of the Orthopaedic Trauma Association.

As a surgeon, Dr. Russell has made groundbreaking contributions to orthopaedic trauma surgery. His invention of the Russell-Taylor Intramedullary Nail revolutionized fracture treatment, and he continued to innovate with the TriGen Closed Section Titanium Nail, the Intertan Integrated Cephalomedullary Nail, and the N-Force Fixation system. Dr. Russell also pioneered the first MRI-compatible external fixation system, the Torus system, and holds over 25 patents in implant design and biomaterials. He has authored numerous research papers and book chapters on surgical innovation and currently serves as the Chief Medical Officer and shareholder for PBC Biomed, Ltd. His work has significantly improved patient care and outcomes through innovative implant systems and fixation techniques.

In support of improving patient care, this activity has been planned and implemented by Medical Education Resources (MER) and Campbell Clinic Foundation. MER is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

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Thank you to the partners who support the Alvin J. Ingram Memorial Lecture in its commitment to provide continuing education to physicians and health professionals dedicated to excellence in orthopaedics.

PRESENTING SUPPORTERS

GOLD SUPPORTERS

SILVER SUPPORTERS

HC BIOMEDICAL

BOOTH SUPPORTERS

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CAMPBELL CLINIC-LED ORTHOPAEDIC SURGERY RESIDENCY PROGRAM CELEBRATES 100 YEAR ANNIVERSARY, GLOBAL REACH IN 2024 Established in 1924 by Dr. Willis C. Campbell, the UTHSC-Campbell Clinic Residency Program has defined itself by advancing orthopaedics, leading across the field, and providing patients with the highest quality of care. The 5-year intensive training is a collaboration among the University of Tennessee Health Science Center (UTHSC), the Campbell Clinic Foundation, and Campbell Clinic Orthopaedics.

training and nurturing the next generation of orthopaedic surgeons has solidified this program as a leader in the field and a driving force behind advancements in orthopaedic medicine.”

“This centennial is a testament to the continued dedication of our faculty, staff, and partners,” said Dr. Frederick M. Azar, Campbell Clinic Chief of Staff. “Together, our unwavering commitment to

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The Foundation facilitates the orthopaedic surgery residency and fellowship programs. To date, more than 750 surgeons have graduated from Campbell and residency and fellowship programs and go on to relieve pain, treat bone and joint conditions, and restore patient well-being.

The demands of our field, trainees and patients – as well as the commitment to foster knowledge, skills and professionalism – led to several program changes in 2024, including: • Program leadership including additional Associate Program Directors: David Bernholt, MD (Research); Clayton Bettin, MD (Compliance); Stephanie Chen, MD (Didactic); and Chris Cosgrove, MD (Surgical Skills); • Weekly didactic lectures moved from Monday Night Meetings (MNM) to Friday Afternoon Meetings (FAM); • Research experience expanded, with additional PGY-2 research rotation, staff and Foundation leadership; Education Course Scholarships expanded to include Orthopaedic Trauma Association Fracture Course for Interns, subspecialty course support for PGY-3s, Miller Board Review Course for PGY-5s; and • New surgical skills curricula expanded for all PGY levels, with simulation tools and instruments to develop agility early.

Operative experience, mentorship, and graduated responsibility remain hallmarks of our program. These thoughtful, strategic changes will enable Campbell to further meet the needs of residents and orthopaedic medicine and excel in education for generations to come.

“We exist to steward and advance this legacy of education and patient care,” said Foundation Executive Director Jenny Koltnow. “Donations to the Foundation help residents, training and research, all of which have a profound impact on patient outcomes.”

GET TO KNOW OUR PROGRAM AT CAMPBELLRESIDENCY.COM!

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PGY-4

Residents 2024-2025

Matthew R. Colatruglio, MD

Lauren A. Foropoulos, MD

Undergraduate: University of Mississippi Medical: University of Tennessee Health Science Center College of Medicine

Paul T. Greenfield, MD

Undergraduate: Rice University Medical: Emory University School of Medicine

Evan P. Johnson, MD

Undergraduate: University of South Florida Medical: University of Central Florida College of Medicine

PGY-3

Undergraduate: The Ohio State University Medical: Ohio State University College of Medicine

Stanley C. Eboh, MD

Thomas J. Iorio, MD

Undergraduate: University of Tennessee Medical: University of Tennessee Health Science Center

Dylan S. Koolmees, MD

Undergraduate: University of California Medical: Wayne State University School of Medicine

Kailey L. Mansour, MD

Undergraduate: University of Florida Medical: University of Miami Leonard M. Miller School of Medicine

PGY-2

Undergraduate: Texas Tech University Medical: Texas Tech University Health Sciences Center

Stefan J. Hanish, MD

Joshua C. Hutchinson, MD

Undergraduate: Clemson University Medical: Medical University of South Carolina College of Medicine

Joseph R. Johnson, MD

Undergraduate: Brown University Medical: Stanford University School of Medicine

Brent V. Scheckel, MD

Undergraduate: Lindenwood University Medical: University of Tennessee Health Science Center

PGY-1

Undergraduate: University of CaliforniaLos Angeles Medical: University of Missouri-Columbia School of Medicine

Ryan C. Avidano, MD

Undergraduate: University of Georgia Medical: Medical College of Georgia

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Alexander S. Guareschi, MD

Undergraduate: Clemson University Medical: Medical University of South Carolina College of Medicine

Blake D. Hajek, MD

Undergraduate: Mississippi College Medical: University of Tennessee Health Science Center

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Nicholas A. Howard, MD

Undergraduate: Valdosta State University Medical: Mercer University School of Medicine, Savannah

University of Tennessee Health Science Center - Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering

PGY-4

Mateo J. Kirwan, MD

Undergraduate: University of Kansas Medical: University of Kansas School of Medicine

Elliot N. Konrade, MD

Undergraduate: Washburn University Medical: University of Kansas School of Medicine

Tanner R. Poppe, MD

Undergraduate: University of Kansas Medical: University of Kansas School of Medicine – Wichita

Ryan G. Rogero, MD

Undergraduate: University of California Medical: Lewis Katz School of Medicine at Temple

PGY-3

William G. Murphy, MD

Undergraduate: Rhodes College Medical: University of Tennessee Health Science Center

Robert T. Neel, MD

Undergraduate: University of Tennessee Medical: University of Tennessee Health Science Center

Kristin Sheaffer, MD

Undergraduate: University of Georgia Medical: Mercer University School of Medicine

Matthew D. Wideman, MD

Undergraduate: University of Alabama Medical: University of Tennessee Health Science Center

PGY-2

Lena N. Sifen, MD

Undergraduate: Florida State University Medical: Wake Forest University School of Medicine

Matthew D. Smith, MD

Undergraduate: University of Georgia Medical: Vanderbilt University School of Medicine

Patrick S. Sullivan, MD

Undergraduate: Texas State University Medical: University of Texas Medical Branch

Nikhil Yedulla, MD

Undergraduate: Wayne State University Medical: Wayne State University School of Medicine

PGY-1

Mustafa Mohamed, MD

Undergraduate: Indiana University – Purdue University Indianapolis Medical: University of Louisville School of Medicine

James M. Ruth, MD

Undergraduate: Auburn University Medical: University of Tennessee Health Science Center

Noah B. Vallette, MD

Undergraduate: Murray State University Medical: Southern Illinois University School of Medicine

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Matthew W. Young, MD

Undergraduate: Auburn University Medical: University of Alabama at Birmingham School of Medicine

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Andrew J. Couture, MD1 Karen J. Derefinko, PhD2 Marcus C. Ford, MD1 John R. Crockarell, MD1 James L. Guyton, MD1 James W. Harkess, MD1 Christian Roberts, MBA3 William M. Mihalko, MD, PhD1 1

Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science CenterCampbell Clinic, Memphis, Tennessee

2

The University of Tennessee Health Science Center, Department of Preventive Medicine, Memphis, Tennessee

3 The University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee

Accepted for publication by Journal of Long-Term Effects of Medical Implants.

This study was a poster presentation at the Orthopaedic Research Society’s annual meeting Feb. 2-6, 2024 in Long Beach, CA. This study was approved by the Institutional Review Board of the University of Tennessee Health Science Center (20-07360-XM).

Corresponding Author: William M. Mihalko, MD, PhD 1211 Union Avenue, Suite 510 Memphis, Tennessee 38104 wmihalko@campbellclinic.com

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Smoking Cessation and Relapse Effects on Patient-Reported Outcomes Following Total Knee Arthroplasty ABSTRACT Introduction Smoking is a known risk factor for poor outcomes following total knee arthroplasty (TKA) surgery. Despite this, many patients continue to smoke before and after surgery, leading to increased complications, costs, and worse patient-reported outcomes (PROs). The purpose of this study was to identify factors that could be modified to increase smoking abstinence and prevent relapse among these patients that would hopefully lead to more satisfactory outcomes. We aimed to evaluate the prevalence of cigarette-smoking relapse, quitting behavior, and identify smokingcessation predictors among patients who underwent TKA surgery.

Methods This study involved a retrospective analysis of medical records and a survey of patients who underwent TKA surgery at a single institution between 2018 and 2021. After receiving IRB approval, we randomly identified 200 patients, including 100 pre-operative smokers and 100 pre-operative nonsmokers, as a control group. Medical records of the pre-operative nonsmokers were reviewed to obtain their postoperative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOSJR) and demographic data, which were recorded in a data spreadsheet. The preoperative smokers were contacted by phone and asked questions about their smoking behavior before and after surgery, using a standardized smoking-habits questionnaire. The data collected included the number of cigarettes smoked per day, the number of household smokers, quitting behavior, and the use of smoking-cessation aids. Additionally, we recorded their KOOSJR Survey responses for comparison between groups.

Results Descriptive statistics showed that the age range of the patients was 28 to 86 years, with a mean age of 65.20 (standard deviation [SD] = 8.92).

Nonsmokers were slightly older than smokers (nonsmoker mean = 67.59, smoker mean = 62.82, F = 15.326, P <.001). Based on KOOSJR scoring, pre-operative nonsmokers had significantly better outcomes compared with pre-operative smokers. Nonsmokers had lower overall KOOSJR total scores compared with smokers (nonsmoker mean = 4.40, smoker mean = 6.32, P =.016). Nonsmokers demonstrated higher overall knee health than smokers as shown by the KOOSJR converted score where a score of 100 equates to a perfect knee (nonsmoker mean = 80.47, smoker mean = 75.18, F = 3.954, P =.048). For specific functional movements, nonsmokers had less pain on stairs (P = 0.025), less difficulty rising from

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sitting (P = 0.006), and less difficulty bending to the floor (P = 0.002). In terms of smoking behavior, the mean number of cigarettes per day among smokers was 13.65 (SD = 11.13). Most smokers (63%) had quit smoking before surgery, with most (61%) doing so at the request of their surgeon. Of those who quit before surgery, over half (52%) resumed smoking after surgery, with no significant difference in KOOSJR scores between those who quit and those who did not (Chi square = 0.779, P = .377). Regarding smoking-cessation methods, the most common method used was prescription medication (59%), followed by nicotine replacement therapy (38%).

However, smoking cessation before surgery did not have a significant impact on rates of returning to smoking post-operatively, with 49% of patients returning to smoking (P = 0.410). Of this group, 50% resumed smoking within one week.

Conclusion The results suggested that nonsmokers have better outcomes after TKA than smokers, as they experience less pain and have better knee health. These findings are consistent with existing literature and reaffirm that post-operative outcomes are better in non-smokers. The study also highlighted the high rate of smoking relapse among patients who quit smoking before surgery, with over half of them returning to smoking after surgery. While smoking relapse may not have a significant impact on pain after TKA, it can affect healing time and the overall health of patients.

Therefore, smoking cessation interventions should be implemented both BEFORE and AFTER surgery to improve outcomes and prevent smoking relapse. This study provided valuable information for clinicians and researchers working with patients undergoing TKA and may serve as the basis for future research and interventions.

ANDREW J. COUTURE, MD Dr. Couture is a native of Rogers, AR, who graduated from the University of Central Arkansas and University of Arkansas for Medical Sciences.

He and his wife, Reagan, met as undergraduates; they have one daughter, 1-yearold Charlee.

Dr. Couture’s hobbies include smoking meats and visiting the family farm in Southern Arkansas.

Why did he pursue a medical career? Several injuries growing up landed me in (my future mentor) Dr. Cooper’s clinic, where we instantly bonded. He took me under his wing. Dr. Couture chose the orthopaedics specialty because I wanted to be just like Dr. Cooper.

His favorite memories of residency include the Wilderness Hand Journal Club, hot sauce night, and the golf tournament.

After graduation, Dr. Couture plans to complete a sports fellowship at Mississippi Sports Medicine and Orthopaedic Center, then practice at Mercy Hospital in Rogers.

Thank you to Drs. Calandruccio, Azar, Dabov, Throckmorton, Kelly, Bettin, Rudloff, Weinlein, Beebe, Cosgrove, and Samborski for the mentorship, guidance, and patience you’ve shown me throughout my training.

You’ve shaped me into the orthopaedic surgeon and person I’ve become, and I will be forever grateful. I also want to thank all the supporting staff who keep everything running smoothly and my fellow residents for their constant support. It’s been an honor to learn and grow alongside such an incredible team.

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Nolan D. Farrell, MD Kailey L. Mansour, MD William J. Weller, MD Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science CenterCampbell Clinic, Memphis, Tennessee

Autograft Reconstruction for Volar Ulnar Corner Insufficiency After Distal Radius Fractures ABSTRACT Hypothesis Volar ulnar corner (VUC) insufficiency after distal radius fracture, either due to inadequate fixation of the VUC or irreparable volar marginal fragment, can be reconstructed using articular autograft, in similar nature to hemihamate arthroplasty.

Research reported in this abstract was supported by Skeletal Dynamics.

Corresponding Author: William J. Weller, MD, PhD 1211 Union Avenue, Suite 510 Memphis, Tennessee 38104 wjweller@campbellclinic.com

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Methods There were two phases of this cadaver study to analyze feasibility and reproducibility of VUC reconstruction. Four articular autografts were selected: dorsal distal capitate (DC), dorsal third metacarpal base (MCB), lateral olecranon facet, and radial styloid, due to their anatomic location and potential similar anatomical shape to the VUC. Analysis of preoperative and postoperative fluoroscopy was performed, measuring volar lip angle (VLA), height of the VUC, and radius of curvature, and qualitative analysis was performed. Two autograft options were selected for further evaluation, DC and MCB. A total of four reconstructions of the VUC were conducted with each of the preferred autografts, and CT analysis was performed measuring VLA, distance to highest buttress of the VUC, and teardrop angle (TA) across multiple sagittal slices. Differences from preoperative to postoperative were compared for each radiographic value using two tailed comparisons of unequal variance. Differences from preoperative measurements were compared between the two groups. A P value of <0.05 was determined significant.

Results DC and MCB autografts performed better both anatomically, with comparable VLA and VUC height to preoperative fluoroscopy. On qualitative measures, DC and MCB reconstructions were easier to obtain with better gross anatomic fit. CT analysis of MCB reconstruction showed no significant difference from preoperative to postoperative in distance to height of VUC (7.82mm vs 7.57mm), VLA (16.70 vs 15.49 degrees), and TA (36.29 vs 31.78 degrees), P > 0.05. CT analysis of DC reconstruction showed no significant difference from preoperative to postoperative in VLA (11.69 vs 2.19 degrees) and TA (34.8 vs 30.26 degrees). There was a significant difference in the distance to height of VUC (8.86 mm versus 6.85 mm, P = 0.03). When comparing change of radiographic measurements from preoperative to postoperative, there was a significant difference in the change from preoperative in distance to height of VUC (-0.26 mm for MCB versus -2.01 mm for DC, P = 0.037) and VLA (1.2 degrees for MCB vs -9.5 degrees DC, P = 0.017).

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Conclusions VUC reconstruction for VUC insufficiency after distal radius fracture is feasible utilizing autograft reconstruction in similar nature to hemihamate

arthroplasty. While there are multiple options for VUC reconstruction autograft, the dorsal third metacarpal base may be the most easily reproducible and best anatomic match.

NOLAN D. FARRELL, MD Dr. Farrell grew up in Perry, OH, and graduated from the Ohio State University and its College of Medicine.

He and his wife, Savannah, knew each other while growing up in nearby towns in Northeast Ohio; they connected during his senior year at Ohio State and have been together ever since. She is an interior designer.

Dr. Farrell’s hobbies include cooking Italian food, spending time with Savannah and their two dogs, and rooting for the Buckeyes.

He chose a medical career because I enjoy learning, struggle, and working through problems while striving to improve others’ lives. My goal is to help restore form and function to patients who are in need. Orthopaedics combines critical thinking, patient-specific decision-making, planning and hands-on experience, which makes it truly rewarding and aligns with my goals.

He says that every rotation at Regional One was special, particularly those in his fourth and fifth years, taking call and working through cases with his co-residents.

Dr. Farrell’s future plans include serving a trauma fellowship at University Hospitals in Cleveland before pursuing a career at a Level 1 trauma center.

Thank you to all the staff for the support, teaching and guidance over the past five years. I would like to specifically thank the trauma team. Drs. Rudloff, Weinlein, Beebe, and Cosgrove have provided continuous mentorship, taught how to take great care of medically complex patients, and have allowed me to grow through their guidance. Thank you to my class for supporting one another, Eric West for putting all the effort as co-chief, and my teams and call partners at Regional One. Most importantly, thank you to my wife for her continued, unwavering support over the past five years.

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Andrew D. Gailey MD1 Elizabeth H. Leonard BS2 Kelley M. Funderburg NP3 Marcus C. Ford MD1 William M. Mihalko MD, PhD1 1

Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science CenterCampbell Clinic, Memphis, Tennessee

2

University of Tennessee Health Sciences Center, College of Medicine, Memphis, Tennessee

3

Campbell Clinic, Memphis, Tennessee

This study was approved by the Institutional Review Board of the University of Tennessee Health Science Center (#21-07945-XP).

Corresponding Author: William M. Mihalko, MD, PhD 1211 Union Avenue, Suite 510 Memphis, Tennessee 38104 wmihalko@campbellclinic.com

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Effectiveness of Weight Loss Treatment in Total Joint Arthroplasty ABSTRACT Introduction Total joint arthroplasty (TJA) is a common major elective procedure performed in over 1 million patients annually in the United States with an expected increase in the coming decades. The prevalence of obesity also continues to increase among patients undergoing both total hip arthroplasty (THA) and total knee arthroplasty (TKA). The increased rate of complications after TJA in patients with obesity is well known, including increased rates of infection, length of stay, component malpositioning, and revision rates. The American Association of Hip and Knee Surgeons (AAHKS) has recommended strong encouragement of weight loss prior to TJA in patients with a body mass index greater than 40. However, there remains a paucity of published studies evaluating the success of preoperative nonsurgical weight-loss initiatives prior to TJA. This study retrospectively assessed the outcomes of provider-assisted weight loss programs prior to TJA for patients with obesity.

Methods All patient encounters with an in-house nurse practitioner between the dates of September 26, 2018 and September 29, 2021 were identified.

A retrospective chart review was completed for patients presenting as a referral for weight loss. Collected data, including baseline BMI, discharge BMI, number of visits completed, estimated weeks of treatment, prescribed intervention, and eventual arthroplasty versus continued nonoperative treatment, were reviewed to identify trends in weight loss and eventual progression to operative intervention for arthroplasty.

Results We identified 817 patients who were referred from surgeons for weight loss prior to possible TJA. The average decrease in BMI was 0.7 for all included patients. Of the patients referred for weight loss, 120 patients underwent TJA, indicating an overall success rate of 14.7%. Patients who proceeded to TJA had an average BMI decrease of 1.7, as compared to those who did not proceed to TJA, who had an average BMI decrease of 0.52 (P < 0.001). The average number of visits with the nurse practitioner was 2.2, and the average length of treatment was 16 weeks, with no significant difference between the two groups.

Discussion This study demonstrated the success of weight loss clinic visits in patients seeking to undergo TJA. Overall, the success rate for patients losing weight and subsequently undergoing TJA was only 14.7%; however, there was a decrease in overall BMI and a statistically significant decrease in

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BMI of those who eventually progressed to operative intervention. This suggests that some patients do benefit from preoperative optimization and are able to make significant changes in their health prior to proceeding to surgery. Future areas of study should include identifying characteristics of patients who are successful in weight loss to improve screening and narrow referral patterns. The retrospective nature of this study did introduce some limitations and further prospective work on modalities and length of treatment may also enhance results.

Significance/Clinical Relevance This study provides baseline data for a provider-assisted weight-loss program in patients with obesity prior to TJA. This data can help guide surgeons in their preoperative optimization, counseling, and referral to such programs.

ANDREW D. GAILEY, MD Dr. Gailey grew up in Asheville, NC, and graduated from the University of North Carolina at Chapel Hill and its School of Medicine.

He met his partner, Dr. Aubrey Schachter, in New Orleans, and they matched together for residency at UTHSC. She will complete residency in General Surgery in June.

Dr. Gailey originally chose a career in medicine because I appreciated an opportunity for lifelong-learning and the ability to dedicate my life to helping others return to living healthy lives. I chose orthopaedics because I wanted to restore form and function for patients so they could get back to doing the activities they most enjoy with those they love.

His hobbies include playing pick-up basketball, weightlifting, cooking, and spending time with his partner and their two dogs, Fleurty and Toula.

Dr. Gailey says he will miss the camaraderie of his fellow residents - spending time together outside of work, whether it be playing basketball or grilling out in someone’s backyard on the weekends.

After graduation he plans to complete a sports fellowship at the American Sports Medicine Institute in Birmingham, AL, alongside Aubrey, who will complete a fellowship in surgical critical care/trauma at UAB. Thank you to all the trauma staff for their patience and hands-on instruction. Every stint at the Med was a journey, and some days were better than others, but by the end of each rotation I was always a much better surgeon than when I started. Most importantly, I want to thank Aubrey and my parents – Michael and Cindy Gailey.

There is no doubt in my mind I would not have made it to this point without their unwavering support. I cannot put into words how much I owe them or begin to express how much they have improved my life, but each has had a profoundly positive impact on my journey through medical training and especially these five years of residency.

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Erick M. Marigi, MD1 Karina A. Lenartowicz, BMSc2 Brenton R. Jennewine, MD3 Thomas W. Throckmorton, MD3 John W. Sperling, MD, MBA1

Clinical and Radiographic Outcomes of Hybrid Glenoid Fixation with a Central Porous Titanium Post: Analysis of 713 Consecutive Shoulders

1

Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

2

Mayo Medical School, Mayo Clinic, Rochester, Minnesota

ABSTRACT

3

Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science CenterCampbell Clinic, Memphis, Tennessee

Background Hybrid glenoid component fixation represents an emerging technology in total shoulder arthroplasty (TSA) design. However, there is a paucity of larger-scale studies reporting the outcomes following implantation of these components. This study aimed to determine the outcomes following primary TSA using hybrid glenoid component fixation with a central porous titanium post.

Mayo Institutional Review Board approved this study (#12-007498).

Marigi EM, Lenartowicz KA, Jennewine B, Throckmorton TW, Sperling JW. Clinical and radiographic outcomes of hybrid glenoid fixation with a central porous titanium post: analysis of 713 consecutive shoulders. J Shoulder Elbow Surg.

2022;31(7):1524-1532. doi:10.1016/j. jse.2021.12.033

Corresponding Author: Thomas W. Throckmorton, MD 1211 Union Avenue, Suite 510 Memphis, Tennessee 38104 tthrockmorton@campbellclinic.com

Methods A retrospective review of 2 institutional databases identified patients aged > 18 years who underwent primary elective hybrid TSA between 2009 and 2018 with a minimum of 2 years of follow-up. Outcomes evaluated included the visual analog scale pain score, range of motion, American Shoulder and Elbow Surgeons (ASES) score, complications, and implant survivorship free from reoperation or revision. Postoperative imaging was assessed for glenoid radiolucent lines and evidence of aseptic glenoid component loosening (AGL).

Results A total of 713 shoulders in 666 patients with a mean age of 61 ± 6 years were included in the study at a mean follow-up period of 4.3 years (range, 2.0-9.1 years); male shoulders comprised 50.9% of shoulders. Notable clinical improvements were observed with respect to the visual analog pain score (7.0 to 1.4, P < .001), active forward elevation (91º to 155º, P < .001), active external rotation (21º to 50º, P <.001), and the ASES score (38.6 to 82.7, P <.001), with all exceeding the substantial clinical benefit threshold for TSA. The active internal rotation score also showed significant improvement (3.1 to 5.7, P <.001). Glenoid radiolucent lines were identified in 58 TSAs (8.2%), with 1 radiographically loose glenoid component (0.1%). There were 54 complications (7.6%), with postoperative rotator cuff tear as the most common complication (n = 15, 2.1%); only 4 cases (0.6%) of glenoid-related complications (AGL) were observed. The Kaplan-Meier rate of survival free from revision surgery was 98.7% at 1 year, 98.5% at 2 years, and 96.7% at 5 years.

Conclusions Hybrid glenoid component fixation of anatomic TSA with a central porous titanium post demonstrated statistically significant and clinically

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meaningful improvements in pain, range of motion, and ASES scores. Although AGL remains a concern, only 0.6% of TSAs sustained glenoid-related complications at a mean follow-up period of 4.3 years and the rate of survivorship free from revision was 96.7% at 5 years. These favorable clinical findings support the theoretical advantages of hybrid glenoid fixation; however, large comparative investigations with long-term follow-up are needed to validate these results.

BRENTON R. JENNEWINE, MD Dr. Jennewine grew up on Dayton, OH, and graduated from Case Western Reserve University and the University of Virginia School of Medicine.

He and his wife, Emily, met in high school; she is a pediatric nurse practitioner.

Their family include two huskies, who behave like toddlers.

Dr. Jennewine’s hobbies include fly fishing, fly tying, golf, and pickleball. In fact, going offshore fishing with Dr. Bettin and other residents at MAOA 2023 is among his favorite memories of his time at Campbell Clinic.

Why did Dr. Jennewine choose a medical career? I studied biomedical engineering in college and wanted to more directly care for patients than with an engineering career. Orthopaedic surgery is an active, hands-on specialty that involves a lot of engineering ideas and abilities.

After graduation, Dr. Jennewine will complete a shoulder and elbow fellowship with Fondren Orthopedic Group in Houston.

Thank you to all of my mentors- especially Drs. Brolin and Throckmorton – who have helped me along the way in my orthopaedic career.

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Andrew D. Nahr, MD1 Stefan J. Hanish, MD1 Tori J. Coble, DO2 Mary C. Hunter, BS2 Thomas W. Throckmorton, MD1 Tyler J. Brolin, MD1 1

2

Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science CenterCampbell Clinic, Memphis, Tennessee Campbell Clinic Foundation, Memphis, Tennessee

This study was a podium presentation at the Mid-America Orthopaedic Association meeting April 9-12, 2025, in San Antonio, and a poster presentation at the American Academy of Orthopaedic Surgeons meeting held March 10-14, 2025, in San Diego.

This study was approved by the Institutional Review Board of the University of Tennessee Health Science Center (2309360-XM).

Corresponding Author: Tyler J. Brolin, MD 1211 Union Avenue, Suite 510 Memphis, Tennessee 38104 tbrolin@campbellclinic.com

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Incidence and Risk Factors Associated with Anterior Shoulder Pain Following Reverse Total Shoulder Arthroplasty ABSTRACT Objective Reverse total shoulder arthroplasty (rTSA) has become one of the most common procedures performed by shoulder surgeons. It has unique complications: prosthetic dislocation, acromial and scapular stress fractures, as well as scapular notching are well known and described following rTSA. Another distinct, yet less recognized complication is the development of anterior shoulder pain. This phenomenon is poorly understood with little literature describing its existence, risk factors, and causes. The purpose of this work was to describe the incidence and associations of anterior shoulder pain following rTSA. Methods A retrospective chart review of a prospectively maintained database was performed for all patients undergoing rTSA by two senior authors. All patients were evaluated for the development of anterior shoulder pain following surgery. The phrase “anterior shoulder pain” was explicitly stated in most notes, and included pain over the anterior head of the deltoid, acromioclavicular joint, biceps, conjoint tendon, and acromion. Patient height and weight, surgical indications, bicep management, version of the humeral component, inlay vs. onlay humeral design, subscapularis management, glenosphere size, total glenoid lateralization, use of glenoid augment, and use of a humeral metallic spacer were evaluated for association.

Results Of the 1,401 patients undergoing rTSA from 2010 to 2023 who were analyzed, 174 (12.4%) had documented anterior shoulder pain at some time point during post-operative follow-up. Variables that were found to be associated with anterior shoulder pain: torn rotator cuff (P = 0.0075), lower weight 185.6 vs. 192.8; P = 0.041, surgeon A (15.2%) vs. B (11.1%); (P = 0.036), version of the humeral component 20º (16.0%) vs 30º (11.2%); P = 0.0084, inlay (15.8%) vs onlay (11.0%) humeral component; P = 0.014, and greater total glenoid lateralization 2.5 vs 1.84mm; 0.0075.

Conclusions To our knowledge, this is the first work that describes the incidence and analyzes variables associated with the development of anterior shoulder pain after rTSA. Our data suggested that inlay prosthesis in 20 degrees of retroversion trend toward having higher rates of anterior shoulder pain post-operatively. Additionally, patients without an intact rotator cuff and

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increasing glenoid sided lateralization tended to have higher rates of anterior pain. Bicep management, subscapularis repair, and glenosphere size did not appear to correlate. This study’s limitations included

the subjective nature of the variable of interest. Further work is needed in this area to continue improving patient outcomes following TSA.

ANDREW D. NAHR, MD Dr. Nahr grew up in Douglass, KS, and graduated from Newman University and the University of Kansas School of Medicine.

He and his wife, Rachel, met in medical school; she is a nurse.

Dr. Nahr chose a medical career because he liked science and working with his hands. I grew up working on things with my father, who was a mechanic. Orthopaedics combines all aspects of medicine I like with a very physically involved specialty. I like the instant gratification and getting people back to doing what they enjoy.

His favorite memory of residency is the Wilderness Hand Journal Club at Dr. Calandruccio’s farm.

After graduation, Dr. Nahr will be completing a shoulder and elbow fellowship in Medford, Oregan.

I want to thank all of the Campbell Clinic staff for becoming life-long mentors. I would also like to thank the other residents for their continued camaraderie and friendships.

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Evan R. Porter, MD1 Manasa V. Ponnuchetty, MS2 Vasuki Silva, PhD2 Nathan Beda, BA3 Karen Hasty, PhD1 Honsik Cho, PhD1 Marko Z. Radic, PhD2 1

Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science CenterCampbell Clinic, Memphis, Tennessee

2

The University of Tennessee Health Science Center, Department of Microbiology, Immunology and Biochemistry, Memphis, Tennessee

3

University of Tennessee Health Sciences Center, College of Medicine, Memphis, Tennessee

Institutional Review Board approval was not required for this study.

Engineered Type II Collagen Chimeric Antigen Receptor (CII CAR) T Regulatory Cell for the Treatment of Arthritis ABSTRACT Osteoarthritis (OA) is a debilitating condition that affects an estimated 240 million individuals worldwide, with no effective disease-modifying drugs currently available. Existing treatments include intra-articular steroids, platelet-rich plasma, biomolecular therapies, and cell-based therapies.

Cell-based therapies provide only short-term benefits, but diseasemodifying status has remained elusive. Recent research demonstrates the inflammatory environment in arthritic joints compromises the efficacy and viability of cell-based approaches.

To address these limitations, we developed a novel therapeutic strategy leveraging engineered T-regulatory (Treg) cells to actively reduce inflammation and promote cartilage regeneration in arthritic joints.

Treg cells are a specialized subset of CD4+ T cells that are essential for maintaining immune homeostasis and suppressing excessive inflammatory responses. These cells exert their anti-inflammatory effects through multiple mechanisms, including the secretion of immunosuppressive cytokines like IL-10, IL-4, and TGF-β, direct cell-cell contact, and metabolic modulation of the immune microenvironment.

Our approach employs a chimeric antigen receptor (E4D4 CSR) that targets exposed collagen type II (CII) in damaged cartilage, delivering a highly specific anti-inflammatory response through Treg activation. This construct combines the CII-binding scFv E4D4 with intracellular signaling domains from CD28 and CD3ζ to bypass the normal activation step and enhance Treg efficacy.

We hypothesize that CII CAR Tregs will reduce joint inflammation and promote regenerative repair in OA and other cartilage-damaging conditions.

Corresponding Author: Honsik Cho, Phd, MBA 1211 Union Avenue, Suite 510 Memphis, Tennessee 38104

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We have demonstrated the efficacy of this engineered protein construct invitro via a Jurkat effector T cell model. The engineered protein successfully transcribes from RNA and expresses on the cell surface. Binding of the receptor to CII activated the appropriate intracellular signaling cascade.

We have also demonstrated that the protein does not auto-activate.

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EVAN R. PORTER, MD Dr. Porter grew up in Jefferson City, MO, with his three brothers. He graduated from Drury University and Geisinger Commonwealth School of Medicine, where Dr. Porter met his wife, Maddison. She is a general surgery resident at the University of Tennessee Health Science Center and has been matched for an acute critical care fellowship at Ohio State University.

Dr. Porter’s hobbies include taking his dogs to the dog park, helping his wife restore old furniture, cycling, going to the gym, and cooking.

He chose a medical career because he wanted to see the impact that his efforts had in improving the lives of other people. The draw to surgery was the ability to acutely address and resolve someone’s problem. Orthopaedics was attractive due to the hands-on, physical nature of the work.

He has especially enjoyed the camaraderie among the residents. Residency can be challenging at times.

Having a good group of people to go through the process can turn a trying time into a fun experience.

After graduation, Dr. Porter will work as an orthopaedic surgeon for the U.S. Air Force. I’m proud to be graduating from this program. The operative training is second to none.

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Eric J. West, MD Derek T. Dixon, BS Thomas W. Throckmorton, MD David L. Bernholt, MD Frederick M. Azar, MD Tyler J. Brolin, MD Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science CenterCampbell Clinic, Memphis, Tennessee

West EJ, Dixon DT, Throckmorton TW, Bernholt DL, Azar FM, Brolin TJ. Internal Rotation Measurements: Correlation between Vertebral Body Level and Goniometer Measurements on Functional Outcome Scores. Arch Bone Jt Surg.

2024;12(8):558-566. doi: 10.22038/ ABJS.2024.77880.3588. PMID: 39211566; PMCID: PMC11353147.

This study was approved by the Institutional Review Board of the University of Tennessee Health Science Center (2108238-FB).

Corresponding Author: Tyler J. Brolin, MD 1211 Union Avenue, Suite 510 Memphis, Tennessee 38104 tbrolin@campbellclinic.com

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Internal Rotation Measurements: Correlation between Vertebral Body Level and Goniometer Measurements on Functional Outcome Scores ABSTRACT Objectives Reverse total shoulder arthroplasty (rTSA) has shown success in the treatment of end-stage glenohumeral pathology. However, one major shortcoming has been the lack of internal rotation (IR), which can have significant functional consequences. Much research has been conducted to maximize IR after rTSA, but the literature is unclear which measurement of IR represents the "gold standard" between vertebral level and goniometer-based measurements.

Methods Patients were prospectively enrolled into one of three groups: postoperative from rTSA, subacromial pain (SA), and normal. IR measurements were obtained either by the vertebral body level, by which radiographic markers indicated the highest level that the patient was able to reach on the body midline; or by using a goniometer while the shoulder was in 90-degree abduction as the patient stood upright.

Results Comparisons between the radiographic vertebral level and goniometer IR measurements showed significant correlations within the normal (r = -0.43, P = 0.02) and SA pain groups (r = - 0.44, P = 0.02). The rTSA group did not quite reach statistical significance (P = 0.11), but had a moderate correlation coefficient (r = -0.33). Accuracy of visual IR measurements was also significant. All rTSA group vertebral level measurements were within two vertebral levels, while only 84.6% of IR measurements by goniometer were within 15 degrees. Visual vertebral level measurements were found to be more accurate for the SA pain group (86.2 vs 66.7%).

Conclusion A comparison of the two primary IR measurement methods for shoulders was shown to have a correlation. This would allow for direct comparison of different literature using only one measurement method. While the correlation is not yet strong enough to allow for conversion between the two measurement types, creating a matched cohort taking into account other factors may lead to the correlation reaching this point.

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ERIC J. WEST, MD A native of Raleigh, NC, Dr. West graduated from Lafayette College and the Brody School of Medicine at East Carolina University.

His wife, Aja, is a pediatric ER nurse at Le Bonheur; they met through a dating app and friends at the hospital. Their first child, Virgil, was born in February.

In his spare time, Dr. West enjoys making sushi and cheering on Liverpool FC and the Memphis Grizzlies.

Asked why he chose medicine as a career, Dr. West said I enjoyed science and problem solving throughout school, and I found that medicine was a great blend of both interests. I had the opportunity to shadow my aunt, who is a pediatrician in a smaller town in Pennsylvania, and seeing her impact on the community made a lasting impression that I wanted to recreate.

Why did he chose orthopaedics as a specialty? I played collegiate soccer at Lafayette, where I suffered multiple injuries that required orthopaedic involvement. It made me realize that the field offered a great mix of patient interaction and immediate impact on a person’s ability to return to the things they enjoy.

Two of my favorite work-related memories would be my first femoral nail as an intern at The Med and my first scoliosis case at Le Bonheur. Outside of work, the Hand Wilderness Journal Club that Dr. Calandruccio hosts annually was always the highlight of the year.

After graduation, Dr. West and his family will be traveling to the West Coast for an adult spine surgery fellowship at the University of California at San Diego. We have not decided on a long-term practice location but are looking at a few large cities in the Midwest and Southeast.

Dr. West added Campbell Clinic is a special place, and I have appreciated everyone whom I’ve worked with along the way. A special ‘thank you’ to the adult spine staff, who have helped shape my skills and training over the last five years while preparing me for the next stage of my career.

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Jacob T. Zalewski, MD1 Nuanqui Hou, MS2 Robert R. Eason, MS3 Zachary R. Diltz, MD1 William M. Mihalko, MD, PhD1 Marcus C. Ford, MD1 1

Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science CenterCampbell Clinic, Memphis, Tennessee

2

Campbell Clinic Foundation, Memphis, Tennessee

3

University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee

This study was approved by the Institutional Review Board of the University of Tennessee Health Science Center (#2208743-XM).

Corresponding Author: William M. Mihalko, MD, PhD 1211 Union Avenue, Suite 510 Memphis, Tennessee 38104 wmihalko@campbellclinic.com

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Comparing Safety of Ambulatory Total Hip Arthroplasty and Total Knee Arthroplasty between MedicareInsured and Privately Insured Patients ABSTRACT Introduction When compared with privately insured patients, Medicare patients have been reported to have higher rates of emergency room visits, readmissions, and reoperations after total joint arthroplasty (TJA). This study aimed to compare the safety of Medicare patients who underwent outpatient primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) to privately insured patients in the ambulatory setting.

Methods A retrospective review of patients 65 years and older who underwent primary TKA and TKA at two freestanding ambulatory surgery centers (ASC) from January 2018 to January 2022 was performed. Insurance status was recorded. Complications in the 90-day global period and same-day discharge (SDD) were used as primary outcomes. Reoperations, readmissions, and emergency department (ED) visits were evaluated as secondary outcomes. One-way ANOVA and Wilcoxon Signed Rank Tests were performed for continuous variables; Fisher’s exact tests were performed for categorical variables in SPSS (Version 29, Armonk, NY: IBM Corp).

Results 364 patients underwent TKA (247 Medicare; 117 private) during the study period. Overall complication rate (P = 0.364) and rates of SDD, reoperation, readmission, and ED visits were not statistically different between groups (P = 0.204, P = 0.658, P = 0.391, P = 1, respectively). One patient in the Medicare group (0.4%) and two patients in the privately insured group (1.7%) were discharged the next day. For THA, 135 patients (83 Medicare; 52 private) were included. All patients underwent successful SDD. There was no difference in overall complication rate (P = 0.204) or rates of reoperation, readmission, and ED visits between groups (P = 0.385, P = 0.559, P = 0.559, respectively).

Conclusion No significant difference was found in 90-day complications or SDD between Medicare-insured and privately insured patients over age 65 for TKA and THA in the ambulatory setting. Outpatient TJA in the ASC can be safe for Medicare patients when compared with privately insured patients.

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JACOB T. ZALEWSKI, MD A native of Cookeville, TN, Dr. Zalewski graduated from Sewanee: The University of the South and East Tennessee State University’s Quillen College of Medicine.

His wife, Erynn, is a radiation therapist.

Dr. Zalewski’s hobbies include hiking, traveling, running, and cooking.

I enjoyed science throughout school and found medicine an excellent career to help people heal. He chose the orthopaedics specialty because he liked the people working in the field and enjoyed the technical aspect of surgery. I also like helping get patients back to enjoying their ‘weekend warrior’ activities.

Dr. Zalewski’s favorite memory of residency is operating with co-residents at The Med and the annual resident roast.

After graduation, he plans to complete an adult reconstruction fellowship at Anderson Orthopaedic Clinic in Alexandria, VA, then practice with the Knoxville Orthopaedic Clinic in Knoxville, TN. Thank you to the Campbell Clinic surgeons and staff for your guidance and training, to the adult reconstruction staff for your support and mentorship as I begin my career as a hip- and knee-arthroplasty surgeon, and thank you to my co-residents for an unforgettable five years.

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An online list of the 2024 Year in Review for Published Research can be found here:

RESEARCH Campbell Clinic physican- and resident-led clinical research helps define best practices, enabling superior, evidence-based orthopaedic care for patients.

“Research and innovation drive patient outcomes.

Simply thinking that something seems like a good idea and trying it just isn’t enough,” said Dr. Derek M. Kelly, director of the residency program. “Better healthcare requires physicians, healthcare systems, and industry are thoughtful in developing great ideas and research questions, conducting well-designed research experiments, and reporting both good and bad results so that all can benefit.”

At the end of 2024, the 166 active research studies included retrospective record reviews, prospective observational studies, prospective randomized controlled trials, Phase III and IV clinical trials, case

series, systematic reviews, repository studies, quality improvement, study group collaborations, and motion science studies.

The Campbell Clinic Foundation research team provides the support and structure to conduct research studies in collaboration with the Clinic. The team includes a research manager, five clinical research coordinators, three research scholars, a librarian, and an editorial team to help hone the written studies before they are submitted for journal publication. Research findings also are shared through academic presentations and posters.

Through this research, new orthopaedic techniques and treatments are found to better serve patients, thus reducing pain, enhancing mobility and improving their quality of life. Research also helps Campbell Clinic maintain a global reputation for orthopaedic excellence.

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MOVING LIVES:

Orthopaedic Research Mayo Clinic Rochester, MN • Shoulder and Elbow Henry Ford Health System Royal Oak, MI • Shoulder and Elbow

Twin Cities Orthopedics Eagan, Minnesota • Sports TRIA Institute Bloomington, MN • Shoulder and Elbow

Case Western Reserve Cleveland Ohio • Cerebral Palsy Center

Helen DeVos Children’s Hospital Grand Rapids, MI • Pediatrics

Harvard University/Brigham and Women's Hospital Boston, MA • Total Joint

Ohio State University Columbus, Ohio • Shoulder and Elbow

American Shoulder and Elbow Surgeons Foundation Schaumburg, IL • Shoulder and Elbow

Southern Oregon Institute Medford, OR • Shoulder and Elbow

Anika Bedford, Massachusetts • Shoulder and Sports

Harvard Boston Children's Hospital ’ Boston, MA • Pediatrics Boston Children’s Hospital Boston, Massachusetts • Pediatrics

University of Buffalo Buffalo, NY • Shoulder and Elbow

Pediatric Orthopaedic Society of North America Oakbrook Terrace, IL • Pediatrics

Dragonfly Waltham, Massachusetts • Adult Recon

Loyola Medicine Burr Ridge, IL • Total Joint

Boston Sports and Shoulder Center Waltham, MA • Shoulder and Elbow

University of Iowa Healthcare Iowa City, IA • Pediatrics

University of Utah Salt Lake City, UT • Pediatrics

Hospital for Special Surgery New York, NY • Shoulder and Elbow

RUSH University Chicago, IL • Shoulder and Elbow

Rothman Orthopaedics Philadelphia, PA • Shoulder and Elbow

Zimmer Biomet Warsaw, Indiana • Shoulder and Elbow

Drexel University Philadelphia, PA • Total Joint and Adult Recon Pediatric Spine Foundation Valley Forge, PA • Pediatrics

Saint Sa int Luke's East Hospital ‚ Lee s Summit, MO • Total Joint

Vanderbilt University, Vanderbilt Children's Hospital Nashville, TN • Pediatrics and Sports

The Washington University St. Louis, Missouri • Pediatrics

Cerebral Palsy Research Network Greenville, South Carolina • Cerebral Palsy Center

Indiana Hand to Shoulder Center Indianapolis, IN • Hand, Foot & Ankle

Erlanger Orthopaedic Institute-Foot and Ankle Chattanooga, TN • Foot & Ankle Northside Hospital Atlanta, GA • Total Joint

Texas Scottish Rite Hospital Dallas, TX • Pediatrics

STUDY TYPES-DECEMBER 2024 The University of Texas at Austin Austin, TX • Pediatrics

QI RCT

Study Group

University of British Columbia BC Children's Hospital Vancouver, British Columbia, Canada • Pediatrics

Pacira Tampa, Florida • Adult Recon

University of Tennessee Health Science Center, Methodist Le Bonheur Children’s Hospital, St. Jude Children’s Research Hospital Memphis, Tennessee • All Subspecialties

Atlantis Orthopedics Palm Beach Gardens, Florida • Shoulder and Elbow

Stryker

Arthrex Naples, Florida • Shoulder and Elbow

Prospective Memphis, Tennessee • Foot and Ankle Sponsored Studies

AxoGen Tampa, Florida • Hand

West Tennessee Bone and Joint Center Jackson, TN • Shoulder and Elbow

Medacta Franklin Tennessee • Adult Recon

Clinique Generale d’Annecy Annecy, France • Shoulder and Elbow

Lab Studies

PBC Biomed Ltd. Dublin, Ireland • Hand

Retro+Prosp SR Mochida Case Series Tokyo, Japan • Hand

Momentum Health Montreal, Quebec • Pediatrics University of Toronto, Hospital for Sick Children Toronto, Ontario, Canada • Pediatrics

Respository Retrospective

Study Designs-December 2024 Study Group

3 Ps - Dec. 2023 vs Dec. 2024

140

117

120 77

40 15

20

Prospective

Retro + Prosp Syst. Review Case Series

76 54

60

RCT

Lab Studies

100 80

QI

21

Repository

0 Publications

Presentations Dec 2023

Posters

Dec 2024

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Jointly provided by Medical Education Resources (MER) and the Campbell Clinic Foundation

CLICK HERE for CME Credit Evaluation

Oblique Trans-syndesmotic Screw to Augment Fixation of Distal Fibular Fractures: A Retrospective Cohort Study and Technique Guide Release Date

Expiration Date

Estimated Time to Complete Activity

May 2, 2025

May 1, 2026

.25 Hours

Mechanism for the learner to contact MER: www.cmepartner.org Link to MER Privacy Policy: http://cmepartner.org/privacy Target Audience: This activity has been designed to meet the educational needs of orthopaedic surgeons, residents, and fellows, allied health providers involved in the care of patients with distal fibular fractures.

Statement of Need/Program Overview: This activity enables providers to choose a distal oblique trans-syndesmotic screw to supplement or replace current fibular fracture fixation constructs in patients with osteoporosis or at risk of wound complications. Providers will learn about the surgical technique as well as the management of postoperative care including recommendations for casting, weight-bearing, and physical therapy.

Educational Objectives: After completing this activity, the participant should be better able to: • Identify patients with osteoporosis or at risk of wound complications in whom placement of a distal oblique trans-syndesmotic screw can be effective to supplement or replace current fibular fracture fixation constructs.

• Use the oblique trans-syndesmotic screw technique to supplement or replace current fibular fracture fixation constructs in patients who would benefit.

• Manage the postoperative care of the same technique with included recommendations for casting, weight-bearing, and physical therapy.

Faculty David R. Richardson, MD Lauren A. Foropoulos, MD Accreditation Statement In support of improving patient care, this activity has been planned and implemented by Medical Education Resources (MER) and The Campbell Clinic Foundation. MER is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team Physician Credit: Medical Education Resources designates this enduring material for a maximum of 0.25 CME AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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Nursing Credit: Medical Education Resources designates this enduring material for a maximum of 0.25 ANCC nursing contact hours.

Medical Education Resources is a provider of continuing nursing education by the California Board of Registered Nursing, Provider #CEP 12299, for 0.25 contact hours.

Concerns or complaints about a CE provider may be directed to the provider, or to the Commission for Continuing Education Provider Recognition at ADA.org/CERP. Physician Associates Credit: Medical Education Resources has been authorized by the American Academy of Physician Associates (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 0.25 AAPA Category 1 CME Credits. Physician Associates should only claim credit commensurate with the extent of their participation.

Disclosure of All Financial Relationships: Medical Education Resources ensures balance, independence, objectivity, and scientific rigor in all our educational activities. In accordance with this policy, MER identifies all financial relationships with its instructors, content managers, and other individuals who are in a position to control the content of an activity. Reported relevant financial relationships are mitigated by MER to ensure that all scientific research referred to, reported, or used in a CE activity conforms to the generally accepted standards of experimental design, data collection, and analysis. MER is committed to providing learners with high-quality CE activities that promote improvements or quality in health care and not the business interest of an ineligible company.

The authors reported the following financial relationships with ineligible companies whose products or services may be mentioned in this activity: David R. Richardson, MD

No relevant financial disclosures

Lauren A. Foropoulos, MS

No relevant financial disclosures

The content managers reported the following financial relationships with ineligible companies whose products or services may be mentioned in this activity: The Campbell Clinic Foundation

No financial relationships to disclose.

Planners at Medical Education Resources

No financial relationships to disclose.

Method of Participation: There are no fees for participating in and receiving credit for this activity. During the period May 2025, through April, 2026, participants must 1) read the learning objectives and faculty disclosures, 2) study the educational activity, 3) complete the posttest by recording the best answer to each question, and 4) complete the evaluation form.

A statement of credit will be issued only upon receipt of a completed activity evaluation form and a completed posttest with a score of 75% or better. Statements of credit will be issued [provide a description of when certificates will be issued and how].

Media: Internet – available on Issuu.com.

Disclaimer: The content and views presented in this educational activity are those of the authors and do not necessarily reflect those of Medical Education Resources or The Campbell Clinic Foundation, The authors have disclosed if there is any discussion of published and/or investigational uses of agents that are not indicated by the FDA in their presentations. Before prescribing any medicine, primary references and full prescribing information should be consulted. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. The information presented in this activity is not meant to serve as a guideline for patient management.

There is no fee for this educational activity.

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Oblique Trans-syndesmotic Screw to Augment Fixation of Distal Fibular Fractures: A Retrospective Cohort Study and Technique Guide ABSTRACT

Lauren A. Foropoulos, MD David R. Richardson, MD University of Tennessee Health Science Center – Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis, Tennessee

This study was approved by the Institutional Review Board of the University of Tennessee Health Science Center (#22-09109-XP).

This research was presented at the MidAmerica Orthopaedic Association annual meeting on April 12, 2024 in Bonita Springs, Florida.

The incidence of ankle fractures has increased among elderly patients due to osteoporosis and increased activity levels. Open reduction and internal fixation (ORIF) is the standard treatment for displaced lateral malleolus fractures, though it poses challenges due to poor bone quality in this population, leading to complications such as implant failure and nonunion. We retrospectively reviewed 50 patients treated with an oblique trans-syndesmotic screw for transverse and short oblique fibular fractures between January 2011 and December 2022. This technique involved placing a screw from the distal fibula to the tibia in an oblique direction, either through a one-third tubular plate, outside the plate, or without a plate altogether. The procedure aimed to enhance fixation and prevent loss of reduction in osteoporotic bone while also offering a method to limit incision size in at-risk patients. The technique demonstrated effectiveness with satisfactory outcomes and minimal complications. Patients initiated weight-bearing at an average of 6.9 weeks postoperatively, with hardware removal occurring at approximately 4 months. The oblique trans-syndesmotic screw technique proved to be a valuable approach for distal fibular fracture fixation, especially in elderly patients, those with osteoporosis and neuropathy, and patients at risk of wound complications. This method facilitates outpatient procedures and enables quicker rehabilitation, addressing the unique challenges in these patient populations.

Level of Evidence: Level IV Keywords: oblique trans-syndesmotic screw, ankle fractures, elderly patients, osteoporosis, internal fixation

HISTORICAL PERSPECTIVE:

Corresponding Author: David R. Richardson, MD 1211 Union Avenue, Suite 510 Memphis, Tennessee 38104 drrichardson@campbellclinic.com

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Ankle fractures are one of the most common orthopaedic injuries, with an incidence of 187 per 100,000 people per year.1 Malleolar fractures account for 9% of all adult fractures.2 In elderly individuals, these ankle injuries are the third most common fracture, following hip and wrist fractures. Studies have shown an increase in the incidence of ankle fractures in elderly patients likely due to the rising prevalence of osteoporosis,3 and the active lifestyle of today’s older adults.4 The treatment of choice for displaced lateral malleolus fractures is open reduction and internal fixa-

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tion (ORIF).5 However, ORIF has proved to be challenging to surgeons treating the elderly population as a result of poor bone quality, including osteoporosis, cutaneous fragility (dermatoporosis) and the frequent associated complications, such as implant failure, malunion, and nonunion.6 Operative fixation of distal fibular fractures in elderly patients often requires more rigid fixation compared with standard AO techniques due to poor bone quality and difficulty adhering to a non-weight-bearing protocols.7 A multitude of methods have been described in the literature for reinforcing the osteosynthesis of ankle fractures, including the addition of K-wires, anti-glide plates, intramedullary nailing, locking plates, and additional fibula-pro-tibia screws.7 However, no single technique has proved superior in providing osteosynthesis for distal fibular fractures in elderly individuals, those with osteoporosis, and patients at increased risk of wound complications.

The most common technique for internal fixation of distal fibular fractures is a lateral plate and screw construct with or without a lag screw.8,9 There are various lateral plate designs for use among different fracture types, with locking plates becoming increasingly prevalent in osteoporotic patients.8 In these patients with poor bone quality and transverse or short oblique fractures at or distal to the tibiotalar joint, distal fixation is often inadequate with a single interfragmentary lag screw. These patients have a higher risk of malreduction and late loss of reduction. Furthermore, pre-contoured plates are more rigid and bulkier than one-third tubular plates, often resulting in prominence, skin irritation, and possible wound issues.

These concerns are often more pronounced in elderly patients or those with certain comorbidities, such as neuropathy and diabetes. They also often do not lay flush to the bone requiring either a non-locking screw to pull the bone to the plate, resulting in malunion, or placement of a locking screw, accepting the incongruity. To address these challenges, we developed a technique to enhance fixation of the distal fragment, reduce the risk of reduction loss and often avoid the use of a plate altogether, thus significantly reducing the size of the lateral incision. We describe the senior author’s technique for this procedure and outline the indications for its use.

PREOPERATIVE PLANNING:

A single-center retrospective review was performed of 50 patients who underwent ORIF of distal fibular fractures with the use of the oblique trans-syndesmotic screw between January 2011 and December 2022.

After obtaining approval from our Institutional Review Board, patients’ charts and radiographs were obtained and analyzed. Inclusion criteria included lateral malleolus fractures treated with an oblique trans-syndesmotic screw. Cases with inadequate documentation or imaging and patients lost to follow-up were excluded.

One fellowship-trained foot and ankle surgeon (the senior author) performed all operative procedures.

Demographic data, patient comorbidities, ankle fracture classification, mechanism of injury, and laterality of the injury were collected. Data from the operative notes included assessment of syndesmosis instability and the type of implant used. Outcome measures included time to weight-bearing, complications, hardware removal, and incidence of broken screws.

INDICATIONS AND CONTRAINDICATIONS:

The author has identified two primary indications for this technique: (1) transverse and short oblique Danis-Weber B distal fibular fractures with inadequate purchase between the plate and the distal fragment, and (2) patients at risk of wound complications where minimizing subcutaneous hardware is desirable. In the latter group, a transverse screw may be placed across this syndesmosis for added stabilization. This adds little morbidity as the oblique screw is routinely removed under conscious sedation with local anesthetic. If the syndesmosis is not unstable, syndesmotic fixation is not coded.

OPERATIVE TECHNIQUE:

The oblique trans-syndesmotic screw technique uses the standard approach to the lateral malleolus. A longitudinal incision is made along the posterior margin of the fibula, centered over the fracture site. The superficial peroneal nerve is identified and protected, if encountered. Following fracture identification, subperiosteal dissection is carried out around the fracture site and any hematoma and intercalary fragments are removed. The fracture is then anatomically reduced and secured with a Kirschner wire. Typically, a lag

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Fig 1: Representative fracture pattern benefiting from oblique screw. Fig. 2: Oblique screw placed through the plate.

Note: distal plate contoured to prevent prominence. Fig. 3: Oblique screw placed outside the plate. Supplemental syndesmotic fixation added.

Fig. 1

Fig. 2

Fig. 3

screw is inserted using standard technique. If necessary, a locking one-third tubular plate is placed and secured with screws. The technique often allows us to avoid plate fixation entirely, thereby minimizing incision size and reducing the inherent risks associated with subcutaneous hardware. In these patients, a transverse screw may be placed across the syndesmosis to enhance fixation of the distal fragment. If plate fixation is deemed necessary, a cortical screw may be used first to allow flush contact of the plate and bone, as the flexibility of a one-third tubular plate allows it to be contoured to the fibula without malreduction. Locking screws can then be added to enhance rigidity. For patients at risk of malreduction with a transverse or short oblique distal fibular fracture (Figure 1), the senior author uses the oblique trans-syndesmotic screw technique. This method involves placing an oblique tricortical or quadricortical screw from the distal fibula into the tibia in a distal-lateral to proximal-medial direction. The screw can be Fig. 4: Oblique screw placed placed in one of three ways: (1) through the distal-most hole of a one-third allowing patient to avoid lateral plate. tubular plate in a neutralization position (Figure 2), (2) outside of such a plate (Figure 3), or (3) independent of plate fixation (Figure 4). If placed through the plate, the distal aspect of the plate should be contoured to the end of the fibula such that the screw head and plate lay parallel when the screw is oriented appropriately. This will prevent prominence of the screw and reduce skin irritation. The screw trajectory resembles that of a typical syndesmosis screw in the sagittal plane, but is aimed proximally rather than parallel to the tibial plafond. The screw enters the tibia at Chaput’s tubercle, lateral to the ankle mortise.

The postoperative protocol includes non-weight-bearing in a short leg splint or cast for 5 weeks. At 5 weeks postoperatively, patients are placed in a walking boot and begin touchdown weight-bearing. They are instructed to gradually progress to full weight-bearing over the next 2 weeks.

Physical therapy (PT) begins at 8 weeks. During PT sessions, patients may remove their walking boot but are instructed to use it when ambulating until the screws (oblique and transverse syndesmotic) are removed around four months postoperatively.

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RESULTS:

Table 1: Study results.

This study evaluated the outcomes of distal oblique trans-syndesmotic screw placement for supplemental fixation in transverse, short oblique Danis-Weber B distal fibular fractures. We analyzed data on 50 patients who underwent operative ankle procedures between 2011 and 2022 to demonstrate appropriate indications and outcomes for this technique (Table 1).

The screw was placed under fluoroscopic guidance and typically removed after fracture union, similar to standard syndesmosis screws. Patients began weight-bearing at an average of 6.9 weeks postoperatively. This relatively short immobilization period for elderly patients helped minimize severe adverse complications associated with prolonged immobilization. The majority of patients underwent removal of the oblique-trans-syndesmotic screw along with any other syndesmotic screws, with an average time to removal of 125.2 days (approximately 4 months). This procedure was performed under light conscious sedation with local anesthetic. Postoperatively, patients were allowed to fully weight-bear in a walking boot until suture removal, which occurred 10-14 days after screw removal. Patients were then transitioned to a lace-up ankle brace and continued PT as needed.

POSSIBLE CONCERNS, FUTURE OF THE TECHNIQUE:

The senior author has employed this technique for many years. There has been only one case of implant failure and major complication: a patient with alcohol-induced neuropathy who fell while intoxicated, requiring conversion to a tibiotalocalcaneal (TTC) nail/ plate construct.

Several population-based studies have projected an increase in ankle fractures among elderly patients over the next several decades. Consequently, orthopaedic surgeons will continue to be challenged with the fixation of unstable osteoporotic ankle fractures.10 Restoration of the ankle mortise and return to preoperative level of function are the treatment goals of ankle fractures.10 Traditionally, unstable ankle fractures of the distal fibula have been managed using either lateral fibular plating with an interfragmentary lag screw or posterior lateral plating with an antiglide plate.10 While both techniques have provided adequate fixation for most distal fibular fractures, they have limitations in

Study parameter

Details

Right-sided ankle injuries

50%

Bimalleolar/bimalleolar equivalent fractures

32%

Trimalleolar fractures

38%

Lateral malleolus fractures

20%

Open injuries

0%

Outpatient procedures

92%

Syndesmosis instability

44%

Traditional syndesmotic screw fixation

46%

Mechanism of injury - falling down stairs

10%

Mechanism of injury - same level fall

34%

Mechanism of injury - twisting injuries

56%

Average time to full weight-bearing Procedure to remove screws

6.9 weeks 70%

Average time to hardware removal

125.2 days

Average duration of follow-up

182 days

specific cases. Particularly challenging are transverse or short oblique fibular fractures at or below the tibiotalar joint level, especially in patients with poor bone quality or those at increased risk of wound complications. To the best of our knowledge, no technique has been developed to adequately stabilize these specific fracture patterns in these high-risk patient groups.

Several biomechanical studies evaluating osteoporotic ankle-fracture fixation have demonstrated that locking plates provide a superior construct to non-locking plates in supination external rotation ankle fractures, when comparing peak torque to failure, angle at failure, and maximal torque.11-13 Combination locked plates have been found to be biomechanically superior to a standard one-third tubular plate in fixation of fibular fractures of osteoporotic patients.10 However, Dingemans et al. (2016) discovered that locked lateral plates do not offer biomechanical advantages over conventional lateral plates. Effectiveness of locked plating seems independent of bone mineral density, suggesting its suitability for stabilizing severe osteoporotic fractures.7 This study had a few limitations. It was retrospective and had the intrinsic flaws of that design method.

Additionally, this study reflected a small cohort of patients having undergone internal fixation of ankle fractures with a particular component of transverse fibular

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fractures close to the level of the tibiotalar joint. Due to the small sample size, this study may not be generalizable to the elderly population. Therefore, the results should be interpreted carefully. Finally, the mean follow-up time was less than 1 year.

In conclusion, placement of a distal oblique trans-syndesmotic screw is a simple and effective technique that can be used to supplement or replace current fibular fracture fixation constructs. Our study proved that

this screw allows surgeons to treat ankle fractures even in patients with osteoporosis or increased risk of wound complications. The procedure can be done on an outpatient basis and utilized in lateral malleolus fractures, bimalleolar fractures, bimalleolar equivalent fractures, and trimalleolar fractures. Overall, this technique has produced good outcomes in our patients at a large urban tertiary referral center.

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Pharmacoepidemiol Drug Saf. 2006;16(2):166–172. doi:10.1002/ pds.1245

9. Bäcker HC, Greisberg JK, Vosseller JT. Fibular plate fixation and correlated short-term complications. Foot Ankle Spec. 2019;13(5):378– 382. doi:10.1177/1938640019873539

4. Tinubu J, Scalea TM. Management of fractures in a geriatric surgical patient. Surg Clin North Am. 2015;95(1):115–128. doi:10.1016/j. suc.2014.09.017 5.

Ali MS, McLaren CA, Rouholamin E, O’Connor BT. Ankle fractures in the elderly: nonoperative or operative treatment. J Orthop Trauma.

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6. Litchfield JC. The treatment of unstable fractures of the ankle in the elderly. Injury. 1987;18(2):128–132. doi:10.1016/0020-1383(87)90189-6 7.

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Dingemans SA, Lodeizen OAP, Goslings JC, Schepers T. Reinforced fixation of distal fibula fractures in elderly patients; a meta-analysis of biomechanical studies. Clin Biomech (Bristol, Avon). 2016;36:14–20. doi:10.1016/j.clinbiomech.2016.05.006

Eckel TT, Glisson RR, Anand P, Parekh SG. Biomechanical comparison of 4 different lateral plate constructs for distal fibula fractures. Foot Ankle Int. 2013;34(11):1588–1595. doi:10.1177/1071100713496223

10. Bariteau JT, Fantry A, Blankenhorn B, et al. A biomechanical evaluation of locked plating for distal fibula fractures in an osteoporotic sawbone model. Foot Ankle Surg. 2014;20(1):44–47. doi:10.1016/j.fas.2013.10.004 11. Kim T, Ayturk UM, Haskell A, et al. Fixation of osteoporotic distal fibula fractures: a biomechanical comparison of locking versus conventional plates. J Foot Ankle Surg. 2007;46(1):2–6. doi:10.1053/j. jfas.2006.09.009 12. Grawe B, Le T, Williamson S, et al. Fracture fixation with two locking screws versus three non-locking screws. Bone Joint Res. 2012;1(6):118– 124. doi:10.1302/2046-3758.16.2000078 13. Zahn RK, Frey S, Jakubietz RG, et al. A contoured locking plate for distal fibular fractures in osteoporotic bone: a biomechanical cadaver study. Injury. 2012;43(6):718–725. doi:10.1016/j.injury.2011.07.009

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HERE FOR YOUR WELL-BEING ORTHOPAEDIC OUTREACH, EDUCATION AND RESEARCH

The Campbell Clinic Foundation empowers bone and joint care. We make life better by reducing pain and keeping you moving.

You can join us! Scan below to learn more.

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Dear Campbell Family, As we reflect on the past year, I want to express my gratitude for your support and dedication to our orthopaedic community. We should take great pride in this centennial and celebrate the century of leadership and innovation that continues today.

We have the opportunity to continue the legacy of Campbell Clinic excellence by investing in the next generation of orthopaedic surgeons and healthcare providers, just as our predecessors did for us.

As you know, the Campbell Clinic Foundation strives to expand and improve medical training from subspecialty courses to leadership development to technology. Each of the elements is critical to the development of great surgeons and physician leaders equipped to navigate the OR and their community.

Letter from the President of the Alumni Board

• Sub-specialty meetings: Campbell alumni gatherings are planned for five subspecialty meetings this year: ○ Pediatric Orthopaedic Society of North America, ○ American Orthopaedic Society for Sports Medicine, ○ American Orthopaedic Foot and Ankle Society, ○ Orthopaedic Trauma Association, ○ American Shoulder and Elbow Society Please contact the Foundation if you plan to attend any of these meetings.

• Scholarships: This year, the Foundation will offer subspecialty education and travel support to PGY-3s and 4s to offer increased subspecialty training.

• Equipment: Residents today use various instruments and technology to augment their skills and precision.

• Mentorship: Your willingness to serve as a mentor, or simply take a call and answer questions, can put early- and mid-career surgeons on the road to success. Please reach out if you would like to help.

Campbell Clinic Alumni Directory To get involved, please take time to complete or update your WCC Alumni Directory profile so we can keep you apprised of the opportunities to learn, network with, and support your Campbell Clinic colleagues.

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• Each of us can do our part to make sure residents, fellows and young surgeons have the mentors, skills, and agility needed to excel in the operation room, clinical practice, and in their communities. Our impact is greatest when we stand together.

We sincerely appreciate your generosity and look forward to working with you to build innovative, well-educated, compassionate, and best-inclass surgeons in our second century.

Sincerely, John Priddy, MD WCC Alumni Board President Class of 2002

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CAMPBELL CLUB IN MEMORIAM Arthur Osborne, MD W. Martin Payne, MD Samuel B. Prevo, MD George D. Purvis, MD R. Beverly Ray, MD Thomas A. Richardson, MD S. L. Robbins, MD R. C. Robertson, MD

FOUND L L E AT B P

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Otis E. James, Jr., MD Leland H. Johnson, Jr., MD David S. Johnston, MD Orville N. Jones, MD Dan Klinar, MD Robert A. Knight, MD Timothy H. Krahn, M.D F. E. Linder, MD Stanley Lipinski, MD James H. Lipsey, Jr., MD Wayne B. Lockwood, MD John F. Lovejoy, MD William L. Lovett, MD Harry A. Luscher, MD Athey R. Lutz, MD Michael Lynch, MD G. Dean MacEwen, MD H. B. Macey, MD Thomas W. Marks, MD Paul H. Martin, MD Benjamin M. Mauck, MD George S. Mauerman, MD Juan A. Mayne, MD James M. McBride, MD Frank O. McGhee, MD C. C. McReynolds, MD I. S. McReynolds, MD Walter C. Metz, MD Lee W. Milford, MD T. Rothrock Miller, MD Alfred F. Miller, MD Andrew H. Miller, MD William L. Minear, MD J. M. Mitchell, MD Joseph Mitchell, MD J. M. Mitchner, MD Wayne S. Montgomery, MD James D. Moore, MD Larry B. Morrison, MD James S. Mulhollan, MD John T. Murphy, MD Julian G. Nemmers, Jr., MD Vernon Nickel, MD

AB

LISH E D

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R. C. Rountree, MD Fred P. Sage, MD Fred M. Sandifer, III, MD Stanley Schwartz, MD T. David Sisk, MD

4 9 1

W. H. Sisler, MD

Donald Slocum, MD Hugh Smith, MD

J. Spencer Speed, MD William B. Stanton, MD Marcus J. Stewart, MD Bruce Stivers, MD Mario M. Stone, MD Henry Thomas Stratton, MD Ernest J. Tarnow, MD Ethan O. Todd, MD Robert E. Tooms, MD Phillip C. Trout, MD

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CA M

Thomas S. Eddleman, MD Allen S. Edmonson, MD Richard L. Ennis, MD J. Kendall Ethridge, MD E.W. Ewart, MD W. McDaniel Ewing, MD Edward L. Farrar, MD M. Craig Ferrell, MD Bryan Fleming, MD Dale E. Fox, MD Kermit W. Fox, MD Isaac L. George, MD Marvin M. Gibson, MD Gary Giles, MD A. Lee Gordon, III, MD Harry R. Gossling, MD John T. Gray, MD Basil Griffin, MD Herbert Alfred Hamel, MD Joe Frank Hamilton, Jr., MD Joe Frank Hamilton, Sr., MD Richard M. Harkness, MD Benjamin L. Hawkins, MD David N. Hawkins, MD Harold M. Hawkins, MD C. Leon Hay, MD Don Henard, MD Edward D. Henderson, MD Malcolm E. Heppenstall, MD George B. Higley, Jr., MD George B. Higley, Sr., MD Kenneth C. Hill, MD Royce Hobby, MD John T. Hocker, MD Frank C. Hodges, MD James D. Hodnett, MD Louis Horn, III, MD Charles N. Hubbard, MD John M. Hundley, MD Wiley C. Hutchins, MD Alvin J. Ingram, MD E.R. ‘Rickey’ Innis, MD H. Peter James, MD

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Alfons Altenberg, MD Lewis D. Anderson, MD Robin Arena, MD Borden Bachynski, MD Troy Bagwell, MD James Barnett, MD Robert Basist, MD Henry Beck, MD Reginald V. Bennett, MD Dan R. Bigelow, MD Thomas H. Blake, Sr., MD W. Griffin Bland, MD Michael Bluhm, MD Joseph C. Boals, III, MD Harrison O. Bourkard, MD Robert L. Bourland, MD William J. Bourland, MD Harold B. Boyd, MD David M. Bratton, MD Hanes H. Brindley, Sr., MD Robert G. Brashear, MD Charles E. Brighton, MD Louis P. Britt, MD Joseph C. Burd, MD John G. Caden, MD Rocco A. Calandruccio, MD Willis C. Campbell, MD S. Terry Canale, MD Dan Carlisle, MD Peter G. Carnesale, MD Charles O. Carothers, MD Charles A. Carraway, MD Paul A. Caviale, MD Tom Phillip Coker, MD Romulo E. Colindres, MD Harry Collins, MD Francis V. Costello, MD John M. Crates, MD P. Thurman Crawford, MD A. Hoyt Crenshaw, Sr., MD Henry I. Cross, MD Jere M. Disney, MD Daniel B. Eck, MD

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Total Trauma Solutions Plates For Every Need 225 dedicated plating options to address all trauma pathologies of the foot and ankle

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