Yale Orthopaedics Quarterly Fall 2016

Ya l e O r t h o pa e d i c s Q u a r t e r ly Volume 1 • Number 2 • Fall 2016

INSIDE: 2 Chairman’s Report

9 Dr. Southwick Memorial

14 Orthopaedic Histology

4 Musculoskeletal Investigation

10 North American Spine Society

14 Yale Orthopaedic Association

11 Trauma Update

12 "The Game"

15 Orthopaedics

Biomechanics Lab

13 Dr. Lee Joins Orthopaedics

and Rehabilitation

15 Orthopaedics Book Club

6 Bones, Bits & Pieces 7 Yale Orthopaedics Cast Technicians Provide Care 8 Cornerstone of Yale Orthopaedics and Nursing

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Chairman's Report We are pleased to provide you with the second issue of Yale Orthopaedics Quarterly. It has been a busy Fall season at Yale Orthopaedics and Rehabilitation, with the addition of seven new faculty members to the Department, Maria Onofrio as Physician Assistant, and Nicole Lavette as new APRN. Heather Ong also joined the Department as new Operations Manager, and there were several promotions of both faculty and staff. In this issue of the YOQ, we feature articles from our talented staff including a piece on traditions from Kris Massey and an article on casting by Corey Reddington.

We also honor our Nurse Manager, Linda Tafuto, who will be retiring from our group after thirty years.

There were several gatherings of our faculty and staff, including a welcome barbecue led

by Lissie Fishman and held at the Yale Course on September 17. Several of the photos from this event are featured in this issue. Honoring former Department Chief Wayne Southwick , a memorial service was held on October 15 at Battell Chapel. Our Sports Medicine section had a busy Fall season with Yale Athletics and capped off a great football season with a big win over Harvard in “The Game.” These events and the care of Yale athletes are discussed in an article by Head Team Physician, Mike Medvecky.

The Department continues to grow both in numbers and geographic footprint, with continued growth in our practice in Fairfield County at the Center for Musculoskeletal Care on Long Ridge Road in Stamford. With new affiliation with Lawrence and Memorial Hospital in New London and Westerly Hospital in Rhode Island, the Department is establishing partnerships to the east, providing elite level musculoskeletal care to the entire south coast of New England.

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The Orthopaedic Research Division also continues to grow. With the addition of Dr. Francis Lee, the research labs are being reconfigured to accommodate new initiatives in the Department.

The Orthopaedic Histology and Histomorphometry Labs continue to provide service to the entire medical center and is also available to other institutions or independent researchers. New initiatives in research include the establishment of a new Yale Precision Orthopaedics and Personalized Musculoskeletal Medicine Center. This Center will develop strategies for targeted therapeutics, stem cells, orthobiologics, and genomics. Personalized medicine strategies will include personalized cancer care and personalized implants. The Center will also have research initiatives focused on challenging orthopaedic disorders including infections, major orthopaedic traumas, and disaster medicine.

We are excited to share with you all of the new developments in our Department, and hope you enjoy the updates in this issue. As always, please share any new developments that you would like to publish in future issues of the YOQ. Have a wonderful Holiday Season!

Yours at Yale, Ted

Theodore A. Blaine, M.D. Professor and Interim Chairman Department of Orthopaedics & Rehabilitation Yale School of Medicine

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Musculoskeletal Investigation and Discovery at Yale Musculoskeletal injuries account for more than 8% of GDP. Despite advances in medicine in the post-genomic era, orthopaedic care heavily relies on traditional surgical or nonsurgical techniques. Yale Orthopaedics and Rehabilitation is uniquely positioned to lead the way in world-class scientific discovery and investigation while building a comprehensive clinical service line at the Yale University School of Medicine.

Clinicians, clinician-scientists, and basic scientists at Yale Orthopaedics see tremendous opportunities for high-impact discoveries that will change daily clinical practice and benefit the next generation. Three high-priority, high-impact, and high-reward areas of musculoskeletal investigation have been identified as focus areas that will enhance the musculoskeletal program at Yale.

I. Precision Orthopaedics and Personalized Musculoskeletal Medicine

Precision medicine is defined as an approach for disease treatment and prevention that takes into account individual variability in environment, lifestyle, and genes for each person.

Despite the importance of this approach in identifying new treatment approaches, there are currently no academic centers that are engaged in Precision Orthopaedics. Leveraging the widespread talent pool of musculoskeletal researchers and clinicians, Yale Precision Orthopaedics will be the first orthopaedic center focused on identifying and discovering new therapies that will be directed at the individual with musculoskeletal disease. To this end, Dr. Theodore Blaine, Professor and Interim Chair, has built a unique program that aligns clinical service line and translational research toward the development of targeted therapeutics, orthobiologics, personalized orthopaedic implants, and personalized cancer therapies.

1) Targeted Therapeutics: Cytokines, chemokines, and kinases mediate inflammation in a confined anatomic location.

An innovative approach to treatment may be to deliver specific pharmacologic blocking agents locally at the site of pain and injury. These agents may be tailored to each patient based upon individual genetic, disease specific, or anatomic variation.

Non- specific anti-inflammatory drugs including NSAIDs and steroids have associated GI and cardiovascular complications.

By establishing new targeted anti-inflammatory therapies, these complications may be avoided and personalized treatments may both decrease morbidity and improve effectiveness.

Current treatments being investigated in our laboratory include specific inhibitors to SDF (stromal cell derived factor) which has been shown to be important in musculoskeletal inflammation.

Dr. Blaine currently has a patent pending on one of these inhibitory agents 2) Orthobiologics and Cell Therapies: Biologic treatments for musculoskeletal disease include cells and their products, stem cells, and growth factors. Currently, blood or bone marrow products (e.g. PRP - platelet rich plasma, concentrated bone marrow aspirate) are being used for musculoskeletal disorders with limited scientific evidence. The Precision Orthopaedic Center at Yale has current basic science investigations ongoing including amniotic membrane augmentation of tendon healing (Kovacevic, 2016 American Shoulder and Elbow Surgeons Research Grant). Mark Horowitz, Ph.D., is a world renowned expert in adipose (fat) derived stem cells. Other clinical investigations and therapies include hyaluronan injections for arthritis, and PRP injections for tendonopathies. This research program will identify novel biologics using a proteomics approach to develop and optimize new therapeutic approaches for musculoskeletal injuries and pain..

3) Personalized Orthopaedic Implants: Every patient has different anatomy, and musculoskeletal disease leads to specifically shaped defects in the bones and joints. Personalized implants may be designed to accommodate for differences in age, size, shape, gender, environment, and biologic response

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to materials. Our team is participating in the design and implantation of cost-effective, patient-matched precision implants. Among many clinical research studies, current active trials include pyrocarbon shoulder prostheses for younger active patients (Blaine) and cervical M6 disc replacement with a novel six degrees of freedom for active patients with cervical disease (Dr. Yue). Basic studies are also being conducted in the biomechanics laboratory to develop 3D printed materials for bony defects in the shoulder and foot/ankle.

Polyethylketoneketone materials (PEKK) have been shown in preliminary studies to withstand physiologic loads required to support joint prostheses. These materials may be 3D printed to perfectly match patients’ anatomy and bony deficiencies for precise joint reconstruction.

4) Personalized Musculoskeletal Cancer Therapy: Metastatic cancers to bone are common orthopaedic problems leading to pain, pathological fractures, neurologic deficits, and increased cancer burden. By intercepting molecular interactions between bone and metastatic cancers, we will provide key clues on mechanisms by which cancer cells grow aggressively at the cost of host bone destruction. We will establish live cancer cell lines and xenografts to enhance cancer research programs in the Yale

Orthopaedics Musculoskeletal Tumor Program and Yale Cancer Center. Next Generation Gene Sequencing and RT-PCR Arrays are used to define the gene expression profiling of aggressive and non-aggressive cancers. Functional characterization of candidate genes will lead to new therapeutics for effective cancer treatments and the prevention of pathological fractures.

Dr. Francis Lee is the Principal Investigator of a NCI R01 grant to lead the Personalized Musculoskeletal Cancer Therapy research program at Yale Orthopaedics.

II. Musculoskeletal Infection Center Broken bones can be fixed and damaged joints can be replaced.

However, infection is the single most important post-surgical event that deteriorates clinical outcome following orthopaedic care. Infections in the bone and implants are very difficult to eradicate. Solutions may include multiple surgeries, prolonged antibiotic treatments, or in extreme cases, amputations.

Paradigm-shifting research in our Department focuses on strategies to eradicate bacteria and to minimize host tissue

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destruction. Dr. Francis Lee is the Principal Investigator of two NIAMS/NIH R01 Grants on bone destruction and infection that will lead the way in developing novel treatment strategies. Dr. Michael Leslie has recently collaborated with Dr. Lee to seek funding support from the AO foundation for the study of infectious fracture nonunions. With these research initiatives and clinical service enhancements, The Yale Musculoskeletal Infection Center looks to be a worldwide destination for the treatment of challenging musculoskeletal infections and microbial disease.

III. Musculoskeletal Disaster Medicine and Global Health

Natural, man-made and military disasters may cause massive orthopaedic injuries that require effective and efficient acute care. Outcomes are dependent on the coordination and quality of care. Recent events, including tsunamis, bombings and mass shootings have made disaster preparedness an institutional imperative. A disaster situation is characterized by demand for health care outweighing the supply of resources, both personnel and material. The management of orthopaedic trauma in disaster response, particularly in the developing world, requires a specialized approach to ensure high quality and sustainable healthcare.

The program in Musculoskeletal Disaster Medicine at Yale, led by the Orthopaedic Trauma Service (Drs. Baumgaertner, Casemyr, Leslie, and Socci), will develop orthopaedic disaster preparedness education that will include faculty, residents, students and other healthcare professionals in the region. The program will also have a global health focus, and will provide educational and clinical support to a hospital in a resource poor setting. This program will establish a long-term collaboration to raise the standard of orthopaedic healthcare in a region while partnering to develop musculoskeletal disaster preparedness and prevention programs in our own community.

The Musculoskeletal Disaster Medicine program will also develop research protocols to investigate and improve disaster responses. Studies will evaluate the effectiveness of orthopaedic care with limited resources, the prevention of catastrophic injuries, and the treatment of musculoskeletal infections and other complications that are seen in the setting of natural and man-made disasters.

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Bones, Bits & Pieces To Grandmother’s house we go…

Baseball season is over. What do we do now? The answer is one word and covers the last quarter year more than any other season. Traditions. It seems when that last autumn leaf changes color in October, the traditions pile up like leaves over the yard. Here is a partial list: parent’s weekend, apple-picking, homecoming weekend, pumpkin-picking, pumpkin-carving, Sunday football games, Trunk or Treat, 5K Turkey Trots, tailgating before Yale/Harvard, family photo shoots, Thanksgiving Before Thanksgiving parties. And we are not into December yet. So what traditions do our Ortho family members partake in?

For starters, the Chair of the Workplace Improvement Committee, Celesta Kearney, and her crew recently kicked off our department’s annual fundraising and collection for the Adopt a Family campaign. The first Pot Luck Luncheon banked $130-plus to start and more fundraisers yet to come. This one goal to help a family in our community creates many smaller traditions and breaks up our busy work routines. Open invitation to all to contribute. Keep a lookout for upcoming events and connect with the fun.

On individual levels, Helen Collibee and Agnieszka Zaleski are two talented artists who carry on customs and crafts they each learned from their grandmother. Their unique handcrafts have turned up for sale or as donations in past office events. Helen is a needlecraft wizard. Some of us may have her knitted shawls, infinity scarves, or reversible aprons. In her family, she keeps a tradition her grandmother started intact. Simply a tablecloth with embroidered signatures of family and friends. This tablecloth begins with the wedding as guests sign the tablecloth instead of a guestbook. More family and friends add their names over the years through the couple’s lifetime. Imagine the memories of loved ones who come and go over the years stitched in time for as long as her 94-year old grandmother—priceless!

Agnieszka sticks to her Polish Catholic roots with her cooking, needlework, and wet wool felting. She sells her stunning one of a kind bags and silk scarf sets internationally and donates her crafts to local fundraising events. Probably a good thing she keeps busy sewing away in her craft room and not whipping up family recipes in her kitchen—it saves our waistline! But then again we need calories to burn calories and keep up the pace here. Bring in those pierogis and paczkis!

Traditions bring people together to help one another, to reconnect and to create memories. No matter what, where or when, these gatherings share our customs and celebrate our life. Our Orthopaedics family has grown in size and so has the potential to start new traditions. Let’s make our pile of traditions bigger and create a difference in our way of life.

Article written by Kristine Massey, who is a Boston Red Sox fanatic!

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Yale Orthopaedics Cast Technicians Provide Care in Team Based Environment Casting and splinting has come a long way over the past half century. New materials and methods have made casting and splinting an integral part of every Orthopaedic practice. It is no different at Yale Orthopaedics and Rehabilitation. Over the last seven years the number of cast technicians has grown from one to four, and all medical assistants have been instructed how to remove casts and splints.

With this rapid growth has come a need to ensure all of the cast technicians are up to date on the latest techniques to assure quality and patient safety. The development of the Casting Quality Improvement (QI) meeting has given a forum to the cast technicians. The bi-monthly meeting consists of reviewing cast techniques, teaching new techniques, and seeing where quality improvements can be made to ensure a unique patient experience.

Through article reviews, peer education, instructional videos and physician feedback, our cast technicians ascertain much needed and valuable information that translates to improved patient care. Reviewing casts, that have come back from patients, is the prime indicator for how each of us can improve our technique, skill, and understanding of how casts impact patient care. The casting QI (QI) meeting, along with daily hands on practice, is one of the best ways to improve technique and patient satisfaction.

The cast technicians are committed to providing outstanding patient care by maintaining, improving, and increasing our skill and knowledge by executing the best casts, splints, and support to our orthopaedic practice.

Article written by cast technician, Corey Reddington, who has worked at Yale Orthopaedics & Rehabilitation for seven years.

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Cornerstone of Yale Orthopaedics and Nursing Looks to Write Next Chapter Linda Tafuto came to Yale Orthopaedics in 1985 with Dr. Peter Jokl when he was invited to return to Yale Orthopaedics from a short stint in private practice to establish the section of Sports Medicine by Dr. Gary Friedlaender. Linda played a prominent role in establishing the first satellite office for the Yale Medical Group in Madison which was, at that time, considered a radical and unheard of expansion for Yale School of Medicine clinical facilities.

After that we built a state of the art sports medicine center on Long Wharf with Linda being instrumental in designing and running that facility as our head nurse. That was the first of several major satellite projects that she coordinated for Yale Orthopaedics, with the next being the Guilford Office followed by the Milford Office.

Linda is an exceptional human being who has selflessly devoted herself to providing exceptional patient care. During her tenure at Yale Linda was an active member in the Connecticut Army National Guard medical section organizing the Connecticut National Guard's medical services. She was called up for active duty and served during the First Gulf War in Operaftion Desert Storm from 1990 to 1991. She eventually rose to the rank of Colonel before retiring from that position. During that time Linda organized and managed the medical support for the Ninth Special Olympics World Summer Games in New haven from July 1 to July 9 1995. This was and still is the largest athletic event ever held in the state of Connecticut with over 10,000 special needs athletes participating. The opening and closing ceremonies were held in the Yale Bowl.

Her leadership and managerial skills are well known to our clinical staff after she became head nurse manager following Maureen Carey's retirement. Linda has gained the respect of all who have worked with for her leadership and organizational skills, her integrity, forthrightness, honesty and loyalty to Yale Orthopaedics. For that we are forever grateful!

Her servant leadership will be difficult to replace as she looks to write the next chapter of her life with her loving husband David. Although she has given so much to Yale Orthopaedics, Linda's main passion is her husband and her family. She is the proud mother of three very successful sons and now her beautiful grandchildren.

Article written by Peter Jokl, MD, Professor of Orthopaedics & Rehabilitation, Chief Emeritus Division of Sports Medicine and Vice Chair Department of Orthopaedics.

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A Fi t t i n g M em orial and Trib ute fo r the “Ch ief ” D r. Wayn e O. S o u thwic k

By K r i s t a p s Keggi, M D On Saturday, October 15, 2016 we held a Memorial Service for Dr. Southwick in Battell Chapel on the Old Yale Campus. It was preceded on Friday by the Annual Southwick lecture, a gathering of our orthopaedic alumni for an informal symposium of reminiscences and a dinner at the Graduate Club.

Wayne O. Southwick was born on February 6, 1923 in Lincoln, Nebraska. He was raised in Friend, graduated from the University of Nebraska Medical School and arrived at Yale as the Chief of the Orthopaedic Section of Surgery in the fall of 1958. His training had been at the Boston City Hospital and Johns Hopkins with a tour of duty in the Navy and war surgery with the Marines in Korea. During the rest of his life he was the official, nominal and inspirational "Chief" of Othopaedic Surgery at Yale University. Two generations of residents were the fortunate beneficiaries of his teaching and encouragement. His artistic skills, which were evident in the operating room, also led him into the world of sculpture and the creation of bronzes that remain admired in front of our lecture halls and in our offices. He was a devoted family man, married for more than seventy years to J. Ann Seacrest and the father of two sons and a daughter who thought of him as the "Best Dad in the world".

The Memorial Service was led by Sharon M.K.Kugler, Yale University Chaplain and Rev. Carleen Gerber, Dr. Southwick's Minister at the First Congregational Church in Old Lyme. It was complete with the Yale Naval ROTC Honor Guard, Presentation of Colors and the Folding of the Flag in honor of a man who had served his country in war and peace. Taps and Reveille were piped by Angus MacDonald.

Dr. Southwick's orthopaedic students, residents and department were represented by Kristaps Keggi, Terry Light, Gary Friedlaender and Ted Blaine, all of whom spoke of his life at Yale and the Yale University Department of Orthopaedics from 1958 to 2016.

In Orthopaedic Surgery the "Chief" was known as a pioneer in cervical spine and hip surgery. He was involved in the earliest work on the anterior approach to the cervical spine for the excision of degenerated discs and intervertebral fusions. Some of his early publications on the posterior decompression of the cervical spine and its stabilization by facette fusion are classics to this day. His biplane osteotomy of the proximal femur for slipped capital femoral epiphyses was innovative and is still in use. These were major contributions to our specialty, but his greatest gift was to encourage all of his students and residents who worked with him to improve and move forward on their own.

That encouragement produced a multitude of superb surgeons, teachers, researchers and leaders.

We count among us Presidents of our Association and Academy, Chair of major orthopaedic departments, researchers of international renown, leaders in Military Medicine and community practices and we have represented him throughout the world. Our very own United States Senator John Barrasso, as a resident thirty years ago, was involved in the study and publication of our work on the anterior decompression of the cervical canal by excision of two to four vertebral bodies - inspired by the "Chief" he practiced orthopaedics in Wyoming until his move to Washington to represent us there.

Many of our former residents had sent in their thoughts and memories of Wayne O. Southwick. Their words tell it all....

“Strong, capable, creative, determined, compassionate and insightful.... a special man“ (Gary Friedlaender) “ I think of him every time I help a resident“ (Tom Trumble) “Playful spirit, vigor, love of simplicity, creativity and intellect“ (John Fulkerson) Doctor Southwick was also a Man of God who must be “Kind, quirky, curious, honest, dedicated” (Captain Marlene DeMaio) expressed in Biblical terms from Isaiah 40 “Men like him are hard to find“ (Bob Stanton) “Unbelievably generous, daily acts of kindness. He loved us all“ (Pat Ruwe) "But they that wait upon the Lord shall renew their strength “Thoughtfulness, guidance, courage, fellow human“ (Gus White) they shall mount up with wings of eagles “Father figure, role model“ (Mike Murphy) they shall run and not be weary “Inspirational guide“ (Peter Jokl) and they shall walk and not faint."

“Kind, talented, inspirational“ (Manhour Panjabi) “Charismatic, challenging us to pursue our own Muse” (Joe Ferrone) He carried that message to give us strength and wings of “Master.“ (John Albright) eagles to walk in his path.

“Desire for his people to succeed“ (Alan Breed)

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North American Spine Society Annual Meeting Update

By Pablo J. Diaz-Collado The Yale Orthopaedics Spine team had a strong presence at the 31st annual North American Spine Society (NASS) meeting held in Boston, MA in October.

Dr. Grauer’s research team presented several abstracts including two podium presentations. Their abstract titled, “Missing Data May Invalidate Spine Surgery Database Studies,” was selected as one of the “best papers” in the meeting. In this study, Dr. Grauer’s research team aimed to shed light on the extent of missing data in national database studies and illustrate how different treatments of missing data can affect the results of studies using such databases. Looking at the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) database, they found that missing data was common for spine surgery patients, with 20 comorbidity variables having 65% missing data, as they are now only collected at certain ACS-NSQIP participating sites. These results highlight the importance of considering the extent of missing data when designing, performing, and interpreting national database studies.

Dr. Yue and Dr. Whang also presented at this meeting. Dr. Yue presented his endoscopic vs open discectomy prospective randomized data as well as a talk on “The Advantage in Endoscopic Transforaminal Lumbar Interbody Fusion: Facet Preservation and Visualized/Targeted Decompression and Endplate Preparation.” Dr. Whang presented 2-year results of a randomized controlled trial comparing minimally invasive sacroiliac joint fusion with triangular titanium implants vs non-surgical management for sacroiliac joint dysfunction (INSITE trial).

Our Spine team’s participation in this year’s NASS meeting was a great success and yet another validation of the exciting Spine research that we do here at Yale.

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Trauma Update The trauma service has had a heavy international emphasis, demonstrating trauma is truly universal and that adherence to basic principles transcends international borders.

We welcomed visiting scholar Marcel Sobrado, a final year orthopaedic resident hailing from the Department of Orthopedics and Traumatology, University of São Paulo, Brazil. His interest in trauma surgery lies in the uniqueness of every fracture and the need for customized plans and methods of fixation. He spent 12 days with us and was very eager to soak up the tremendous wealth of knowledge emanating from within the trauma team.

Continuing with the international trend, Dr. Socci has been steadfastly working towards establishing what will likely be a tremendous hands-on orthopaedic experience overseas, in a resource-poor setting where skills can be translated into training local clinicians and improving orthopaedic care for a region. This experience will tie into the department’s interest in developing our own and the hospital’s ability to respond to a disaster. As we consider recent earthquakes, bombings, and other natural or manmade disasters, we recognize the need for orthopedists to be prepared to respond in specialized ways, without necessarily having the usual tools, time, or support we are used to. Working in a resource limited setting will allow us not only to support a community, but will also give us the opportunity to learn from our colleagues and enrich our approach to orthopedic care.

Last, but certainly not least - a most hearty congratulations to Dr. Casemyr on the celebration of her wedding.

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"The Game"

The Yale Football team scored a stunning win this past weekend at the Yale-Harvard game in Cambridge. This was Yale’s first win over Harvard since 2006, and capped off an exciting season of rebuilding for the Yale University Football team. Several underclassmen stepped up to help their veteran teammates in “The Game,” paving the way for a bright future for Yale Football.

Providing elite level sports medicine care for the athletes for the third consecutive year was the Sports Medicine Section members led by Head Team Physician Mike Medvecky and Karen Sutton, Liz Gardner, Cordelia Carter, David Kovacevic and Ted Blaine. Included in the comprehensive athletic medicine program are team physician coverage for all of the 31 Yale varsity athletic teams, game day coverage for Varsity Football events, as well as training room coverage and office appointments at Yale Health Center on Lock Street.

Using the extensive resources available at Yale Health including X-ray, CT scan and MRI, athletes are immediately evaluated on or off field to diagnose injuries and develop treatment plans to return athletes to the field of play. Our physicians have close interaction with the Primary Care Sports Medicine physicians at Yale Health and provide our expertise in musculoskeletal injuries and injury prevention to keep the student-athletes as healthy and competitive as possible.

Our physicians also work in conjunction with the athletic training staff to evaluate acute and chronic injuries, establish treatment plans, monitor progress of recovery and make adaptations to treatment based upon any residual symptoms.

The Yale University athletic teams are supported by the Yale Department of Orthopedics and Rehabilitations and its expertise in all subspecialties, ranging from back & spine injuries, hand & wrist injuries, foot & ankle injuries and fractures. The Department and Sports Medicine Section are also supported by a dedicated team of staff members that work diligently to get these students seen quickly and with the least distraction to their schedules.

During the summer of 2016, the Department sponsored four freshman football student-athletes working in the Department on various projects under the direction of Drs. Carter, Gardner, Kovacevic and Sutton. Their experiences were invaluable and provided a glimpse into the field of orthopaedics and sports medicine. The Department of Orthopaedics is committed to this program and to helping shape the lives and careers of our future student-athletes.

This has been an exciting year for Yale Football and for the Yale Sports Medicine, and we are looking forward to more success with all the Yale teams in the Winter and Spring Seasons. Together with Yale University, we would also like to welcome to the newest edition of Handsome Dan (8 weeks old) and hope to see him out at on the Football field for the 2017 season!!

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Francis Y. Lee, M.D., Ph.D., Professor of Orthopaedics and Rehabilitation joins Yale Orthopaedics and Rehabilitation In September 2016, the Yale University Department of Orthopaedics and Rehabilitation welcomed its newest tenured Professor of Orthopaedics and Rehabilitation, Francis Y. Lee, M.D., Ph.D. Dr. Lee is an internationally renowned orthopaedic surgeon with expertise in musculoskeletal tumors, diseases, complex reconstruction, and infection. His multi-dimensional expertise includes clinical, academic, and educational accomplishments in fracture repair, infection, bone resorption, and bone biology. Dr. Lee is also the recipient of four NIH R01 grants – a rare achievement in the field of orthopaedics – for his research into bone destruction and regeneration.

Dr. Lee arrives at the Yale School of Medicine after serving 17 years as Tenured and Endowed Professor of Orthopaedic Surgery at Columbia University Medical Center. He has completed fellowships in Musculoskeletal Tumor Surgery at the Massachusetts General Hospital & Boston Children’s Hospital and Pediatric Orthopaedic Surgery at the Hospital for Sick Children at University of Toronto. Dr. Lee is eager to continue providing exceptional and compassionate care to adults and children with metastatic bone cancers, soft tissue tumors, infections, osteoid osteomas, and fracture nonunions, and to patients who have suffered complex failed reconstructive surgeries.

In addition to his clinical expertise, Dr. Lee is one of a small number of orthopaedic surgeons with multiple active NIH R01 grants.

At Yale Orthopaedics, Dr. Lee is excited to develop high-impact, NIH R01-funded research programs focusing on metastatic breast cancer-induced bone destruction, infection, precision medicine, and fracture healing. He is a permanent member of the NIH Skeletal Biology, Structure, and Regeneration Study Section. In 2016, the American Academy of Orthopaedic Surgeons awarded Dr. Lee its highest academic honor, the Kappa Delta Award. He is excited to continue his innovative and impactful research at the Yale School of Medicine.

The Yale University Department of Orthopaedics and Rehabilitation is excited to expand its musculoskeletal healthcare services in Greenwich, Stamford, New Haven, and the New York Metropolitan area with the addition of Dr. Lee’s extensive expertise. Currently, Dr. Lee provides orthopaedic surgical care at Greenwich Hospital, Yale New Haven Hospital, and YNHH’s Center for Musculoskeletal Care in Stamford. For appointments, please call: (203) 737-5656.

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Orthopaedic Histology and Histomorphometry Laboratory The Orthopaedic Histology and Histomorphometry Laboratory provides a variety of specialized services to biomedical researchers. Histological processing of undemineralized bone requires specialized plastic embedding techniques utilizing either methylmethacrylate or glycolmethacrylate methods, which are done on site to assure quality. This laboratory is a full service histology facility that also provides routine paraffin processing and cryotomy of bone and soft tissues.

This laboratory utilizes state of the art equipment including specialized microtomes, cryostats and knives specifically designed to section hard tissues from an array of species and applications. Microscopy services and high resolution digital photography of specimens is available for light and fluorescent microscopy.

A wide array of special stains for bone including Goldners trichrome, Von Kossa, tartrate-resistant acid phosphatase (TRAP), alkaline phosphatase, Safranin O and toluidine blue stains are performed on a routine basis. Immunohistochemistry of bone and other hard tissue is available. Consultation is available to assist researchers on experimental design, specimen preparation, fixation and choice of special stains tailored to the needs of specific research projects. Quantitative bone histomorphometry services are available utilizing the Osteomeasure® analysis system.

For more details, contact Ms. Nancy Troiano at nancy.troiano@yale.edu

Yale Orthopaedic Association On Friday October 28, 2016, the YOA Board gathered in New Haven for the annual board meeting. The meeting was attended by Ted Blaine, Gary Friedlaender, Peter Jokl, Kris Keggi, Ken Kramer, Jamie Lawrence, Jack Raycroft, Lee Rubin, and Karen Sutton. Plans were discussed for the 2017 Disputations (June 16, 2017) and the 2017 Southwick lecture. New Initiatives include a new website and social media for the YOA and planning is now in process with members including Drs. Ennis, Kramer, Rubin and Sutton. Please mark your calenders for the YOA reception at the Annual AAOS meeting in San Diego scheduled from 6-8PM on March 16, 2017.

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Orthopaedics Biomechanics Laboratory The Orthopaedic Biomechanics Laboratory assesses the biomechanical properties of musculoskeletal tissues by providing services and technical assistance in a variety of biomechanical testing techniques.

The faculty works with investigators to design optimal animal models and testing methods for each project. Mechanical testing of large (e.g., monkey, human) and small (mouse, rat) animal tissues is possible, and larger samples can be machined to smaller dimensions. Design and fabrication of loading fixtures are offered. All methods of testing are customized for the user’s need. Available methods using our 2 biomechanical testing systems (Instron 8874 and Instron 5542) include: 3- and 4-point bending of whole bone and machined bone samples; Static compression, tension, or torsion of whole bones (vertebrae) and machined samples; Tensile testing of tendons, ligaments, and enthuses; Dynamic loading (fatigue) of bone, tendons, ligaments, and enthuses; In vivo loading of musculoskeletal tissue in small animals; Mechanical testing of orthopaedic implants and devices and Finite element model validation.

For more details, contact Dr. Steven Tommasini at steven.tommasini@yale.edu

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Dr. Friedlaender and Yale Orthopaedics Book Club The first book club meeting of the academic year was well attended by junior and senior residents and attendings to discuss “When Breathe Becomes Air” by Paul Kalanithi. The group discussed topics such as achievement and drive, life as a surgeon, rigors of surgical training, dealing with your own mortality and confronting terminal illness while enjoying Mediterranean food and red wine.

The next book club meeting will be Tuesday December 6th at 7 PM at Dr. Friedlaender’s house in Woodbridge. All are invited and welcomed to joint us for a lively and interesting discussion of “The Underground Railroad” by Colson Whitehead. The author of this exceptional novel recently won the National Book Award for its depiction of American slavery and poignant examples of racism through the eyes of a young slave Cora who escapes a Georgia plantation and travels north via an underground subway.

Yale Orthopaedics & Rehabilitation faculty Interim Chair

Shoulder and Elbow

Theodore A. Blaine, MD

Theodore A. Blaine, MD David Kovacevic, MD

Adult Reconstruction Frank A. DiFazio, MD Kristaps J. Keggi, MD, DrMed Mary I. O’Connor, MD Richard R. Pelker, MD, PhD Lee E. Rubin, MD

Spine

Foot and Ankle

Elizabeth C. Gardner, MD Peter Jokl, MD Michael J. Medvecky, MD Karen M. Sutton, MD Craig D. Tifford, MD

John S. Reach, Jr, MD, MSC, FAAOS Raymond J. Walls, MD, FRCS (Tr&Orth), MBBCh

Fractures/Fracture Problems Michael R. Baumgaertner, MD Natalie E. Casemyr, MD Michael P. Leslie, DO Adrienne R. Socci, MD

Hand and Upper Extremity Kenneth W. Donohue, MD Felicity Fishman, MD Andrea Halim, MD Carrie R. Swigart, MD

Musculoskeletal Oncology

Jonathan N. Grauer, MD Peter G. Whang, MD, FACS James J. Yue, MD

Sports Medicine

West Haven VA Lawrence Weis, MD *Chairman Emeritus **Residency Program Director

Yale Access Line

Cordelia W. Carter, MD Daniel R. Cooperman, MD Melinda S. Sharkey, MD Brian G. Smith, MD**

Yale Access Line offers a streamlined patient transfer service that ensures quick and easy admission to Yale New Haven Hospital. With one call—888.YNHH.BED (888.964.4233)— referring physicians can speak directly with an attending specialist for an immediate transfer. Trained paramedics assist with admission processing, bed assignment, and critical-care air transport, using Yale New Haven Health System’s interhospital emergency helicopter, SkyHealth, when necessary.

Physiatry

Scope of Service

Gary E. Friedlaender, MD* Frances Y. Lee, MD, PhD Dieter M. Lindskog, MD

Pediatric Orthopaedics

Marc Rosen, MD David Woznica, MD Vivian Shih, MD

Research Faculty Mark C. Horowitz, PhD Jacob V. Eswarakumar, PhD Jackie A. Fretz, PhD Steven M. Tommasini, PhD

• 24-hour single access point for all patient transfers • Quick connection to on-call attending specialists for patient transfers • A dedicated physician referral director available for urgent appointments, hospital care, or ambulatory evaluations • Trained paramedics ready to expedite your request for a transfer

Learn more at medicine.yale.edu/ortho