Orthopedic Surgery

Course #: 880J

Title:  Orthopedic Surgery

Selective Director(s):  Langdon Hartsock, M.D., John Glaser, M.D., & Joe Calandra, M.D.

Maximum Number of students per block: 2

LEARNING GOALS AND OBJECTIVES:
At the completion of this clinical rotation, students will be able to:

1.  Discuss bone formation; Describe the growth plate anatomy; Describe osteoblasts; osteoclasts and osteocytes; Discuss mineral homeostasis
2.  Describe the histology of articular cartilage; Describe how the histology allows for the function of articular cartilage; Discuss how aging affects articular cartilage and osteoarthritis; Discuss the healing process of articular cartilage
3.  Discuss the physiologic function of the meniscus and the intervertebral disc
Describe how their histology plays a role in their function; Discuss how the aging process affects the histology and thus the function of these
4. Discuss the pertinent anatomy about the shoulder as it relates to the function of the upper extremity
5.  Discuss the pertinent anatomy about the elbow as it relates to the function of the forearm and hand
6.  Contrast the bony anatomy of the hip joint and the shoulder joint
7.  Describe the location of the major ligamentous structures about the knee and how their location relates to their function
8.  Explain the concept of “Compartments” in both the upper and lower extremities; What are the advantages / disadvantages of this arrangement?
9.  Explain the differences between primary and secondary osteoarthritis and the patho-physiology of each; List the most common signs and symptoms of osteoarthritis; Discuss some of the treatment options of osteoarthritis
10.  Discuss the differential diagnosis of Lower Back Pain (L.B.P.).; Describe the typical history and presentation; Explain how alterations in the anatomy may cause these symptoms; Discuss treatment options of L.B.P.
11.  Compare the osteomyelitis in the child and the adult – mention the organism, the anatomical differences and treatment options.
12.  Describe the clinical presentation of septic arthritis – adult and child
13.  Discuss some musculoskeletal manifestations of TB and lymes disease
14.  Describe compartment syndrome
15.  Compare a “primary survey” to a “secondary survey”
16.  Describe the anatomy of fracture patterns; Explain the difference between an open fracture and a closed fracture; Discuss how the application of force will dictate the fracture pattern; Describe how you would examine a limb with a fracture; Discuss several treatment options for closed fractures
17.  List 5 different musculoskeletal emergencies and explain why each is an emergency
18.  Discuss the secondary complications of:

a) Pelvic fractures
b) Long bone fractures
c) Joint dislocations

19.  Discuss the etiology of a stress fracture; List 3 common sites for stress fractures
20.  Explain 3 causes for anterior knee pain
21.  Discuss the natural history of apophysitis
22.  Define Dysostosis, Dysplasia and Dystrophy
23.  Discuss Achondroplasia
24.  Discuss Duchenne Muscular Dystrophy
25.  Describe Osteogenisis imperfecta and its clinical presentation
26.  Describe the anatomy of a nerve
27.  Explain the etiology of Carpal Tunnel Syndrome; Discuss the diagnosis of Carpal Tunnel Syndrome
28.  Name and describe one other compressive neuropathy in the upper extremity
29.  Discuss 3 causes of “In Toeing” of a child
30.  Explain the Salter Classification of growth plate fractures
31.  Compare and contrast SCFF and Legg Perthes
32.  Discuss idiopathic scoliosis, and how it differs from congenital and neuromuscular scoliosis
33.  Understand and perform

a) An upper extremity examination
b) a lower extremity examination
c) a lumbar examination

TEACHING METHODOLOGIES AND ROTATION ACTIVITIES:
Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:

1.  Attend all Orthopaedic conferences.
2.  Attend patient rounds on appropriate service.
3.  Attend clinics.
4.  Participate in examination (H.I.P.S.) of:

a) Upper Extremity
b) Lower Extremity
c) Cervical and Lumbar Spine

5.  Observe and “scrub in” on appropriate cases.
6.  Read pertinent anatomy and concepts of procedure
7.  Make presentation: 1 per rotation; Follow patient pre-operative →surgery→post operative
8.  Read weekly assigned chapters.
Reading Assignments from Musculoskeletal Medicine:
Chapters: #1 Bone; #2 Articular Cartilage; #5 Meniscus & Intervetebral Disc; #8 Anatomy;#9 Osteo-arthritis; #11 Back pain, Sciatica; #12 Infection; #15 Fracture;
#16 Musculoskeletal Emergencies; #17 Over-use Injuries; #19 Disorders of Development; #21 Compressive Neuropathies; #24 Special Pediatric Concerns; #26 Physical Exam
9.  Select 3 of the following rotations:

a) Spine
b) Pediatric Orthopaedics
c) Hand/Upper Extremity
d) Sports Medicine
e) Total Joint
f)  Trauma
g)  VA

PATIENT ENCOUNTERS
Students on this rotation will be expected to work up and/or follow the following minimum number of patients with the specified conditions (i.e, 2 pediatric ear infections, 2 adult migraine headaches):

Students will participate in selected subspecialty services: joints, pediatrics, trauma, hand, sports and the VA. The student will select three different services to participate in, one for each week of the selective.
1. At least one patient on each subspecialty service that the student participates in.

EVALUATION AND FEEDBACK:
Students on this rotation will be evaluated through the following methods, and designate by whom for each method:

1.  Exam given on Day 1 and exam given on last day.
2.  Direct observation of clinical skills by residents and attendings.

Please outline when and how the learners will receive feedback on their performance:
Students will receive feedback following rounds and participation in surgeries. Students will also receive feedback following their patient presentation at the student conference.