This document summarizes key issues in treating fractures of the distal humerus. It discusses the increasing incidence of these fractures, especially in elderly women. Classification systems and preoperative planning are outlined. Surgical approaches like the olecranon osteotomy are described, along with techniques for fracture stabilization and indications for total elbow arthroplasty in complex fractures of elderly patients.
By replacing all or a portion of the meniscus with donor cartilage, the patient can regain the natural “shock absorber” in the knee and experience many additional years of activity, even in the presence of arthritis. Being "bone on bone" does not always mean that the joint needs to be artificially replaced, often the "bone on bone" is isolated to a portion of the knee joint and this can be repaired using meniscus transplant alone or in combination with any of the Biologic Knee Replacement procedures.
Periprosthetic fractures are the third most common reason for revision total hip arthroplasty. Surgical treatment of periprosthetic fractures belongs to the most difficult procedures due to the extensive surgery, elderly polymorbid patients and the high frequency of other complications. The aim of this study was to evaluate the results of operatively treated periprosthetic femoral fractures after total hip arthroplasty.
We evaluated 47 periprosthetic fractures in 40 patients (18 men and 22 women) operated on between January 2004 and December 2010. The mean follow-up period was 27 months (within a range of 12-45 months). For the clinical evaluation, we used modified Merle d'Aubigné scoring system.
In group of Vancouver A fractures, 3 patients were treated with a mean score of 15,7 points (good result). We recorded a mean score of 14,2 points (fair result) in 6 patients with Vancouver B1 fractures, 12,4 points (fair result) in 24 patients with Vancouver B2 fractures and 12,8 points (fair result) in 7 patients with Vancouver B3 fractures. In group of Vancouver C fractures, we found a mean score of 16,2 points (good result) in 7 patients.
Therapeutic algorithm based on the Vancouver classification system is, in our opinion, satisfactory. Accurate differentiation of B1 and B2 type of fractures is essential. Preoperative radiographic images may not be reliable and checking the stability of the prosthesis fixation during surgery should be performed.
Ligamentotaxis in the Intraarticular and Juxta Articular Fracture of Wristiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Arthrolatarjet (Arthroscopic Latarjet Proc) Dr Sujit Jos keralaSujit Jos
Arthroscopic Latarjet procedure is gaining popularity in every part of the world as it combines the strength of Latarjet procedure while retaining the advantages of Arthroscopy. It is most useful shoulder recurrent dislocation associated with bone loss in the glenoid (Bony Bankart) or humeral head (Hill Sach's defect).
The presentation discusses evidence based medicine in the stream of Orthopaedics. Here I have discussed a case of Ipsilateral Intertronchanteric and Femoral shaft Fracture and its various treatment modalities. The presentation was done at J.N. Medical College Belagavi, India. Lets share, discuss and keep learning.
By replacing all or a portion of the meniscus with donor cartilage, the patient can regain the natural “shock absorber” in the knee and experience many additional years of activity, even in the presence of arthritis. Being "bone on bone" does not always mean that the joint needs to be artificially replaced, often the "bone on bone" is isolated to a portion of the knee joint and this can be repaired using meniscus transplant alone or in combination with any of the Biologic Knee Replacement procedures.
Periprosthetic fractures are the third most common reason for revision total hip arthroplasty. Surgical treatment of periprosthetic fractures belongs to the most difficult procedures due to the extensive surgery, elderly polymorbid patients and the high frequency of other complications. The aim of this study was to evaluate the results of operatively treated periprosthetic femoral fractures after total hip arthroplasty.
We evaluated 47 periprosthetic fractures in 40 patients (18 men and 22 women) operated on between January 2004 and December 2010. The mean follow-up period was 27 months (within a range of 12-45 months). For the clinical evaluation, we used modified Merle d'Aubigné scoring system.
In group of Vancouver A fractures, 3 patients were treated with a mean score of 15,7 points (good result). We recorded a mean score of 14,2 points (fair result) in 6 patients with Vancouver B1 fractures, 12,4 points (fair result) in 24 patients with Vancouver B2 fractures and 12,8 points (fair result) in 7 patients with Vancouver B3 fractures. In group of Vancouver C fractures, we found a mean score of 16,2 points (good result) in 7 patients.
Therapeutic algorithm based on the Vancouver classification system is, in our opinion, satisfactory. Accurate differentiation of B1 and B2 type of fractures is essential. Preoperative radiographic images may not be reliable and checking the stability of the prosthesis fixation during surgery should be performed.
Ligamentotaxis in the Intraarticular and Juxta Articular Fracture of Wristiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Arthrolatarjet (Arthroscopic Latarjet Proc) Dr Sujit Jos keralaSujit Jos
Arthroscopic Latarjet procedure is gaining popularity in every part of the world as it combines the strength of Latarjet procedure while retaining the advantages of Arthroscopy. It is most useful shoulder recurrent dislocation associated with bone loss in the glenoid (Bony Bankart) or humeral head (Hill Sach's defect).
The presentation discusses evidence based medicine in the stream of Orthopaedics. Here I have discussed a case of Ipsilateral Intertronchanteric and Femoral shaft Fracture and its various treatment modalities. The presentation was done at J.N. Medical College Belagavi, India. Lets share, discuss and keep learning.
Elbow arthroplasty associated with distal humerus fracture -spanish - HovsepianJean Michel Hovsepian
Orthopaedic Surgery Residency Presentation from Universidad Central de Venezuela, Hospital Universitario de Caracas. Seminar about Elbow arthroplasty associated with distal humerus fracture: Biomechanics, Types, Indication, Surgical Procedure, Justification, Complications. Jean Michel Hovsepian. Material in Spanish.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Within a period from January 2010 to January 2016, there were total of 920 surgically treated patients of Orthopaedy and Traumatology Department, Dubrovnik County Hospital, Croatia, which is a single acute hospital in Dubrovacko-neretvanska County where all patients with proximal femoral fracture are treated within the Orthopaedic-Traumatology Department. The aim of this retrospective study is to compare used implants according to type of the proximal femoral region fracture (femoral neck, pertrochanteric , subtrochanteric) and used osteosynthetic implant depending on the type of fracture. A new surgical techniques were used more commonly. Osteoporotic proximal femoral fractures stayed the major and growing problem in the geriatric traumatology and the traumatollogy in general as well.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Mandibular angle fractures account for 23% to 42% of all facial fractures. Fracture of mandibular angle can be classified as (A) Vertical favorable or unfavorable, (B) Horizontally favorable of unfavorable. Traditionally, mandibular angle fractures have been treated with either closed reduction and inter-maxillary fixation or open reduction and internal fixation with or without inter-maxillary fixation. Patients treated with inter-maxillary fixation have a restricted airway and loose excess weight. Rigid internal fixation and early return to function have eliminated the use of wire osteosenthysis and prolonged use of inter-maxillary fixation. The principal of rigid fixation, however, have inherent set of disadvantages including damage to the inferior alveolar nerve and the marginal mandibular branch of facial nerve. Postoperative malocclusion rates are also high. With the introduction of semi-rigid technique fracture of the mandibular angle could be treated according to Champy’s Ideal lines of osteosenthysis. The technique involves placement of a single monocortial miniplate on the superior border of the mandible. However, some studies suggested using a second miniplate along the inferior border. Wether one or two miniplates should be used is still debatable. The application of 3D plates may provide additional stability in 3 dimension and good resistance against torque forces.
Adult Stem cells in Orthopaedics present and future perspectives.
Παρουσίαση του Δρ. Σταύρου Αλευρογιάννη που έγινε στο ξενοδοχείο Χίλτον, στις 12/06/15 στα πλαίσια Ημερίδας της Ελληνικής Εταιρείας Αναγεννητικής Ιατρικής, Αντιγήρανσης και Βιοτεχνολογίας, στο 41ο Πανελλήνιο Ιατρικό Συνέδριο.
"H θέση της αναγεννητική Ιατρικής στις παθήσεις Οστών και Αρθρώσεων"
Slides from Prof Dan Pratt presented at the Teaching to Teach Workshop in Boston, MA, May 1-2, 2009;
Massachusetts General Hospital, Harvard Medical School.
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
1. P A R T N E R S O R T H O P A E D I C
Trauma Rounds
Case Reports from the Mass General Hospital and Brigham & Women’s Hospital
A Quarterly Case Study Volume 2, Summer 2011
Fractures of the Distal Humerus
Jesse Jupiter, MD
Fractures of the distal end of the humerus,
while relatively uncommon, continue to stimu-
late discussion as to the optimal method of
treatment. Unfortunately, there are relatively
few Level I or even Level II studies to guide the
fracture surgeon.1 I will attempt to identify and
clarify a number of contemporary issues and provide a perspec-
tive of 30 years experience in the study and management of
these injuries.
Epidemiology
People are living longer and healthier, and the incidence of dis-
tal humerus fractures is increasing. In a revealing retrospective,
epidemiological study from Finland of women over the age of
60 years, the incidence of distal humerus fracture increased
from 12/100,000 women in 1970 to 28/100,000 women in 1995.2 Figure 1: Two forms of plate application are seen here: (left) Medial
These data suggest a likely 3-fold increase by 2030. Also note- lateral, (right) 90-90.
worthy is that we are all treating more complex fracture types
fragments extending across to include the medial and lateral
in these osteoporotic patients. This has provoked some dis-
agreement as to whether or not attempts should be taken to ob- epicondyles.3
tain stable internal fixation versus treatment with a total elbow Surgical Exposures
arthroplasty. What to do with the ulnar nerve? There remains some dis-
Preoperative Planning agreement among investigators as to whether the ulnar nerve
Although there is little evidence regarding the importance of should be mobilized as well as transposed anteriorly to rest in
CT scanning or MRI in preoperative decision making regarding the soft tissues. There is fair evidence for transposition of the
more complex articular fractures, the ability to isolate the distal ulnar nerve in all patients who exhibited preoperative ulnar
humeral articular surface in multiple planes is certainly helpful nerve symptoms, but insufficient evidence for anterior transpo-
in shearing articular fractures. sition if the patient had no preoperative symptoms.
Fracture Classification Having treated a large number of patients for reconstructive
The classification systems of the AO group as well as problems following surgery for a distal humerus fracture, I
Orthopaedic Trauma Association are widely accepted, yet they have been impressed with how often the ulnar nerve is found
both have limitations - especially in accurately defining some compressed at or distal to Osborne’s ligament at the entrance of
articular injuries. We have published a classification of articu- the two heads of the flexor pronator muscle. For this reason, it
lar shearing fractures extending from a simple capitellum frac- has been my preference to mobilize the ulnar nerve a minimum
ture to the very complex articular shearing fracture in multiple of 6-8 centimeters proximal and distal to the medial epicondyle.
Trauma Rounds, Volume 2, Summer 2011
1
2. P A R T N E R S O R T H O P A E D I C T R A U M A R O U N D S
Approach to the Fracture
Enthusiasm has been tempered for an olecranon osteotomy ap-
proach to the distal humerus due to reported complications of
nonunion at the osteotomy site, yet it still provides excellent
exposure for those complex very distal articular fractures. I still
favor this approach, creating a chevron shaped osteotomy with
the apex pointing distally and secured with standard tension
wire fixation modified only by two tension wires.
Alternative exposures include a midline split of the triceps, tri-
ceps elevation with a small fragment of the proximal olecranon,
or the extended lateral approach, which is especially useful for
anterior shearing articular fractures.
The literature suggests that a triceps-splitting approach will
lead to functional outcomes similar to that of the olecranon os-
teotomy, without associated complications.
Fracture Stabilization
Some current discussion focuses on whether to apply plates and
Figure 2: Radiograph of a patient who underwent total elbow
screws parallel to each other, or placing the implants orthogonal arthroplasty for a distal humerus fracture.
to one other (Figure 1). Biomechanical studies have not demon-
strated a major advantage for either method, but there is some seen renewed interest following the publication of the Canadian
evidence to support the use of parallel plate applications for Multi-center Trial.4 Patients over 65 years were prospectively
comminuted or osteoporotic fractures. randomized to total elbow arthroplasty or open reduction and
The development of anatomically shaped implants with angu- internal fixation. The results suggested that those patients who
lar stable locking screw fixation may offer some advantages in had the arthroplasty functioned better on both objective and
providing stable internal fixation in the osteoporotic patient. patient rated scores (Figure 2). These data combined with addi-
There is, however, little evidence in the literature to support this tional studies would support the indications for total elbow
concept. One should always realize the ability to anatomically arthroplasty for patients over the age of 65 years who have sus-
shape standard implants to meet the unique requirements of tained a displaced comminuted fracture NOT amenable to sta-
complex fractures. ble internal fixation.1
For stable fixation of complex, articular shearing fractures, I References
1. Nauth A et al, Current Concepts Review. Distal Humeral Fractures in Adults: J
find that headless screws placed from anterior to posterior di- Bone Joint Surg 2011; 93:686-700.
rection through an extended lateral approach are predictable for 2. Palvaren M et al, Secular trends in distal humeral fractures of elderly women:
most fracture patterns. Bone 2010; 46: 1355-8.
Indications for Total Elbow Arthroplasty 3. Mckee M, Jupiter J, Bamberger HB, Coronal shear fractures of the distal end of
the humerus: J Bone Joint Surg 1996; 78: 49-54.
Arthroplasty for complex fractures in the older aged patient, 4. McKee M et al, A multicenter prospective, randomized, controlled trial of open
especially those with complex multi-fragmented fractures has reduction-internal fixation versus total elbow arthroplasty for displaced intra-
articular distal humerus fractures in elderly patients: J Shoulder Elbow Surg
AchesAndJoints.org/Trauma 2009; 18: 3-12.
Please share your comments online, or by email:
Trauma Faculty Michael Weaver, MD — 617-525-8088
Mark Vrahas, MD / mvrahas@partners.org
BWH Orthopedic Trauma
Mark Vrahas, MD — 617-726-2943 Yawkey Center for Outpatient Care, Suite 3C
mjweaver@partners.org
Partners Chief of Orthopaedic Trauma 55 Fruit Street, Boston, MA 02114
mvrahas@partners.org Jesse Jupiter, MD — 617-726-5100
MGH Hand & Upper Extremity Service Editor in Chief
Mitchel B Harris, MD — 617-732-5385 jjupiter@partners.org Mark Vrahas, MD
Chief, BWH Orthopedic Trauma
mbharris@partners.org David Ring, MD — 617-724-3953
MGH Hand & Upper Extremity Service
Program Director
R Malcolm Smith, MD, FRCS — 617-726-2794 dring@partners.org Suzanne Morrison, MPH
Chief, MGH Orthopaedic Trauma (617) 525-8876
Brandon E Earp, MD — 617-732-8064 smmorrison@partners.org
rmsmith1@partners.org
BWH Hand & Upper Extremity Service
David Lhowe, MD — 617-724-2800 bearp@partners.org Editor, Publisher
MGH Orthopaedic Trauma George Dyer, MD — 617-732-6607 Arun Shanbhag, PhD, MBA
dlhowe@partners.org BWH Hand & Upper Extremity Service www.MassGeneral.org/ortho
gdyer@partners.org www.BrighamAndWomens.org/orthopedics
2
Trauma Rounds, Volume 2, Summer 2011