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Introduction

Now nearing the end of its 5th year as a revitalized clinical service, Orthopaedic Surgery at the Beth Israel Deaconess Hospital has continued to grow into a vibrant and exciting Department with excellence in education and research. It has been another busy year! Here are some of the highlights:

  • The Spine Center officially opened in March 2008.
  • This July we will have 6 Harvard residents (2 PGY 2’s, 2 PGY 4’s and 2 PGY 5’s) rotating at any one time at the BIDMC.
  • BIDMC welcomes 3 New Hires: Fadi Badlissi, M.D.,M. Sc., Musculoskeletal Medicine Unit, Ayesha Abdeen, M.D., Arthroplasty Service, John C. Keel, M.D., The Spine Center.

OFFICES AND CLINICAL SERVICES.

The new academic offices on Stoneman 10 include offices for our entire faculty and their administrative assistants as well as a state of the art conference room and space for resident and medical student study modules. The hospital received a donation to make the clinical space on Shapiro 2 possible and we are now officially the Carl J. Shapiro Department of Orthopaedics. The construction of our new clinical space on Shapiro 2 is complete. We expanded the space nearly doubling the number of functional exam rooms, improved the appearance and comfort of the waiting areas, and added a new digital radiology unit. The newly created Spine Center has officially opened for business in March 2008 offering multidisciplinary care including departments of neurosurgery, neurology, anesthesia, radiology and physical therapy.

TEACHING EXPERIENCE

We have continued to develop the teaching program for the residents. We will expand the PGY 1 orthopaedic interns at BIDMC to 5 who each will spend 2 months on the orthopaedic service. We will have 6 Orthopaedic residents starting July of 2008 where the resident will have the chance to work with the sports, joints, spine and trauma services both in the clinic and operating room under the direction of Drs. Ramappa, Ayres, McGuire and Rodriquez, along with Drs. Davis, White and Appleton. All the residents are very happy with their rotations and the PGY 2 and PGY 5 residents continue to hone their arthroscopic skills with the continued excellent contributions of the Meeks, Zilberfarb, Richardson group as well as Drs. Ramappa and Davis. Doug Ayres provides an excellent educational experience in operative arthroplasty. The dedication of our faculty has been largely responsible for making the return of the residents to the BIDMC such a positive experience.

The following is a brief synopsis of our faculty accomplishments and activities for the academic year:

Annual Augustus A. White, III, M.D., Ph.D. devotes his attention and energies to the students of Harvard Medical School. We had another very successful Annual Augustus A. White, III, M.D., Ph.D. Spine Symposium in October, 2007 discussing Low Back Pain: Basic Science to Clinical Care which included Drs. James Weinstein, Gunnar Andersson, Richard Woolf and Preston Phillips.

SPINE SERVICE

Dr. Kevin J. McGuire continues as the Program Director of a new ACGME-approved Spine Fellowship and is the Co-Director of the Spine Center, a joint venture with the departments of neurosurgery, neurology, anesthesia, radiology and physical therapy that opened in March 2008. Andrew P. White, M.D. who joined the spine service in August 2007 has expanded his practice to the Orthopedic Care Consultants in Stoughton and continues to grow his practice at BIDMC. John C. Keel, M.D., a graduate of Emory University School of Medicine and fellowship trained in pain management from Mass General, Boston will join the Spine Center in August 2008 as a Physiatrist. Paul Glazer, M.D. continues his practice in the Shapiro Clinical Center and research in several areas of spine surgery. Jay Zampini, M.D. is completing his year as the 1st ACGME Spine Fellow and will start a position at Drexel University College of Medicine in Philadelphia.

HAND SERVICE

The Hand Service continues to generate large clinical volumes and excellent academic research. Charles Day, M.D. has been working on several research projects with Harvard Medical students and continues to contribute actively in the medical student education. His excellent work with assessing the musculoskeletal education of Harvard medical students has led to a revision of the curriculum to include more education for first, second and third year students. He recently published his results on student’s assessment of their musculoskeletal education and received wide-spread attention. Dr. Day won the best poster at AAOS convention 2008 for Practice Management/ Non-Clinical Section. Tamara Rozental, M.D. has been very busy academically along with building a successful hand and upper extremity practice. Her research efforts are focused in the area of fragility fractures of the upper extremity. Over the last year, she has had six publications, has been working on 8 IRB approved studies and has received funding for many of these efforts. Tamara and Peter are the proud parents of their first child Anaise. Hillel Skoff, M.D. continues to have an active practice in Hand Surgery. Rebecca Bennett, M.D. is completing her year as the 2nd Orthopaedic Hand Fellow at BIDMC (a combined ACGME fellowship with Plastic Surgery) and will be starting a position at Lake Shore Bone and Joint Institute, Chesterton, Indiana.

TUMOR SERVICE

Megan E. Anderson, M.D. continues to grow her practice in musculoskeletal oncology, at the BIDMC and Children’s Hospital. She also provides primary orthopaedic care at our Chelsea Clinic once a month. She has been active with presentations at the Musculoskeletal Tumor Society and the New England Orthopaedic Society. She is a member of the faculty of the Boston Pathology Course and continues to organize the Tumor Core Curriculum for the residents. She has also been busy writing chapters in OKU-9 on the topic of pediatric tumors and in a textbook that will be published by David Fisher. Despite rumors to the contrary, Mark C. Gebhardt, M.D. is very busy clinically as well with his tumor practice at BIDMC and Children’s Hospital. His administrative duties occupy a large part of his time and he continues to participate in several local, national and international orthopaedic organizations as well as continuing collaborative research and publications. The two “extracurricular” activities for this year included a tour to London with the Longwood Symphony Orchestra where we presented a tumor symposium at St. Barts Hospital and visited the Marie Curie Cancer Institute. We performed 3 concerts at various venues in London and visited the Harvard Club of London where we performed some chamber music. The plan was to combine the missions of music and fund raising for medical charities, in this case, The Marie Curie Cancer Institute. It was quite successful. On this side of the pond, I plan to ride my first Pan Mass Challenge to raise money for the DFCI and “Pedal for Peds”. All contributions are welcome!

TRAUMA SERVICE

E. Ken Rodriguez, M.D., Ph.D. (a.k.a. “K-Rod”) is our Chief of Orthopaedic Trauma. Ken continues to organize our orthopaedic trauma service at the BIDMC and is very glad to share his duties with Paul Appleton, M.D. Both Ken and Paul have participated in several regional, national and international courses over the last year. The trauma service has also had several publications on the treatment of distal femur fractures, tibia and ankle fractures. Ken and Paul remain committed to educating our residents, fellows and medical students and consistently get rave reviews from those who rotate through their service. Paul and his wife, Catelyn, are proud parents of their fourth child born in October 2008. The trauma service continues to provide not only excellent trauma care, but is active in research of interest to all. A JBJS article on which orthopaedic devices are likely to set off the metal detectors in the airport made the local and national lay press, and a study on when it is safe to return to driving after an orthopaedic injury is also receiving a lot of attention.

JOINT ARTHROPLASTY SERVICE

Doug Ayres, M.D. continues his appointment as Vice Chair of the Department this year and retained his position as our Quality Assurance Director. Despite these administrative burdens his practice is booming. He instituted our arthroplasty clinical pathway and preoperative teaching classes for our patients. His teaching in the operating room and clinic has received praise from the PGY-2 residents who have rotated with him. He continues to work closely with the geriatrics service to make this a unique educational experience within the Harvard residency program. Harris Yett, M.D. has also been working closely with the geriatrics service to provide specialized care for the elderly patients with fracture and arthroplasty needs. He and Doug lead the geriatric care program in the Harvard residency program. Ayesha Abdeen, M.D., a graduate from McMaster University, Hamilton, ON, Canada, and fellowship trained in adult reconstruction and orthopaedic oncology from the University of Southern California and Memorial Sloan Kettering Cancer Center will be joining the Arthroplasty service in September 2008. Donald Reilly, M.D. continues his clinical practice at the New England Baptist Hospital and the BIDMC. He remains active in the teaching of Harvard residents and HMS students and continues his research in the areas of knee replacement implants.

SPORTS SERVICE

Robert Davis, M.D. has continued his clinical work and expanded his practice in sports medicine and trauma. He currently serves as member at large of the Medical Executive Committee of the BIDMC and has an active role in teaching of the PGY-1 and Emergency Department residents that rotate on the Orthopaedic Department. Arun Ramappa, M.D. provides expertise in sports medicine and shoulder surgery. He continues his efforts as Team Physician of the Lowell Devils, a farm team for the New Jersey Devils and remains Co-Director of Medical Research for the Boston Red Sox. He received a grant from Major League Baseball to study shoulder labral tears. His research interests include shoulder and elbow injuries in throwers, articular cartilage injuries and ACL tears, and rotator cuff repair. He continues to publish scientific articles and is very active in regional and national meetings.

Drs. Louis Meeks, Lars Richardson and Jeffrey Zilberfarb continue their busy practice and make a big contribution to the education of the sports medicine resident on their service, as well as to the education of HMS students.

FOOT AND ANKLE SERVICE

Naven Duggal, M.D. continues to grow the foot and ankle service. His practice has expanded to Milton Hospital and he maintains an active link to the trauma service. He is involved in research related to outcomes from total ankle arthroplasty. He has a guest editorial in Orthopaedics on quality assurance in orthopaedic surgery.

MUSCULOSKELETAL MEDICINE UNIT

The Musculoskeletal Medicine Unit, located in the orthopaedic suite of the Shapiro Clinical Center is under the direction of Fadi Badlissi, M.D., M.Sc. Fadi is a rheumatologist and geriatrician with a joint appointment in the orthopaedic and rheumatology division who started with us in May 2008. His clinical interests include rheumatic diseases in the elderly, regional pain syndromes and inflammatory arthritis. Research interests include inflammatory arthritis in the elderly, depression in rheumatoid arthritis, foot disorders and their relation to pain and function. He, and Sharon Gates, N.P., continue to provide excellent care for non-operative musculoskeletal disorders in close collaboration with our Department members. Drs. Michael O’Brien and Ryan Friedberg, continue to develop their busy practice as primary care sports medicine physicians.

ORTHOPAEDIC BIOMECHANICS LABORATORY

The Orthopaedic Biomechanics Laboratory at the Beth Israel Deaconess Medical Center continues to thrive as a worldrenowned center for biomechanics research. We had a total of 9 abstracts, 1 podium presentation and 6 posters at the ORS in February. This year Brian Snyder, M.D., Ph.D. was promoted to Associate Professor of Orthopaedic Surgery. Dr. Mary Bouxsein currently holds joint appointments as an Assistant Professor of Orthopedic Surgery at Harvard Medical School, Boston, MA, adjunct Assistant Professor of Mechanical and Aerospace Engineering at Boston University, and as a visiting scientist at the Jackson Laboratory in Bar Harbor, ME. Her research interests include identification of the genetic determinants of bone strength; non-invasive imaging for assessment of bone strength; and the biomechanics of age-related fractures. She serves on the committee of scientific advisors for the International Osteoporosis Foundation. Dr. Bouxsein has published over 70 peer-reviewed articles and 15 book chapters. Ron Alkalay, Ph.D. has developed novel CT and MRI compatible, computer controlled loading system which, in conjunction with the development of parametric high-resolution Finite Element Models, offers a unique multi-disciplinary approach in studying the complex behavior of the human spine. He continues to focus on pathologic fractures of the human spine. He just received an R0-1 grant. Robert Fajardo, Ph.D. has had a very productive year. He gave a presentation at the ORS as well as several presentations at the annual conference for the Society for Integrative and Comparative Biology. Chris Evans, Ph.D. will join the lab in July 2008. He is primarily interested in translational research, developing novel molecular therapies for the treatment of conditions affecting bones and joints. His unique emphasis is placed upon the use of gene therapy in arthritis and the regeneration of orthopaedic tissues. These projects require the close collaboration of laboratory scientists with clinicians. He is also active in studying the regeneration of orthopaedic tissues and developing minimally invasive, clinically expeditious, cost-effective technologies based upon the in situ genetic modification of stem cells. This approach is called “facilitated endogenous repair.” Avoiding traditional approaches to tissue engineering that require ex vivo cell culture greatly improves clinical applicability, as well as reducing cost and complexity. He has shown that this technology can heal experimentally created segmental defect in rat femora by the direct, in vivo adenoviral transfer of a gene encoding bone morphogenetic protein-2. His group is also studying genetic enhancement of cartilage repair using autologous bone marrow. The proposed role for Dr. Evans at the OBL will be to create a laboratory that combines molecular biology and biomechanics of the musculoskeletal system under one roof and in close collaboration. In addition to Chris and his lab, Kevin P. McHugh, Ph.D. will move to the OBL to be an integral part of the research effort. He is a molecular biologist with a specific interest in bone cell biology. Initially he honed his molecular biology skills working on conserved DNA sequences in the Family Anatidae (waterfowl). He subsequently turned his attention to osteoclasts and the effects of adhesion of osteoclasts to bone matrix on differentiation and gene expression in the Avioli-Teitelbaum laboratories in St. Louis. This evolved into the study of expression and function of integrin cell adhesion molecules in bone osteoclasts, which are the cells that primarily resorb bone. He cloned the mouse ß3 integrin cDNA and subsequently characterized the regulation and functional activities of the ß3 integrin gene.

Bringing together the Center for Molecular Orthopaedics and the Orthopaedic Biomechanics Laboratory will provide a rare opportunity to develop novel, cutting edge programs that encompass both modern biology and modern mechanics. Initially, there will be approximately 7 Principal Investigators among total personnel of some 35 scientists and engineers, sharing approximately 6,000 square feet of contiguous laboratory space. The opportunities for advanced pre-clinical research are enhanced by the proximity of a large animal facility, while collaboration with the clinicians within the Department of Orthopaedic Surgery will facilitate translation. Guided appropriately, these synergies will allow us to develop new and better treatments for some of the most disabling, prevalent and costly diseases on the planet. I fully believe that within a 5 year period, we can be one of the top few orthopaedic research centers in the world.

I hope this gives you some idea about the progress and excitement that has occurred at the BIDMC Orthopaedic Department in clinical care, research and education. The first five years have been very rewarding for me and we have achieved tremendous growth. The clinical and educational programs are thriving and we anticipate that they will continue to grow. We aim to provide a venue for compassionate care of patients and an educational environment in which medical students, residents and fellows will learn and thrive. We look forward to an even more exciting 2008-2009 academic year and invite you to visit the Department and Laboratories.