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Introduction
The Department of Orthopaedic Surgery at the Beth Israel
Deaconess Hospital has continued to grow – we now have all
subspecialties represented on the faculty. It has been a busy
year! We added four new faculty this year and introduced the
inclusion of a Dartmouth resident to the program for education
in musculoskeletal oncology.
The new faculty includes:
- Paul Appleton, MD, (orthopaedic trauma)
- Naven Duggal, MD, (orthopaedic foot and ankle surgery and trauma)
- Tamara Rozental, MD, (hand and upper extremity)
- Edward J. Vresilovic, Jr., MD, PhD (spine surgery)
Dr. Paul Appleton joined BIDMC’s
multidisciplinary orthopaedic trauma
team that operates in conjunction
with the medical center’s Level
I trauma center to manage acutely
injured patients. He brings to BIDMC
expertise in the treatment of open
and closed fractures of the upper and
lower extremities, including periarticular
fractures of the knee and ankle.
He also has a special interest in and
significant experience with geriatric fractures, particularly in
the management of osteoporotic hip fractures. He received his
medical degree from Dartmouth Medical School. He completed
his internship in general surgery at Massachusetts General
Hospital and his residency in orthopaedic surgery through the
Harvard Combined Orthopaedic Surgery program. Additionally,
he received fellowship training in orthopaedic trauma at the
Royal Infirmary of Edinburgh in Scotland.
Dr. Naven Duggal joined staff at
BIDMC in October, 2005 after completing
orthopaedic education at the
University of Western Ontario and fellowships
at the Royal North Shore
Hospital (Sydney, Australia) and St.
Michael’s Hospital (University of
Toronto, Canada). His interests include
the treatment of athletic injuries;
arthritic conditions, including rheumatoid
deformities; fracture care and
diabetic foot and ankle complications. Having worked in Canada
and Australia prior to coming to BIDMC, he has broad-based
training in ankle arthroscopy for cartilage injury, ankle joint
replacement and reconstruction, ligament reconstruction for
ankle instability. Additionally, he has extensive expertise in the
treatment of common forefoot conditions, including bunions,
claw toes and neuromas. He will head the new Orthopaedic
Foot and Ankle Service at BIDMC and will provide treatment
for individuals with a variety of foot and ankle problems, including
athletic injuries, fractures, arthritis, diabetic complications
and deformities of the fore and hindfoot. In addition to the
Orthopaedic Foot and Ankle Service, Dr. Duggal will also be
involved with the Orthopaedic Trauma Service at BIDMC. He
received an award for a research project entitled “Functional
Comparison of Ankle Arthroplasty versus Ankle Arthrodesis for
End-Stage Ankle Arthritis” recently at the American Orthopaedic
Foot and Ankle Society Meeting (Best Scientific Poster) and the
International Federation of Foot and Ankle Societies Meeting
(Best Clinical Paper) in Naples, Italy. Certainly more exciting
that all of that is the announcement that Pamela and Naven are
expecting their second child in June!
Dr. Tamara Rozental specializes
in wrist and carpal reconstruction;
arthritis of the elbow, wrist and hand;
and common overuse syndromes. She
brings to BIDMC proficiency in leading-
edge comprehensive treatment of
the upper extremities, from minimally
invasive procedures to total joint
replacements of the wrist, elbow and
small joints of the hand. She employs
minimally invasive techniques to treat
thumb arthritis and advanced, low-profile plating systems for
fractures of the distal radius. Additionally, she has an interest
in the treatment of elderly patients. She received her medical
degree from Cornell University Medical College and completed
her internship and residency in general and orthopaedic
surgery at the Hospital of the University of Pennsylvania in
Philadelphia.
Dr. Ed Vresilovic, Jr., a nationally
recognized expert in degenerative
spine disease, has joined the department
as chief of the spinal disorders
service. Having served more than ten
years as chief of the spinal disorders
service at the Hospital of the University
of Pennsylvania, Dr. Vresilovic brings
to BIDMC a wide range of clinical
expertise in managing pain, neurological compromise and
deformity associated with neck and back disorders with a
special interest in lumbar and cervical disease. Additionally,
he has extensive experience in treating disc herniation, spinal
stenosis, spondylolithesis, traumatic and pathologic fracture
with associate radiculitis, radiculopathy and myelopathy. He
received his medical degree from the University of Pennsylvania
and completed his internship and residency in general surgery
and orthopaedic surgery at the Hospital of the University of
Pennsylvania. In his new role, he will work with the departments
of neurosurgery, neurology and other specialists to
establish a multidisciplinary, full-service spine center devoted
to providing total spine care. He will be joined this summer by
Dr. Kevin McGuire, a graduate of the University of Pennsylvania
residency program and the Bolman spine fellowship. He has a
strong interest in outcomes studies and has a Masters degree in
Epidemiology and Biostatistics that will augment the research
aspects of our program.
The other members of the faculty have been very busy
during the year.
Megan E. Anderson, MD specializes in musculoskeletal
oncology, has been instrumental in building the multidisciplinary
tumor team at the BIDMC and has rapidly built a busy
practice. She also works at Children’s Hospital as part of the
tumor team and participates in our trauma call system. She
also provides primary orthopaedic care at our Chelsea Clinic
once a week. She has been active with presentations at the
Musculoskeletal Tumor Society. Dr. Anderson is the surgical
coordinator for a new Children’s Oncology Group study for first
time relapsed Ewing sarcoma using antiangiogenic medications
with standard therapy. She and I have been working with a second
year Harvard Medical student on a Unicameral Bone Cyst
project that is nearly complete and it will be presented at the
Musculoskeletal Tumor Society in June, 2006. We plan to get
it published soon thereafter. She was a member of the faculty
of the Boston Pathology Course (which was very successful and
full this year largely due to the tireless efforts of Stacy Lewis!)
and also gave some talks to the children’s pathology fellows.
From a personal standpoint, she reports that the cats are fine (I
am sure you will all be glad to hear that). One got out the other
night, but he came back when she found him missing in the
morning and went around the neighborhood calling for him.
Arun Ramappa, MD provides expertise in sports medicine
and shoulder surgery along with R.G. Davis and is building a
research program in sports injuries. He is the Co-Director of
Medical Research for the Boston Red Sox and a member of
the team caring for the players. His research interests include
shoulder and elbow injuries in throwers, articular cartilage
injuries, ACL tears, and rotator cuff repair. He continues to
publish scientific articles and present at national meetings.
Dr. Ramappa recently completed a book chapter on shoulder
injuries in the throwing athlete. He has assumed administrative
responsibilities in the Department heading the committee of
equipment procurement and cost containment.
E. Ken Rodriguez, MD, PhD (aka “K-Rod”) is our Chief of
Orthopaedic Trauma. Ken has rapidly organized orthopaedic
trauma care at the BIDMC and is very glad that Paul Appleton
has arrived to share the duties. In addition to establishing trauma
care protocols, he has established a dedicated orthopaedic
trauma room available 7 days a week . The trauma service at
the BIDMC now consists of two full-time trauma attendings, a
foot and ankle trauma attending, a PGY-4 orthopaedic resident,
an intern, a PGY-2 EW resident, a full time trauma PA, and a
full time trauma nurse coordinator. Ken has begun several
research projects particularly assessing outcomes of fracture
care in the geriatric population. He and his wife Madeline are
expecting their third child next October
Harris Yett, MD has been working closely with the geriatrics
service to provide specialized care for the elderly patients with
fracture and arthroplasty needs. He and Douglas Ayres, MD
have been providing an educational program in geriatric care
of the orthopaedic patient, a unique program in the Harvard
residency program. A PGY-2 resident is part of this service.
They run a clinic at the Hebrew Rehabilitation Center and care
for elderly patients in conjunction with the geriatrics service.
Doug was recently appointed as Vice Chair of the Department
of Orthopaedic Surgery and has been very helpful in organizing
the Quality Assessments of the Department. Some of his new
duties will include oversight of the operations of the Inpatient
Orthopaedic Service, participation in development of departmental
long-term strategy and organizational structure, and
assistance with training clinic staff related to JCAHO and other
documentation and process standards.
Robert Davis, MD has continued his clinical work and
expanded his practice in sports medicine and trauma. He currently
serves as an at large member 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.
Charles Day, MD was a HMS Rabkin Education Fellow
this year to learn educational and leadership skills and was also
promoted to Assistant Professor at Harvard Medical. He applied
for and has been approved for an ACGME fellowship in Hand
and Upper Extremity. He has been working on several research
projects with Harvard Medical School students. He continues
to contribute actively in the medical student educational program
and is in the process of submitting a medical student
IRB to HMS to survey their subjective and objective knowledge
of some fundamental musculoskeletal diagnoses. Dr. Day
has been appointed to establish a four year musculoskeletal
medicine curriculum for the HMS students. He will be working
on weaving in the first two years of the curriculum in the
upcoming academic year. From the clinical research perspective,
he has ten IRB approved on-going projects in the fields of
distal radius fracture treatment, geriatric distal radius outcome,
trigger fingers, total wrist arthroplasty, functional outcome of
distal radius malunions, and thumb MP arthritis. Two papers
have been accepted into the Journal of Hand Surgery and Hand
Clinics. This year Dr. Day also had two podium presentations at
the AAOS and two poster presentations at the ASSH.
Donald Reilly, MD 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.
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.
Paul Glazer, MD continues his practice in the Shapiro
Clinical Center and continues his research in several areas of
spine surgery. Hillel Skoff, MD has an active practice in Hand
Surgery.
Augustus A. White, III devotes his attention and energies
to the students of Harvard Medical School, serving as Master of
the Holmes Society. We had another very successful Augustus
A. White, M.D. Spine Symposium in October, 2005 dealing with
disc disease which included Drs. Alf Nachemson and Louis
Sullivan amongst other luminaries. Past fellows and friends
from around the country attended and were treated to an exciting
program discussing aspects of spine surgery.
The Musculoskeletal Medicine Unit, located in the orthopaedic
suite of the Shapiro Clinical Center is under the direction
of John Donohue, MD. John is a rheumatologist with a joint
appointment in the orthopaedic and rheumatology division.
He, Sharon Gates, NP, and Deb Brown, NP continue to provide
excellent care for non-operative musculoskeletal disorders in
close collaboration with our Department members.
Michael O’Brien, M.D. has developed a busy practice as
a primary care sports medicine physician and we are adding a
second sports trained emergency medicine physician part time
to our department this year. Ryan Friedberg, M.D. also works
as an emergency room physician and we hope that this will
enhance the communication and patient flow from the ER to
our offices.
My time as Chair on the Council of Musculoskeletal
Specialty Societies (COMSS) and on the AAOS Board of
Directors has ended, but the Departmental duties have kept me
plenty busy. We have begun construction for our new academic
offices on Stoneman 10 that will include offices for our entire
faculty and their administrative assistants as well as a state of
the art conference room and space for resident study modules.
Soon after we move into these offices in July, construction
will begin on Shapiro 2 to expand the clinic space - we have
outgrown our “blood supply” and need more clinic rooms and
radiology units to see all the patients that the new physicians
are attracting. The hospital received a nice donation to make
this possible and when completed will be named the Carl J.
Shapiro Department of Orthopaedics.
We have also been working with a consultant group to
develop service lines within the Department to improve patient
care. As part of this we will be working with the neurosurgical
division, neurology, the pain clinic and physical therapy to
develop a spine center. We are also working with the hospital
to make our clinical care cost effective by developing clinical
pathways and monitoring the costs of implants and biologicals
that we employ in the care of our patients.
Another exciting event this year for the Department of
Orthopaedics was the return of the Harvard residents to the
BIDMC. There are now 4 HCORP residents at the BIDMC (in
addition to four PGY-1’s): one in each of the PG years. The
PGY-5 spends half of his or her time on a research elective. As
reported last year, the program was reviewed recently and was
granted approval for 2 additional residents per year (a total of 12)
making the return of residents to the BIDMC possible. We also
have an Emergency Medicine resident, the Dartmouth resident
on the oncology service, a PGY-2 on the arthroplasty/geriatrics
service, a PGY-3 on sports and a PGY-4 on the trauma service.
The reports so far indicate that the residents like the new rotations.
The PGY-5 resident has the opportunity to participate in
cases with which he or she feels they need more experience and
the remainder of their time is spent on their research elective.
We have a vibrant conference schedule including:
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Weekly: |
Trauma Conference, Chief’s Conference, Tumor Conference, and Geriatric rounds |
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Monthly: |
Sports Medicine Journal Club, Tumor Journal Club, and Combined Sports Medicine/Radiology Conference. |
It was a busy Orthopaedic Biomechanics Laboratory at the
Beth Israel Deaconess Medical Center continues to thrive as a
world-renowned center for biomechanics research in orthopaedics.
We had a total of 14 abstracts, 3 podium presentations
and 11 posters at the ORS in March. This year Brian Snyder
received funding from the Scoliosis Research Society for a
project entitled “How Does VEPTR Affect Pulmonary Function:
An in-vivo Assessment Using the Rabbit Scoliosis Model.” The
goal of this study is to extend an animal model of Thoracic
Insufficiency Syndrome previously developed by his group
and to use this animal model to quantify the effect of VEPTR
on thoracic volume, lung volume, respiratory mechanics, gas
exchange, lung cell growth, spine growth, and spinal deformity.
He also received funding from the National Institutes of Health/
National Institute of Dental & Craniofacial Research for study of
Craniofacial Tissue Engineering based on the hypothesis that
craniofacial structures with physiological gradients of structural
and mechanical properties can be grown in vitro through biophysical
regulation of adult human stem cells. The work will
produce high fidelity grafts for studies of stem cell responses to
genetic and environmental signals in the short term and suitable
grafts for regenerative medicine in the long term.
Dr. Bouxsein received her doctorate in Mechanical
Engineering from Stanford University and completed a postdoctoral
fellowship at the Orthopedic Biomechanics at Harvard
Medical School. She currently holds joint appointments as an
Assistant Professor of Orthopedic Surgery at Harvard Medical
School, Boston, MA 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, specifically improving
our understanding the various components contributing to
increased skeletal fragility with aging and decreased skeletal
fragility with osteoporosis therapies. She serves on the committee
of scientific advisors for the International Osteoporosis
Foundation, was co-editor of the Osteoporosis International
Supplement on Bone Quality published in 2003, and was a coorganizer
of the NIH-sponsored workshop on Bone Quality held
in May 2005. She authored the guidelines for optimal treatment
of fragility fracture patients in the Journal of the American
Academy of Orthopedic Surgeons. In 2005, she received the
Fuller Albright Award from the American Society of Bone and
Mineral Research, in recognition of meritorious scientific contributions
by a young investigator. Dr. Bouxsein has published
over 60 peer-reviewed articles and 15 book chapters.
Ron Alkalay, Ph.D. has been focusing on pathologic
fractures of the human spine which is a major cause of morbidity
and mortality in both the adult and elderly population.
His research aims to elucidate the role of vertebral structures
namely, cancellous bone and vertebral cortex, in effecting
the mechanism of failure and consequently the post-failure
response of thoracolumbar vertebra to complex loading scenarios.
He developed a novel, CT compatible, computer controlled
spinal testing device which allows for acquisition of real-time
CT images of the deforming spine. In part of a new collaborative
effort with the Mayo Clinic in Rochester, MN, his group is
evaluating the use of a Quantitative CT image based structural
analysis program to classify whether vertebrae with metastatic
defects are at a risk of premature failure. Such materials offer
the possibility of inclusion of therapeutic drugs as well as bone
enhancing agents to ameliorate the effect of the disease on
the spine. This latest effort forms the basis of a Department
of Defense Grant application entitled “Computed tomography
guided protocol for prophylactic augmentation of metastatic
diseased spine using structural biopolymers”. He is also investigating
the ability of MR based diffusion imaging (ADC, tensor)
to delineate the effect of age-related degeneration on the
anatomy and structure of human intervertebral discs. This
effort, supported by a grant from the Robert Mathys foundation,
Switzerland, forms the basis of an R21 application entitled
“Correlation of diffusion MRI and disc biomechanics”. He
contributes to the teaching of engineering subjects at Harvard
and HST Faculty at the Orthopedic Biomechanics course. Dr.
Alkalay has similarly tutored several students from Harvard
Division of Engineering Sciences and the Bioengineering
program at Boston University, on research projects involving
both vertebral and intervertebral disc mechanics. He published
a paper entitled “A biomechanical analysis of an instrumented
spinal under torsional loads” (Alkalay RN, Sharpe D, Bader DL.
J of Biomech, 38(4), 865-876, 2005) and and received funding
from the Robert Mathys Foundation, Stryker Medical.
Robert Fajardo, Ph.D. was promoted to Instructor in
Orthopaedics at Harvard Medical School and had a very productive
year. He had a presentation at the ORS entitled “Validation
of a micro-CT image based algorithm to estimate the structural
integrity of tissue engineered bone” along with his co-workers
PN Bansal and Brian Snyder. He also had a presentation
at the annual conference for the Society for Integrative and
Comparative Biology entitled “Axial postcranial skeleton in
birds: comparison of centrum bone structure in two anatids
with different pneumatic states” with his co-investigators E.
Cory, ND Patel, A. Nazarian, V. Glatt V, BD Snyder and ML
Bouxsein.
On a personal note, he and his wife, Genevieve, are also
expecting their 3rd daughter in early June.
I hope this gives you some idea about the progress and
excitement that has occurred at the BIDMC Orthopaedic
Department both in clinical care, research and education. We
look forward to an even more exciting 2006-2007 academic year
and invite you to visit the Department and Laboratories.
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