THE BETH ISRAEL DEACONESS MEDICAL CENTER
MARK C. GEBHARDT, MD
Department of Orthopaedic Surgery

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:

Weekly: Trauma Conference, Chief’s Conference, Tumor Conference, and Geriatric rounds
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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