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Orthopaedic & Rehabilitation Services

Besides a general capability in all aspects of orthopaedic surgery, the faculty have special interests in spine disorders, pediatric orthopaedics, hand reconstruction, sports medicine, total joint arthroplasty, multi-trauma management, foot and ankle surgery, orthopaedic oncology, and rehabilitation. A close working relationship is maintained with the Arthritis Center and with Physical and Occupational Therapy. Related subspecialties include the following:

Basic Science

Residents devote a three-month rotation to Basic Science in the orthopaedic research laboratories. They have the option of working in the field of computational and experimental biomechanics or cell biology. Residents are encouraged to develop projects within existing orthopaedic research programs, including the following: investigations into static and dynamic mechanical behavior of the lumbar spine; the stress-strain behavior of ligaments; bioelectricity in bone and nerves; clinical microcirculation; analyses of the form, structure, and physical properties of bone utilizing stereological computer imaging techniques; and the role of growth factors in oncogenesis, bone growth, and the healing of ligaments and tendons.

Spine

The Adult Spine Service is concerned with assessment and management of acute and chronic back pain secondary to osteoarthritis, spinal stenosis, rheumatoid arthritis, musculoskeletal neoplasms, and acute spine injury. The Spine Service maintains a close relationship with the Department of Neurosurgery. Research programs focus on the effect of injury and degenerative change on the spine. In addition, a variety of ongoing projects exist which focus on biomechanical and biological aspects of spinal instrumentation and spinal disorders.

Hand

Diagnosis and treatment of traumatic, congenital, and acquired disorders of the hand and upper extremity is the mission of the Hand Service. Special interests and capabilities include rheumatoid and other adult hand reconstruction, management of acute hand trauma involving microvascular surgery and reimplantation, and the surgical reconstruction of congenital hand deformities. This service coordinates its rehabilitative hand care with programs offered by the Occupational Therapy Department.

Trauma

Orthopaedic Trauma physicians provide treatment for major trauma victims in coordination with a multidisciplinary team of physicians and surgeons at the Vanderbilt University Medical Center and Veterans Administration Medical Center. Areas of expertise include management of the multiply injured patient, internal and external fracture fixation, and the treatment of fracture nonunions, malunions, and segmental defects. A subspecialty clinic at Vanderbilt is devoted to the care and rehabilitation of amputees. Research programs focus on fracture healing, cartilage metabolism, and clinical outcome studies of musculoskeletally traumatized patients.

Sports Medicine

The Sports Medicine Service offers an athletic medicine and rehabilitation program coordinated with the Athletic Department of Vanderbilt University, with consultants from all medical and surgical specialties, psychology, sociology, and nutrition. It specializes in the treatment and rehabilitation of individuals with sports-related injuries, as well as the training and conditioning of competitive and recreational athletes. The staff is also involved with educational programs for trainers and coaches in the community, and with research studies in knee biomechanics and knee ligament injuries. A fully equipped and staffed gait and kinesiology laboratory is also available through this service for thorough computer analysis of gait and motion problems.

Joint Replacement

The Vanderbilt Department of Orthopaedics offers its Residents comprehensive experience in total joint replacement. This includes primary replacement of the hip, knee, shoulder, elbow, and ankle joints using both cemented and uncemented techniques. In addition, there is an in-depth experience in revision total joint arthroplasty, emphasizing preoperative planning, the design and use of custom CAD/CAM revision prostheses, and bone allografting techniques. FDA-monitored investigations of uncemented prostheses have been undertaken as well as clinical trials of new, conventionally fixed prostheses. Basic research includes biomechanical analysis and design of implants for total joint replacements.

Foot & Ankle

Orthopaedists at Vanderbilt are also skilled in the management of complicated foot and ankle problems resulting from failed prior foot surgery, congenital deformity, neuromuscular disease, or diabetes. This service also specializes in the treatment of complex ankle fractures and reconstructive surgery for adults with post-traumatic lower extremity problems. Other foot disorders treated include bunions, metatarsalgia, hammer toe deformities, painful heel syndrome, and symptomatic pes planus. Basic research in foot mechanics is aimed at improving fusion techniques in the foot and ankle as well as artificial ankle replacement.

Pediatric Orthopaedics

The Pediatric Orthopaedic Service provides extensive outpatient and inpatient experience in the diagnosis and treatment of all musculoskeletal diseases of children. Most inpatients are housed in the Children's Hospital, on the fifth and sixth floors of Vanderbilt University Hospital. In addition to a general orthopaedic outpatient facility, subspecialty clinics focus on the management of cerebral palsy, spina bifida, hemophilia, scoliosis, muscular dystrophy, and rheumatic disorders. The staff works in conjunction with the departments of Medical Genetics, Neurology, Pediatrics, and Rheumatology. The Division of Pediatric Orthorpaedic Surgery also corrects pediatric spinal deformities using a thoracoscope, which requires only tiny incisions in the chest and allows for a much faster and easier patient recovery. Other areas of special capability include the diagnosis and treatment of congenital foot deformities, osteomyelitis, and congenital dislocation of the hip. Research includes biomechanical analyses of instrumentation for spinal fusion and clinical outcome studies to evaluate the surgical treatment of scoliosis, clubfoot, vertical talus, and congenital hip dysplasia.

Rehabilitation

The Rehabilitation Service provides exposure to the treatment of individuals with significant orthopaedic and neurologic impairment who require long-term hospitalization to achieve maximal independence. Primary responsibility is for care of those patients with spinal cord injury, multiple trauma, amputations, and head injuries, with secondary responsibility for patients with stroke and other neurologic abnormalities. Various outpatient clinics, including an amputee clinic, are held monthly to expose residents to the long-term problems which these patients encounter.

Oncology

The Orthopaedic Musculoskeletal Oncology Service provides an in-depth, multidisciplinary exposure to the diagnosis and management of musculoskeletal tumors. Bone and soft tissue neoplasms in both adults and children are covered. Clinical expertise includes histologic and radiographic diagnosis, adjuvant therapy, biopsy, and limb-salvage techniques. Research activities in cytogenetics, molecular genetics and in vitro osteoblast cultures focus on investigating the origin of bone tumors and the mechanisms of osteogenesis. Collaborative relationships are maintained with the Departments of Pathology, Cell Biology, and Pediatrics.