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Jenna Galloway: Stem Cells & Regenerative Medicine in Orthopaedics

Grand Rounds Video of Dr Jenna Galloway at Mass General Hospital, Boston, MA
Stem Cells & Regenerative Medicine in Orthopaedics

Jenna Galloway, PhD
Musculoskeletal Genetics & Regenerative Biology
Department of Orthopaedic Surgery
Grand Rounds presented on May 15, 2014 at the Massachusetts General Hospital, Boston, MA
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Orthopedic Trauma Initiative Launched

Mark Vrahas Mass General Trauma Surgeon Mark Vrahas, MD is the Chief of Partners Orthopaedic Trauma Service and Vice Chairman of the MGH Department of Orthopaedic Surgery.

In March 2014, Harvard Medical School welcomed the Harvard Medical School Orthopedic Trauma Initiative as part of an elite group of twenty-two Institutes, Centers, Divisions and Initiatives. We are proud to be part of this group and our new name is reflected in our updated masthead. The primary purpose of this Initiative is to foster collaboration amongst the orthopedic trauma services at all four Harvard Teaching Hospitals in Boston: Mass General, Children’s, Brigham and Women’s, and Beth Israel Deaconess. This effort (and a long effort it was) formalizes our dedication to ensuring excellent educational opportunities in musculoskeletal trauma for HMS students, our HCORP Residents, and Fellows in the Harvard Orthopedic Trauma Fellowship Program. As a group, our trauma surgeons will work together to develop clinical pathways, collaborate on clinical research, and be – in large part because of our size – the premier research center nationally and internationally. Continue reading

Thomas Cha: Role of Specialists in Accountable Care Organizations

Grand Rounds Video of Dr Tom Cha at Mass General Hospital, Boston, MARole of Specialists in Accountable Care Organizations:An Example of Spinal Stenosis
Thomas Cha, MD
Department of Orthopaedic Surgery
Massachusetts General Hospital,
Boston, MA
Grand Rounds presented on March 28, 2013 at the O’Keeffe Auditorium, Massachusetts General Hospital, Boston, MA
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Jon JP Warner: Value-Driven Shoulder Care

Grand Rounds Video of Dr Jon JP Warner at Mass General Hospital, Boston, MAValue-Driven Shoulder Care: Alignment of Stakeholders
Jon JP Warner, MD
Department of Orthopaedic Surgery
Massachusetts General Hospital,
Boston, MA

Grand Rounds presented on October 31, 2013 at the O’Keeffe Auditorium, Massachusetts General Hospital, Boston, MA
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Harvard Advances in Arthroplasty 2012

Harvard Medical School Advances in Arthroplasty Course

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In-Toeing Gait In Children

Intervention is often not necessary for children with in-toeing gait. Kids grow out of it.

If you observe people’s feet as they stand or walk, you may notice that their feet generally point straight ahead or perhaps slightly outward. However, many people point their feet inward. This is called in-toeing or pigeon toes.

In-toeing is common in young children, a frequent concern of many parents and a very common referral to our Pediatric Orthopaedic Clinic. In the overwhelming majority of patients, in-toeing corrects itself with time. Treatment is only necessary in a tiny fraction of patients.

“In-toeing does not lead to arthritis or interfere with sports. Toddlers who in-toe do tend to fall more frequently, because unlike adults, toddlers cannot increase the length of their strides, but can only increase the number of steps, which results in clumsiness and tripping,” asserts Dr Brian Grottkau, Chief of Pediatric Orthopaedic Surgery at the Massachusetts General Hospital, and Assistant Professor of Orthopaedic Surgery at Harvard Medical School, Boston, MA.

Causes of In-toeing Gait
The three most common causes of in-toeing in children are twisting of the thigh bone (femoral anteversion), twisting of the shin bone (internal/medial tibial torsion) and curved feet (metatarsus adductus). Your pediatric orthopaedic surgeon will evaluate your child and determine if in-toeing is coming from the hips, legs, or feet.

schematic of different types of In-toeing gait in children
Illustration by Navina Chabria – Thank you
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Femur Fractures Around Hip Implants

David Lhowe, MD, is an Orthopedic Trauma Surgeon, at Massachusetts General Hospital and Assistant Clinical Professor of Orthopaedic Surgery at Harvard Medical School.

Approximately 200,000 total hip replacements and an equal number of hemiarthroplasties are performed annually in the United States. With the marked success of this procedure, patients are able to maintain active lifestyles for many more years. Consequently, millions of elderly are at risk for fracture around their prosthesis.

Periprosthetic fractures typically result from common household falls. The Mayo Clinic reported a 1% prevalence of periprosthetic fracture after primary THR, increasing to 4% following revision surgery (1). Barring dramatic improvements in treating osteoporosis or reducing falls in an aging population, periprosthetic fractures will become an increasing medical and societal burden.

Fortunately, the majority of periprosthetic fractures do not result in implant loosening and may be managed without the need for implant revision. These fractures include the isolated trochanteric fractures (Vancouver A), diaphyseal fractures about a well-fixed stem (Vancouver B1), and fractures well below the distal tip of the stem (Vancouver C). Complex management with revision of components is required when the femoral stem is loose (Vancouver B2) and loosening is further complicated by inadequate bone stock (Vancouver B3). These variants are appropriately referred to experienced hip revision surgeons.

Femur fracture around well-fixed total hip replacement
Femur fracture around a well-fixed cemented THR component. Note the presence of a medullary cement plug in the distal fragment.
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