MOVING ONOrthopedics Throughout Your

Life

TW Grossman, Jr., MD, FACSAgnesian Center for Bone & Joint Health

Our Team

Thomas Grossman, Jr., MD, FACS

Joe Kemp, MD Steven Magoline, MD

Our Team

Michael Mannebach, MD Karl Pennau, MD Alan Roetker, MD

Our Team

Clark Searle, MD Margie Anderson, APNP Meagan Kruck, PA-C

Orthopedics - History• 1741 Orthos = Straight

Paidon = Child• 1780 First hospital dedicated to treatment

of children’s deformities• 1851 Plaster of Paris invented by a Dutch

military surgeonCorrection of spinal and bony deformities are a cornerstone of orthopedic practice.

Who Are We?About:

• 20,400 orthopedic surgeons

• 700 “new” per year

• Three to four percent of all physicians are orthopedic surgeons

• 90 percent male

• Average age is 55

• In Wisconsin, 9.9 orthopedic surgeons/100,000 people

• 563 in Wisconsin

Top 10 Procedure List10. Radius and Ulna Fracture Surgery

9. Rotator Cuff Surgery

8. Hip Replacement

7. Hip Fracture Surgery

6. Knee Replacement

5. Anterior Cruciate Ligament Reconstruction

4. Remove Plates and Screws

3. Carpal Tunnel Release

2. Shoulder Arthroscopy

1. Knee Arthroscopy and Menisectomy

Orthopods Are Surgeons• We are surgeons, but not everyone gets an

operation.• In my practice about 50 percent of patients

are treated without surgery.

Children• Children are not small

adults• Unique anatomy of

growing bone• Growth plate - cartilage

cells

Children’s Fractures

• Children do not get sprains - they get fractures

• The growth plate is “weaker” then the rest of the bone and is often injured

Children’s Fractures (continued)

• Greenstick Fracture - bone partially breaks

Greenstick Fracture

Torus or Buckle• One side bends but does

not break• Resembles bending a

plastic drinking straw

Children’s Fracture (continued)

• Most treated with immobilization• Healing time usually four to eight weeks

The ACL• ACL = anterior cruciate

ligament• Usually report “My knee

gave out”• Often football, basketball,

soccer, skiing or a slip and fall

• Twisting knee while running or cutting

The ACL (continued)

ACL Anatomy

• One of two crossing ligaments

ACL Anatomy (continued)

ACL Surgery

ACL Injury & Treatment

• Report a “pop”• Rapid swelling• Unsteady or trick

knee• Men and women

are different

ACL Injury & Treatment (continued)

• The tears do not heal• Non-operative

treatment– Brace– Strengthen quads and

hamstrings• Operative Treatment– Reconstruct ACL

Joint Replacement

• Arthroplasty - realign or reconstruct joint to relieve pain

• Hips, knees, shoulders, ankles, knuckles

• Highly effective for pain relief• Completely elective surgery

Joint Replacement – When?• When?– Must be “old enough”– Other measures (cane, crutches, walker,

rehabilitation, medications) no longer effective• Keep your original equipment as long as possible• Most patients say they waited too long to have it

done

Joint Replacement - Knee• How?– Open knee– Machine thigh bone

(femur)– Machine shin bone

(tibia)– Glue in components– Plastic insert

Joint Replacement - Hip

• How?– Open hip (back, outboard

side, inboard side, front, front from the outboard side)

– Machine the thigh (femur)– Machine the socket

(acetabulum)– Impact or glue in

components

Hip Fractures

• Surgery is the conservative treatment• Non-operative treatment - Bed rest, traction• Non-operative treatment is greater risk than

surgery– Pneumonia, blood clots, pressure sores, poor

outcome• Risk of death following hip fracture 20 to 35

percent within one year

Hip Fractures In the Elderly• About two percent of falls yield a fracture• Most commonly due to

brittle bones (osteoporosis)• 80 percent are women• Average age - 77 women• Average age - 72 men• 310,000 per year in the United States

Hip Fractures In the Elderly (continued)

Hip Fractures In the Elderly

• Surgery sooner rather then later– Align the fracture– Stabilize with an implant– In some instances, “half replacement” (hemi

arthroplasty”– Rarely hip replacement

Hip Fractures In the Elderly (continued)

Hip Fractures In the Elderly (continued)

Hip Fractures In the Elderly (continued)

Hip Fractures In the Elderly (continued)

Thank You!

Questions?