The doctors from the Agnesian HealthCare Center for Bone & Joint Health discuss what is going on in the world of orthopedics, including the most common diagnoses and the treatments offered to the patients.

1. MOVING ON
Orthopedics Throughout
Your Life
TW Grossman, Jr., MD, FACS
Agnesian Center for Bone & Joint Health

2. Our Team
Thomas Grossman, Jr.,
MD, FACS
Joe Kemp, MD Steven Magoline, MD

3. Our Team
Michael Mannebach, MD Karl Pennau, MD Alan Roetker, MD

4. Our Team
Clark Searle, MD Margie Anderson, APNP Meagan Kruck, PA-C

5. 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 surgeon
Correction of spinal and bony deformities are a
cornerstone of orthopedic practice.

6. 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

7. Top 10 Procedure List
10. 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

8. Orthopods Are Surgeons
• We are surgeons, but not everyone gets an
operation.
• In my practice about 50 percent of patients
are treated without surgery.

9. Children
• Children are not small
adults
• Unique anatomy of
growing bone
• Growth plate - cartilage
cells

10. 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

11. Children’s Fractures (continued)
• Greenstick
Fracture - bone
partially breaks

12. Greenstick Fracture

13. Torus or Buckle
• One side bends but does
not break
• Resembles bending a
plastic drinking straw

14. Children’s Fracture (continued)
• Most treated with immobilization
• Healing time usually four to eight weeks

15. 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

16. The ACL (continued)

17. ACL Anatomy
• One of two
crossing ligaments

18. ACL Anatomy (continued)

19. ACL Surgery

20. ACL Injury & Treatment
• Report a “pop”
• Rapid swelling
• Unsteady or trick
knee
• Men and women
are different

21. ACL Injury & Treatment (continued)
• The tears do not heal
• Non-operative
treatment
– Brace
– Strengthen quads and
hamstrings
• Operative Treatment
– Reconstruct ACL

22. Joint Replacement
• Arthroplasty - realign or
reconstruct joint to relieve
pain
• Hips, knees, shoulders,
ankles, knuckles
• Highly effective for pain relief
• Completely elective surgery

23. 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

24. Joint Replacement - Knee
• How?
– Open knee
– Machine thigh bone
(femur)
– Machine shin bone
(tibia)
– Glue in components
– Plastic insert

25. 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

26. 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

27. 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

28. Hip Fractures In the Elderly
(continued)

29. 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

30. Hip Fractures In the Elderly
(continued)

31. Hip Fractures In the Elderly
(continued)

32. Hip Fractures In the Elderly
(continued)

33. Hip Fractures In the Elderly
(continued)

34. Thank You!
Questions?