Ortho Hyperguide


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ORTHOPEDICS HYPERGUIDE

Program Goals and Target Audience
The goal of the ORTHOPEDICS HYPERGUIDE is to provide an interactive study tool and educational resource for orthopedists, resident orthopedists, and professionals in the field of orthopedics.

Educational Objectives
See each Module's objectives below.

Accreditation
Vindico Medical Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation
Vindico Medical Education designates this educational activity for a maximum of 50 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Nurses and Surgical Technicians
Continuing medical education credits may be applied toward licensure requirements in those states that recognize ACCME accredited providers. Please check with your state accreditation board for specific guidelines.

International
The educational activity on this site is designated for AMA PRA Category 1 Credits™ for US physicians only. The national orthopaedic associations in other countries may have reviewed this activity and granted CME equivalents. All non-US surgeons should contact their respective Boards for accreditation/credit status.

Commercial Acknowledgement
This continuing medical education activity is supported by an educational grant from Stryker.
The osteoarthritis module is supported by an educational grant from Genzyme Biosurgery.

Release Date: January 1, 2008 Expiration Date: December 31, 2010

Disclaimer

The material presented on the ORTHOPEDICS HYPERGUIDE Web site does not necessarily reflect the views of Vindico Medical Education, the authors, and the company providing an educational grant in support of the activity. The material may discuss uses and products that have not been approved by the U.S. Food and Drug Administration. All readers and continuing education participants should verify all information and consult a qualified healthcare professional before treating patients or utilizing any product discussed in this continuing medical education activity.

Full Disclosure Policy

In accordance with the Accreditation Council for Continuing Medical Education's Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of the planners, teachers, and authors involved in the development of CME content. An individual has a relevant financial relationship if he or she has a financial relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control. Relationship information appears below.

Faculty Disclosure



Faculty participating in the ORTHOPEDICS HYPERGUIDE has provided the following information that is accurate at the time of printing.

Faculty MemberRelationship identified with
Stephen Abelow, MDNo relevant financial relationship to disclose.
Matthew S AustinSpeaker's Bureau: DePuy
Bernard R Bach, JrNo relevant financial relationship to disclose.
Sam Bajaj, BENo Relationship to Disclose
Jack Barker, PhD.No Relationship to Disclose
Katherine BarnumNo relevant financial relationship to disclose.
Enrique Gomez BarrenaNo relevant financial relationship to disclose.
Jack Bert, MDConsultant (Paid only for service rendered): Exactech, Wright Medical Technology. Genzyme, ReGen
Ashley BlomConsultant: Stryker
Lester S BordenConsultant: Stryker Orthopaedics
Gavin BowyerNo relevant financial relationship to disclose.
Kenneth D Brandt, MDConsulting Fees: Pfizer, AstraZeneca, Purdue Pharma, Bioiberica, Covidien, Nicox, Ferring, Sanofi-Aventis Ownership Interest: Pfizer
Volker BuehrenNo relevant financial relationship to disclose.
Miguel E CabanelaConsultant: Stryker; Scientific Advisor: Stryker; Royalties: Stryker
Ruggero CadossiStockholder: IGEA
William N CapelloConsultant: Stryker
John CapoNo relevant financial relationship to disclose
Pedro CarpinteroNo relevant financial relationship to disclose.
James B CarrNo relevant financial relationship to disclose.
Fabio CataniNo relevant financial relationship to disclose.
Kenneth MC CheungNo relevant financial relationship to disclose.
Kevin C ChungNo relevant financial relationship to disclose.
Brian Cole, MDRoyalty: Arthrex, Stryker. Consulting Fees: Genzyme, Arthrex, Zimmer. Research Funding: RTI, Genzyme, Arthrex, Pfizer, Dj Ortho, Zimmer.
Cory A CollingeNo relevant financial relationship to disclose
Christina ColsmanConsultant: Stryker
R. Alexander CreightonNo relevant financial relationship to disclose.
Robert D D'AmbrosiaNo relevant financial relationship to disclose.
James A D'AntonioConsultant: Stryker; Speaker's Bureau: Stryker; Research Grant: Stryker
Michael DaytonConsultant: Smith & Nephew Orthopaedics
Ronald E DelanoisNo relevant financial relationship to disclose.
Douglas A DennisGrant/Research Support: DePuy Orthopaedics, Zimmer, Biomet; Consultant: DePuy Orthopaedics
Kyle DicksonNo relevant financial relationship to disclose.
Douglas DirschlNo relevant financial relationship to disclose.
Martin DominkusNo relevant financial relationship to disclose.
Jonathan EldridgeConsultant: Stryker
Payam FarjoodiNo relevant financial relationship to disclose.
Thomas K FehringConsultant: DePuy
Amon T FerryNo relevant financial relationship to disclose.
James FlintNo relevant financial relationship to disclose.
Francisco ForriolNo relevant financial relationship to disclose.
Frank FrassicaStockholder: Stryker and Zimmer
Alan FreelandOther Financial or Material Support: AO/ASIF; Churchill Livingston Publishers
Michael FreemanConsultant: Stryker
Xavier GallartNo relevant financial relationship to disclose.
Marc Garcia-EliasNo relevant financial relationship to disclose.
Bhavuk GargNo relevant financial relationship to disclose.
Rudolph G T GeesinkConsultant: Stryker
Joseph GjolajNo relevant financial relationship to disclose.
Jeffrey A GreenbergConsultant: Stryker
Kenneth A GreeneConsultant: Stryker
Gary S GruenNo relevant financial relationship to disclose.
Robert C GrumetNo relevant financial relationship to disclose.
Enrique GueradoConsultant: Stryker
Ranjan GuptaNo relevant financial relationship to disclose.
Peter GutsfeldSpeaker's Bureau: Stryker
Fares HaddadNo relevant financial relationship to disclose.
David HakConsultant/Speaker's Bureau: Medtronics
Arlen D HanssenNo relevant financial relationship to disclose.
Samuel HarmsNo relevant financial relationship to disclose.
Steven F HarwinGrant/Research Support: Stryker Howmedica Osteonics; Consultant: Stryker Howmedica Osteonics; Scientific Advisor: Stryker Howmedica Osteonics; Product Designer: Stryker; Other Financial or Material Support: Stryker Howmedica Osteonics; Royalties: Stryker Orthopaedics; Stockholder: Stryker Orthopaedics
Daniel S HeckmanNo relevant financial relationship to disclose.
Craig HoganNo relevant financial relationship to disclose.
Colin HowieNo relevant financial relationship to disclose.
Michael H HuoConsultant: Stryker, Zimmer, Boehringer Ingelheim, Portola; Speaker's Bureau: Sanofi-Aventis
David J JacofskyConsultant: Stryker; Royalties: Stryker, Smith & Nephew; Grant: Stryker, Smith & Nephew, Ortho Fix; Research: Stryker
Clifford JengConsulting Fees: DePuy, Ortho Helix
Timothy JudkinsNo relevant financial relationship to disclose.
Atul Kamath, MDNo Relationship to Disclose
Michael A KellyConsultant: Zimmer; Designer: Zimmer
James Kercher, MDNo Relationship to Disclose
A. Jay KhannaConsulting Fees: Orthofix Spine, DePuy Spine Ownership Interest: New Era Orthopaedics, LLC.
Young-Hoo KimNo relevant financial relationship to disclose.
Richard KimNo relevant financial relationship to disclose.
Dieter KohnConsultant: Stryker
Rainer KotzNo relevant financial relationship to disclose.
Kenneth J KovalConsultant: Stryker, EGI, Biomet; Designer: Biomet; Royalties: Biomet
Marshall Kuremsky, MDNo Relationship to Disclose
Soren LarsenConsultant: Stryker
Bryan LeBudeNo relevant financial relationship to disclose.
Wilson LiNo relevant financial relationship to disclose.
Thomas R LyonSpeaker's Bureau: Stryker Incorporated, Medtronic; Consultant: Stryker
Rajesh MalhotraNo relevant financial relationship to disclose.
Augustus D MazzoccaResearch Grant Recipient: Arthrex, Inc.
Michael D McKeeConsultant: Zimmer, Stryker; Research Support: Stryker Biotech.
David A McQueenGrant/Research Support: Stryker Howmedica Osteonics, Stryker; Consultant: Stryker Howmedica Osteonics, Stryker
Simon C MearsResearch Grant: Zimmer
Michael MeneghiniConsultant: Zimmer
Mario MercuriResearch Grant Receipient: Stryker International.
Tony MilesConsultant: Stryker
Wolfram MittlemeierNo relevant financial relationship to disclose
Michael A MontGrant/Research Support, Consultant, Scientific Advisor: Stryker Howmedica Osteonics
Seong-Hwan MoonNo relevant financial information to disclose
Hugh B. Morris, MDConsulting Fees: Stryker Orthopaedics
Amir H MostofiNo relevant financial relationship to disclose.
Brian H MullisConsultant: Stryker Biotech, Speaker's Bureau: Stryker Trauma, Smith & Nephew, AO Syn Res.
Michelle NapoliNo relevant financial relationship to disclose.
Shane NhoNo relevant financial relationship to disclose.
Trevor OrenNo relevant financial relationship to disclose.
Anne E OuelletteNo relevant financial relationship to disclose.
Brett D OwensNo relevant financial relationship to disclose.
Costas G PapakostidisNo relevant financial relationship to disclose.
Javad ParviziConsultant: Stryker Orthopaedics.
Dana Piasecki, MDNo Relationship to Disclose
Andrew PortNo relevant financial relationship to disclose.
Robert A ProbeConsultant: Stryker; Speaker's Bureau: Stryker, Synthes, Zimmer
Chitranjan S RanawatGrant/Research Support: Stryker; Royalty: Stryker; Consultant: Stryker, DePuy
Ville M RemesNo relevant financial relationship to disclose.
Paul RivatConsultant: Stryker
Jose A RodriguezNo relevant financial relationship to disclose.
Melvin P RosenwasserNo relevant financial relationship to disclose
Richard H RothmanConsultant: Stryker; Royalties: Stryker
Ian D RussellNo relevant financial relationship to disclose.
Nicholas K SablanNo relevant financial relationship to disclose.
Michael Salata, MDNo Relationship to Disclose
Danielle L ScherNo relevant financial relationship to disclose.
John R Schurman IIGrant/Research Support: Stryker Howmedica Osteonics; Consultant: Stryker Howmedica Osteonics
William H Seitz Jr.Consultant: Stryker, SBI, Inc., Kapp Surgical; Research Support: Arthrocare.
Milan SenConsultant: Stryker, Honorarium: Synthes, Smith & Nephew
Steven ShamashNo relevant financial relationship to disclose.
Rafael J SierraNo relevant financial relationship to disclose.
Hamish Simpson, MDNo relevant financial relationship to disclose.
Daniel J SolomonNo relevant financial relationship to disclose.
John Sperling, MDRoyalty: Biomet Aircast
Consulting Fees: Tornier
Ownership Insterest: Tornier
Paul D SponsellerGrant and Research Support: DePuy Spine; Consultant: Globus
Scott Steinmann, MDRoyalty: Depuy
Consulting Fees: Arthrex, Wright
Jason StonebackNo relevant financial relationship to disclose.
Michael StrassmairSpeaker Bureau: Stryker
Eric Strauss, MDNo Relationship to Disclose
Christina Stukenborg-ColsmanConsultant: Stryker
Eric TanNo relevant financial relationship to disclose.
George Theodore, MDNo Relationship to Disclose
Marc ThomsenNo relevant financial relationship to disclose
Soren Toksvig-LarsenConsultant: Stryker
Andrew TomsNo relevant financial relationship to disclose.
Laura L TosiConsultant: Merck
Michael UllmanNo relevant financial relationship to disclose
Vilmos VecseiNo relevant financial relationship to disclose.
Nicholas VendemiaNo relevant financial relationship to disclose.
Rene VerdonkNo relevant financial relationship to disclose.
Nikhil N. Verma, MDRoyalty: Smith & Nephew. Property Rights/Patent Holder: Smith & Nephew. Consulting Fees: Smith & Nephew. Fees for Non-CME Services: Arthrosurface. Contracted Research: Anthrex, Smith & Nephew. Ownership Interest: Omeros. Fellowship Support: Arthrex, Smith & Nephew, Ossur, DonJoy.
Vindico Medical Education StaffNo relationship to disclose
Kathy Weber, MDNo Relationship to Disclose
Jennifer M WolfNo relevant financial relationship to disclose.
Alexander WoltmannNo relevant financial relationship to disclose.
Tomokazu YoshiokaNo relevant financial relationship to disclose.

Signed Disclosure(s) are on file at Vindico Medical Education, Office of Medical Affairs of Compliance.

Eligibility for Credit

Continuing medical education credit will be awarded to all physicians who successfully complete this activity as described in the section Instructions for Credit.

Instructions for Credit

To successfully complete this educational activity and receive credit, participants must follow these steps during the period January 2002 through December 2010.

1. Spend time learning on the ORTHOPEDICS HYPERGUIDE Web site by reading the tutorials, answering the practice questions, and viewing the online lectures. The materials have been designed to provide a useful link between the content and your everyday practice.
2. Read the overall activity goal and educational objectives for each module.
3. Complete an activity evaluation for the ORTHOPEDICS HYPERGUIDE CME activity.
4. Complete the enrollment form. Please type your name and mailing address on the enrollment form. Vindico Medical Education will verify your time spent online. Upon receipt of your program evaluation, Vindico Medical Education will issue an AMA Physician's Recognition Award category 1 credit certificate via email. You must print the certificate from your computer and maintain it for your records as verification of your participation in the educational activity. Your total credits will be maintained in a database at Vindico Medical Education.

Learning Objective for the ORTHOPEDICS HYPERGUIDE

Adult Orthopedics

  1. Review the anatomy of the musculoskeletal system.
  2. Discuss current internal prosthetic design for the hip and knee.
  3. Describe types, symptoms, and treatment of shoulder injuries.
  4. Review the common surgical procedures (nerve and vessel repairs and fracture fixations) of the arm and forearm.
  5. Describe instrumentation that is frequently used in adult orthopedic procedures.

Basic Science

  1. Explain the biomechanical forces that break bone, shear cartilage, and stretch tendons.
  2. Review biochemical principles of connective tissues.
  3. Discuss the importance of immunology in understanding the acceptance/rejection of nerve, bone, and tendon grafts.
  4. Explain how the methods of affixing external prosthetics have changed in the past 20 years.
  5. List the chemical properties of collagen.

Foot and Ankle

  1. Review the functional anatomy and topography of the foot and ankle.
  2. Specify the general considerations, clinical evaluation, and surgical options for hallux rigidus and hallux valgus.
  3. List common fractures of the foot and ankle.
  4. Discuss treatment of acute rupture of the achilles tendon.
  5. Describe clinical and applied biomechanics of the foot and ankle.

Hand

  1. Review the anatomy of the hand including muscles, ligaments, nerves, and bones.
  2. Recognize deformities caused by rheumatoid arthritis, nerve injuries, and congenital defects.
  3. Differentiate among types of tendon surgeries of the hand.
  4. Explain how infections of the hand may result in compartmental syndrome.
  5. List common fingernail injuries and explain the steps of treatment.

Orthobiologics & Pharmacologics

  1. Define the terms osteoconduction, osteoinduction, and osteogenesis as they relate to bone healing and bone graft substitutes.
  2. Understand the mechanical properties of different osteoconductive bone graft substitutes.
  3. Describe the different clinical indications for osteoconductive bone graft substitutes versus osteoinductive bone morphogenetic proteins.
  4. Review the available clinical studies which have evaluated the use of different bone graft substitutes.

Osteoarthritis

  1. Assess the incidence of osteoarthritis in the orthopedic practice and identify patients at risk for developing osteoarthritis.
  2. Compare the guidelines and standards established by the American Academy of Orthopaedic Surgeons, American College of Rheumatology and other national initiatives that define the appropriate use of and standards for osteoarthritis treatment, management and prevention to improve patient health.
  3. Evaluate current and future therapies to assist in the treatment and prophylaxis of osteoarthritis.

Pediatric Orthopedics

  1. Recognize types of congenital deformities.
  2. List types of skeletal dysplasias.
  3. Discuss pediatric spinal deformities and treatment options, both operative and nonoperative.
  4. Identify injuries frequently associated with child abuse.
  5. Explain the etiology, types, symptoms, and treatment of connective tissue disorders.

Spine

  1. Review the general anatomy of the spine.
  2. Discuss conservative forms of treatment for spinal cord injuries.
  3. Recognize the disorders of the cervical, thoracic, lumbar, and sacral spine.
  4. State the steps in treating infections of the spine including disk, vertebral, epidural, and postoperative infections.
  5. Discuss the etiology and manifestations of tumors and differentiate among the types of tumors.

Sports Medicine

  1. Classify fracture types according to anatomic location.
  2. Define the nature and degrees of bone healing.
  3. Identify the most common sprains associated with the shoulder, knee, and ankle.
  4. Explain why most sports-related injuries are the result of muscle and tendon overuse rather than a specific sprain or strain.
  5. Identify sports-related injuries of the soft tissue.

Trauma

  1. Review the principles of the Gustilo Classification, the Mangled Extremity Score (MESS), and the Injury Severity Score (ISS).
  2. Identify the difference between an amputation and a disarticulation and list the indications for each procedure.
  3. List the steps of managing an open fracture wound.
  4. Describe the various types of fixation devices that are used during open reduction and internal fixation (ORIF).
  5. List common traumatic injuries of both adult and pediatric upper and lower extremities.

Tumor

  1. Differentiate between malignant bone-forming tumors and benign bone-forming tumors.
  2. Compare and contrast the characteristics of benign cartilage tumors and malignant cartilage tumors.
  3. Describe the various forms of destructive lesions that are found in the older patient population.
  4. Discuss presentation, treatment, and prognosis of rare tumors.
  5. State the three types of malignant fibrous lesions and list the characteristics of each lesion.

Case of the Month

A 46-year-old male, nonsmoker, presented with clubbing and pain in his digits. A radiograph of both hands was obtained.


your diagnosis?

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