This Wednesday, May 19th, is the Grant Medical Research Sharing Day.

For over 20 years at Grant Medical Center, physicians have come together to share their research among their peers. This is a great opportunity for Doctors of all specialties to come together and share their accomplishments and findings in order to improve patient care and outcomes. Orthopedic Foot and Ankle Center (OFAC) is excited to help continue this tradition.

We are happy to announce that OFAC has 9 contributions to share at this year’s event:

• Cannulated Screw Fixation of Jones 5th Metatarsal Fracture: A Comparison of Titanium and Stainless Steel Screw Fixation. This poster and research is presented by Dr. Hyer, Dr. Cuttica, and Dr. DeVries.
• Bi-Plane Chevron Medial Malleolar Osteotomy for Increased Exposure of the Medial Talar Dome. This topic and poster is presented by Dr. DeCarbo, Angela Granata, and Dr. Hyer.
• Evaluating Two Types of Fixation for a 1st Tarsometatarsal Arthrodesis: A retrospective comparative cohort. This presentation is brought to us by Dr. DeVries, Dr. Hyer, and Dr. Jaymes Granata.
• The Use of Bone Growth Stimulators in Diabetic Patients: A Retrospective Case Series of Ankle Fusions. This poster and research is presented by Dr. Jaymes Granata, and our own Dr. Philbin.
• Xenograft Soft Tissue Scaffold for Tissue Augmentation in Foot & Ankle Surgeries. This presentation and research is presented by our own Dr. Hyer, Dr. Berlet, and Dr. Lee.
• Interpositional Arthroplasty of the First Metatarsalphalangeal Joint Using a Regenerative Tissue Matrix for the Treatment of Advanced Hallux Rigidus: 5 Year Case series Follow-up. This poster and study is presented by Dr. Hyer, Dr. Jaymes Granata, Dr. Berlet, and Dr. Lee.
• A Retrospective Review of First Metatarsophalangeal Joint Arthrodesis Using a Locked Plate and Compression Screw Technique. This presentation is brought to you by Dr. Ringus, Dr. Michael Swiatek, and Dr. Hyer.
• A Retrospective Review of Insertional Achilles Tendinosis Treated with the Dual Incisional Surgical Technique. This poster will be presented by Dr. Ringus and Dr. Lee.
• A Retrospective Comparison of Four Plate Constructs for First Metatarsophalangeal Joint Fusion: Static Plate, Static Plate with Lag Screw, Locked Plate, Locked Plate with Lag Screw. This research was conducted and is presented by Dr. Michael Swiatek, Dr. Ringus, and Dr. Hyer.

If you have little-to-no clue as to what half of these topics are – don’t feel bad, our Docs are pretty smart. All of these posters and research from not just the OFAC team, but from all the other great researchers and doctors will be presented at the Grant Medical Center Auditorium. Poster presentations will run from 7 to 9am, and oral presentations will be from 9:30 until 11:30am. After all that, a set of awards will be presented to our winners around 11:45 am.

Please join us in congratulating all the talented researchers and doctors that continue to advanced not just our field, but the Medical profession overall.

Columbus Orthopedic Symposium

Orthopedic Foot and Ankle Center (OFAC) is pleased to host the 7th Annual Columbus Orthopedic Symposium. If past years are any indication, this will be a great event, with a fast paced and energetic line up of presenters. The program will be held at the Westerville Medical Campus, and give a brief overview of what is new and great in the orthopedic world. Attendees can also earn up to 5 credit hours of Continued Medical Education (CME). Dr. Philbin has put together an exciting group of speakers for this year’s event. This conference is intended for Primary Care Physicians, Physical Therapists, Athletic Trainers, Orthopedic Surgeons, and Podiatrists but we certainly encourage those outside these medical arenas to attend.

This year the program is designed to give the attendees a better perspective on the current practice of the sports medicine and orthopedic surgery, as well as focus on how physicians are using a team approach to care for diabetes patients with lower extremity concerns. Attendees will also learn how the current and future use of social media will impact healthcare. The overall purpose and goal of attending is to give physicians, physical therapists, and athletic trainers useful tools and information on these topics in order improve their practice and patient care. After attending, participants should be more confident in their ability to assess best practices for the treatment of common sports injuries, utilize the team approach in managing lower extremity concerns diabetic patients, and summarize the management of Charcot deformities.

The morning will start with registration at 7am and a welcome from Dr. Philbin at 7:30am, followed by 2 hours of presentations focused primarily on sports related injuries and sports medicine. After a short break and Q&A session, the 10am presentations will begin, focusing on extremity challenges. Around 11am, the presentations will shift focus to diabetes challenges. At 12:30, attendees will hear from a great resource on social media as it relates to healthcare, and at 1pm a short Q&A will wrap-up the day.

We are grateful for the support of the Arthritis Foundation of Central Ohio, OhioHealth, as well as numerous vendors. Without their support this event would not be a success. We invite you to join us for what is sure to be an exciting and beneficial program. The registration deadline is May 14th, or when the maximum attendance capacity has been reached.

Admission is $75 for Physicians, $50 for Allied Health Care Professionals, and free for Residents and Medical Students.

Date:
Saturday, May 22, 2010

Place:
Westerville Medical Campus
300 Polaris Parkway
Westerville, OH 43082
Phone:(614) 533-3000

For more information, please contact Lexie Sines at (614) 566-4675

On January 12th, 2010 at 4:53pm, an earthquake struck 7.0 on the Richter scale just 10 miles south of Port-au-Prince.

With 2 weeks notice, Columbus Team 5 responded. This is our story.

_____

As was mentioned in Dr Decarbo’s earlier link, the physicians of OFAC were awarded an “Honorable Mention” in the Manuscript Competition at the 68th Annual Scientific Conference of the American College of Foot and Ankle Surgeons in Las Vegas, Nevada. Congratulations to Dr Decarbo, lead author of the winning manuscript!

OFAC also presented 2 other manuscripts and 12 scientific poster presentations. The physicians of OFAC continue to lead the charge in education and research in the field of foot and ankle surgery. This was the single largest presence of any group or institution in the entire country.

Our other manuscripts were:

1. Evaluation of Two Types of Fixation for a 1st Tarsometatarsal Arthrodesis: A Retrospective Comparative Cohort. Authors: Drs. DeVries, Granata and Hyer

2. Age Stratification of Outcomes for Osteochondral Lesions of the Talus. Authors: Drs Deol, Berlet, Hyer, Philbin, Lee

Our scientific posters were:

1. A Retrospective Review of First Metatarsophalangeal Joint Arthrodesis Using a Locked Plate and Compression Screw Technique. Authors: Drs Ringus, Swiatek, Hyer

2. A Retrospective Comparative Analysis of Charcot Ankle Stabilization using an Intramedullary Rod with and without Application of Circular External Fixator. Authors: Drs DeVries, Hyer

3. Xenograft Soft Tissue Scaffold for Tissue Augmentation in Foot & Ankle Surgeries. Authors: Drs Hyer, Berlet, Lee

4. Conversion of Failed Total Ankle Arthroplasty to Tibial Stemmed Prosthesis: Techniques for Anterior and Posterior Approaches. Authors: Drs DeVries, Hyer, Berlet, Lee

5. A Retrospective Comparison of Four Plate Constructs for First Metatarsophalangeal Joint Fusion: Static Plate, Static Plate with Lag Screw, Locked Plate, Locked Plate with Lag Screw. Authors: Drs Swiatek, Ringus, Hyer

6. Surgical Technique: Retrograde Drilling of Medial Osteochondral Lesions of the Talus. Authors: Drs Hyer, Berlet, Lee, Granata.

7. Autogenous Bone Graft Harvest Using Reamer Irrigator Aspirator (RIA) Technique for Tibiotalocalcaneal Arthrodesis. Authors: Drs Cuttica, DeVries,Hyer

8. Porcine Dermal Matrix for Tendon Augmentation; A Prospective, Multi-center Series. Authors: Drs. Hyer, Liden

9. Cannulated Screw Fixation of Jones’ 5th Metatarsal Fracture: A Comparison of Titanium and Stainless Steel Screw Fixation. Authors: Drs Hyer, Cuttica, DeVries

10. Interpositional Arthroplasty of the First MTP Joint Using a Regenerative Tissue Matrix for the Treatment of Advanced Hallux Rigidus: 5-year Case Series Follow-up. Authors: Drs Hyer, Granata, Berlet, Lee

11. Wound Complications in Operative Treatment of Calcaneal Fractures. Authors: Drs DeCarbo, A. Granata, Hyer

If you have any questions or interest in these posters or manuscripts, please don’t hesitate to contact OFAC for more information.

In addition to our large research presence at ACFAS, the physicians of OFAC also led educational lab and lecture sessions on the following:

1. Advanced Techniques in Diabetic Reconstruction Workshop: Dr Hyer

2. The Evolution of Surgery: Dr Hyer

3. Surgery in the Advanced Aged Flatfoot: Dr Hyer

4. Curbside Consult Forum: Dr DeCarbo

5. Traumatic Complications-Malunited Ankle Fractures: Dr Hyer

6. Cavus Foot Reconstruction Workshop: Dr Hyer

As you can see, the physicians of OFAC are the leading experts in all aspects of foot and ankle care. If you need the highest level of expert care, don’t hesitate to contact us.

“Be safe”… probably the most common statement made to me as I prepared for my trip here. I appreciated the undertones of comfort and security. A nurturing statement that my mom would have said as I walked to preschool.

“Be safe”.  It infects nearly every decision.  Because the water is not drinkable, a slight mistake brushing your teeth can lead to days of diarrhea.  The dirt road separating the hospital from our cabin has large trucks and buses barreling along at 45 mphs.  Besides getting run over, the shower of rocks and pebbles pelt my surgical eyeglasses and headlamp that I wear all the time.  If you forget your bug repellant or your malarial medication, any one of my numerous and growing mosquito bites would be the concern for serious illness.  During one of our surgeries yesterday, safety was never more evident as one of our very own team members sat in the corner with an IV to hydrate as we addressed a child’s perforated intestine.

Safety is a constant process that weighs on every decision.  In surgery, we have to organize our own equipment.  Because there is only one sterilizer, if you forget an instrument, a scissor, a scalpel, or a screw, you will have to wait nearly 30 minutes before that critical tool is available.  Forget twice and it’s an hour. An hour more of anesthesia is also an hour more for the flies to roost on your surgical field and an hour more of danger for your patient.

There is no easily available x-ray.  To x-ray a patient a team member has to transfer the patient on a wobbly wooden stretcher and pull the cart across the gravel road 300 yards to the ancient machine where a near nuclear dose of radiation will produce a gray plastic image to be read like tea leaves.  There is no safety in making orthopedic decision without x-ray.  There is no safety in surgery without proper instruments.  How would we know if our bones are straight or if our screws are too long or too short?  How would we put a screw in without the proper screwdriver? Like Hamlet agonizing over death, we ask, “to be safe or not to be safe”.  I wonder which will lead to more regret.  I know what it means to be safe.  But do I know what it means not to be safe?

There is a patient here with a complex femur fracture.  We were planning an operation to fix it without x-ray or the proper insertion equipment.  If the surgery went smoothly, we could straighten his crooked leg in 30 minutes.  If it went badly, we would struggle for hours and then amputate his leg.  In the aftermath of our recent death, I chose to be safe. Far better, I reasoned, for him to have a crooked leg than no leg at all.  There was no need to be dangerous.

As I unpacked newly arrived crates of equipment today, the insertion tools for his operation hid in the corner of the box.  Then a pick up truck began backing into the dusty entrance with an 1800 lb crate protecting a full size portable x-ray machine.

Goethe said, “be bold and great forces will come to your aid”.  As I looked at the newly arriving aid, I regret the decision I made for my patient.  It is too late in the week to tackle such a large operation. Fortunately, it will be an easier decision for next week’s team.  So I wonder about the words “be safe”.  What is the opposite?  Is it “be dangerous”?

Like a man standing in the middle of the highway, he must decide to jump left or to jump right.  Because to play it safe and stand still will lead to a far worse outcome.

The opposite I think is “be bold”.  By coming to Haiti, I have learned that I may never have enough information or equipment to make a perfect decision and that even an imperfect decision may be better than no decision at all.

Haiti street scene before earthquake

At 4:53:09 pm on January 12, 2010, 15 miles southwest of the capital city of Port-au-Prince, Haiti, an earthquake measuring 7.0 on the Richter scale struck. In the ensuing days, its estimated that 200,000 people lost their lives.  As phone camcorders documented the Asian tsunami disaster, Twitter and blog feeds recorded the devastation in real time.  For many of us on Twitter at the time, we’ll recall the flurry of activity on our Tweetdecks.

As an active orthopedic practice with some experience in humanitarian missions, the question of how to help came up rapidly.

Several influential teams responded rapidly. Here is an email from Dr. Dean Lorich who participated in a rapid response team within the first week:

I believe we went in with a reasonably comprehensive service we wanted to provide acute trauma care in an orthopedic disaster.  Our plan was to be at a hospital where we could utilize our abilities as trauma surgeons treat the acute injuries involved in an orthopaedic disaster.  We expected many amputations however came with a philosophy that would reasonably start limb salvage in what we thought was a salvageable limb.

David Helfet put a team together which  included:
2 orthopaedic trauma surgeons
3 orthopaedic trauma fellows
2 highly skilled anesthiologists
1 general surgery trauma surgeon
2 synthes reps who were also scrub techs
1 trauma nurse practioner to do triage
2 OR nurses

Our equipment including a huge amount of anesth medications and equipment, ability to construct 150 ex fix both small and large, OR equipment including scalpels etc, OR soft goods, splint material, OR prep material.

We also had a plan of physician and equipment replacemnt that was dynamic where w/i 24hrs we could bring in what was necessary on the Synthes private jet.

We thought the plan was a good one.

We were incredibly naïve.

Disaster management on the ground was nonexistent.  The difficulties in getting in despite the intelligence we had from people on the ground and david helfet’s high political connections with Partner’s in Health as well as the Clintons only portended the difficulties we would have once we arrived.

We started out friday morning, got a slot to get in friday that was eventually cancelled when we were on the runway to be rescheduled the next day.  We diverted to the DR and planned on arriving in P OP saturday.

Once on the ground the hospital we had intelligence that was up and running with 2 OR’s General Hospital was included severely in the earthquake and not capable of running functioning OR’s as there was no running water and only a limited electrical supply on generator.

We quickly took our second option
Community Hospital of Haiti.  We found approx 750 pt in the hospital upon our initial eval, the hospital had running water, electricity and 2 functional OR’s
Our naivette did not expect that the 2 anesth machines would not work, there would be 1 cautery for the hospital, autoclave that fit instruments the size of a cigar box, no sterile saline, no functioning fluoro and no local staff only a ragtag group of voluntary health providers who like us had made it there on there own.

To summarize we had no clue the medical infrastructure of the country was so poor.

As we got up and running in the OR and organized the patients for surgery we communicated our new needs back to Synthes and more supplies were loaded for a second trip – these included battery operated pulse lavage, a huge supply of saline, soft goods in the OR.  This plane landed as planned sunday pm, equipment was loaded on a truck and subsequent hijacked between the airport and the hospital.

At the hospital we had zero security despite promises form NYPD and NYFD to provide that to us.

Our philosophy was to work like this was a marathon run the OR’s around the clock with the idea that we would have a defined extraction time of 11pm tues.  The plane that extracted us would come in with a new medical staff compliment to replace us. Equipment included urgent things to maximize issues that were nonexistent in the hospital that would enable us to provide better and more efficient care:
2 portable anesth machines
2electrocautery
2 portable monitors for the pacu
2autoclaves
Replacement exfix
Things that didn’t arive with the previous flight

That planes slot was cancelled by the military at 6am tues.
We also previously had seen daylight in the remaining patients monday night haviving completed approx 100 surgeries.  However on tues morning we found a huge # of new patients.  The hospital was forced to undergo lockdown closing its gates to the outside and outside crowd becoming angry.

We also noted tues morning that many of the patients we were operating on were becoming septic.
We finished operating at noon tues, the last surgery our group assisting an obstetrician on a caesarian and resuscitating a baby that was not breathing.

We decided as a group the situation for us at the hospital was untenable supplies were running out, team was exhauted, safety a huge concern, and no extraction plan with resupply.  We decided to make our way to airport thru the help of a hospital benefactor.  Jamaican soldiers with M-16 were necessary to escort us out with our luggage as the crowd outside saw us abandoning the hospital.

We made it to airport on back of a pickup track, got onto the tarmac, hailed a commercial plane that carried cargo to montreal and had private jet pick us up there.

The issues we were unprepared for and witnessed were
1.  The amount of human devastation
2.  The complete lack of a medical infrastructure in the country
3.  The lack of support of the haitian medical community
4.  The complete lack of any organization on the ground.  Noone was in charge, we had the first functional up and running hospital in the P OP area yet noone and I me NOONE came to the hospital to assess what we were doing, what we were capable of doing and what we would need, to be more efficient. The fact that the military could not or would not protect the resupply equipment on sunday or let the tues flight come in says it all.
5.  Lack of any security at all at the hospital

I would take away that disasters like this need organization on a much higher level than we had with the clear involvement and approval of the military from the beginning.

Currently there is Noone obviously running the show and care is in chaotic at best.  MD’s are coming in country with no plan of what the are going to do. Surgeons that expect to just show up and operate are delusional as to what there role would be as without a complement of support staff and supplies they would be of limited or no value.

I hope this helps.  We all felt as though we abandoned these patients and that country and feel terrible.  Our role now being back in NY is to expose the inadequacies of the system to the media in the hopes of effecting a change in this system immediatly.  We feel that the only way to really help now is an urgent programtic change and organization in the support of the medical staff on the ground and what is critically needed to expeditiosly bring in.

Cherrios on the tarmac are not getting it done on these patients which clearly would be savable if good care could urgently be provided.

Please share this email with everyone and anyone you find might help.

Good luck
Dean

With these obstacles in mind, Minh Nguyen MD, a chief resident at the Ohio State University recalled an established organization he interacted with while riding his bicycle across America fund raising for Partners in Health.  This group, Project Help Haiti, ran an established orphanage in Pierre Payen.  This orphanage and hospital sits about 60 miles north of Port-au-Prince.

http://www.project-help-haiti.blogspot.com/

Because they had an intact infrastructure, they have been able to maintain a functional hospital through this disaster.  With a goal of serving the disaster but more important to keep a functional mission in the months/years to come, they have been sending medical missions rapidly.

With donated private jets and clearance from the 82nd Airborne, 7 teams have been organized.  Team 1 is just returning while team 2 has landed.  Here in Columbus, we are assembling team 5 for a departure of February 13.  Planning a team of 2 orthopedic surgeons, 1 general surgeon, 1 anesthesia, and 2 nurses, our goals will be to get on the ground and help in anyway possible.

This team will land almost exactly 1 month after the earthquake strike.  The challenges will be different from the acute devastation of the first few weeks.

Unlike the usual challenges of orthopedic surgery to return function, our goals here will focus on stabilizing bodily function and averting infection.  And in the end, hopeful save a life.

Follow us here on this blog as well as on Twitter for continual updates

The OFAC Fitness Challenge has become an annual tradition and the time is here again!

The holidays can be a tough time to stay active and healthy. So, now is the time to finish off the last of your cravings and desserts and buckle down for the OFAC Fitness Challenge.

A Final Dessert

Each year we put together a competition to encourage health and fitness in a fun, lively atmosphere with a little competitive spirit thrown in as well. This contest has grown in number every year and each year is a bit different. It has been my pleasure to organize this year’s challenge with help from our friends at Baseline Fitness.

This year we are going to use social media and our OFAC Facebook site to help coordinate and update everyone on the contest over its 3 months. Sorry, you will need a facebook account to view the postings I believe.

Here are some details:

• Contest open to all ‘friends of OFAC’- everyone is welcome to participate. The more the merrier.
• Contest runs from Jan 4 to March 31. Yeah, I know—IT’S 3 MONTHS LONG! Only the strong survive.
• RSVP to Katie Allen @ OFAC to confirm you’re joining  allenkm@orthofootankle.com
• Coordinate with Eve Ann @ Baseline Fitness to complete your BOD POD which is a body analysis of lean muscle and body fat content. We’ll do this as a ‘weigh-in’ at the beginning of the contest and another at the end as a ‘weigh-out’. ‘Weigh in’ has to be done by Jan 1.
• You’ll need a pedometer. You can use your own or get one from Eve Ann @ Baseline. One that measures steps for a week is preferable and easier on you.

We will have a Weigh Out Party in early April to celebrate everyone’s improvement and announce the winner!

• This party will feature all the fried food, carbs and sugar laden treats you’ll be skipping on during the contest. This is a nice reward for a job well done.

Here’s how the competition will work:

Points will be calculated by-

• 20% BOD POD- you’re raw numbers won’t be published or identified. We’re looking at who can make the greatest improvement in loss of % body fat- % body fat is changed by losing fat and/or gaining lean muscle–either way, you make positive change to this number.
• 20% Pedometer steps- steps need to be recorded and reported on a weekly basis via email to Katie Allen allenkm@orthofootankle.com First email report to Katie will be Sunday, Jan 10 and every Sunday night after that. If you don’t report, you don’t get credit.
• 20% January Weekly Fitness Events- Each week will have a new ‘Fitness Event’ to perform. It can be done anytime during that week. These events are designed to promote health, wellness and camaraderie amongst contestants. Everyone of all activity levels will be able to perform.  Each Sunday night, starting January 3rd, the event and description will be posted on to the OFAC Columbus Facebook Site . Most events will require you to upload photo evidence to the Facebook site that you completed the event. If you don’t prove you did it, you can’t get credit for that week’s event.
• 20% February Weekly Fitness Events- same rules as January
• 20% March Weekly Fitness Events- same as Feb.

I hope everyone will consider joining this year’s contest! I think with the addition of a new event each week, we should have more fun than ever before!

Good luck—see you at the Weigh Out Celebration Party

Christopher Hyer, DPM, FACFAS

Orthopedic Foot&Ankle Center

Cleaning up mounds of snow can cause more pain than just a headache. While this seasonal activity may seem mundane, it can also be dangerous.
According to the U.S. Consumer Products Safety Commission:

In 2007, more than 118,000 people were treated in hospital evergency rooms, doctors’ offices, clinics and other medical settings for injuries that happened while shoveling or removing ice and snow manually.
More than 16,000 were injured using snowblowers.
Types of injuries can include sprains and strains, particularly in the back and shoulders, as well as lacerations and finger amputations.
The Orthopedic Foot and Ankle Center offers the following tips for safe snow clearing:

Check with your doctor. Because this activity places high stress on the heart, you should always speak with your doctor before shoveling or snow blowing. If you have a medical condition or do not exercise regularly, consider hiring someone to remove the snow.
Dress appropriately. Light, layered, water-repellent clothing provides both ventilation and insulation. It is also important to wear the appropriate head coverings, as well as mittens or gloves and thick, warm socks. Avoid falls by wearing shoes or boots that have slip-resistant soles.
Try to clear snow early and often. Begin shoveling/blowing when a light covering of snow is on the ground to avoid dealing with packed, heavy snow.
Be sure you can see what you are shoveling/blowing. Do not let a hat or scarf block your vision. Watch for ice patches and uneven surfaces.
Shoveling tips:

Warm-up your muscles. Shoveling can be a vigorous activity. Before you begin this physical workout, warm-up your muscles for 10 minutes with light exercise.
Pace yourself. Snow shoveling and blowing are aerobic activities. Take frequent breaks and prevent dehydration by drinking plenty of fluids. If you experience chest pain, shortness of breath or other signs of a heart attack, stop shoveling/blowing and seek emergency care.
Use a shovel that is comfortable for your height and strength. Do not use a shovel that is too heavy or too long for you. Space your hands on the tool grip to increase your leverage.
Try to push the snow instead of lifting it. If you must lift, do it properly. Squat with your legs apart, knees bent, and back straight. Lift with your legs. Do not bend at the waist. Scoop small amounts of snow into the shovel and walk to where you want to dump it. Holding a shovelful of snow with your arms outstretched puts too much weight on your spine. Never remove deep snow all at once. Do it in pieces.
Do not throw the snow over your shoulder or to the side. This requires a twisting motion that stresses your back.
Snowblowing tips:

Never stick your hands in the snow blower! If snow jams the snowblower, stop the engine and wait more than 5 seconds. Use a solid object to clear wet snow or debris from the chute. Beware of the recoil of the motor and blades after the machine has been turned off.
Do not leave the snow blower unattended when it is running. Shut off the engine if you must walk away from the machine.
Add fuel before starting the snow blower. Never add fuel when the engine is running or hot. Do not operate the machine in an enclosed area.
Stay away from the engine. It can become very hot and burn unprotected flesh.
Watch the snow blower cord. If you are operating an electric snow blower, be aware of where the power cord is at all times.
Do not remove safety devices, shields or guards on switches, and keep hands and feet away from moving parts.
Beware of the brief recoil of motor and blades that occurs after the machine has been turned off.
Never let children operate snowblowers. Keep children 15 years of age and younger away when snowblowers are in use.
Read the instruction manual prior to using a snow blower. You need to be familiar with the specific safety hazards and unfamiliar features. Do not attempt to repair or maintain the snow blower without reading the instruction manual.

Late last night, the House of Representatives passed HR 3962 by a vote of 220 to 215.  Very close. One Republican jumped ship and a huge debate over federally funded abortion was resolved to carry the vote.

From an orthopedic surgeons point of view, there are a few good things about this bill.  There are provisions which promote a state grant for medical liability alternatives.  There are provisions eliminating the antitrust exemption for health insurance and liability insurance companies.  There are no provisions for a punitive Physician Quality Reporting Initiative.  Finally, there are no provisions for Independent Medicare Advisory Council where Congress would abdicate its reposonsibility for Medicare policy.

These are the good things.  But there are many things of great concern for those of us who remain thoughtful about health care reform.

HR 3962 calls for the formation of a new advisory body, similar to the CMS Innovation Center proposed by the Senate.  This body lacks input from physicians.  There will be no regulatory agency accountability either.

There will be a redistirbution of residency slots with the sole focus on primary care.

There will be restrictions on physician owned hospitals.

There will be the establishment of a public national medical device registry which lacks privacy protection for physician level data.

Finally, there needs to be a permanent repeal and replacement of the Medicare Sustainable Growth Rate formula.

HR 3961, the “companion bill”, takes these major factors into account.  The provisions within this bill will allow health care reform to succeed by creating a stable Medicare program on which our elderly patients can rely.  If we allow these current flaws to continue, health care reform will be in trouble.  We all know our current system is in trouble. But like surgery, we can’t stop after the diseased organ is removed, we still have to finish the operation until the patient is closed up and successfully awake in the recovery room.

Apologies for a very serious blog but major changes are coming and we are all in a position to influence how health care will be delivered to us in the coming generations.

  One of the many challenging and complex problems our diabetic patients face is Charcot foot or neuroarthropathy. This condition creates destruction and collapse of the bones in the foot and can lead to amputations.

"Normal" foot on xray

“Charcot Foot” with joint dislocations

The physicians at OFAC  are skilled at this complex reconstructive surgery and are constantly developing and using new techniques to improve patient outcomes. Recently, Dr. Hyer is one of the first physicians in the world to utilize this innovative, new intramedullary compression device within the bones of the foot as part of this reconstruction. This new implant (called TarsX) provides a much stronger form of fixation compared to typical screws and plates that are used and should allow for better bone healing. 

Here is a video of technique on cadaver specimen (you’re warned!)

Case Presentation

This case has a typical pattern of midfoot joint destruction with severe foot deformity as a result.

Severe Charcot Midfoot deformity with planned correction

Reconstruction in process. Half of implants in.

Reconstruction and realignment finished. Complete implants in.

Implants in. Realigned foot and arch achieved.

  Please check back often for updates and new techniques such as this for these challenging cases.

Dr. Hyer