Clinical Services

The Department of Orthopaedic Surgery and Rehabilitation

Orthopaedic Residency Program

Clinical Learning Opportunities

Our orthopaedic residency program offers an organized educational program with appropriate supervision and a strong base of varied clinical experiences. The faculty is committed to teaching and has a record of scholarship and research activity. At UTMB, residents see enough volume for an excellent clinical experience, but not so much that it interferes with their overall education. Our department enjoys strong support from the hospital, medical school, and other academic departments. Although residents are well supervised, they will be given opportunities to assume increasing responsibility as their capabilities develop.
All services are organized so that their regularly scheduled operating days do not conflict with clinic days. This allows residents on each service to attend clinic, participate in preoperative decision-making, and to learn about the postoperative course of their patients.

Orthopaedic surgery at UTMB is organized into seven orthopaedic surgical services plus rehabilitation.

The resident’s first year includes three months of orthopaedics, six months divided between various surgical subspecialties, and the three months divided into either emergency medicine, medical/cardiac intensive care, neurology, neurological surgery, rheumatology, or anesthesiology.

The typical resident’s educational program from post graduate year PGY 2 through PGY 5 is shown below. There are four three-month rotations for each level of training.

Educational Program

Orthopaedic Surgical Services
12-month program for PGY 2-PGY 5,
divided into four rotating quarters

PGY 1
Includes Three Months of Orthopaedics



PGY 2 Ortho A
(Knee, Sports, Trauma) Foot T/TDCJ
Spine

PGY 3
Ortho B
(Hip, Trauma)
Hand

T/TDCJ

Pediatric Orthopaedics



PGY 4
Ortho A
(Knee, Sports, Trauma)
Foot

T/TDCJ

Spine



PGY 5

Ortho B
(Hip, Trauma) Hand
T/TDCJ

Pediatric Orthopaedics

Adult A:
Sports Medicine and Knee & Shoulder Surgery

The Adult A Service emphasizes sports medicine and acute and chronic disorders of the knee and shoulder.

The Adult A Service is one of the two adult general orthopaedic services that alternates adult trauma admissions. Educational objectives on the Adult A service are to increase the residents’ knowledge and ability in the following areas:

Knowledge of anatomy and biomechanics of knee and shoulder.

Knowledge of sports medicine, emphasizing off-season training methods, pre-participation exam and disqualifying conditions, on-the-scene exam for injury, and criteria for return to play.

Knowledge of early- and long-term knee and shoulder rehabilitation, including modalities, exercise, and orthotics.

Ability to use arthroscopic diagnostic and surgical techniques for managing disorders of the shoulder, knee, elbow, and ankle.

Ability to evaluate and surgically treat knee and shoulder disorders utilizing joint replacement, arthrodesis, and other techniques as needed.

Ability to evaluate and non-operatively manage chronic knee and shoulder disorders.

Ability to evaluate and manage, both operatively and non-operatively, extremity trauma, including fractures, with emphasis on the shoulder and knee.

Adult B:
Joint Arthroplasty & General Orthopaedics

The Adult B Service emphasizes reconstructive surgery of the hip, including proximal femoral and pelvic osteotomies, arthroplasty, and fixation of pelvic fractures.

The Adult B Service is the other general adult orthopaedic surgery service that takes trauma admissions. Educational objectives on the Adult B service are to increase the residents’ knowledge and ability in the following areas:

Knowledge of anatomy and biomechanics of hip and pelvis.

Knowledge of early and long-term rehabilitation of patients with hip disorders.

Ability to evaluate and manage chronic hip disorders non-operatively.

Knowledge of principles of prosthetic design and materials in total hip replacement.

Ability to pre-operatively evaluate and plan prosthetic and non-prosthetic arthroplasties.

Ability to evaluate and operatively manage chronic hip disorders using techniques including joint replacement, non-implant arthroplasty, osteotomy of the pelvis and hip, and arthrodesis.

Ability to evaluate and manage extremity trauma with an emphasis on the pelvis, hip and upper femur, both operatively and non-operatively.

Pediatrics C:
Pediatric Orthopaedics & Scoliosis Surgery

The Pediatrics C Service deals with all aspects of pediatric orthopaedics.

Educational objectives are to increase the residents’ knowledge and ability in the following areas:

Knowledge of normal and abnormal musculoskeletal development and anatomy.

Ability to assess and manage common pediatric orthopaedic disorders including developmental dislocation of the hip, scoliosis, avascular necrosis of the hip, slipped capital femoral epiphysis and clubfoot.

Ability to assess and manage pediatric neuromuscular diseases.

Ability to assess and manage limb length discrepancy.

Ability to assess and manage common angular and torsional variations.

Ability to assess and manage pediatric trauma both operatively and non-operatively.

Spine Surgery & Rehabilitation:

The Spine Service manages adult spine problems, including degenerative disease, infection, trauma, and tumors.

Educational objectives are to increase the residents’ knowledge and ability in the following areas:

Knowledge of the anatomy of the spine, spinal cord, and nerve roots.

Proficiency in assessing low back and neck pain and non-operative and operative management with specific emphasis on the psychological aspect of back pain. Knowledge of the sound principles of spine rehabilitation programs.

Ability to assess and manage, non-operatively and operatively, acute disc herniation of the lumbar, thoracic, and cervical spine.

Ability to assess and manage spinal trauma, both non-operatively and operatively.

Ability to assess and manage spinal tumors, primary and metastatic, with the same approach that is used in the trauma principles of reconstructing the spine after extensive spinal resection.

Ability to assess and manage spinal disorders, such as spondylolisthesis, adult scoliosis, and post-traumatic deformities.

The residents will become comfortable in the use and handling of modern spinal instrumentation, including hooks, rods, plates, pedicle screws, and wires.

Foot & Ankle and Infections & Wound Care:

The Foot & Ankle Service manages patients with acute and chronic disorders of the foot, particularly those with diabetic ischemic foot disease, as well as foot, ankle, and leg trauma.

The Osteomyelitis Service deals with bone and joint infections, including post-traumatic and postoperative infections.

Educational objectives are to increase the residents’ knowledge and ability in the following areas:

Knowledge of anatomy and biomechanics of the foot and ankle.

Ability to assess and manage, operatively and non-operatively, chronic foot disorders including bunions and other dynamic deformities and motor and sensory deficits.

Ability to assess and manage acute disorders of the foot and ankle including inflammatory states.

Ability to perform operative reconstruction of the foot and ankle, including arthrodesis.

Ability to assess and manage, operatively and non-operatively, trauma to the foot, ankle, and leg.

Knowledge of identification and antibiotic susceptibility of organisms.

Ability to plan and execute long-term non-operative management of complex musculoskeletal infection, including chronic osteomyelitis and diabetic foot infection. Knowledge of long-term rehabilitation.

Ability to plan and execute operative management of complex musculoskeletal infection, including debridement, antibiotic bead implantation, reconstruction with and without bone lengthening or transport (Ilizarov), arthroplasty, and arthrodesis.

Hand:

The Hand Service deals with acute and chronic disorders of the hand, wrist, elbow, and shoulder, including tumors and congenital anomalies and upper extremity trauma.

Educational objectives are to increase the residents’ knowledge and ability in the following areas:

Knowledge of anatomy and biomechanics of the upper extremity.

Ability to assess and manage acute upper extremity problems, including inflammatory states and infection.

Ability to assess and manage chronic upper extremity disorders, including rheumatoid arthritis, motor and sensory deficits, and resulting deformities.

Ability to assess and manage hand and upper extremity trauma including fractures, tendon, nerve, and vascular injuries.

Proficiency in microsurgical techniques.

Trauma and Texas Department of Criminal Justice (TDCJ):

The Trauma and Texas Department of Criminal Justice (TDCJ) Service is a general orthopaedic service, meeting the orthopaedic needs of the inmates of the Texas Department of Criminal Justice System.

Educational objectives are to increase the residents’ knowledge and ability in the following areas:

Knowledge of the anatomy and biomechanics of the shoulder, knee, hand, and foot.

Knowledge of early- and long-term shoulder, knee, hand, and foot rehabilitation, including modalities, exercise, and orthotics.

Ability to manage chronic knee, shoulder, hand, and foot disorders.

Proficiency in the arthroscopic diagnosis and surgical management of shoulder, knee, elbow, and ankle disorders.

Ability to operatively manage shoulder, knee, hand, and foot disorders, including joint replacement and arthrodesis.

Ability to operatively and non-operatively treat extremity trauma, including fractures, of the shoulder, knee, hand, and foot.

Orthopaedic Rehabilitation:

The UTMB Department of Orthopaedics and Rehabilitation offers a broad rehabilitation experience for the orthopaedic resident.

A multidisciplinary team approach to patient care is a prominent feature of patient care, both in the inpatient setting and in the clinic. The orthopaedic resident has extensive opportunities to participate in and direct the team’s treatment of patients. These experiences as well as participation in journal club, lectures, and faculty teaching rounds lead to an in-depth understanding of both short- and long-term management strategies to optimize functional outcomes and quality of life.

Educational objectives are to increase the residents knowledge and ability in the following areas:

Ability to recognize and manage complications of orthopaedic and neurologic impairment including immobility, spasticity, pain, paralysis, sensory loss, and cognitive deficits.

Ability to order ancillary services, monitor functional progress, and direct the multidisciplinary team.

Ability to measure functional outcomes including independence in daily living skills, mobility, vocational potential, and psychosocial adjustment.

Knowledge of impairment, disability, and handicap measures and community resources, including assistive technology to optimize functional independence and vocational productivity.

Ability to implement both nonsurgical and surgical treatments of contractures and the potential complications of these treatments.

Clinical Volume

Orthopaedic surgery is the single busiest service in the operating room, performing more than 21% of all operative cases at UTMB. This consists of more than 2,900 adult and nearly 300 pediatric cases a year. In your folder is a copy of the resident operative experience for a recent graduate of the UTMB program.

The adult orthopaedic clinics had more than 33,000 patient encounters last year and the pediatric orthopaedic clinics saw more than 4,000 patients. Most patients in clinic are initially evaluated by the resident, with faculty serving as a consultant.

All surgical procedures, including those performed on call, are directly supervised by a member of the faculty. The level of supervision will vary depending on the complexity of the case and the experience of the resident.

Call Duty

Both junior and senior residents take call, averaging once every seven to eight nights. Due to the level of activity in UTMB’s emergency room, the resident can expect to be busy on call nights dealing with orthopaedic trauma.