Orthopaedics

Rotation Contact

Rotation Director - Vinay Narotam, MD (vinay_narotam@med.unc.edu)

First Day Information

Prior to your first day, please email Dr. Narotam to confirm clinic start time.  Clinic is located on the 2nd floor of the ACC Building.

Goals and Objectives

OVERALL EDUCATIONAL GOAL:
The goal of the orthopedic rotation is to provide residents with the knowledge, skill and clinical experience necessary to recognize and manage orthopedic conditions which usually do not require referral to an orthopedist. Residents should also appreciate the role of the orthopedist as a consultant and be able to appropriately recognize those conditions which should be referred.

OBJECTIVES:
Recognize and discuss proper management of the following common orthopedic conditions: (PC, MK, SBP)

Scoliosis

Kyphosis

Low back pain and other joint pain

Developmental dysplasia of the hips (DDH)

Avascular necrosis of the femoral head

Slipped capital femoral epiphysis (SCFE)

Femoral anteversion and retroversion

Knee ligament and meniscal tears

Osgood-Schlatter disease

Tibia vara (Blount’s disease)

Internal and external tibial torsion

Metatarsus adductus

Congenital club foot

Flat feet

Simple joint sprains

Muscle strains

Clavicular fractures

Birth brachial plexus palsies

Extremity fractures and dislocations

Septic joint

Demonstrate competence in performing a focused orthopedic exam of the following anatomical areas recognizing common abnormal findings such as effusions, ligament injuries, limitation of motion, localization of pain, associated neurologic symptoms, fractures, dislocations: (PC, MK)

Major joints (knee, hip, ankle, wrist, elbow and shoulder)

Cervical, thoracic and lumbar spine

Minor joints (carpel, tarsal, metacarpal and metatarsal)

Demonstrate competence in evaluating the child with a limp. (PC, MK)

Understand the role of commonly used radiologic and imaging techniques in assessing orthopedic conditions. (MK)

Plain x-rays

Ultrasound

MRI

CT

Bone scans

EVALUATION:
Resident performance will be evaluated by direct faculty assessment during clinical activities, teaching rounds, and teaching conferences. A written evaluation on the resident will be completed by faculty preceptors using the attached evaluation form through e*value.

LEARNING ACTIVITIES OF THE ROTATION:
All learning activities involve working directly with the Pediatric Orthopaedic Attendings* in their outpatient clinics at the ACC. Pediatric residents will assess patients in these clinics, review relevant x-rays and other studies, and discuss the cases with the Pediatric Orthopaedic Attending. Currently there are typically 14 half day clinics each week, depending on the ‘away’ schedule of the Attendings. Pediatric residents on this rotation are expected to participate in at least 18 half day clinics.

*Pediatric Orthopaedic Attendings:
Drs Edmund Campion and Richard Henderson are orthopaedic surgeons with subspecialty training and expertise in Pediatric Orthopaedics. Dr. Vinay Narotam is a non-surgical Pediatric Orthopaedist who has been trained as a pediatrician, with post residency fellowship training in Pediatric Orthopaedics.

Readings and Resources

Weinstein SL, Zavala DC, Ponseti IV. Idiopathic scoliosis: long-term follow-up and prognosis in untreated patients. J Bone Joint Surg [Am] 1981;63(5):702-12.

Clinical practice guideline: early detection of developmental dysplasia of the hip. Committee on Quality Improvement, Subcommittee on Developmental Dysplasia of the Hip. American Academy of Pediatrics. Pediatrics 2000; 105( 4 Pt 1): 896-905.

Matava MJ, Patton CM, Luhmann S, Gordon JE, Schoenecker PL. Knee pain as the initial symptom of slipped capital femoral epiphysis: an analysis of initial presentation and treatment. Journal of Pediatric Orthopedics 1999; 19( 4): 455-60.

Staheli LT, Corbett M, Wyss C, King H. Lower-extremity rotational problems in children. Normal values to guide management. Journal of Bone & Joint Surgery -American Volume 1985; 67( 1): 39-47.

Salenius P, Vankka E. The development of the tibiofemoral angle in children. J Bone Joint Surg Am. 1975 Mar;57(2):259-61.

Wenger DR, Mickelson M, Maynard JA. The evolution and histopathology of adolescent tibia vara. Journal of Pediatric Orthopedics 1984; 4( 1): 78-88.

Ogden JA, Southwick WO. Osgood-Schlatter's disease and tibial tuberosity development. Clinical Orthopaedics & Related Research 1976; 116: 180-9.

Ponseti IV. Treatment of congenital club foot. Journal of Bone & Joint Surgery -American Volume 1992; 74( 3): 448-54.

Staheli LT, Chew DE, Corbett M. The longitudinal arch: A survery of eight hundred and eighty-two feet in normal children and adults. J Bone Joint Surg (Am) 1987; 69: 426-28.

Skaggs DL, Mirzayan R. The posterior fat pad sign in association with occult fracture of the elbow in children. Journal of Bone & Joint Surgery -American Volume 1999; 81( 10): 1429-33.

Noonan KJ, Price CT. Forearm and distal radius fractures in children. J Am Acad Ortho Surg 1998; 6: 146-56

http://www.posna.org/education/StudyGuide/index.asp

http://www.wheelessonline.com/