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Cultural Competence Is a Continuous Learning Opportunity

By | News, Uncategorized
By: Kaitlyn D’Onofrio

Improve your communication with patients with different experiences

The population is increasingly diverse, and physicians likely interact with patients whose cultures and life experiences differ from their own. This could impact patient-physician interactions and communication.

During a career development session at the AAOS 2019 Annual Meeting, Hassan R. Mir, MD, MBA, FACS, director of the orthopaedic residency program and director of orthopaedic research at the Florida Orthopaedic Institute and associate professor at the University of South Florida, discussed tactful ways to communicate with patients of different cultures and explained why cultural competence requires being open to learning.

Patient-centered care involves including patients and their families in medical decision-making. When communicating, the patient should be the center of the conversation; this is always the goal, Dr. Mir said.

Patient-centered care involves four tiers: “whole person” care, ready access, comprehensive communication and coordination, and patient support and empowerment. The former two components fall under the health policy umbrella, whereas the latter factors encompass the physician-patient relationship.

Patients have become more concerned with the duration of time physicians commit during a visit than their education and training. An AAOS survey on patient expectations and perceptions of communication obtained different results when conducted in 1998 and 2008. In the earlier survey, 87 percent of patients expected their providers to be highly trained; by 2008, this dropped to 82 percent. In 1998, 35 percent of respondents said they expected their providers to both spend time answering questions and be caring and compassionate; 10 years later, those figures rose to 51 percent and 55 percent, respectively.

Complete clinical care is two-pronged, requiring the completion of communication and biomedical tasks. Communication tasks are:

  • engagement
    • verbal (speaking calmly, asking open-ended questions, avoiding interruptions)
    • nonverbal (making eye contact, smiling, sitting to speak with the patient)
  • empathy
    • establish trust
  • education
    • interactive (asking the patient to explain the visit in his or her own words)
  • enlistment
    • shared decision-making

Several medical decision-making models can be considered: paternalistic (clinician is dominant; patient is passive), consumeristic (emphasis on patients’ rights and clinical obligations), and mutualistic (equal patient-clinician involvement). In most scenarios, the ideal approach is mutualistic. However, in situations where there is only one best-practice treatment option with unequivocal evidence and the patient is low risk, the paternalistic model might be most effective.


Hassan R. Mir, MD, MBA, FACS, discusses communication tactics when interacting with patients with different experiences.

In preference-sensitive treatment discussions, there may be multiple reasonable options, for which a risk/benefit analysis should be conducted. In such cases, shared decision-making is most suitable.

Health literacy can impact a patient’s outcomes, Dr. Mir noted. Evidence has shown links among low literacy, poor education, poor health, and early death. During discussions about surgical procedures, a patient’s health literacy must encompass an understanding of the condition, treatment options, interventions, and post-surgical plan. A few helpful communication aids include written, pictorial, audio, video, and interactive media tools, as well as support groups.

Even in the presence of preventive measures and a well-planned strategy, adverse events (AEs) can occur—necessitating prior shared decision-making and informed consent. Should an AE occur, the physician may experience feelings of sadness or guilt, possibly becoming defensive, whereas the patient and family will likely feel fear, confusion, and anger. In such scenarios, the physician’s plan must include:

  • open communication with the healthcare team
  • open communication with the patient and family
  • a discussion of all aspects (details, possible causes, proposed course of action)
  • an apology without accepting blame (this does not suggest admission of wrongdoing)

Patients who receive full disclosure will have more trust in their physicians and will be less likely to take legal action, Dr. Mir added.

Cultural differences can make communication challenging, but it is crucial to provide culturally competent care to a variety of patients. Dr. Mir defined culturally competent care as “the ability to understand and work with patients whose beliefs, values, and histories are significantly different from our own.”

For engaging with patients with cultural differences, Dr. Mir suggested upgrading the classic “Golden Rule” to the “Platinum Rule”: rather than treating others as you would like to be treated, treat others as they would like to be treated.

Failing to provide culturally competent care could result in harm to patients and your practice. Consequences could include:

  • alienating your patients
  • misdiagnosing their medical problems
  • nonadherence to your treatment plans
  • worse outcomes
  • poor word-of-mouth for you and your practice

Dr. Mir suggested that physicians become familiar with the cultures and beliefs of their patients and families. He acknowledged that being a clinical expert is not the same as being a communication expert, so he urged physicians to be open to learning and changing their behaviors and attitudes. When they are becoming educated about a different culture, generalizations may help them focus their thoughts and provide potential background, but only if that is followed by recognizing each patient as an individual. Stereotypes, on the other hand, are oversimplified, could be offensive, and do not consider the patient as an individual.

Dr. Mir also recommended AAOS’ Culturally Competent Care resources, including the AAOS diversity webpage and the AAOS Culturally Competent Care guidebook and test, which provide six hours of continuing medical education.

Kaitlyn D’Onofrio is the associate editor for AAOS Now. She can be reached at kdonofrio@aaos.org.

The Reconstructive Limb Loss Clinic at FOI

By | News, Physicians

Florida Orthopaedic Institute announces a dedicated clinic for patients with upper and lower amputation – The Reconstructive Limb Loss Clinic at FOI.

The Clinic is ideal and best suited for patients experiencing pain due to neuroma or phantom limb pain, unable to wear a prosthetic, unable to function and other amputee concerns.  

Individuals with amputations face many daily challenges that can significantly affect their lives, including general health, wellness, mobility, independence and more. The Reconstructive Limb Loss Clinic at FOI helps amputees by offering patients a multidisciplinary approach to the latest surgical innovations and technology to help them restore maximum limb performance and live life to the fullest.

The Reconstructive Limb Loss Clinic at FOI is led by surgeon Dr. Jason Nydick, a Florida native who was born and raised in Sarasota. After receiving his upper extremity fellowship with Florida Orthopaedic Institute, he dedicated his years from 2011-2014 to serving in the United States Navy at Pensacola Naval Hospital, including deployment to Kandahar Multinational Role 3 Combat Hospital in Afghanistan.

Reconstructive Limb Loss Clinic at FOI includes several healthcare providers attending each monthly clinic. New reconstructive procedures and technology are available for patients with upper and lower amputations. Cutting-edge techniques and surgeries include targeted muscle reinnervation.

Targeted Muscle Reinnervation (TMR) brings amputees relief and helps them get back to their daily lives. TMR was initially developed to work with new technology in bio-prosthetic limbs, but surgeons noticed that amputees who had TMR surgery also reported a significant reduction in both neuroma and phantom limb pain.

The Reconstructive Limb Loss Clinic at FOI coordinates with local and regional prosthetists and utilizes the most advanced myoelectric prostheses available. Physical therapists, occupational therapists, pain management specialists, and psychologists are available to the patient as needed for a comprehensive patient solution.

During the Clinic, patients will receive an initial evaluation by Dr. Nydick to determine if they are a candidate for the procedures and then be able to meet with both a therapist and a prosthetist, all in one appointment. Every medical professional involved in the clinic has been carefully selected for their experience and expertise on working with this patient population. Through a strong partnership with local medical professionals dedicated in achieving a common goal of improving the lives of post-amputee patients, this Clinic offers a truly innovative approach to the Tampa Bay community and its surrounding areas.

The Clinic occurs on the first Tuesday of each month at the main FOI campus, 13020 Telecom Pkwy N., Temple Terrace, FL 33637 FOR MORE INFORMATION, CALL ERICA NIEVES AT 813-978-9700, EXTENSION 6265

Dr. Gasser & FOI Physicians to Lead FORE Orthopaedic Conference in Clearwater

By | News

Course Director Dr. Seth Gasser and FORE will host an orthopaedic continuing medical education conference in Clearwater this summerJuly 26-28, 2019. 

This conference is open to physicians, physical therapists, athletic trainers, and other allied healthcare professionals. 

The Foundation for Orthopaedic Research & Education (FORE) is proud to announce that Florida Orthopaedic Institute surgeon Dr. Seth Gasser is once again directing the Orthopaedics for the Primary Care Practitioner & Rehabilitation Therapist course this July. This conference is designed to provide healthcare professionals with the most current diagnostic and treatment options in the orthopaedic sub-specialties. A distinguished faculty, many of whom are FOI physicians, will present recent advances in trauma and fracture fixation, arthritis management, joint reconstruction, treatment of sports-related conditions, spine surgery, hand and upper extremity evaluation and management, and physical therapy. 

Orthopaedics for the Primary Care Practitioner & Rehabilitation Therapist 

July 26-28, 2019
Sandpearl Resort
Clearwater, Florida
Registration Link: https://foreonline.org/gasser-orthocourse-2019

Participants will be given ample time for interactive discussions and opportunities to interact with faculty, plus hands-on workshops. Faculty from FOI that will be presenting at this conference are:

  • Christopher Baker, MD
  • Eddy Echols, MD
  • Timothy Epting, DO
  • Michael Garcia, MD
  • Christopher Grayson, MD
  • Alfred Hess, MD
  • Benjamin Maxson, DO
  • Mark A. Mighell, MD
  • Michael Miranda, DO
  • Jason Nydick, DO
  • Brian Palumbo, MD
  • Ioannis Pappou, MD
  • Donna Saatman, MD
  • Jeff Sellman, MD
  • Anjan Shah, MD
  • John Small, MD
  • Steven Tresser, MD
  • Seung Yi, MD

This 3-day conference features didactic lectures, case presentations, and a hands-on ultrasound and injections workshop. This live continuing education activity is approved for the following:

  • Physicians – 18.75 AMA PRA Category 1 Credit(s)™
  • Athletic trainers – 18.75 Category A hours/CEUs
  • Physical Therapists – 18.75 CE hours

FOI staff receive a $100 discount when registering for the course, by using code FOI100. For registration, agenda, and more course information, please visit https://foreonline.org/gasser-orthocourse-2019

If You Have Pain Behind the Knee, Here’s What It Could Mean

By | News

If You Have Pain Behind the Knee, Here’s What It Could Mean

Reader’s Digest

BY: Emily DiNuzzo

First, Elevate the Pain

Pay attention to the type of pain you experience since some causes for pain behind the knee warrant a trip to the emergency room. Miho Tanaka, MD, associate professor, Department of Orthopaedic Surgery at the Johns Hopkins Hospital says to watch out for blood clots, numbness and weakness in the leg, and fevers and redness associated with swelling. Blood clots should be quickly evaluated, and tingling or numbness that makes it hard to walk are also a sign to go to the ER, Dr. Tanaka says. Although swelling in the knee has many causes, in rare cases, it could be a sign of an infection, so it’s a good idea to seek immediate care. Steven Lyons, MD, for Florida Orthopaedic Institute, adds knee pain experienced after a major trauma like a fall or a car accident are also appropriate times for an ER visit. If the knee pain lingers longer than a week or two without any prior injury, Dr. Lyons recommends visiting a doctor instead.

Meniscus Tear

According to the American Academy of Orthopaedic Surgeons, meniscus tears are among the most common knee injuries. The meniscus act as “shock absorbers” between your thigh and shinbones. Someone with a torn meniscus might feel a “pop” along with pain, stiffness, and catching or locking the knee, according to the academy. Here are the 9 best moves to end knee pain.

Arthritis and Gout

Arthritis and gout, inflammatory arthritis, could cause pain behind the knee as well as a few other types of arthritis. Osteoarthritis is the most common type and breaks down the cartilage or cushioning between joints, according to the Arthritis Foundation. Psoriatic arthritis also contributes to knee pain as well as autoimmune diseases such as lupus and rheumatoid arthritis, according to the National Psoriasis Foundation and Johns Hopkins Medicine.

Baker’s Cyst

It’s named after the surgeon who first described it, William Morrant Baker. Dr. Lyons explains a Baker’s cyst as a collection of fluid that goes from the front of the knee to the back of the knee and is accompanied by arthritis or a meniscus tear. Dr. Tanaka adds a Baker’s cyst is often a sign of an underlying knee problem and can be quite uncomfortable. “This will typically go away with management of the underlying source of the swelling; treating the arthritis, etc.,” she says. These are the 9 proven knee pain treatments you kneed to know.

Calf or Hamstring Stain or Cramp

Sudden activity and overuse are two leading causes of pain behind the knee due to a calf or hamstring strain or cramp, according to Dr. Tanaka. Movements that require pushing off or severe knee bending cause this calf and hamstring pain, respectively. “Both can be managed with ice, rest, gentle stretching and anti-inflammatories; however, one should seek care if there is swelling or persistent pain associated with this to rule out blood clots,” Dr. Tanaka says. Dr. Lyons adds that although an orthopedist could treat this, if you can’t bear weight on the knee or are at risk of falling, then it’s time to go to the emergency room.

Jumper’s Knee

Jumper’s knee is an “overuse injury,” according to the Nemours Foundation. For example, athletes and kids are especially at risk of injuring this chord-like tissue when repeating irritating movements like jumping, hard landings, or changing directions too quickly. These movements could all cause strains, tears, and damage to the patellar tendon, also known as jumper’s knee, per Nemours Foundation. Pain, stiffness, and even weakness are a few symptoms of this injury. A doctor might simply prescribe rest and ice or surgery, in rare cases. These are the 6 hidden muscles that could be causing you pain.

Ligament Injuries

Various ligament injuries could contribute to behind the knee pain. This includes a partially or entirely torn ACL (anterior cruciate ligament) or MCL (medial collateral ligament), according to VeryWell Health. ACL tears are common with athletes. The ligament tears or stretches while twisting with planted feet. MCLs tear when something strikes the outside of the knee, forcing it to buckle. Along with many other knee injuries, both require the RICE treatment approach: rest, ice, compression, and elevation to reduce both pain and swelling, according to Mayo Clinic. Next, check out 24 secrets pain doctors won’t tell you.

Florida Orthopaedic Institute Announces New Orthopedic Surgeon

By | News, Sports Medicine News

FOR IMMEDIATE RELEASE:

Media Contact
Donna Bossuyt
(813) 480-4591
dbossuyt@floridaortho.com

FLORIDA ORTHOPAEDIC INSTITUTE ANNOUNCES NEW ORTHOPEDIC SURGEON

Tampa, Fl. – February 28, 2019 – Florida Orthopaedic Institute (FOI) announces the recent hiring of Dr. David M. Donohue to its practice of more than 40 fellowship-trained physicians. Dr. Donohue is an orthopedic surgeon who is fellowship trained in orthopedic trauma and adult reconstruction and arthritis.

“Dr. Donohue brings a wealth of experience and understanding of trauma and adult reconstruction solutions that will allow us to extend our arthritic services to patients,” says Dr. Roy Sanders, president and chief medical officer of Florida Orthopaedic Institute. “We’re delighted to have him join our growing team.”

After his residency at the University of South Florida, Dr. Donohue went on to complete his Orthopedic Trauma Surgery fellowship at Harborview Medical Center. He obtained his second fellowship in Adult Reconstruction and Arthritis Surgery upon returning to Tampa.

“Florida Orthopaedic Institute is unique,” Dr. Donohue said. “This is because of our affiliation with the University of South Florida and our commitment to the education of medical students, residents and fellows. In addition to providing conscientious patient care, my goal is to further the academic pursuits of our group and the university in orthopedic trauma and adult reconstruction.”

Dr. Donohue has contributed to several published chapters and peer-reviewed articles regarding topics such as treatment of infection, biomechanics, orthopedic trauma and computer navigated assistance. He has also given lectures nationally pertaining to orthopedic trauma repair. Among others, Dr. Donohue is a member of the Orthopaedic Trauma Association (OTA), the American Academy of Orthopaedic Surgeons (AAOS) and the Foundation for Orthopaedic Trauma (FOT).

Dr. Donohue began seeing patients February 25, 2019 at the Brandon, North Tampa and South Tampa offices in the Tampa Bay area.
Florida Orthopaedic Institute

Founded in 1989, Florida Orthopaedic Institute is Florida’s largest orthopedic group and provides expertise and treatment of orthopedic-related injuries and conditions, including adult reconstruction and arthritis, chiropractic services, foot and ankle, general orthopedics, hand and wrist, interventional spine, musculoskeletal oncology, orthopedic trauma, physical medicine and rehabilitation, physical and occupational therapy, sports medicine, shoulder and elbow, spine and chiropractic services, among others. The organization treats patients throughout its surgery centers in North Tampa and Citrus Park, two orthopaedic urgent care centers in South Tampa and Brandon, and 9 office locations in Bloomingdale, Brandon, Citrus Park, North Tampa, Northdale, Palm Harbor, South Tampa, Sun City Center and Wesley Chapel. For more information, please visit: FloridaOrtho.com and ‘like’ us on Facebook: facebook.com/Florida.Orthopaedic.Institute.

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Treat Your Patients Like Valued Guests, Or Else

By | News

By Lisa D. Ellis

The last time you went on vacation, you probably enjoyed five-star treatment from
the staff at the hotels and restaurants you visited. But while customer service is
paramount when it comes to dining and accommodations, most health care systems
don’t think to treat their patients like valued guests.

The High Cost of Not Making Patients Feel Valued

The danger is that if you’re not following the hospitality industry’s example, you
may be leaving patients feeling disappointed in their overall experiences. This can
be costly — especially if your dissatisfied patients then go online and give your
physicians or service lines bad ratings, according to Kim Mott, marketing and
customer service manager for Florida Orthopaedic Institute.

With most patients today shopping for health care online and comparing physicians
and organizations, it’s more important than ever to make sure physicians and
health care administrators are listening to what people are requesting, and respond
accordingly, Mott stresses.

Sharing Florida Orthopaedic Institute’s Experiences

Mott and her colleague Donna Bossuyt, director of marketing and customer service
for the Florida Orthopaedic Institute, recently shared their experiences at the 2018
annual conference held by the Society for Healthcare Strategy and Market
Development (SHSMD).

Mott points out that that the institute’s journey in this area began a few years ago,
when its leadership recognized that while the organization already had a stellar

reputation for providing world-class care, its patient reviews were not living up to
its high quality of care.

Part of the problem was that the organization had grown a great deal in recent
years, expanding from just a dozen orthopaedists working in one office and one
hospital to now including more than 40 physicians, 25 mid-level providers, 15
fellows, and more than 600 professional staff members working in 10 offices, two
surgery centers, two orthopaedic urgent cares, and 19 regional hospitals. Such
growth made managing the patient experience a much more complicated process.

The Need to Be Patient Centric

Another problem was with that the expanded organization was focusing on the
physicians and their needs instead of putting the patients first.

“When we look to the hospitality field, it’s clear that we can’t be physician-centric,
but rather, we must be patient-centric to be successful,” Mott stresses

In practical terms, this meant that, with the support of the c-suite, she and Bossuyt
needed to help physicians reframe their service delivery to operate with the attitude
of a high-end hotel that wants to please the people it serves.

“I ask our physicians to think about staying at the Marriott or Ritz Carlton. How can
we compare our interactions to that?” she asks.

Responding to Patient Feedback

The real key to success, though, was finding the best mechanism to capture online
feedback from patients on what works well — and what needs to change. Rather
than trying to follow all of the websites where patients can rate the organization,
Mott now uses a tool from Binary Fountain.

“This allows us to put all of our listings into one dashboard. When a patient posts a
new review, I get an email that shows where it’s posted, who wrote it, and when,
so I can respond right away,” Mott says. Currently she gets between 10 and 25
reviews a week, with 10 percent or less containing negative feedback. Patients can
share their stories on Florida Orthopaedic Institute’s website or other review sites.

Providing Concrete Feedback for Physicians

Having a way to organize reviews also provides a great way to show physicians
what people think of their service and where they are unhappy. This has been an
important motivator to help the medical staff really focus on the patient experience.

“When we receive a complaint, I can show physicians this is the perception they are
giving to patients,” she explains. “We never accuse physicians of anything when we
get a bad review but ask to hear their side of the story and use this as a catalyst to
talk about what patients want. This helps to remind everyone that we are trying to
provide a better customer experience,” she adds.

Strengthening Personal Interactions

For many physicians, personal interactions are not something they learned in
medical school, so this can require taking a fresh approach to patient care. “I meet
with the entire medical team, not just the doctor, and educate them that
prospective patients are shopping online for health care services, using websites
like Google, Healthgrades, and RateMD. If a patient sees a bad review, this can
deter the patient from coming to our practice. We have to actively play a role in
asking all of our patients to share their stories online. These group conversations
also provide us with coachable moments for the teams,” she says.

When necessary, Mott also shadows physicians who have gotten bad reviews or
complaints to see any missed opportunities during patient exams for making a
deeper connection.

For example, she recently shadowed one physician who consistently received
patient complaints and found that he showed up late for his appointments, did not
introduce his team to the patients and their families, didn’t express empathy, and
showed his frustration with the computer system.

While the doctor initially seemed reluctant to change his ways, ultimately the
feedback was very helpful to him. Several months later, Mott shadowed him again
and she saw he had incorporated some of the suggestions and showed real
improvement in his style. He also was no longer getting bad reviews from patients.

Feedback Can Help Doctors Do Their Job Better

While no one likes to hear criticism, at the end of the day, doctors who get
feedback on how to improve patient relations are able to express more compassion
to patients.

“They got into the medical profession because they cared,” Mott points out.
Therefore, being able to put this caring into their daily practice ultimately helps
them do their job better and have a deeper impact. Mott says she tries to stress
this concept, so physicians can see the bigger picture.

While they have not formally tracked the results of their efforts to elevate patient
service, Mott says that the good reviews and ratings are paying off in improving the
institute’s online profile.

What You Can Do

For organizations looking to step up their patient satisfaction in healthcare, Mott
offers these three tips to guide their efforts:

  1. Use a tool to streamline your patient reviews in a way that makes it easy to
    track them and to respond to the reviewer in real time. She responds to both
    positive and negative reviews right away, so people feel that their voice is being
    heard and they matter.
  2. Share tangible feedback with physicians and their teams in an organized
    fashion, such as through team huddles, where everyone can come up with an
    orchestrated way to integrate the information into their daily operations. Often
    breaking down the criticism into several concrete bullet points can make it
    easier to digest.
  3. Be sure to follow up with physicians to see how any changes they have put into
    practice are working. Customer satisfaction should be the focus of an ongoing
    conversation that an organization has with its staff. Remember that people’s
    needs and desires change over time, so this should always be a work in
    progress.

Lisa D. Ellis is a contributing writer for Strategic Health Care Marketing. She is a journalist
and content development specialist who helps hospitals and other health care providers and
organizations shape strategic messages and communicate them to their target audiences.
You can reach her at lisa.ellis@strategicHCmarketing.com.

patient satisfaction in healthcare - Kim Mott

“When we receive a complaint, I can show physicians this is the perception they are
giving to patients,”

Kim Mott, marketing and customer service manager for Florida Orthopaedic Institute

Tampa Bay Orthopaedic Patients Will Have Simple Quick-Access To Book appointments

By | News

FOR IMMEDIATE RELEASE:

Media Contact
Donna Bossuyt
813-480-4591
dbossuyt@floridaortho.com

Tampa Bay Orthopaedic Patients Will Have Simple Quick-Access To Book appointments

Leading Florida Orthopaedic Practice Will Utilize DocASAP Online Scheduling Across Digital Channels for Enhanced Patient Access

Tampa, Fl. – Jan. 29, 2019 – Florida Orthopaedic Institute (FOI) announced today that it is partnering with DocASAP to enhance patient access. Florida Orthopaedic Institute has selected DocASAP to provide its leading online scheduling solution for all of the practice’s physicians.

As the first orthopedic practice in the Tampa Bay area to onboard DocASAP, Florida Orthopaedic Institute is spearheading a new standard in patient access for orthopedic practices across the state of Florida. With DocASAP, patients can seamlessly access physician and physician assistant’s schedules and book appointments from their mobile device, tablet or desktop on a 24/7 basis.

What sets this partnership apart from other online scheduling implementations is the breadth of access channels available. Patients can access these features through Florida Orthopaedic Institute’s website. Additionally, patients will have options to book appointments with FOI physicians through Google My Business, Facebook, Twitter and Instagram.

“We are devoted to providing the highest level of care and access for our patients. Offering round-the-clock access in almost every sub-specialty is part of that commitment,” said Dr. Roy Sanders, MD, president of Florida Orthopaedic Institute. “As we continue to grow, it is clear we need a tool that will help us meet patients where they are and also ensure that our patients are matched with a provider that meets their clinical needs and availability. DocASAP’s capabilities help us connect with new patients and strengthen relationships with current patients.”

Florida Orthopaedic Institute

Founded in 1989, Florida Orthopaedic Institute is Florida’s largest orthopedic group and provides expertise and treatment of orthopedic-related injuries and conditions, including adult reconstruction and arthritis, chiropractic services, foot and ankle, general orthopedics, hand and wrist, interventional spine, musculoskeletal oncology, orthopedic trauma, physical medicine and rehabilitation, physical and occupational therapy, sports medicine, shoulder and elbow, spine and chiropractic services, among others. The organization treats patients throughout its surgery centers in North Tampa and Citrus Park, two orthopaedic urgent care centers in South Tampa and Brandon, and 9 office locations in Bloomingdale, Brandon, Citrus Park, North Tampa, Northdale, Palm Harbor, South Tampa, Sun City Center and Wesley Chapel. For more information, please visit: FloridaOrtho.com and ‘like’ us on Facebook: facebook.com/Florida.Orthopaedic.Institute.

About DocASAP

DocASAP is working to close gaps in healthcare access, improve the patient experience and boost provider performance through technology. Our intelligent patient-provider matching and online appointment scheduling solution connects patients with the right healthcare providers to improve population and community health. Our robust analytics and data insights help healthcare providers improve staff utilization and service offerings, all while improving patient experience. Some of the most well-known healthcare providers rely on DocASAP every day to extend their brand to the patients that need them most. To learn more, visit our website and blog.

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Fixing, salvaging radial head after fracture may prevent severe future injuries

By | News

Healio

BY: Casey Tingle
January 16, 2019

Fixing, salvaging radial head after fracture may prevent severe future injuries

WAIKOLOA, Hawaii — When faced with a radial head fracture, surgeons should fix it when possible and replace it when not salvageable to avoid more severe injuries, according to a presenter at Orthopedics Today Hawaii.

According to Mark A. Mighell, MD, type 2 radial head fractures can be treated either operatively or nonoperatively, with most able to be treated nonoperatively.

“Even when they are displaced 2 mm to 5 mm it is usually that portion of the radial head that is not supported with the strong subchondral bone,” Mighell said in his presentation.

When performing internal fixation, Mighell noted the plates need to be placed in the safe zone and either headless or 2 mm screws should be placed off the articular margin.

Surgeons should not perform tenuous fixation on a type 3 radial head fracture, according to Mighell.

“Plating provides the greatest torsional rigidity vs. pins, but … if you place the lag screws like Graham King has shown us, you can get more stability to that construct, also,” Mighell said.

For radial head arthroplasty, he noted all bony fragments should be removed from the elbow and to resect a minimal amount of bone.

“Do not get crazy with cutting down the neck of the radius to get down to where you need to be,” Mighell said. “You want to deliver the proximal radius and avoid injury to the [posterior interosseous nerve] PIN.”

One mistake Mighell noted he sees is when surgeons place too big a piece of metal in the radial head.

“You should replace what you took out,” he said. “You are not sticking a big hunk of metal in. That does not make your elbow any more stable.”

He added the height of the radial head “should be the same as the lesser sigmoid notch of the coronoid,” and the radial length should be within about 2.5 mm.

“If you get it too much more than 2.5 [mm] you are going to overstuff the lateral side of the joint, the consequences of which are that the medial side narrows … and they get arthritic change,” Mighell said. – by Casey Tingle

Reference:

Mighell MA, et al. Should you be trying to save the radial head? Presented at: Orthopedics Today Hawaii; Jan. 13-17, 2019; Waikoloa, Hawaii.

Disclosure: Mighell reports he is on the speakers bureau and is a paid consultant for DJO Surgical and Stryker, and receives research support as a primary investigator from DJO Surgical.

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Speaker discusses intraoperative, postoperative rotator cuff complications

By | News

Healio

BY: Casey Tingle
January 16, 2019

Speaker discusses intraoperative, postoperative rotator cuff complications

WAIKOLOA, Hawaii — In a presentation at Orthopedics Today Hawaii, Mark A. Mighell, MD, discussed intraoperative and postoperative complications in rotator cuff repair and how to handle these complications.

In patients with cysts or poor-quality bone, Mighell said in his presentation that it is important to get the tendon to heal. He noted nonoperative treatment is ideal because a tear associated with a cyst is not traumatic in nature. However, when surgery is needed for a large cyst, Mighell said to take care of the poor-quality bone.

For patients with poor tissue quality, Mighell noted previously published literature has shown good results infusing the tendon with fiber tape.

He advised to always be prepared in the event of a large rotator cuff tear that is medialized to the glenoid and the tissue is immobile.

“Always be prepared to have something there available and, in this case, we chose to use one of those dermal grafts,” Mighell said.

He continued, “That means you are looking at your MRI scan [and] you are doing preoperative planning. You do not want to get into surgery and then find you cannot fix the tendon.”

When performing superior capsular reconstruction to repair large rotator cuff tears with immobile tissues, Mighell recommended using a graft in which the medial dimensions are 30 mm, the lateral dimensions are 40 mm and the length is about 50 mm. He also noted that surgeons should create holes large enough to pass sutures through without becoming tangled or flipped.

“I always like to incorporate the infraspinatus, whether I put an anchor in or do a side-to-side to repair it,” Mighell said.

For postoperative complications, Mighell noted stiffness becomes a real problem in 3% to 5% of cases. Although most patients who are stiff early on have better outcomes, according to Mighell some patients may need to undergo capsular release due to adhesions and scarring around the subscapularis and thickening of the anterior capsular. He cautioned to perform the release gently so as not to retear the rotator cuff.

“The last thing you want to do is manipulate your patient that you just fixed a rotator cuff and tear out your rotator cuff repair,” Mighell said. – by Casey Tingle

Reference:

Mighell MA, et al. Rotator Cuff Repair Complications. Presented at: Orthopedics Today Hawaii; Jan. 13-17, 2019; Waikoloa, Hawaii.

Disclosure: Mighell reports he is on the speakers bureau and is a paid consultant for DJO Surgical and Stryker, receives royalties from DJO Surgical and receives research support as a primary investigator for Stryker.

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Outpatient total shoulder replacement: Pick the right patients, set the proper mindset

By | News

Healio

BY: Kristine Houck, MA, ELS
January 9, 2018

Outpatient total shoulder replacement: Pick the right patients, set the proper mindset

KOLOA, Hawaii – With many compelling reasons for outpatient total shoulder replacement surgery, orthopedic surgeons need to be aware that one of the biggest factors for success is the mindset of the patients, said a presenter at Orthopedics Today Hawaii 2018, here.

“Some of outpatient surgery is the way we explain this to patients,” Mark A. Mighell, MD, said. “By doing this and by having a well-organized team, there are certain patients who would benefit greatly.”

Mighell said a successful outpatient total joint replacement program needs to have buy-in from multiple stakeholders. The programs also need centers of excellence; a dedicated shoulder team; established pathways for postoperative issues; cooperation from anesthesia and administration teams; and implant and vendor costs. Patient selection is also key, he said.

“Patient selection – this is where the rubber meets the road,” he said. “You have to pick the right patients.”

Studies have shown the best candidates are patients younger than 70 years, patients with a BMI of less than 35 kg/mand the absence of significant cardiopulmonary comorbidities, he said. Patients must have private insurance, as outpatient shoulder replacement cannot be offered to patients with governmental insurance. Mighell said published studies have shown no significant differences in complications and no significant differences in readmission rates between properly selected patients. He also advised surgeons to have mechanisms in place to mitigate blood loss. Other critical issues are enhanced, pain control procedures and having the proper infrastructure to address postoperative management issues.

“You want to make sure your patient can get in touch with you,” he said. – by Kristine Houck, MA, ELS

Reference:

Mighell MA. Outpatient shoulder arthroplasty: How to ensure success and safety. Presented at: Orthopedics Today Hawaii 2018; Jan. 7-11, 2018; Koloa, Hawaii.

Disclosure: Mighell reports he receives royalties from NewClip Technics; is a consultant for and is on the speakers bureau for DJO Surgical and Stryker; and does contracted research for Stryker.