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    Residency training program clinical and surgical opportunities

The Adult Reconstruction Service concentrates on the care of patients with major joint arthritis. Patient referrals, received throughout the Central Valley of California, represent all adult age groups and a wide variety of types of arthritis. Common referrals are for osteoarthritis, post-traumatic arthritis, avascular necrosis and arthritis secondary to hemophilia. Common surgical procedures include total hip replacement, total knee replacement, osteotomy for realignment of extremities and arthroscopy with chondroplasty.

The department also offers a unique program in joint preservation surgery of the knee and hip. The program's objective is to maximize the function of native joints and to potentially prevent or delay the ultimate need for total joint arthroplasty. The various procedures with this aim include fresh cartilage transplantation (osteochondral allografting); mosaicplasty; unicompartmental knee arthroplasty; realignment of the pelvis, femur and knee (osteotomies); and resurfacing hip arthroplasty. Program faculty frequently employ revision total joint replacements and two-stage reconstructions for infection. The total joint components include modern cementless modular total joint replacement, custom prosthetic components and allograft replacement when medically indicated. The program also includes treatment of early chondral defects, including chondroplasties with drilling, shell allografts, autologous transplantation and "mosaic plasty" techniques.

Ongoing research in the Lawrence J. Ellison Musculoskeletal Research Center addresses the issue of strain distribution with various components and the use of lasers and photochemistry for the treatment of rheumatoid and osteoarthritis. Ongoing clinical series of primary and revision joint replacements address the issues of long-term functional outcome and predictors of success.

The Adult Foot and Ankle Service specializes in the care of patients with common and complex disorders of the foot and ankle. Orthopaedists treat both acute and chronic disorders by conservative and operative means. Special areas of interest include the evaluation and management of cartilage disorders, foot and ankle sports medicine and post-traumatic deformity.

The Orthopaedic Oncology Service is a regional referral service for the surgical treatment of musculoskeletal neoplasms and tumor-like conditions. It provides care for primary benign and malignant tumors arising within bone or soft tissues. The service pursues aggressive treatment of metastatic skeletal lesions to prevent threatened fracture or to stabilize completed fractures. The primary thrust is in the area of limb salvage for malignant tumors of the extremities. Patient referrals frequently represent diagnostic problems. Department experts reconstruct limbs using custom endoprosthetic replacements or allografts. They frequently excise benign tumors and reconstruct the bone with bone graft or demineralized cortical bone powder.

The Hand, Upper Extremity and Microvascular Service provides experience in common and complex traumatic and acquired disorders of the hand and upper extremity. Special interests and capabilities are congenital hand disorders, microvascular surgery, Ilizarov surgery and upper extremity arthroscopy and brachial plexus surgery. The service performs rheumatoid and all other reconstructive surgeries, including complex shoulder reconstruction and joint replacement. Residents gain experience in major soft tissue reconstruction, free microvascularized flaps and bone grafts. In addition to weekly gross anatomy dissections, residents on the hand service spend one week per rotation in the departmental microvascular surgery laboratory refining their surgical skills.

The Spinal Disorders Service encompasses the evaluation and treatment of both pediatric and adult spinal deformities and operates in collaboration with the multidisciplinary UC Davis Spine Center. The service is involved in the management of all acute injuries of the cervical, thoracic and lumbar spine. It is also the primary source of treatment for degenerative spinal disorders, infections and tumors. The service has three major components, each directed by an attending orthopaedic surgeon: (1) treatment of scoliosis and kyphosis in children, including patients with myelodysplasia, cerebral palsy, osteogenesis imperfecta and congenital malformation; (2) adult spinal deformities, spinal cord injury and spine trauma; and (3) adult degenerative processes of cervical and lumbar spine and spine trauma.

The service emphasizes a balanced approach to conservative and surgical management. Residents will gain surgical experience working inside and outside the spinal canal. The service emphasizes both the decompression of the neurological elements as well as spinal stabilization.

The Orthopaedic Trauma Service is an integral part of the multispecialty trauma services that provide a Level 1 trauma referral center for Northern California, Eastern Nevada and Southern Oregon. The Trauma Service specializes in the treatment of nonunions, malunions and leg-length discrepancies using closed intramedullary shortening, Ilizarov and osteotomy techniques. Treatment of pelvic and acetabular malunions is a special interest. The service constantly evaluates innovative treatment modalities such as synthetic bone and new forms of internal and external fixation. As much as possible, the service coordinates these projects with research in the Lawrence J. Ellison Musculoskeletal Research Center.

The Orthopaedic Trauma Service coordinates closely with general surgery, neurological surgery, anesthesiology  and other specialty services at the UC Davis Health. With this multispecialty care, the trauma team is able to provide comprehensive 24-hour service specializing in the patient with multiple system injuries. The service emphasizes early stabilization of fractures and aggressive rehabilitation of victims of major trauma.

Specialized surgical techniques employed are closed intramedullary fixation and combinations of internal and external fixation. Complex fractures of the pelvis, acetabulum and extremities are of particular interest.

The Sports Medicine Service evaluates and treats common soft tissue injuries of the upper and lower extremities. Surgical experience includes knee, shoulder and ankle arthroscopy and reconstructive ligament procedures. Participation as a team physician for high school athletics programs is available. Research opportunities include clinical and basic science.