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Bones & Joints JUNE 2009 YOUR GUIDE TO MUSCULOSKELETAL & ORTHOPAEDIC HEALTH Improving the Quality of Life for over 20 Years Dr. Howard Freedberg specializes in sports medicine, minimally invasive surgery, and arthroscopy of all joints. Dr. Thomas McNally is an expert in comprehensive spinal orthopaedics. www.suburbanortho.com 1110 W. Schick Road, Bartlett Il 60103 • (630) 372-1100

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Page 1: Bones & Joints - Mediaplanetdoc.mediaplanet.com/all_projects/3550.pdf · Bones & Joints june 2009 Your ... inserted to stabilize the clavicle, but she ... internal fixation (OriF)

Bones & Jointsjune 2009 Your Guide to Musculoskeletal & orthopaedic health

Improving the Quality of Life for over 20 Years

Dr. Howard Freedberg specializes in sports medicine, minimally invasive surgery, and arthroscopy of all joints.Dr. Thomas McNally is an expert in comprehensive spinal orthopaedics.

www.suburbanortho.com1110 W. Schick Road, Bartlett Il 60103 • (630) 372-1100

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bones & joints

special thanks to Major orthopaedic

Contributors

Reversing Orthopaedic Trauma By Harvesting Stem Cells by: kirk van hyning

CONTENTS 2 ReversingOrthopaedicTrauma

3 PreventingHipReplacments

3 NewLifeforOldJoints

4 WristFractures

4 AdvancesinArthroscopicSurgery

5 TheElectronicHealthRecord

6 SportsMedicine

7 HealingWoundedWarriors

8 Osteoporosis

9 ReturningtoIndependence

10 PanelofExperts

11 FutureofOrthopaedicResearch

11 AdvancesinAnteriorHipReplacment

bONES&JOINTSa special supplement produced by Mediaplanet and distributed by the chicago tribune.

Publisher:[email protected]

Contributors: SeanDougherty RichardLeonard KenNanus MarlenePiturro,PhD KirkVanHyning EmilyZyborowicz

Design:[email protected]

Printer:ChicagoTribune

Photos:©iStockPhoto.com

Mediaplanet is the leading publisher in providing high quality and in-depth analysis on topical industry and market issues, in print, online and broadcast.For more information about supplements in the daily press, please contact allan chiu, 1 312 222 5966 [email protected]

www.mediaplanet.com

Stem cells cultures may be

capable of reversing a patient’s

painful and debilitating ortho-

paedic conditions in the near future.

This method is already used to repair

fractures and bone defects at a small

number of orthopaedic surgical cent-

ers. but the healing potential of stem

cells is far greater. The full range of this

therapy’s applications has not been

determined, but is expected to include

improved tissue and muscle regenera-

tion and cartilage repair, which could

eliminate the need for artificial joints.

research scientists are also testing ef-

ficacy against osteoarthritis, osteosar-

coma and muscular dystrophy.

george F. Muschler, MD, director

of Cleveland Clinic’s Clinical Tissue

Engineering Center (CTEC) conducts

greatly effective and lasting surgery

using these methods. he has used the

therapy on at least two patients, both

of whom had chronic bone trauma

or nonunion (i.e., gapped bones not

joining). One of Dr. Muschler’s patients

was a 22 year-old college senior

injured from a motorcycle crash. her

compound fractures were treated with

conventional surgery immediately after

her crash, but she still experienced pain

and bone nonunion two years later.

She contacted Dr. Muschler, who set

the fractured areas with bone matrices,

scaffolds of sorts that act as a medium

for the stem cells and injected the gaps

with the patient’s own stem cells, which

are combined into a “matrix gel” from

harvested stem cells. She experienced

a full recovery.

Dr. Muschler also treated successfully

a full-time nurse, wife and mother with

lingering post-op pain who also recov-

ered fully. During a softball game she

dove to catch a line drive, tripped and

fell fully on her left shoulder. an x-ray

showed her collar bone had broken in

two places. a plate and five screws were

inserted to stabilize the clavicle, but she

found herself unable to perform most

of the activities as she had before. She

could not play the piano or work and

lost much mobility in her shoulder, and

suffered chronic pain. after the removal

of the shoulder screws and plates due

to the pain she suffered fracture non-

union. Dr. Muschler’s used his stem cell

intervention and after two surgeries

she had recovered and returned to

normal functioning.

While the total number of successful

stem cell treatments for orthopaedic

injuries is still small, pioneers in medicine,

using the science of healing with one’s

own cells, are expanding the use of

biotechnology to give patients with

serious injuries a better quality of life.

...expanding the useof biotechnology to give

patients with serious injuriesa better quality of life.

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bones & joints

A New Approach in Joint Replacement Surgery

Joint University at Weiss Memorial Hospital has changed the paradigm of long, painful recoveries by offering patients the latest minimally invasive and rapid-recovery techniques in hip and knee replacement surgery.

To learn more, visit www.weisshospital.com, or call (800) 503-1234 to schedule an appointment with a physician.

by: kirk van hyning

by: MarlEnE piTurrO, phD

Recognized by the aaOS on its

75th anniversary as one of the

greatest advances in ortho-

paedic surgery, joint replacements

have brought a higher quality of life

and independence to millions. henry

Finn, MD, Medical Director of the uni-

versity of Chicago bone and Joint re-

placement Center at Weiss Memorial

hospital and creator of the Finn knee

recalls his first case. “Mrs. hobart was

eight months pregnant with cancer of

her distal femur. i replaced her knee

and the diseased bone and she’s still

walking on it,”

in addition to primary joint replace-

ments many of the surgeries per-

formed by Dr. Finn and his colleagues

are complex, involving situations such

as failed joint replacements, infections,

deformities, and bone cancer. “These

cases require extreme pre-operative

planning and are labor intensive.

because we do a high volume of

surgeries that helps us anticipate and

avoid problems,” he says. planning

conferences are held every week to

discuss conditions that could impact

surgery and recovery and arrange for

special equipment if necessary.

More than 90 percent of individuals

who undergo total knee replacement

have much less knee pain and are able

to do the activities they enjoy. The first

knee replacement was performed in

1968. improvements in surgical materi-

als and techniques since then - such as

the Finn knee and many others - have

greatly increased its effectiveness.

Commenting on the growth of mini-

mally invasive joint surgery Dr. Finn

points to recent research (Journal of Ar-

thoplasty June 2009) that such surgery

had a high prevalence of failure within

24 months. The study’s author, Dr. rob-

ert barrack, concluded that “these fail-

ures are disturbing and warrant further

investigation.” another recent article in

Knee (Jan. 2009) comparing minimally

invasive to total knee replacement

showed identical accuracy, operating

time and blood loss, with less recovery

time for minimally invasive surgery. Six

months later, patients showed equal

knee functionality.

New Life For Old Joints

Traditional hip surgery replaces a

worn, arthritic joint with an artificial

hip, relieving chronic pain in older

patients and greatly improving mobil-

ity and quality of life. however, when

young or middle age people face hip

injuries, replacement may not be an

option. in that type of patient, a hip re-

placement is likely to wear out during

the patient’s lifetime, making an active

lifestyle impossible.

in contrast, hip arthroscopy is per-

formed using a camera and small in-

struments inserted through minimally

invasive incisions. This allows the sur-

geon to diagnose and repair injuries,

restoring function. hip arthroscopy

has emerged in the past few years as

a treatment for two common injuries,

the torn labrum and femoro-acetabular

impingement.

Dr. benjamin Domb, an arthroscopic

surgeon with hinsdale Orthopaedic

associates, notes that a torn labrum is

often misdiagnosed as sciatica, groin

pulls or early arthritis. “With the correct

diagnosis, we can now fix many injuries

that used to require hip replacements.”

baseball player alex rodriquez of the

new york yankees and football player

kurt Warner of the arizona Cardinals

both have had arthroscopic hip sur-

gery and were able to return to playing

professionally within months.

“The labrum is like a rubber seal

around the socket of the hip,” said

Dr. Domb. “When the seal is broken,

the hip loses lubrication and stabil-

ity, which leads to arthritis. The new

treatment can fix the seal, avoiding or

delaying the need for replacement. ”

Dr. Thomas byrd, team physician for

the Tennessee Titans, has published

data demonstrating long-term effec-

tiveness of arthroscopy in the hip for

patients who have not yet developed

arthritis. a handful of surgeons around

the country, including Dr. Domb,

continue to develop improvements in

technique and to study the long-term

success rate of these procedures.

although initially slow to accept this

new procedure, the medical profession

has now affirmed it as an essential op-

tion in treatment of hip injuries. “These

medical breakthroughs represent new

opportunities for athletes of all ages,”

Dr. Domb said. “now athletes and ac-

tive individuals can receive treatment

for major hip injuries and return to

playing the sports they love.”

Preventing Hip Replacements: Keeping A-Rod and Weekend Athletes Alive on the Field by: SEan DOughErTy

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bones & joints

Chicagoland’s Premier Orthopaedic Group

Ask Anyoneand you ‘ll make us your

first choice

It’s true. Our doctors have built such a tremendous following, “word of mouth” is our best advertising. It’s helped us become the Chicago area’s largest orthopaedic group, with specialists with advanced training in the most clinical areas.

The point is, if you have a sports injury, require treatment for arthritis or back pain, are a candidate for joint replacement, or have any other bone- or joint-related problem, find out why generation after generation of families have made us their “go to guys.”

Arlington Heights1300 E. Central847-870-6100Bannockburn2101 Waukegan Rd.847-914-9096

Chicago2860 N. Broadway773-327-8300Chicago150 N. Michigan Ave.312-444-1145

Chicago4801 W. Peterson773-777-9900Chicago205 W. Randolph312-920-9805

Des Plaines900 Rand Rd.847-375-3000Glenview2350 Ravine Way847-998-5680

Glenview2401 Ravine Way847-998-5680Gurnee350 S. Greenleaf847-336-3335

Lake Forest 900 N. Westmoreland847-336-3335Lake Forest 1200 N. Westmoreland847-247-4000

Libertyville720 Florsheim Drive 847-247-4000Lincolnwood7126 N. Lincoln Ave.847-676-5979

Morton Grove 9000 Waukegan Rd.847-375-3000Wilmette1144 Wilmette Ave.847-998-5680

The ultimate Frisbee player ex-

tending his arm to break a fall

and the hurried homeowner

slipping on the ice and bracing for

impact have something in common.

They’ve got a distal radius fracture,

sometimes called a broken wrist, and

one of the most commonly broken

bones in the body. The radius is the

larger of two bones that make up the

forearm, located on the same side as

the thumb, and often breaks after a

patient falls on the hand while it is

stretched outward. There have been

major advances over the years in how

orthopaedists treat such fractures.

“The technology behind fixing these

fractures has evolved, making the

recovery simpler and allowing patients

to use their hand faster than they could

before,” says Dr. leon benson, MD, at-

tending orthopaedic surgeon, hand

and upper Extremity Surgery, at the

illinois bone and Joint institute. Casts

have traditionally been used to immo-

bilize the wrist while the radius fracture

healed. They continue to be prescribed

for patients with minor fractures. Exter-

nal fixation, which involves an ortho-

paedic surgeon placing pins on both

sides of the fracture and linking them

together with a rod along the outside

of the wrist, realigns fractured bones

more precisely than a cast because it

prevents wrist movement.

More recently, orthopaedists have

developed surgical techniques with

faster recovery times and better

outcomes. They use open reduction

internal fixation (OriF) surgery to treat

distal radius fractures by implanting

hardware such as plates and screws

to secure the broken bone in place

as it heals. The surgical implants are

available in a variety of sizes and

are designed to fit fractures more

accurately. OriF surgeries last approxi-

mately an hour and are performed on

an outpatient basis. Depending on the

recommendation of the orthopedic

surgeon, the hardware can remain

implanted or can be removed at a later

date. Dr. benson explains, “The rigid

fixation of the implant to the bone

allows the patient to regain mobility

faster when compared to wearing a

cast or an external fixation device and

thereby enables less “down time” from

work or activities of daily living.”

While orthopaedists have sophisti-

cated treatment options for healing

distal radius fractures, assessing which

treatments will improve the quality of

life for patients depends on a variety

of factors such as the extent of the

fracture as well as the age and activity

level of the patient.

Americans are living longer,

more active lives. While we

know the benefits of in-

creased exercise, joint problems have

also increased with the level of activ-

ity. Many corrective joint procedures

that would have required extensive

rest, pain medication, or rehabilitation

have been much improved. Dr. Freed-

berg of Suburban Orthopedics states,

“The arthroscope is one of the greatest

advances in the history of orthopaedic

technology.”

The arthroscope, a tiny instrument

inserted into a joint by an orthopaedic

surgeon, has changed the way joint

surgery is done. “We can give people

who are injured the quality of life they

are looking for,” states Dr. howard

Freedberg. arthroscopic intervention

has allowed doctors to get patients

back in the game with less pain. ar-

throscopic surgery can be performed

on joints, including knees, shoulders,

hips and ankles. The doctor examines

and can repair cartilage, ligament, and

the area around the joint with mini-

mum damage to surrounding tissue.

arthroscopic knee surgery fre-

quently involves repairing meniscus

cartilage. The meniscus, according to

Dr. Freedberg, who is affiliated with

alexian brothers Medical Center, St.

alexius Medical Center, Sherman hos-

pital, and Central Dupage, is the “load

transmitting shock absorber” for the

knee. We can now repair the meniscus

instead of just removing it. This helps

delay that arthritic process. in some

cases, Dr. Freedberg said, ‘Cartilage

from the knee can be grown in the

lab and implanted or a plug of bone

and cartilage can be transferred from

one part of the knee to the damaged

portion.”

Other joints benefit from joint sur-

gery advances. “loss of motion in the

shoulder is very painful,” Dr. Freedberg

observed. “With the arthroscope we

can take out loose bodies, contour the

shoulder socket better. The patient

experiences major pain relief.” in ad-

dition, he continued, “arthroscopically

fusing ankles that have arthritis is one

of the best things i do. by not being

invasive into a joint, rehab becomes

easier and there’s substantially less scar

tissue.” The hip joint is one of the latest

to be helped arthroscopically. The

cartilage can be repaired, loose bodies

removed, and the joint reshaped by

removing bone.

by not being invasive into a joint

there is substantially less scar tissue and

rehabilitation is quicker. “Many people

can go back to work in two days”, Dr.

Freedberg commented. “Some people

will hurt less, some slightly more, but

everyone can get into rehabilitation

quickly because there’s much less

discomfort than before arthroscopy.”

Wrist Fractures: new surgical options

Advances in Arthroscopic Surgery

by: EMily ZybOrOWiCZ

by: kEn nanuS

by: MarlEnE piTurrO, phD

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bones & joints

Chicagoland’s Premier Orthopaedic Group

Ask Anyoneand you ‘ll make us your

first choice

It’s true. Our doctors have built such a tremendous following, “word of mouth” is our best advertising. It’s helped us become the Chicago area’s largest orthopaedic group, with specialists with advanced training in the most clinical areas.

The point is, if you have a sports injury, require treatment for arthritis or back pain, are a candidate for joint replacement, or have any other bone- or joint-related problem, find out why generation after generation of families have made us their “go to guys.”

Arlington Heights1300 E. Central847-870-6100Bannockburn2101 Waukegan Rd.847-914-9096

Chicago2860 N. Broadway773-327-8300Chicago150 N. Michigan Ave.312-444-1145

Chicago4801 W. Peterson773-777-9900Chicago205 W. Randolph312-920-9805

Des Plaines900 Rand Rd.847-375-3000Glenview2350 Ravine Way847-998-5680

Glenview2401 Ravine Way847-998-5680Gurnee350 S. Greenleaf847-336-3335

Lake Forest 900 N. Westmoreland847-336-3335Lake Forest 1200 N. Westmoreland847-247-4000

Libertyville720 Florsheim Drive 847-247-4000Lincolnwood7126 N. Lincoln Ave.847-676-5979

Morton Grove 9000 Waukegan Rd.847-375-3000Wilmette1144 Wilmette Ave.847-998-5680

The Obama administration

allocated $19 billion of stimulus

funds to connect physicians,

hospitals, pharmacies, labs, imaging

centers, and other healthcare provid-

ers through Electronic health records

(Ehrs]. The carrot for physicians is

$44,000 to adopt an Ehr, a develop-

ment that is expected to improve

patient care and lower health care’s

staggering costs. glen Tullman, CEO of

Chicago based allscripts, the nation’s

largest publicly-traded Ehr provider,

reacts to the health care stimulus

spending: “Enabling a majority of

physicians to use electronic health

records is the single most important

thing we can do to improve the quality

and lower the cost of healthcare in

america.” but implementing Ehrs for

the u.S.’ 633,000 physicians and 5708

hospitals will be daunting. a New Eng-

land Journal of Medicine study (March,

2009) showed that only 1.5 percent of

hospital records are fully computerized,

while just four percent of physician

groups have “fully functional” Ehrs

(17% have some form of Ehr.)

To change that, allscripts, Cisco,

Citrix, Dell, inuit, Microsoft and nuance

have formed the Ehr Stimulus alliance

to educate america’ s doctors about

Ehrs. “The core issue in healthcare is

that it is not connected—functionally,

financially or technically. Connecting

to information from different care set-

tings and stakeholders is what physi-

cians need,” says Tullman, adding: “our

aim is to create the Microsoft Office of

health care—to develop a standard all

doctors can rely on.

For orthopaedic practices electronic

health records help by providing

extensive orthopaedic-specific clini-

cal content, capturing clinical images

directly into the patient’s chart where

they can be viewed remotely via the

Web when needed, generating auto-

matic referral letters, and eliminating

paper transmission of laboratory and

other diagnostic reports. The Ehr also

allows physicians to automate vital

clinical functions including writing and

refilling prescriptions, ordering tests,

viewing test results, documenting care,

and checking for harmful drug-allergy

interactions. Ehrs allow our physicians

to continue to practice medicine at

their pace while streamlining many

office functions,” said anthony pachelli,

M.D., of new Mexico Orthopaedics in al-

buquerque, nM. “With only a few clicks, i

can customize forms, patient education

information and prescriptions. Without

an Ehr, it would take several minutes

per patient to complete.”

using iT to connect america’s health

care stakeholders is a huge task with

huge potential payoffs. Tullman sums

up: “it’s likely we’re moving towards

uniform standards that enable con-

nectivity and interoperability of patient

information across multiple platforms,

but [as the Ehr becomes more wide-

spread] you’ll see far fewer platforms as

the industry consolidates.“

by: MarlEnE piTurrO, phD

Stimulating The Electronic Health Record

$44,000 $44,000 $44,000 $44,000 $44,000 $44,000 $44,000 $44,000 $44,000 $44,000 $44,000 $44,000 $44,000 $44,000

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$35,000 $35,000 $35,000 $35,000 $35,000 $44,000 $44,000 $44,000 $44,000 $44,000 $44,000 $44,000 $44,000 $44,000

Know how to get $44,000+ for using an EHR?The Stimulus Plan provides physicians an unprecedented opportunity to adopt Electronic Health Records to improve healthcare in America.

“Now is the right time to implement a state of the art EHR and Practice Management system to create a superior quality environment for patient care. Allscripts is an exceptional leader in this industry for performance excellence and will make a substantial impact in the success of any organization. ” - Jay L. Levin, M.D., Adult & Pediatric Orthopedics, Vernon Hills, IL

The Time is Now. The Choice is Allscripts.

Call877-EHR-NOW1

[email protected]

Join the Tourwww.ehrstimulustour.com

$44,000

...improve the quality and lower

the cost of healthcare in

America.

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bones & joints

Buford Acklin and his teammates were doing a routine punt drill during football practice in Chicago when the defense came at him full force. His leg got caught in the middle, twisting it and dislocating his knee. “I thought I’d just be out for a couple of months, and then I’d be back to practice,” 18-year-old Buford says. When Buford was examined by Martin Leland III, MD, Assistant Professor of Surgery at the University of Chicago Medical Center, advanced diagnostic imaging revealed a much more serious injury.

An MRI showed that Buford had ruptured three of the four ligaments in the knee — the ACL, PCL and MCL — and had a torn medial meniscus, one of the knee’s two shock absorbers. Dr. Leland knew that if Buford didn’t receive immediate treatment, the injury could be devastating — he might never be able to bend his knee, run or play sports again.

Under Dr. Leland’s care, Buford was in surgery the next morning for the first of two operations to complete a complex multi-ligament knee reconstruction. With state-of-the-art

technology, Dr. Leland was able to prevent scarring of the tissue, fix the meniscus and reconstruct the ligaments with arthroscopic surgery.

Injuries of this type are rare. But Dr. Leland and his orthopaedic team were able to craft a treatment plan that would not only give Buford the full use of his knee, but get him back in the game.

After four months and aggressive physical therapy, Buford has regained full range of motion in his leg. “I’m back to doing everyday things,” he says. “Dr. Leland helped me understand what they were doing and made me feel comfortable. They really cared.”

For more information about our Orthopaedic Sports Medicine program, visit uchospitals.edu or call 773-834-3531.

sports medicine surgeon gets athlete back in the game

J. Martin Leland III, MDOrthopaedic Sports MedicineUniversity of Chicago Medical Center

Martin leland, MD, of the uni-

versity of Chicago Medical

Center’s Orthopaedic Sur-

gery/Sports Medicine department,

sees all kinds of sports injuries. “The

most common sports injuries are to

the knees, for meniscus and aCl (ante-

rior cruciate ligament) tears; and for the

shoulder, rotator cuff and labral tears“

he says.

Dr. leland explains that athletes

usually injure the meniscus through

cutting or pivoting motions common

in most sports, from golf and tennis

to soccer and football. aCl injuries

are usually caused by a direct blow to

the knee or abnormal rotation of the

knee over a planted foot. “recreational

in-line (straight) running, on the other

hand, usually doesn’t cause these

injuries,” he adds.

rotator cuff injuries to the shoulder

are common in individuals over age

40, particularly athletes that receive

a sharp blow to the arm. Tennis and

swimming more often cause chronic

problems, such as tendinitis, rather

than a torn rotator cuff. in adolescent

athletes in the 12-22 year old range,

many labrum (soft tissue disc in the

shoulder) injuries are common. “in

these cases, shoulder dislocations or

repetitive high-speed motions, such as

pitcher throwing fastballs, can cause

the labrum in the shoulder to tear,” Dr.

leland says.

To get athletes with injured knees

and shoulders back to their sports

quickly and safely, minimally invasive

arthroscopic outpatient surgery is an

option. “patients receive nerve blocks

and are numb so they don’t experience

much pain after surgery. recovery

time is surgery specific. a patient with

meniscus surgery can walk the same

day and function fully in one to two

weeks, while an aCl reconstruction

means no aggressive sports for five to

six months,” Dr. leland explains.

The best treatment for injury is

prevention and Dr. leland offers this

advice about decreasing the risk of

injury:

• Stay in shape

• Stretch frequently to avoid tight

muscles

• Stay well hydrated during activity by

drinking plenty of fluids

Sports Medicineby: MarlEnE piTurrO, phD

Most Common Musculoskeletal Reasons People Visit their Doctors: 2006

The top five reasons for the office

visit are pain, ache, soreness

or discomfort

• back 12,846,000

• knee 12,315,000

• lower back 8,608,000

• Shoulder 7,550,000

• neck 4,968,000

Total musculoskeletal/orthopaedic

surgeries-2006

• 7.4 million surgeries

Sources: american academy of Orthopaedic Surgeons, national Center for health Statistics, 2009

americans love their sports, both indoors and out. according to american Sports Data, inc. 50.6 million of us exercise regularly, 39.9 million participate in recreational sports teams, and 15.3 million regularly hike and bike. Overall, 68% of us, nearly 200 million people from ages four to 100 participate occasionally in sports. The downside is that all this activity results in over four million trips to the E.r annually, of which children ages 5-14 account for 1.6 million visits.

orthopaedics Fast FactsRecovery time is surgery

specific. A patient with meniscus surgery can walk the same day and function fully in one to two weeks...the best

treatment for injury is prevention.

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bones & joints

Buford Acklin and his teammates were doing a routine punt drill during football practice in Chicago when the defense came at him full force. His leg got caught in the middle, twisting it and dislocating his knee. “I thought I’d just be out for a couple of months, and then I’d be back to practice,” 18-year-old Buford says. When Buford was examined by Martin Leland III, MD, Assistant Professor of Surgery at the University of Chicago Medical Center, advanced diagnostic imaging revealed a much more serious injury.

An MRI showed that Buford had ruptured three of the four ligaments in the knee — the ACL, PCL and MCL — and had a torn medial meniscus, one of the knee’s two shock absorbers. Dr. Leland knew that if Buford didn’t receive immediate treatment, the injury could be devastating — he might never be able to bend his knee, run or play sports again.

Under Dr. Leland’s care, Buford was in surgery the next morning for the first of two operations to complete a complex multi-ligament knee reconstruction. With state-of-the-art

technology, Dr. Leland was able to prevent scarring of the tissue, fix the meniscus and reconstruct the ligaments with arthroscopic surgery.

Injuries of this type are rare. But Dr. Leland and his orthopaedic team were able to craft a treatment plan that would not only give Buford the full use of his knee, but get him back in the game.

After four months and aggressive physical therapy, Buford has regained full range of motion in his leg. “I’m back to doing everyday things,” he says. “Dr. Leland helped me understand what they were doing and made me feel comfortable. They really cared.”

For more information about our Orthopaedic Sports Medicine program, visit uchospitals.edu or call 773-834-3531.

sports medicine surgeon gets athlete back in the game

J. Martin Leland III, MDOrthopaedic Sports MedicineUniversity of Chicago Medical Center

THE STRENGTH TO HEAL

and learn lessons in courage.We’ll pay you more than $1,900 a month while you are in a residency program. This monthly stipend will help you gain the Strength to Heal. In addition, you’ll gain experience with top medical professionals and the most advanced technology. You’ll be able to practice in your community and serve when needed. You’ll be helping our Soldiers, your country and your career.

To learn more about the U.S. Army Reserve Health Care Team, call Sgt. 1st Class David Ryan at 877-655-6529, email [email protected], or visit healthcare.goarmy.com/info/mcstrap1.©2008. Paid for by the United States Army. All rights reserved.

© 2009 NAS(Media: delete copyright notice)

Mary/AR10.1 x 4.54 color

If you are an american service mem-

ber, his or her spouse, or child, your

shattered hip or fractured ulna will

probably be reconstructed by one of

our nation’s finest orthopaedic sur-

geons. The army orthopaedists’ skills

are fostered and challenged by see-

ing patients such as a 20-year old with

burns over 90 percent of his body and

an arm and a leg lost to a roadside

bomb in iraq. That soldier was treated

by Todd Feathers, MD, third year ortho-

paedic surgical resident and Captain in

the uSa Medical Corps at brooke army

Medical Center (baMC). “i felt so close

to him,” explains Dr. Feathers. “it’s al-

most impossible to survive that much

burn, but he did and recovered well

enough to get around in a motorized

wheelchair. he’d play basketball and fall

out of his wheelchair, break a bone and

i’d fix him up. a day before another sur-

gery, out of the blue, he died. it shocked

me.” a not uncommon story for valiant

soldiers and their doctors.

“We have to think outside the box

to devise unconventional treatments

to save mangled limbs and lives,”

says Captain Joanna branstetter, MD.

Citing a young soldier with a large

lower leg wound that would ordinarily

require amputation because of the

gap between leg bones, she describes

applying a Taylor spatial frame for 9-12

months, which gives “six degrees of

freedom to straighten the leg.” a com-

puter program directs the patient to

adjust the frame’s six struts every day

until the bone mends.

it’s not all heart-stopping orthopae-

dic care at baMC and Madigan army

Medical Center in Tacoma, where

Dr. branstetter deploys next. army

orthopaedic surgeons treat service

members’ dependents and retired

personnel as well as active duty sol-

diers, sailors and airmen. That brings

countless elective hip, knee, bunion

and carpal tunnel surgeries. “in some

ways we have a normal orthopaedic

surgical practice with an added subset

of wounded soldiers,” adds Dr. brans-

tetter, who recently completed a sixth

year of residency researching advanced

wound care.

although some deploy to the bat-

tlefield, all of the army’s orthopaedic

surgeons learn war medicine. Through

the Defense Medical readiness Train-

ing institute (DMrTi), physicians from

the services receive combat casualty

training, preparing them to provide

basic field medical and survival skills,

to work in battalion aide stations,

advanced trauma training, and medi-

cal forward support. Col alan Moloff,

DMrTi’s former director, now retired,

said “the course is the first echelon

of care for physicians, physician as-

sistants, nurses, dentists and medical

service corps officers to be combat

casualty ready.”

Dr. Feathers explains how combat

training works in a war zone: “Some-

one on the battlefield stops any

bleeding and transfers the soldier to a

combat support hospital for stabiliza-

tion. Then it’s on to landstuhl aFb in

germany where they’re treated more

comprehensively, then sent to baMC

or another u.S. facility within three

days of their injury.”

army orthopaedic surgeons have

chosen a rigorous path. Dr. Feathers

says he would choose the same route

again. “Working with these disfigured

soldiers every day, it’s amazing they re-

main so positive. They have been dealt

terrible hands by war and life, but they

fight hard to recover. We are exposed

to extreme and complicated cases and

are highly sought after for civilian prac-

tice. but to work with young soldiers

who lose a leg and want to go back to

the battlefield to serve their country

yet again is a powerful reward,” he

says. Dr. branstetter claims she’s got

the best job in the world. “i expected

my soldiers to be horrible and mean

because of what they have suffered

but they are so upbeat. They are the

best of the best” she concludes.

Healing Wounded Warriors: the Army’s orthopaedic surgeonsby: MarlEnE piTurrO, phD

The american academy of Orthopaedic Surgeons will host an art show in new

Orleans in March 2010 to honor wounded warriors and their medical teams. For more

information and submission guidelines, visit www.woundedinactionart.org.

We are exposed to extreme and

complicated cases and are highly sought after for civilian practice.

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bones & joints

Experience the Differencein Rehabilitation

More than 40 sites of care throughout Chicago, suburbs, Rockford and southern WisconsinFor more information, call 1-800-351-3130 or visit us at www.thealdennetwork.com

Short-Term RehabilitationOrthopedic, Cardiac and Stroke Recovery

Physical, Occupational and Speech Therapies

HEALTH CARE & SENIOR LIVING

Mark gonzalez, MD, professor

and chairman of orthopae-

dic surgery at university

of illinois Medical Center, stresses the

importance of screening women over

the age of 65 and men over the age of

70 for osteoporosis. Early detection can

help prevent devastating fractures that

can result in a loss of independence,

a lower quality of life and even pre-

mature death. Dr. gonzalez says that

screenings should also be performed

at even earlier ages for people with

certain risk factors including having a

very thin frame, a family history of oste-

oporosis and fractures, and smoking.

although bone loss is a naturally

occurring process that begins when

patients enter their thirties, a life-long

diet rich in calcium and vitamin D can

help maintain bone density, says Dr.

Subhash C. kukreja, MD, professor of

medicine and co-director of the bone

health program at the university of

illinois Medical Center. The national

Osteoporosis Foundation recom-

mends that adults under the age of 50

take 1,000 mg of calcium and 400-800

iu of vitamin D daily, while adults over

the age of 50 take 1,200 mg of calcium

and 800-1,000 iu of vitamin D daily.

Exercise such as weight training is also

an important component of helping

sustain bone density.

Dr. kukreja adds that once a patient

is diagnosed with osteoporosis, various

medicines with anti-fracture properties

can be prescribed to decrease and

even reverse the bone loss. Two such

examples include bisphosphonates

and teriparatide, both of which can be

used by women and men. bisphospho-

nates, including boniva, Fosamax and

reclast, are a class of drugs that inhibit

bone loss by destroying osteoclasts,

the cells responsible for eating away

at the bone. Teriparatide, a type of

parathyroid hormone, is used for treat-

ing severe cases of osteoporosis and

induces new bone growth by stimulat-

ing osteoblasts, the cells that form new

bone. postmenopausal women should

ask their doctors whether hormone

replacement therapy or selective

estrogen receptor modulators (SErMs)

are right for them to prevent osteopo-

rosis.

Osteoporosis: early Prevention Reduces Fractures by: EMily ZybOrOWiCZ

Osteoporosis is widespread among aging popula-tions. it reduces bone density and heightens the risk of serious, life-altering bone fractures. The disease is asymptomatic, frequently detected after a fracture occurs when bones have already become weak. according to the american academy of Orthopaedic Surgeons (aaOS), osteoporosis affects approximately 28 million americans and contributes to an estimated 1.5 million bone fractures each year, particularly in the hip, spine and wrist.

Although bone loss is a naturally occurring process that begins when

patients enter their thirties, a life-long diet rich in calcium and vitamin D can help maintain bone density

Advanced science for real living.™

800.581.8169

www.oxfordknee.com/IL

©

®

®

®

Mary Lou Retton1984 Olympic Gold MedalistBiomet Joint Replacement Patient

®

®

®

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bones & joints

While a fractured hip or worn

out knee are inconvenient

for the young, these condi-

tions can be life threatening for older

adults. according to hip Fractures: a

practical guide to Management, be-

tween 14 to 36 percent of individuals

die within one year of a hip fracture;

many others suffer a diminished qual-

ity of life. people of all ages with joint

repair or replacement need a reha-

bilitation program to return to the

best functioning they can. For bob

Tripicchio, pT, DSc, president of Com-

munity physical Therapy & associates

(CpT), whose physical, occupational

and speech therapists provide reha-

bilitation services to more than 8,000

individuals each year at 22 alden re-

habilitation and health Care Centers

throughout Chicago and the suburbs,

each patient has a different mindset

and goals that shape the course of

their rehabilitation.

“We have some patients, with the

support of a caregiver, who complete

their therapy program at the SnF

(skilled nursing/rehabilitation facility)

as quickly as possible so they can be

discharged home, while others stay

longer because they want to achieve

the highest level of independent

functioning possible. before treatment

all patients receive functional perfor-

mance tests to determine the most ef-

fective course of treatment. Therapists

perform a falls risk assessment to see

what environmental adaptations that

person needs to be safe at home,”

explains Dr. Tripicchio. For hip fracture

and knee replacement surgery, much

depends on whether the patient can

bear weight on the limb, and their

ability to withstand rehab’s intensity

and duration. “For patients who are

fast tracked to return home in seven to

10 days after surgery, they may have

physical therapy two to three hours a

day, seven days a week,” he adds.

regardless of whether or not a

person chooses a fast-track rehabilita-

tion program or increases their stay

to achieve maximum function, it is

important to know what is necessary

in order to function safely at home and

reintegrate successfully into the com-

munity. The minimal requirements to

be independent in the community are

as follows:

• Walk a minimum of 1,000 ft per

errand for 2-3 errands per trip

• Carry packages averaging 6-7 pounds

(a gallon of milk) while walking

• Safely negotiate stairs, curbs, slopes;

walk and look in all directions in a

reasonable amount of time

• Safely engage in frequent postural

transitions, including changing

directions, reaching, looking up and

moving backwards

• Walk at a minimum speed of 160 ft

per minute (or about 2.6 ft/sec)

• rise from a chair without using your

arms and with minimum effort

While helping a patient with joint

involvement overcome pain and

swelling and regain range of motion

and muscle strength are important to

rehabilitation, other factors need to

be taken into consideration. “Meeting

each patient’s goals associated with

their preferred lifestyles, whether it’s

putting on their shirt independently or

being able to negotiate stairs to go to

work, is what motivates them and us,” concludes Dr. Tripicchio.

Experience the Differencein Rehabilitation

More than 40 sites of care throughout Chicago, suburbs, Rockford and southern WisconsinFor more information, call 1-800-351-3130 or visit us at www.thealdennetwork.com

Short-Term RehabilitationOrthopedic, Cardiac and Stroke Recovery

Physical, Occupational and Speech Therapies

HEALTH CARE & SENIOR LIVING

Returning to Independence: one step At A timeby: MarlEnE piTurrO, phD

Advanced science for real living.™

800.581.8169

www.oxfordknee.com/IL

©

®

®

®

Mary Lou Retton1984 Olympic Gold MedalistBiomet Joint Replacement Patient

®

®

®

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bones & joints

Q: What could be the cause of the

dull and aching pain that radiates

down my inner thigh?

A: you are likely experiencing osteo-

arthritis, or degenerative arthritis of

the hip, which is the breakdown of car-

tilage in the joints. it usually develops

as we age, with symptoms commonly

presenting in the groin area and pain

radiating down the inner thigh and

even the buttocks.

an X-ray of the hip area will deter-

mine the severity of the osteoarthritis.

if there’s little cartilage deterioration,

the first course of treatment we recom-

mend is nonsteroidal anti-inflammatory

medications. prior to considering sur-

gery, a patient may also consider a cor-

ticosteroid injection in the hip. because

of the sensitivity of the area, patients

are sedated as a needle is guided into

the affected hip during a flouroscopic

X-ray-controlled procedure. When

the patient awakes, they experience

complete pain relief for about one year

before another injection is needed.

if the osteoarthritis has progressed

to a point where little cartilage remains

in the hip joint, surgery is advised.

When we perform a total hip replace-

ment, we utilize minimally invasive

techniques, high-demand bearings

and uncemented technology. The

implant may last indefinitely, absent of

any complications. Within three weeks,

patients should be back to life as they

knew it, without the pain.

risks are minimal—there’s a 1

percent chance of infection (3 to 5 per-

cent for diabetics or patients who are

immunosurpressed)—and include the

possibility of blood clots, sciatic nerve

damage, fracture of the bone, bleeding

and wound complications.

Q: how do you separate hype from

reality in Orthopaedic Surgery?

A: america faces a crisis of rising

health care costs and a troubled

economy. patients are reading or hear-

ing of new ways to grow or transplant

cartilage in damages joints and are

shown a few patients which have

experienced good results. The past

decade told patients about minimally

invasive surgeries which “do not cut

any muscles” and use shorter incisions.

it is appealing due to the potential of

avoiding pain or recovering faster. Doc-

tors must always embrace the ethics

and morality in our life’s work. We need

to filter out the media noise that exists

in internet, print media, and broadcast

media. Though we treat a patient for

the here and now, we must care for

their long term result. The choice for a

patient might be a procedure proven

in the literature for long term success.

The other choice is unproven recon-

structions that seem to be less invasive

or seem to preserve more of their

anatomy. This might cause a patient to

spend precious healthcare dollars for a

consultation to find out they have been

simply attracted to hype and not the

reality. One of the best recommenda-

tions to a patient is simply to ask their

doctors if there are long term studies

in the literature to show whether their

reconstruction will serve them over a

period of decades. if they cannot, then

they must realize they are now a part

of an unofficial study which may lead

them to a larger and more dangerous

operation in the near future

Q: i’m a baseball player and with a

torn labrum in my shoulder. What is the

labrum and how is it treated?

A: The labrum is a soft, ring of tissue

that encircles the shoulder joint and

adds stability to the shoulder. labral

injuries in athletes usually occur in

one of two locations: the front of the

labrum, called a bankart lesion, or the

top of the labrum, called a Slap tear.

bankart lesions are usually caused by

traumatic injuries, such as shoulder dis-

locations. young athletes with bankart

lesions are at a high risk of repeated

shoulder dislocations unless they seek

treatment. While physical therapy can

help strengthen the shoulder and de-

crease the risk, the most reliable way

of preventing future dislocations is by

fixing the torn labrum. The labrum can

be fixed using a minimally invasive,

arthroscopic technique which allows

for less pain and less scarring. rehabili-

tation after surgery normally takes 4 to

6 months to allow for healing of the

labrum but most patients can expect a

full return to all sports.

Slap tears can also occur from a

traumatic injury but are more com-

monly the result of repeated forceful

motions, such as pitching. Often, these

injuries will improve using conserva-

tive therapies, such as rest, ice, anti-

inflammatory medications (ibuprofen,

naproxen, etc.), and physical therapy. if

these options do not help resolve the

pain, Slap tears can also be repaired

using arthroscopic techniques.

if you have problems with shoulder

pain or instability, see an Orthopaedic

Sports Medicine surgeon who can help

make the diagnosis using physical

exams and an Mri and get you on the

road to recovery!

Q: What should i know about reha-

bilitation?

A: When recovering from hip or

knee surgery, you often have a choice

between recovering at home or in a

skilled nursing facility such as an alden

rehabilitation and health Care Center.

Though there are benefits to both,

those who choose to receive rehabilita-

tive care at an alden rehabilitation and

health Care Center benefit from the

24/7 attention of a multidisciplinary

team of health care professionals that

includes on-staff physicians, therapists,

nurses and other caregivers. What is

important to know about any reha-

bilitation program, whether at an alden

facility or elsewhere, is that it should be

designed to restore functional abilities

so you can return to leading the life-

style you desire as quickly and safely

as possible.

alden rehabilitation and health

Care Centers can offer a wide range

of services including physical, oc-

cupational, speech and respiratory

therapy services up to seven days a

week. in addition to applying the most

current treatment interventions for

your condition, you can expect alden

therapists to focus on you as a person,

addressing your needs, your concerns

and your goals. research shows that

when patients play an active role in

their own recovery and participate in

their treatment goals, clinical outcomes

and satisfaction are both significantly

higher. involving yourself in your treat-

ment plan by voicing your needs and

goals will ensure that each therapy

session is productive and meaningful

to you, and that your recovery will be

just as you want it to be.

Panel of Experts

Henry finn, MDMedical Director, University of Chicago Bone and Joint replacment Center at Weiss Memorial Hospital

Wayne M golDstein, MDClinical Professor or orthopaedics, University of illinois at Chicago; President illinois Bone and Joint institute

Martin lelanD, MDassistant Professor of surgery University of Chicago Medical Center

BoB triPiCCHio, Pt, DsC President, Community Physical therapy & associates (CPt)

Q: What is bone density scanning

and should i have it done?

A: bone density screening, often

referred to as bone densitometry or

dual-energy x-ray absorptiometry

(DXa), can be a vital tool to determine

bone loss. if you are at risk for osteopo-

rosis, a weakening of the bone, which

often effects post-menopausal women,

and can occur in men, then you should

definitely ask your physician about

measuring your bone mineral density.

This non-invasive, low-radiation test

can help predict your risk for bone

fractures, especially in the hip and

spine. The DXa machine emits two

low-dose x-ray beams through the

bones of the hip and lower back. The

test is quick, painless, and similar to

a regular x-ray; however, if you are

at risk, it could help prevent painful,

debilitating bone fractures by alerting

you and your physician to decreasing

bone density. risk factors include

post-menopausal age, history of hip

fractures for you or women in your

family, type 1 diabetes, kidney or liver

disease, and smoking. you should make

sure that the american board of radiol-

ogy certifies your radiologist, and the

location you select for your DXa test

is accredited by the american College

of radiology—do not be afraid to ask.

These credentials assure you that the

physician who interprets your results,

and the technologist who conducts

the test, and the equipment used, all

meet the highest level of training and

performance. Once you have a baseline

measurement, you will get the best

indication of changes if you go to the

same facility for future tests.

Peter CorMier, MD northwest Community Hospital Board Certified american Board of radiology

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bones & joints

708.429.3455 • www.integrityorthopedics.com6850 W. Centennial Drive, Tinley Park, IL 60477

A Premiere Orthopedics Practice

Dr. Daniel Weber

Specializing in knee and hip replacement, knee and shoulder arthroscopy, and sports related injuries.

>> Join Dr Weber for a talk on Anterior Hip Replacement July 16 at 6pm. call 708.429.3455 for details.

According to Dr. Joshua J. Jacobs,

MD, professor and Chairman of

the Department of Orthopae-

dic Surgery at rush university Medi-

cal Center, evidence-based medicine

will help shape the future of muscu-

loskeletal surgery by providing ortho-

paedists with a solid understanding

of which patients will respond best to

which treatments. This evidence will be

provided by high-quality randomized

controlled clinical trials that compare

the efficacy and cost efficiency of dif-

ferent types of surgical and non-sur-

gical treatments, as well as the use of

various materials and biological agents

in implants. The american academy of

Orthopaedic Surgeons (aaOS) is ad-

vocating the launch of a national joint

registry, which would track the results

of joint replacement surgeries across

the u.S. giving surgeons access to such

a registry would allow them to assess

procedures and types of implants

based on their performance across

populations. This will help to reduce

the number of failed prostheses and

lead to better patient outcomes and

lower health care costs.

according to Dr. Jacob, early inter-

vention can greatly curtail the effects

of musculoskeletal diseases on patients

in many cases. biotechnology research

is playing a key role in developing

advanced detection and diagnostic

tools to help. The development of ge-

netic tests that can predict a patient’s

likelihood of ever developing an ortho-

paedic disorder will lead to better pre-

vention strategies, and evaluating the

genetic composition of patients’ tissue

will one day help surgeons predict how

patients will react to different surger-

ies. in addition, establishing biomarkers

for orthopaedic diseases will allow

doctors to pinpoint the disorder more

accurately than by interpreting x-rays

or evaluating clinical symptoms.

Orthopaedic tissue engineering

is a growing area of study that uses

engineering principles to regenerate

tissues that are vital to the musculo-

skeletal system, including cartilage,

bone, tendons and ligaments. The goal

of researchers is for patients whose

joints have become damaged due to

worn cartilage to eventually receive

implants made from new cartilage and

bone constructs grown in a lab rather

than from the artificial materials cur-

rently being used.

in an effort to minimize pain and

invasiveness while increasing success

rates, computer- and robot-assisted

orthopaedic surgeries will also become

more commonplace.

by: EMily ZybOrOWiCZ

The Future of Orthopaedic Research

Recovery time, four-six weeks

of limited movement following

the surgery, is one of the major

drawbacks of traditional hip surgery.

it can be addressed by an innovative

but less commonly performed version

of the treatment, anterior approach

hip replacement.

The anterior approach to hip

replacement surgery allows the

surgeon to reach the hip joint from

the front of the hip as opposed to the

side or back, which is the approach

used in the traditional version of the

procedure. The anterior approach

allows the surgeon to replace the hip

without cutting or splitting muscle

tissue, a source of pain and time to heal

following traditional surgery.

Daniel Weber, M.D., of integrity

Orthopedics and board-certified or-

thopaedic surgeon at ingalls Memorial

hospital in harvey, il says that patients

who undergo the minimally invasive

procedure leave the hospital with no

precautions, allowing them to immedi-

ately try to resume normal activity.

he notes that a common misconcep-

tion is that this procedure is a recent

or radical development.

“anterior hip replacement has been

performed regularly by specialists in

the u.S. for at least 15-20 years,” he says,

“it is still uncommon because of the

investment in training and equipment

required of the surgeon and treatment

facility. There are surgeons who resist

training on the procedure because the

traditional approach works well and

three-six months out, there really are

no differences in patient outcomes.”

Dr. Weber believes the accelerated

rehabilitation potential makes the

investment worthwhile.

The procedure is made easier by

a modified surgical table that holds

the patient on his or her back with

an enhanced support for moving and

aligning the leg during surgery. This

allows the surgeon to see all angles of

the patient’s hip. X-rays taken during

surgery ensure correct positioning,

sizing and fit of the artificial hip com-

ponents, as well as correct leg length.

Dr. Weber observes that the table

makes the procedure much easier

to perform. patients who have had

previous hip surgery, particularly inser-

tion of a plate and screw, are generally

poor candidates for the anterior proce-

dure but most others can discuss the

option with their surgeons.

Advances in Anterior Hip Replacement by: SEan DOughErTy

Musculoskeletal diseases and injuries including osteoporosis, arthritis, and bone fractures account for a majority of disabilities in the u.S., particularly among the growing population of patients over the age of 50. This impels orthopaedic researchers to accelerate the rate at which more precise diagnostic tools and cost-effective, reliable treatment options become available.

hip replacement surgery is a wonder of modern surgical practice. The surgery corrects hip problems that lead to crippling pain in arthritic patients and restores them nearly to full function following surgery. More than 235,000 procedures are performed annu-ally, according to a study in the December 2007 issue of The Journal of bone and Joint Surgery.

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Image is Everything

It matters who takes the image, reads, and interprets it. At NCH, you can count on experienced, board-certified-radiologists and

highly trained technologists to make sure your diagnostic image is the

best possible tool to help get you better. We produced more than 1

million diagnostic images last year.

You can count on NCH for state-of-the-art technology, precision, safety,

comfort, and speed. For the most accurate and detailed images, our

advanced technology includes a dual-source CT scanner, high-field open

MRI, full-field digital mammography, digital X-rays and more.

We can get the reports—and your image—sent directly to your physician

within just hours. With NCH’s digital technology and electronic archiving,

multiple users can even look at the image, simultaneously, and manipulate it

online for results that are more accurate. We offer locations and times that

make it easy for your diagnostic imaging needs. Learn more at

www.nch.org/image. Or call 847.618.4YOU (4968).