byb_2010

OrthoIndy First to Knock Out Chris “Lights Out” Lytle

Also:The Use of Boxtox in Orthopaedics

OrthoIndy Trauma Study to Benefit Military

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BeyondYourBones l 3

4 l Bone,Joint,SpineandMuscleCare

I want to welcome you to the eighth edition of the OrthoIndy & Indiana Orthopaedic Hospital (IOH) Magazine, Beyond

your Bones. As in past years, we hope you enjoy reading about OrthoIndy and IOH. It is our on-going commitment to

provide quality bone, joint, spine and muscle care.

OrthoIndy, the largest full-service orthopaedic practice in the Midwest, provides a complete range of orthopaedic care. With

over 75 physicians, serving you from over 14 locations, our physicians are dedicated to providing 5-Star care to you and

your family.

To ensure residents of Indiana and the surrounding communities continue to receive the best orthopaedic care, OrthoIndy

has added more physicians and locations to provide orthopaedic care close to your home.

We value our relationship with each and every one of you and we look forward to

serving you in the future.

Respectfully,

John Martin

Chief Executive Officer

OrthoIndy

GreetinGs From the Ceo oF

orthoindy:

BeyondYourBones l 5

As a former or future patient or partner of OrthoIndy and IOH, I hope that you enjoy our latest issue of Beyond your

Bones. As in past issues, this magazine provides you with the latest information on our company, its services, patients

and physicians.

IOH’s philosophy is a physician-owned hospital model where patients experience superior service, safety and patient

satisfaction because physicians are involved in every aspect of care. IOH is ranked in the top

five percent in the nation for joint replacement and 5-Star rated for its orthopaedic

services by HealthGrades. IOH received the Summit Award from Press

Ganey for sustaining the highest level of customer satisfaction for three

consecutive years.

With our hospital’s ratings and exceptional service, I hope you will

consider IOH for all your future orthopaedic needs. I offer you my best

wishes for a healthy and active life.

Sincerely,

Jane Keller

Chief Executive Officer

Indiana Orthopaedic Hospital

GreetinGs From the Ceo oF

indiana orthopaediC hospital:


BeyondYourBonesisdesignedandpublishedbyCustomPublishersGroup.Toadvertiseortopublishyourowncorporatepublication,pleasecallGaryWright:(502)721-7599.

OrthoIndy First to Knock Out Chris “Lights Out” Lytle

Helping Haiti: OrthoIndy Physicians and Physician Assistant Travel to Haiti to Provide Orthopaedic Care

Anti-Gravity Treadmill® Now Available at IOH

The Use of Botox in Orthopaedics

The Hippest Treatment:Young Gymnast Receives an Artificial Hip to Treat Condition

Improving Patient Outcomes

Broken? OrthoIndy’s new docs and locations are here to fix it!

Naptown Roller Girls

OrthoIndy Opens Walk-In Clinics

Helping Your Hands

OrthoIndy Trauma Department’s Study to Benefit Military

Straightened Out: Young lady receives surgery to correct scoliosis

Keeping You On Your Toes

Physicians Directory

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OrthoIndy Mission StatementTo provide the highest quality of

comprehensive orthopaedic care to patients throughout the Midwest, the United States and around the world.

Indiana Orthopaedic Hospital Mission StatementTo be the leader in advancing quality musculoskeletal care and technology

while providing superior access, service and care to our patients and their families.

CEO, OrthoIndyJohn Martin

President, OrthoIndyDr. Frank Kolisek

CEO, Indiana Orthopaedic HospitalJane Keller

Chairman of the Board of Directors, Indiana Orthopaedic Hospital

Dr. John Dietz

EditorKasey Prickel

Marketing DirectorJennifer Fox

Contributing WritersLindsay McClure

Kasey Prickel

Contributing PhotographerKim Connett

Tommy Lake Photography

Special Thanks:Chris Lytle

OrthoIndy8450 Northwest Boulevard

Indianapolis, IN 46278

Indiana Orthopaedic Hospital8400 Northwest Boulevard

Indianapolis, IN 46278

®

®

TABLE OF CONTENTS

BeyondYourBones l 7


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BeyondYourBones l 9

More and more, individuals are paying admission to local

bars or ordering pay-per-view to watch the most popular

mixed martial arts competition known as the Ultimate

Fighting Championship® (UFC®). Fighters compete in

an octagon shaped platform, enclosed by a cage with

walls made of a metal chain-link fence coated with black

vinyl, with the goal of winning by knockout or tap out.

One such fighter, who has never been knocked out, is

Indianapolis native, Chris “Lights Out” Lytle.

The UFC started in 1993 when a Brazilian form of mixed

martial arts, Vale Tudo (anything goes) created interest

in the sport. Mixed martial arts first became popular in

Brazil and then in Japan. In 2001, Zuffa, LLC took over

ownership of the UFC, restructuring mixed martial arts

into an organized combat sport.

The rise in popularity of the UFC occurred after the UFC

released a mixed martial arts reality television show called,

“The Ultimate Fighter,” which aired on Spike TV. The

fourth season, “The Ultimate Fighter 4: The Comeback”

featured UFC fighters who had not yet won a UFC title.

The UFC has five weight classes: lightweight (146 to 155

lbs.), welterweight (156 to 170 lbs.), middleweight (171

to 185 lbs.), light heavyweight (186 to 205 lbs.) and

heavyweight (206 to 265 lbs.). The show however, only

featured the welterweight and middleweight divisions.

Both divisions had a tournament and the runner up of

the welterweight division was Chris Lytle.

Lytle was born in 1974 in Indianapolis, Indiana. A

1993 graduate of Southport High School, Lytle was an

active member of the high school wrestling team. After

school, Lytle missed the contact and competitiveness

that wrestling gave him that he decided to train in mixed

martial arts because he said it “looked like fun”.

Mixed martial arts (MMA) is a full contact combat sport

that allows a wide variety of fighting techniques, from

a mixture of mixed martial arts traditions and non-

traditions, to be used in competitions. According to the

UFC, Ultimate Fighting® events feature the highest caliber

mixed martial arts competition in the world between high

level professional fighters who utilize the disciplines of

jiu-jitsu, karate, boxing, kickboxing, wrestling, and other

forms in UFC live events. With all the various disciplines

incorporated into the sport, there are strict rules against

various moves, including: no head butting or kicking to

the head of the downed opponent, no knees to the head

of a downed opponent, no downward point of the elbow

strikes, no strikes to the spine or the back of the head and

no groin or throat strikes.

With the amount of contact in this sport, a number

of injuries could occur. “Unfortunately, with the high

velocity and high force movement, blunt trauma to all

aspects of the body occur,” said Dr. Jack Farr, orthopaedic

surgeon at OrthoIndy. “Sprains and strains of all four

extremities, as well as the spine can also occur.”

For several years, Lytle participated in both boxing

and mixed martial arts until he was signed with UFC.

As a mixed martial arts fighter, Lytle is no stranger to

extreme conditions. He is also a full-time fire fighter

with the Indianapolis Fire department, in addition to

training for his fights.

OrthoIndy First to Knock Out

By: Kasey Prickel

Chris “Lights Out” Lytle


To prepare for a fight, Lytle does a training regiment

five times a week. His training consists of a lot of

cardio, sparing and plyometrics. While training for his

upcoming fight with Carlos Candit, Lytle heard his knee

pop when he twisted it during a cardio regiment. He

went to OrthoIndy South, where he met Dr. Jack Farr.

In his first appointment, Dr. Farr diagnosed Lytle’s

injury as a torn anterior cruciate ligament (ACL), as well

as the medial meniscal cartilage. The knee is the largest

joint in the body and is comprised of many parts.

Because of its excessive use, it is vulnerable to injury.

A torn ACL is one of the most common knee injuries.

The ACL runs diagonally in the middle of the knee.

Its main function is to prevent the tibia (shinbone)

from sliding out in front of the femur (thighbone).

The ACL also provides rational stability to the knee.

About 50 percent of all injuries to the ACL occur along

with damage to other parts of the knee, including the

articular cartilage, other ligaments or the meniscus,

such as Lytle’s case. The most common symptom of

a torn ACL is a popping sound one may hear at the

time of the injury. Additional symptoms include pain,

swelling, loss of full range of motion, tenderness and

discomfort while walking.

The other injury Lytle sustained was a meniscal tear,

which is the most common type of injury among

athletes who participate in contact sports. The meniscus

are two tough, rubbery, wedge-shaped pieces of cartilage

that are located between the thighbone and shinbone.

The meniscus acts as shock absorbers that help cushion

the joint and keep it stable. Like the ACL, an individual

may feel a “pop” when the meniscus is torn; however,

many athletes will continue their sport. After two to

three days, the knee will become stiff and swollen.

Other symptoms include pain, catching or locking of

the knee and the inability to move the knee through its

full range of motion.

To correct Lytle’s condition, Dr. Farr performed surgery

that included a diagnostic arthroscopy, meniscal

chondral surgery and the reconstruction of the ACL. “The

ACL was reconstructed using a sterilized cadaver donor

graft,” said Dr. Farr. “The meniscus was extensively torn,

but was salvaged by repairing it. As part of the repair, I

Dr. Farr performs surgery on Chris Lytle. Chris doing his post-operative workout.

used a unique new device, Bioduct, that is FDA approved

to augment the healing process. The duct is analogous to

a small tube that allows healing cells to better migrate to

the site of the injury.” Never been knocked out in a fight,

OrthoIndy was the first to “knock out” Lytle when he

received anesthesia for surgery.

Lytle’s surgery was successful and he started physical

therapy to regain strength in his knee. He was surprised

how quickly he was able to return to his sport and work.

“About six weeks from surgery I was able to go back to

the firehouse,” he said. “And before that, I was already

back into the gym, shadow boxing and avoiding impact.”

His recovery led him to a UFC fight in Australia, which

he won by knee bar. With the training leading up to the

fight and the actual fight itself, Lytle didn’t have any

issues with his knee. “I didn’t have any problems at all.

My knee has been 100 percent.”

With the help of Dr. Farr, Lytle was able to get back to the

firehouse, back into the ring and back to spending time

with his wife and children. He wanted to find someone

who he could trust with his knee – and he did. “I had a

real good experience with Dr. Farr,” he said. “He was very

knowledgeable and asked me what my goals were and

what I wanted. I told him I wanted to get back to work as

soon as possible and he told me exactly what to expect. It

was a lot easier than I thought it would be.”

Lytle continues to train for upcoming fights. Knowing

that his knee is in good condition makes training that

much easier. “I have been fighting for 12 years and I have

always had some sort of physical element that hurts,” he

said, “but my knee feels great and its nice to not worry

about that.” His main goal is to win his next few fights

to put himself in a position for a title.

Lytle competed at the UFC 116 Lesnar vs. Carwin

event against Matt Brown, winning by submission (arm

lock). Lytle will compete in Indianapolis at Conseco

Fieldhouse in September 2010. OrthoIndy wishes him

the best of luck on all his future events.

To see an interview with Chris, please visit

OrthoIndy.com/videos.

BeyondYourBones l 11

Q&A with Chris LytleDo you have any rituals before a fight?Go where I am supposed to fight and focus.

What is the best part of your job? UFC Fighter and Fire Fighter?The best part about being a fighter is when you put in the time and energy into the fight and you win. As a fire fighter it is the sacrifice and work. It’s so rewarding when you are able to help somebody.

What types of activities do you enjoy?Work, training and spending time with my family.

Favorite TV show?“It’s Always Sunny in Philadelphia”

Favorite Movie?“Pulp Fiction”

Favorite Singer or Group? What do you listen to before a fight?No favorite, I just like to listen to something hardcore before a fight.

If you could meet anyone dead or alive, who would it be and why?Ron Paul, the politician. He is pretty amazing to me because no one would listen to his message, but he kept saying his message over and over again and eventually people started to listening to him. I think that it’s an admirable quality to stick with what you believe in.

What is something about yourself that not many people know?I am very interested in politics.

Favorite place in Indy to hang out?Home, the gym and my kids’ games.


OrthoIndy Physicians and Physician Assistant Travel to Haiti to Provide Orthopaedic Care

By: Kasey Prickel

Helping Haiti:

On January 12, 2010, a major earthquake struck southern

Haiti. Over the course of 12 days since the 7.0 earthquake,

at least 52 aftershocks measuring 4.5 or greater were

recorded. Approximately one month after the catastrophic

quake, the Haitian Government estimated that between

217,000 and 230,000 people lost their lives, 300,000 we

injured and 1,000,000 became homeless. After seeing the

devastating images of crumbled buildings and homes on

the news, a number of OrthoIndy physicians and staff

decided to lend their medical services to our international

friends in Haiti. Dr. Joe Baele, an orthopaedic trauma

surgeon, Dr. Eric Monesmith, a total joint replacement

surgeon and Deborah Robinson, a physician assistant of

the total joint center of excellence, share their experiences

of a trip they will never forget.


Saturday, January 29th, 2010

We left for Haiti Friday, January 28th, leaving from

Atlanta and then traveling to Santo Domingo. The next

leg was a bus, headed for the border, which we got to the

following day. We arrived to Pastor Esperandieu Pierre’s

complex, where we were staying, which includes his

house, a preschool and church. As I climbed off the bus,

I spotted my wife who had been in the same place with

the same group a week prior to my arrival. She looked so

beautiful, smiling like she always does. She didn’t see me

until I was ten feet away. I gave her a big bear hug and a

long kiss and then she was gone. Her group left on the

bus we came in on and she headed for the border.

Once in the complex, my group found our bunks,

stowed our gear and headed for Chambron. We

moved our supplies into the clinic (school), which

had four classrooms. Three of the rooms were used

for medical purposes, two of which we used to see

patients, one used as a dental room and the last room

served as the pharmacy where medicine, vitamins

and soy bars were handed out.

We saw patients for a couple of hours that day. Seeing

patients here was a lot different than seeing patients

at the OrthoIndy office. Each doctor or nurse who

was seeing patients had an interpreter who translated.

We’d ask a few questions and got the answers. Most

people’s symptoms consisted of a headache, bellyache,

itchy eyes or worms. I think that many people came to

just see if someone from the outside might just touch

them; physically or emotionally, especially the kids.

People lined up on the benches in the shade outside,

and two or three nurses and their interpreters worked the

lines and triaged the crowd. We really only treated based

upon symptoms: no lab work, wet preps, urinalyses or

X-rays. You had to make quick decisions about why they

were really there. We did the best we could. Something

was better than nothing.

Sunday, January 31, 2010

Sunday was a day of rest. We drove out of Chambron

to go to worship with all of the Haitians who come to

that church. Now, when I say people come to church, I

don’t mean they walk up the street or down the block.

I mean they walk miles, sometimes a couple hours on

foot and a few burros. Behind the church was a burro

“parking lot” with the few animals tied to low shrub

trees. In all, the service lasted three hours. We hung

around for another couple hours playing with the kids

and planning the week.

Monday, February 1, 2010

The group was split up, two-thirds went to the clinic and

the rest of us took the school bus to an IDP camp, the

official name of the “tent” cities that have sprung up on

every free piece of real estate in the Port au Prince area.

The “tents” are made up of skinny tree limbs dug into

the hard earth and cross pieces were tied on with wires

and then sheets, cardboard and corrugated tin sheets tied

onto the frame.

Once we arrived, people lined up rapidly, sometimes

over a hundred long in the line. One of the interpreters

would work crowd control, as did a Pastor from South

Bend. A couple of nurses and physician assistants would

sit in chairs and talk to each patient or family to find

out what was wrong. Myself and a podiatrist from

South Bend, worked inside the bus. We positioned an

interpreter in one seat with us next to them. We wrote a

slip of paper for each patient and what we wanted given

to them, which they took to the pharmacy located in the

back of the bus. Sometimes we just reassured a mother

that her baby was fine and that she was doing a great

job in spite of what had happened three weeks ago or

From the Journal of Dr. Joe Baele, orthopaedic trauma surgeon

A line of people waiting for medical treatment.


we redressed wounds, having been placed three weeks

earlier. I never did much orthopaedics.

Tuesday, February 2, 2010

We went out on the bus again to the same IDP camp we

were at the day before. The line stayed just as long as the

day before. The camp itself had grown, doubling in size

from Monday morning.

Every day we operated under the rule that everyone gets

back to the Pierre home by dark. The line of people

was long in the late afternoon. We started to run short

of antibiotics for kids, worm pills and many other

supplies and drugs. Once we made the decision to leave,

we positioned the interpreters around our canopy as

we folded it and stowed it. The crowd knew what was

happening and started to push in towards us, everyone

wanting to be seen. We held them at bay when some of

the nurses started to go around the leading edge of the

crowd, putting Visine in each eye. That’s all they wanted:

something to get some relief of one of their physical

irritations. When everything and everyone was loaded we

rolled out onto the street and headed home.

Wednesday, February 3, 2010

Wednesday started the same as the others. Most of the

crew would head to the makeshift clinic at the school,

but I stayed on the bus this day and went to a new IDP

camp, this time behind the U.S. Embassy. This camp

was much poorer, if that is possible, than the camp we

worked at the day before. The tents were even less well

constructed. The people looked a little more gaunt.

Several babies walked around the open part of the field

with no apparent supervision.

The crowd was smaller all day this day. I saw four people

with orthopaedic needs, all of which had already been

treated with casts or splints, so I checked the injury and

redressed them. One was a boy with a midshift tibia

fracture. Another was a man in his 40s who probably had

a lateral malleolus fracture. The last orthopaedic case was

a lady with a midshaft humerus fracture. One injury that

required a little more attention was a seven-year-old boy

who had gotten the tip of his middle finger on his right

hand smashed in the mechanism of a water pump. He

had a compound fracture of the phalanx under his nail;

a laceration of the nail bed was infected and very painful.

left to right: the destruction of the Haiti National Palace; young children walked around unsupervised.


I took the boy back to the clinic at the school where there

were more supplies. I numbed his finger with a local

anesthetic, cleaned it up, removed the bone beyond the

fracture and took the nail bed and folded the skin over

the end. We gave him antibiotics and hoped he would

return to have it looked at.

Everyday was rewarding but this day was especially

rewarding because I got to do some real orthopaedics.

Once again, we headed back home before dark.

Thursday, February 4, 2010

The clinic ran the same as every other day and late

in the afternoon we headed back to the Pierre house.

We rode this way in the back of a box truck with the

sides cut out for air and benches lining the sides of

the truck’s bed. As we drove down a highway we saw

a girl fall off a moving motorcycle. She was carrying a

bundle of water bladders, little water containers made

of soft plastic sealed bags given out around the country.

Her boyfriend, who was driving the motorcycle, had a

sack of rice in between his legs. She bounced once and

stopped. We got the truck stopped and several of us

jumped out and ran over to her. We looked her over,

got her standing and off the street and sat her down

on a stone wall. She only had a road rash, but no

significant injuries were apparent. We loaded up again

and continued back.

That night we got to see downtown. As we approached

the center of the city of Port au Prince, the number of

destroyed buildings increased immensely. We saw a

government building, leveled. The colorful debris in

front of it was official government records. I had no

doubt there were people still inside. We drove past a

prison where 4,000 prisoners escaped. We also drove

past the National Palace, the Haitian White House, only

to see it destroyed.

Friday, February 5, 2010

Friday was the day to head home. We were all packed

and ready, but we had planned one last trip to the

clinic/school to say goodbye to the kids and make sure

our replacements, a group from Paso Robles, CA, was

in place. We said some painful goodbyes and then got

on the big truck and headed for the airport, seeing tent

camp after tent camp. We arrived to the airport and

started our journey home.

Medical Clinic in Haiti.


Saturday, February 6, 2010

We left the airport early that morning and a few hours

later landed in Newark. It was odd to be surrounded

by mostly white people. Odd that everyone had winter

clothes on. And it was odd that I could buy huge

amounts of food and drink within a hundred feet of me.

And everyone rushed and pushed and no one smiled

very much.

For nearly 24 hours after landing I had some trouble

getting my mind to stop racing. I didn’t want to forget

any of it. I actually wanted to still be there in a way. I

will go back; we all need to help. No matter what you

think is the true reason for Haiti to be the way it is, it’s

not their fault. Bad politicians and bad outside influence

are mostly to blame. But these are people. And no one

should have to suffer like they are suffering.

The group I went with has been making trips to Haiti for

ten years. The trip that I joined had been planned for this

week since last year. The group consists of oral surgeons,

dentists, nurses and techs. My brother is one of the oral

surgeons. After the earthquake, he and I were talking,

and I asked him if they needed orthopaedic surgeons to

volunteer. He made contact with the people in Milot, and

they responded in the affirmative, and so off I went.

Milot is a village about 60 miles north of Port Au Prince.

Hospital Sacre Couer was founded approximately 25 years

ago, and has become a regional hospital for northern

Haiti. During my week there, it became a huge referral

center, with US Navy helicopters arriving daily with

patients who were injured. Because it was left untouched

by the earthquake, and because of its reputation as a

quality facility, and because of the amazing work of all

the volunteers, it grew into probably the largest hospital

in Haiti during the aftermath of the quake.

Saturday, January 30, 2010

We left the airport in Indianapolis at 7 am, bound for

Santo Domingo, Dominica Republic. From there, a

charter prop plane with all our supplies flew us to Cap-

Haitien, where the hospital picked us up in a couple of

Jeeps and drove us to Sacre Couer. There are few paved

roads in Haiti, so driving was an adventure. Lots of

motorbikes, horses, mules, bikes and just pedestrians

clog the roads. Trash was everywhere, and none of the

buildings looked finished, and this in an area where the

quake didn’t hit. As soon as we arrived at the hospital,

the helicopters started landing, and we went to work.

Sunday, January 31, 2010

We rose early and begin making rounds, learning our

way around the different areas of the hospital. The local

school and nutrition center had been converted into

wards and tents were being built in a field across the

street from the hospital to house patients. We had six

orthopaedic surgeons from around the country, several

with military backgrounds, and we began organizing the

OR’s, along with the help of several nurses. Because

the volume of patients was growing rapidly, we had to

develop a system for moving people through the OR

more efficiently. The injuries were incredible: terrible

crush injuries with open fractures, delayed crush injuries

with dead extremities and large open wounds.

Monday, February 1, 2010

Our system began to work better on Monday, performing

over 30 surgeries. Utilizing the oral surgeons as

anesthesiologists, we were able to do minor cases such as

debridements, skin grafts and reducing simple fractures

in procedure rooms, freeing the main OR’s to do big

cases. We would do our ward rounds between cases. The

language in Haiti is a French Creole and communication

with patients was difficult early in the week. A group of

translators was formed which helped us greatly as the

week progressed.

We developed a simple tool—writing on the dressing or

cast to let whoever is rounding know what to do. Charts

are a mess, with Creole and English mixed together,

and no organizational structure to charts, just loose-

leaf paper. One of the “retired” orthopaedic surgeons

developed a wound management team that spent each

day on the wards, rounding and changing dressings. This

was a huge help. Each night, we had staff meetings to

work out details for next day. Progress was slow.

Tuesday, February 2, 2010

We did over 35 surgeries this day, yet more kept piling

up. We kept working. The volunteer staff was amazing

From the Journal of Dr. Eric Monesmith, Orthopaedic Surgeon


with doctors, nurses, therapists and techs, from all over

the country. No one complained. Egos were left at the

door, and everyone did whatever was needed. The local

townspeople were amazing too. Already poor, with little

to eat, they helped feed and take care of the patients, none

of whom are from the local area, but from Port Au Prince.

Those that can speak English worked as translators. Local

kids become the litter bearers, transporting patients for us.

The tent hospital was nearly up and running. Helicopters

kept coming, bringing more patients. We didn’t know

how many more would come. The hospital was originally

built to hold 60 patients and by this day there were now

over 300, with more on the way, and few discharges.

Wednesday, February 3, 2010

We did nearly 40 surgeries this day. Amputations,

revision amputations, skin grafts and debridements—

it could get depressing, but we kept at it. What else

can you do? These people need help and if we don’t

help them, who will? Our staff swelled to nearly 70

volunteers, but we could have used more, especially

nurses and therapists. Lack of nursing care was a big

problem. It is simply a matter of math, too many

patients, and too few nurses. The Haitian nurses have

been at this for weeks and are exhausted, and not really

trained for this type of severe trauma. The injuries

are incredible, and would be extraordinarily difficult

to deal with in the best trauma center in the USA. In

Haiti, they are impossible. The pediatric ward shows

a generation of kids who will grow up without one of

their limbs. Sad. What will happen to these kids?

Thursday, February 4, 2010

Light at the end of the tunnel-or is it an oncoming

train? We did about 30 cases again on Thursday, but

the to-do list is not as bad for the next few days—maybe

we are over the hump? I fear there will be another wave

in a week or two, as wounds become infected, stumps

break open, fixators fail, etc. Infection is rampant. We

decided two days previous not to open any fracture that

was closed—the risk of infection is too great.

The clinic where Dr. Monesmith worked.


Friday, February 5, 2010

Only 25 cases on Friday and we began to feel like we were

making a difference. The backlog shrank. The system

was working, but folks were getting tired. I wondered

how long the locals could keep this up? We volunteers

come and go, but the Haitians can’t leave. Quietly, I give

my two translators a tip for helping me all week. They

are very appreciative, but it is I who was grateful. We

enjoy cigars and a few beers that night before we all leave

and a new group arrives to take our place.

Saturday, February 6, 2010

I was ready to go home by Saturday! Our trip home took

longer than expected, but we made it safely home to a

long hot shower and our own beds!

The week was incredible. The people I worked with

were amazing: competent, caring, hardworking, selfless

and fun. After a week to decompress, I actually began

to miss the place. There will be plenty of opportunities

to go back there and help, as the need for orthopaedics

will continue for years to come. I can’t imagine the

stress of living in Haiti, what the people must endure on

a daily basis is incredible. We are truly blessed to live

in America.

Because of its location in the mountainous region of

northern Haiti, further from the epicenter of Haiti’s

earthquake, the Sacred Heart Hospital in Milot, Haiti,

was fortunately undamaged. However, hundreds of

patients from the Port au Prince area were airlifted to

Milot, overwhelming the 65-bed hospital, normally

run by local Haitian staff and supplemented by foreign

medical volunteers. Five large overflow tents (MASH

units) with a 40-patient capacity each were erected, and

nearby elementary school classrooms were converted to

in-patient wards to accommodate this influx of injured

people. My travel took place two months after the

“quake.” I was inspired to go to Haiti by an email from

Dr. Monesmith, relating his experiences and the great

need for more help.

Saturday, March 13, 2010

Upon arriving at the terminal, I met most people in my

group that I would be living with for the week, most

of whom had never made a trip like this before. We

were all eager and a bit nervous with anticipation about

our upcoming experience. And the boxes of donations

we were supposed to haul with us! I don’t think

the world realizes how much corporate and religious

America donated: surgical/medical equipment, supplies,

pharmaceuticals, orthotics, crutches and walkers

through medical supply companies, churches and non-

governmental organizations (NGOs). Fortunately, three

people postponed their travel to Haiti, which created

room for those donations on our flight down there.

Weight was an issue. (No wonder we broke the axle

during a hard landing in a thunderstorm to gas up on

Exuma Island, Bahamas.)

Sunday, March 14, 2010

Some of us started the day with Catholic Mass at the

Sacre Couer Basilica on the other side of the town, a

big beautiful church situated next to the historic Palace

ruins. The local Haitians attending wore perfectly clean,

starched outfits, men in ties and ladies in their finest

dresses. Church is an oasis within poverty. The children

were all dressed in white and the little girls wore colored

bows in their hair to signify their particular parochial

school. The choir was fantastic and accompanied by

a four-piece band. The priest included the foreign

volunteers by interjecting English translations in his

sermon. Thank goodness we sat near the window with

an occasional breeze! On the walk back toward the

medical compound, the executive director of Crudem

Foudation, Inc., Dr. Peter Kelly, gave us a personal tour

of the new solar panel and oxygen equipment that served

the hospital, all of which were donated. He showed us

the Nutrition Center that housed orphans and injured

children with their parents. There are plans for further

expansion, thanks to further donations and support.

Surgeries were winding down to primarily irrigation

and debridements of infections, revision amputations,

external fixator removals and two successful spine

surgeries. There were plenty of surgeons and techs;

so the most need was in patient care, wound care and

physical therapy. At first, it was so overwhelming with

all that needed to be done in the five MASH unit tents.

I did external fixator pin site care and dressing changes,

bedside wound care and some debridements and taught

From the Journal of Deborah Robinson, RN Total Joint Educator/Coordinator


others new to trauma how to do pin site care. There were

lots of sacral decubitis wounds in the older, less mobile

patients. A little six-year-old visiting a family member

became bored and shadowed me while I worked. Before

the day was over, he was bandaging his own pretend

patients. Little “Dr. Windy” tried to teach me Creole.

He already knew how to say in English, “I love you,” and

“one dollar, please” in that order.

Monday, March 15, 2010

Two volunteers spent the entire week organizing and

placing supplies and equipment in tents to protect

from the afternoon rain showers that were increasing

in frequency as the rainy season approached. To lift

spirits and mobilize in the afternoon, some creative

and fun-loving nurses organized a dance outside the

tents complete with boom box music. Those who were

not ambulatory were transported outside the tents in

wheelchairs to enjoy watching everybody dance together.

This day, music was the “universal language,” and

everybody forgot about their troubles for a while and

enjoyed the fresh air.

Tuesday, March 16, 2010

Today after wound care rounds, we organized charts in

half English and half Creole and posted care summaries

above patients’ beds for faster, easier rounding by MDs

and PT. The rewarding part of my work there was not

only seeing the pin sites and wounds improve each

day with better nutrition and wound care, but getting

to know the patients and facilitating solutions to their

problems by listening to their stories. I came across

a 62-year-old lady who adamantly refused necessary

bilateral amputation of her infected legs, despite the

surgeon’s warning that she would die if she didn’t

consent. She repeated, “I am nothing without my legs.”

So, I asked another lady, Rita, who was already healed

from her bilateral above knee amputations to share her

story of rising from the depths of depression to her new-

found joy in life and faith in God. Several of the nearby

patients joined in this impassioned hour-long discussion

(the translator assured me it was “positive”), and the next

morning the infected lady agreed to the surgery.

Wednesday, March 17, 2010

We were asked to mentally prepare and instruct patients

on stump shrinkers in preparation for the prosthetic

teams that were planning to arrive in April. Nineteen-

year-old Josef, whose forearm amputation skin graft

was almost healed, just stared straight ahead without

speaking, in a bad mood. When I asked him what was

on his mind, he explained (through a translator) that

he was told he would need revision surgery to better

accommodate a prosthesis. Because the process would

take a few more months, he thought he had to remain

in Milot and thus miss resumption of his vocational

training and graduation with his buddies back home, as

well as miss his wedding in July. As soon as we assured

him that it was OK to go on home, get his life on target,

and return for surgery later when convenient for him, he

was elated.

Thursday, March 18, 2010

Early in the morning a small group of us were taken up a

nearby mountainside to tour the Citadel, a huge fortress

built in 1804 by King Cristoff to defend the island from

Napoleon (who never did show up). That was a brief

three-hour respite from the long, hot days working in the

tents. I took a ton of pictures.

Friday, March 19, 2010

The discharge process began. Patients returning to Port

au Prince were supplied with vouchers for tents, cooking

utensils, social services contact info, prescriptions and

one week’s supply of meds. Given their personal losses

Deborah and a patient taking a break in the fresh air.


and what they were returning home to, these people

exuded an air of excitement and anticipation to return

to family and/or friends.

Like all previous days, my last day included more

wound care rounds, summary updates, and rounding

with the orthopaedic surgeon to prepare for hand-over

to the next group of medical volunteers. Volunteers

wore scrubs day and night, with the ever-present

waft of insect repellent mixed with perspiration. We

had showers available at the Crudem Mission; but

the patients and their families were quite creative

in bathing with just a big plastic bowl of water and

soap and managing to maintain privacy in the tents

or “out back.”

While saying our farewells on my last day in the tent,

my patients said, “Please, ‘Dr. Deb,’ never forget us.”

How could anyone? But with humor still intact, one

fellow asked, “And when you eat beans and rice, you

will especially think of us?” This was our staple diet for

the week, which even the patients joked about.

Saturday, March 20, 2010

Before boarding the shuttle, we deposited our sneakers

on the pile of other shoes to be given to patients

discharged back to Port au Prince. As we bounced

along the bumpy, muddy dirt road toward the airport

in Cap-Haitien, we recounted our week in Milot. All

agreed that although it was physically demanding with

“rustic” accommodations (thanks for the warning, Dr.

Monesmith!), our experiences there were fulfilling

professionally and spiritually. I found Haiti to be

a beautiful countryside filled with such widespread

poverty that most Americans would never witness in

their lifetime. The country and its people have so much

potential; and I hope someday the Haitians will have

the same opportunities that we Americans often take

for granted.

top to bottom: Afternoon activity of music and dance –the universal language; inside view of a typical temporary in-patient tent; Deborah with a patient just outside the temporary in-patient tent.

“This day, music was the ‘universal

language,’ and everybody forgot

about their troubles for a while

and enjoyed the fresh air.”

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Upper and Lower Extremity Prosthetics—We offer a complete line

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Great care is taken by the AOI professionals to achieve great looks

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• Hand Prosthesis

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The next time you need professional results, from a caring provider, please give us a call!

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Knee Osteoarthritis: Valid Evidence for Conservative ManagementArthritis is a health care epidemic. Forty six million

Americans suffer from arthritis and more than half of

them, 27 million, have osteoarthritis (OA)1. Nearly half

the adult population (46%) will develop painful knee

OA in at least one knee over their lifetime.2 According

to the Centers for Disease Control and Prevention nearly

one in two people, and two out of three obese adults,

will develop symptomatic knee OA in their lifetime.3

In 2004, OA resulted in over 11 million physician

visits, 662,000 hospitalizations and more than 632,000

total joint replacements in the US, with accompanying

hospital costs of $22.6 billion.4

The costs associated with total knee replacement and

the increasing number of patients who are presenting

with knee OA symptoms at a younger age, have turned

the focus to conservative treatment options. Research is

showing that there is a close link between knee cartilage

injury, occurring very commonly in sports, and the

occurrence of knee OA in mid life. Disabling knee OA

is now often seen in people who are in their 50’s, an

age when total knee replacement doesn’t provide the

best quality of life option. Arthritis affects people in the

prime of their lives, with nearly two-thirds under the age

of 65. 5

The primary treatments for OA have been analgesic

and anti-inflammatory prescription medications. Now

included is an emphasis on weight management, proper

nutrition, and appropriate physical activity to maintain

all important muscle strength and flexibility. The

American Academy of Orthopaedic Surgeons state that

the goals of treatment are pain relief and improvement

or maintenance of functional status. Patients are

encouraged to participate in self management, education,

and activity modifications.6

Current research is putting the spotlight on one of the

most effective, and most underutilized conservative

treatments – Unloader® braces. These braces provide a

mechanical means to reduce pain by shifting forces off

the affected compartment of the knee.

Unloader braces provide several benefits to

patients with knee OA. Pain relief is achieved by

reducing stress on the affected compartment and

restoring a more normal joint motion. Also, by

redistributing the weight load, a more normal

joint alignment is restored. Unloader braces are

also designed to improve joint stability. This

gives patients a sense of confidence and a lower

risk of stumbles or falls. By adding stability

and reducing pain, many patients are able to

maintain or regain their previous level of activity

and their quality of life is definitely enhanced.

BY MARJORIE J. ALBOHM, MS, ATC

Knee before Unloader Brace. Knee with Unloader Brace.

P A I D A D V E R T I S E M E N T


Current scientific research

provides valid evidence to

support the use of Unloader®

bracing in the management

of knee OA. Kirkley,

et al, validated the

effectiveness of the

Unloader brace

in a prospective,

r a n d o m i z e d

controlled trial,

comparing the Unloader

to a knee sleeve and no

brace. Results indicated

a significant decrease in

pain and improvement in

function in subjects wearing

the Unloader brace.7

A meta analysis by Pollo, et

al, validates the Unloader

brace and demonstrates

that knee bracing for OA

effectively relieves pain

and improves function.8

In addition, randomly

controlled trials by Pollo,

et al9 and Hillstrom, et

al10 demonstrate that the

Unloader brace reduces pain

and improves function.

And, the most compelling

patient outcomes studies

to date, demonstrate that

patients wearing an Unloader One® brace had significant

decrease in pain, improvement in function, and, a 24%

reduction in the use of pain medications.11,12

So, with this available scientific evidence, why are

OA braces selected only 0.5% as a treatment option,

compared to 93.5% for pharmaceuticals?13 Previous

versions of OA braces have been less than user friendly.

Cumbersome braces, with frequent slippage and heat

generating liners, made patients, understandably, non-

compliant. Patient satisfaction was poor and physician

prescribers could not appreciate the benefits because

many patients didn’t give the braces a chance.

New technology has dramatically changed fit, comfort,

and the effectiveness of unloading braces. For example,

specially designed Sensil® liners and ventilated lightweight

shells have made the Ossur Unloader One® brace a 16 oz.

low profile, extremely comfortable brace that is easy to

wear under clothes, and achieves a high level of patient

satisfaction and compliance.

Prescriber education and consumer awareness is

needed to demonstrate the value of Unloader braces,

to give patients a viable, clinically-proven alternative

to prescription medication and total knee replacement.

Knee OA patients deserve to know ALL options available

to them.

Much still remains to be learned regarding the most

effective treatment protocol for knee OA. Effective

management does not involve only one treatment option.

A combination of proven therapies and interventions

will result in the best patient outcomes. These may

include prescription exercise programs, weight loss/

control programs, neutraceuticals, analgesics, anti-

inflammatories, and, Unloader braces.

Knee osteoarthritis may inevitably result in total knee

replacement surgery. But, non-invasive treatment

options, specifically Unloader braces, have been proven

to provide safe pain relief and improved function that

prevent or delay the need for this major surgery. We

should take every opportunity we can to do just that!

1. Arthritis Rheum 2006; 54(1) 266-2292. Arthritis Rheum 2008; 59(9) 1207-12133. Centers for Disease Control and Prevention. 2008. Arthritis types-

overview. http://www.cdc.gov.arthritis/arthritis/osteoarthritis.htm4. Arthritis Foundation: http://www.arthritis.org/disease-center.

php?disease_id=32&df=whos at risk5. Osteoarthritis Public Health Agenda: Policy and Communications

White Paper; Arthritis Foundation, April 20096. AAOS Clinical Practice Guideline Summary: Treatment of

Osteoarthritis of the Knee (nonarthroplasty. JAAOS 2009; 17(9): 591-600

7. Kirkley A, et al; “The Effect of Bracing on Varus Gonarthrosis.” JBJS, 81(4): 539-547, 1999.

8. Meta analysis; Pollo FE et al; J of AAOS, 14:5-11, 2006.9. Pollo FE, et al; “Reduction of Medial Compartment Loads with

Valgus Bracing of the Osteoarthritic Knee”. AJSM, 30(3): 414-421, 2002.

10. Hillstrom HJ, et al; “Lower Extremity Conservative Realignment Therapies for Knee Osteoarthitis”. Physical Medicine & Rehabilitation: State of the Art Reviews. Philidelphia: Hanley & Belfus, Inc., 2002:507-520.

11. riggs KK, Matheny LM, Steadman, JR, Autlman H; Use of an Unloader Brace for Medial or Lateral Compartment Osteoarthritis of the Knee. Presented at the AAOS Academy, 2010.

12. Ingvarsson T, Franklin J, Hardardottir E; Patients With Moderate and Severe OA Do Benefit From Using a Valgus Knee Brace. Presented at the AAOS Academy, 2010.

13. Frost and Sullivan, 2008.



Anti-Gravity Treadmill® Now Available at IOH

The IOH Outpatient Therapy – Northwest office recently acquired an Anti-Gravity

Treadmill, offering a revolutionary approach to rehabilitation, providing the ability for

patients to defy gravity and work towards regaining function like never before. IOH is the

first and only facility to obtain the technologically advanced treadmill in Indiana.

This treadmill is new to Indianapolis, but it is not

new around the county. It is gaining popularity and

is being used in over 200 facilities across the country

ranging from therapy clinics and healthcare facilities,

to colleges and universities, as well as professional

football/baseball/basketball teams. “They are using the

treadmill because they are seeing improved results in

athlete’s performance, but also the increased speed in

the rehab process following surgery or injury,” said Jeff

Sorg, Manager of the IOH Physical Therapy department.

“The treadmill is gaining a lot of notoriety across the

country and we are excited to bring that same level of

excitement to our facility and to the Indianapolis area.”

By: Kasey Prickel


The AlterG® Anti-Gravity Treadmill, created by AlterG,

Inc., gives patients the opportunity to exercise without

pain, even while the patient is still recovering from

surgery or an injury. The anti-gravity treadmill uses

AlterG’s patented Differential Air Pressure (DAP)

technology, developed at NASA. This technology

applies a comfortable and uniform lifting force to the

body, allowing the patient to run or walk normally,

with full range of motion, making it feel like you are

running 50 pounds lighter.

The AlterG Anti-Gravity Treadmill gives patients the

opportunity to experience rehab or training without

pain. The unique unweighting technology reduces the

impact of walking or running, while the body goes

through the normal healing process. “The AlterG will

greatly enhance rehabilitation for our patients,” said

Sorg. “In addition to the early weight-bearing for

our post-operative patients, it will allow many of our

patients an earlier and pain-free return to running

and walking. Many of our patients deal with needing

assistive devices for walking, and also limping. The

treadmill will allow them to improve their technique

to reduce the compensations that develop leading to

limping, and to do so without pain.”

The importance of the treadmill lies in its ability to

improve IOH’s current rehab program, as well as

developing a program for runners. “I believe that we

have a lot of local patients, and a community of runners

who will greatly benefit from us offering the AlterG

treadmill,” said Sorg. “The treadmill can be used by

runners to run pain-free, or to increase training through

additional weekly mileage or higher intensity and

speed than they would normally run at. It can create a

way for them to improve their performance, speed and

endurance, while also minimizing the stress and strain

on their lower extremities.”

The world’s best athletes and sports teams consider the

Anti-Gravity Treadmill an essential part of their athletic

conditioning and rehabilitation programs. For athletes

the machine helps strengthen and improve coordination

of muscles and protects surrounding joints, promotes the

full range of motion while minimizing stress and enables

injured athletes to maximize their fitness retention as they

recover. Professional and Olympic athletes and teams

utilize the treadmill to reduce the frequency of injuries,

build fitness, and train and recover more quickly. They

also use it as a core art of their athletic conditioning and

training programs to strengthen and improve muscle

coordination while minimizing stress on their bodies.

Some of these athletes and teams include: elite distance

runners, Dathan Ritzenhein and Shannon Rowbury, top

professional and Olympic athletes, like Oguchi Onyewu

and dozens of pro teams worldwide, including the Los

Angeles Lakers and Manchester United.

Check out the AlterG Anti-Gravity Treadmill for yourself.

We are currently offering a coupon on our Web site for a

free, ten-minute trial. Visit IndianaOrthopaedicHospital.

com and click on the AlterG logo on the left side of the

page to download your coupon.

To see how the treadmill works, visit

OrthoIndy.com/videos.


After his ride, Aidan and his mom, Kim, pet Applesauce.


The Use of Botox in Orthopaedics

By: Kasey Prickel

When one hears the term “Botox,” most of us immediately

think of injections used to enhance one’s appearance

from aging. However, botulinum toxin therapy or Botox

is also used in orthopaedics as a treatment option.

OrthoIndy was one of the first orthopaedic practices

to use this medication for muscle care. OrthoIndy

physicians, Drs. Carlos Berrios, Joshua Salyer and Mark

Stevens use Botox injections as a form of treatment to

help improve the quality of life in their patients.

The most common types of

conditions where Botox might

be prescribed by Drs. Berrios

and Stevens is for the spasticity

of muscles, usually caused from

cerebral palsy, a closed head

injury or stroke. “Botox is a

relatively safe and successful

tool,” said Dr. Stevens. “It

is primarily used for muscle

spasticity, which is a disorder of the central nervous

system in which certain muscles continually receive a

message to tighten and contract.”

Dr. Salyer, a physiatrist at OrthoIndy, uses Botox for

the treatment of pain syndromes involving muscle

spasm or hyperactivity, including: cervical dystonia,

which is a painful condition, which causes your neck

muscles to contract involuntarily, causing the head to

twist from side to side; limb spasticity and hemifacial

spasm, a neurological disorder causing varying degrees

of facial spasms.

“In some instances, simply breaking the pain cycle by

decreasing muscle spasms may be enough to help make

therapeutic gains,” said Dr. Salyer. “On the other hand,

calming down painful muscle spasms would allow a

patient to participate in other types of treatment such as

physical therapy that would help restore biomechanical

balance and decrease the risk of symptom recurrence.”

One of the most common conditions treated with

Botox is cerebral palsy. Meet Dr. Berrios’s patient,

Aidan Fitzpatrick.

Meet Aidan Fitzpatrick

When writing this article on Botox, I wanted to introduce

readers to a dear friend of mine, Aidan Fitzpatrick.

Aidan is no normal six-year-old boy. He’s a special one,

especially to me. A dear friend of mine is Aidan’s mom,

Kim Fitzpatrick. I have known Kim for four years and

I will never forget the first time I met her son. I didn’t

really know much about Aidan until that first day I met

him. Kim talked about him, but I didn’t know that he

had a severe case of cerebral palsy, which was caused by

a lack of oxygen at birth. When I first saw Aidan, he was

sitting in his wheelchair and I learned that he couldn’t

walk or talk. At first, I was caught off guard. I was a

little nervous because I wasn’t sure how to interact with

him or how he would interact with me. Kim told me

to repeatedly pat the top of his hand. Unsure, I did as

instructed and discovered that Aidan reacts very well

to that type of stimulus. Immediately, a huge smile lit

up his face and right there, he won my heart. Anyone

who meets Aidan falls in love with him and that’s why

he is special.

Even though Aidan’s condition is severe he is not that

different from other kids his age. He goes to Pleasant

View Elementary School in Zionsville and enjoys the

same things that most kids enjoy. Some of Aidan’s

favorite activities include floating around in the pool and

Dr. Carlos Berrios


going for walks with his mom and dad, Andy, playing in

ball pits with his younger sister, Keira, swinging in his

swing and listening to music.

Aidan’s special education teacher, Jillian McCune says

that Aidan’s favorite classes at school include: cooking,

music and art. Aidan is able to do a number of activities

in class because Jillian does the “hand over hand”

technique, which means she helps guide his hands so he

can participate in class since he can’t do it on his own.

“Aidan loves helping in cooking class, music and brightly

colored books,” said Jillian. “But what he enjoys most is

being with the kids in his class. Aidan’s head perks up

when the kids are around. The kids love pushing him

around in his wheelchair and in the morning they take

turns reading to him.”

However, unlike most kids, Aidan has received a lot of

different treatments to help with his condition. Aidan

receives Botox injections from Dr. Berrios to help with

his muscle spasticity. “Aidan’s muscles are very tight and

resistant to movement,” said Kim. “For us, his biceps are

most severely affected, but we also treat his hamstrings,

Achilles, hands and wrists. The Botox allows Aidan to

relax those muscles and makes it much easier for his

therapists to work on his range of motion.”

Dr. Berrios has been using Botox for the last ten

years. He usually uses it for children, like Aidan, with

cerebral palsy. “The purpose of the medication is to

decrease spasticity,” said Dr. Berrios. “In order to use the

medication you have to have a good understanding of

the particular disease or condition affecting the patient.“

Aidan receives Botox injections at the Indiana

Orthopaedic Hospital (IOH). When using Botox, usually

there is slight sedation with anesthesia. The medication is

directly injected into the muscle, causing it to relax. “The

medication is useful in cerebral palsy because the tight

spastic muscle can dislocate hips, produce contractures

in several joints that interfere with gait, hygiene, sitting

or putting clothes on,” said Dr. Berrios. “The medication

works by blocking the neuromuscular junction and will

relax the muscles for three to six months, sometimes

longer and that depends on dosage and severity of the

condition.

According to Dr. Berrios, Botox is one more tool in

the arsenal that physicians have to treat spasticity,

other measures are baclofen by mouth or pumps,

physical therapy, bracing or surgeries with lengthening

of muscle and sometimes bone if there are dislocations

or malrotations. “I use the medicine for children who

are too young to have surgery because it can decrease the

amount of surgeries needed,” he said.

Aidan has received injections from Dr. Berrios every 12 to

16 weeks for the last three years, unfortunately for Aidan;

he has also had a number of orthopaedic surgeries,

which were performed by Dr. Berrios. Aidan had a knee

surgery for a bone infection, known as osteomyelitis.

In the same knee, his growth plate stopped growing

and had a surgery to correct it. He then had a third

surgery in both knees to stop the growth plates. “It was

a personal decision of us to agree to this surgery,” said

Kim. “The first method didn’t work and the likelihood of

Aidan walking is minimal. If only one growth plate was

working it would have made it uncomfortable for him

in his wheelchair.”

“Dr. Berrios is wonderful. We feel very

safe in his hands because he is very

knowledgeable about disabled children

and really takes into consideration

their special lifestyles when making

treatment decisions.” – Kim Fitzpatrick

Aidan and his dad, Andy.


While the surgeries and Botox have helped with the

quality of Aidan’s life, another method of treatment used

is horse therapy. Once a week Aidan goes to Morning

Dove Therapeutic Riding Inc. for therapy. Morning Dove

Therapeutic Riding Center is located in Zionsville and

provides equine assisted therapy services for those with

physical, mental and/or emotional challenges. Aidan’s

therapist, Teresa and a volunteer assist Aidan while he

rides on a pony that is walked around a barn by a horse

handler. The benefits from riding the pony include: an

increase in head and trunk control, a decrease in muscle

tone and a good sensory input. It can also improve

balance and coordination.

Kim and Andy are very thankful for Dr. Berrios. “Dr. Berrios

is wonderful,” said Kim. “He is very compassionate and

skilled and has always been more than accommodating to

us. He always takes the time to explain the process, how

it will affect Aidan and the risks of not doing something

versus doing a treatment. He always lets us make the final

decision and shows us a great deal of respect. We feel very

safe in his hands because he is very knowledgeable about

disabled children and really takes into consideration their

special lifestyles when making treatment decisions.”

With the help of Dr. Berrios, Aidan’s quality of life has

improved. His teacher, Jillian, says Aidan is working on

sitting up on his own and starting to be able to do it more

and more. “He is continuing to make improvements and

progress,” she said.

Aidan started second grade and continues to ride horses

at Morning Dove.

If you or a family member is interested in learning more

about Botox as an orthopaedic treatment option, please

call (317) 802-2851.

To see Aidan ride horses at Morning Dove,

please visit OrthoIndy.com/videos.

Aidan with his therapist, Teresa at Morning Dove.


“Wii-habilitation” at Nazareth Home

The popular Nintendo system’s motion-sensing

controller and the wireless balance board are proving

to be for more than just virtual entertainment. Though

we have seen the Wii become popular in retirement

communities everywhere as a way to play traditional

sports and stay active, many are experiencing benefits of

the Wii and WiiFit in therapy.

Nazareth Home’s therapy department has introduced

the Nintendo Wii and WiiFit to their rehab program.

“Wii-habilitation” as it’s called, can be used for persons

recovering from joint replacement surgery, fractures,

strokes, Parkinson’s or other ailments and injuries.

Though it is not a stand-alone program, it is used in

conjunction with traditional therapy techniques to get

the most out of each therapy session. “Wii-habilitation

is a creative adjunct to traditional therapy and offers

our clients a more creative and visual experience. The

patients look forward to coming to therapy and we

have seen an increase in their motivation,” states Cindy

Linton, COTA and Rehab Manager.

Persons working on standing and weight tolerance will

stand for longer periods of time using the Wii Sports

AMANDA GREEN, HEALTHCARE THERAPY SERVICES, INC.



Golf game, than with traditional therapy methods,

thus increasing the effectiveness of the treatment. “It

increases socialization because they leave therapy and

immediately tell their friends about the fun experience.“

–Linton.

Also, let us not forget about intrinsic competitiveness.

We certainly don’t become less competitive as we age.

Competition is a large motivator or it can be a pain

distracter and increase tolerance for therapy sessions.

Wii Sports and WiiFit offer games and activities to help

improve:

• Range of Motion

• Trunk Control

• Endurance

• Standing Tolerance

• Eye Hand Coordination

• Weight Bearing

• Weight Shifting

• Posture

Yoga - improves balance, posture and isometric

strengthening

Tennis - improves bilateral upper extremity range of

motion and eye-hand coordination

Ski-Shalom - For a person who has been non-weight

bearing after a hip replacement, weight shifting is

tough to accomplish. The Ski Shalom allows for the

person to shift the weight while visually tracking their

improvement.

Bubble Game

Persons who have had poor posterior leaning (results

in falling backwards) use the bubble game which forces

them to shift their weight forward through their toes to

create better upright posture.

Game descriptions and benefits provided by Nazareth Home

Occupational Therapist, Angela Augustine, OTR/L

With the recent addition of Nazareth Home’s sub-

acute rehabilitation unit, they have expanded to have

two large therapy gyms along with two Wii and WiiFit

systems to accommodate the large number of clients.

“We now have two Wii systems because they are used

every day and everyone wants to use it when they come

to therapy. I look to add another Wii system in the next

6 months to a year.” –Cindy Linton, Rehab Manager.

The Nazareth Home Rehabilitation Department

continues to monitor progress and increase motivation

with the Nintendo Wii gaming system. They also

take special care to guard against overexertion, injury,

appropriateness as well as following all infection

control precautions with the equipment, controllers

and balance boards.

For more information about “Wiihabilitation”

or any of the leading therapy technology at Nazareth Home,

contact Cindy Linton, Rehab Manager or Brook Wilson, Marketing

at 502-459-9681.



My family and I loved him from the moment

he walked in. We knew he was the right

doctor when he took the time to research

the best type of hip for me.” – Allison


Today, more than 193,000 total hip replacements are

performed each year in the United States, according to the

American Academy of Orthopaedic Surgeons. A majority

of patients who undergo hip replacement surgery are

60 to 80 years old; however, some candidates for a hip

replacement are much younger.

The hip is one of the largest weight-bearing joints in

the body, consisting of the femoral head at the top of

the thighbone that fits into a rounded socket called the

acetabulum in the pelvis. To provide stability to the joint,

ligaments connect the ball to

the socket. The bone surfaces

of the ball and socket are

covered with articular

cartilage that cushions the

end of the bones, enabling

them to move easily.

Covering all the remaining

surfaces of the hip joint is

the synovial membrane,

which is a thin smooth

tissue. This membrane

makes a small amount of

fluid that lubricates and

almost eliminates friction in

the hip joint.

According to Dr. David

Fisher, an orthopaedic hip and knee replacement specialist

at OrthoIndy and the Indiana Orthopaedic Hospital

(IOH), a hip replacement is a wonderful procedure for

people with disabling hip disease; however, there are

other treatment options that should be tried before hand.

“The average age of a hip replacement patient today is

67,” he said. “Younger patients are a particular concern

because of the longevity they have and the demand that

will be placed on that artificial bearing. We continue

to do research to find the optimum solution for these

challenging clinical problems.”

In younger individuals, it is extremely rare to

undergo a hip replacement; however, there are some

circumstances where the hip has been destroyed,

there are secondary arthritic changes, pain and loss of

function that require the surgery. When 13-year-old,

Allison Saylor came to OrthoIndy complaining of

pain in her hip, she didn’t realize that she would be a

candidate for a hip replacement at such a young age.

“It is extremely rare for a patient that is Allison’s age

to have a hip replacement, said Dr. Fisher. “In my 22

year career as a total joint specialist, I have treated less

than 12 patients under the

age of 18 with a total hip

replacement.”

Allison Saylor started

gymnastics when she was

six years old because her

mother thought it would

be a good thing to “wear

her out”. She immediately

fell in love with gymnastics.

“I love the individual

competitiveness and

team competitiveness,”

said Allison. “I love the

bars. They were always

the biggest challenge for

me because of the release

moves required and because I loved my coach and that

is his specialty.”

In December 2008, Allison started having some

discomfort in her hip. Her coach believed it was a

pulled muscle and she continued to compete; however,

the pain persisted. In March of 2009, Allison had an

MRI, which indicated that she had a late developing

condition known as Perthes disease and part of the

ball in her hip was cracked.

The Hippest Treatment: Young Gymnast Receives an Artificial Hip to Treat Condition

By: Kasey Prickel


Perthes is a term for Legg-Calve-Perthes disease, which

is a disorder of the blood flow to the femoral head in

children between the ages of 2 and 13 years of age.

The exact cause of the disease remains unknown and

therefore, physicians don’t know how to prevent the

disease from affecting the hip. Symptoms include the

gradual onset of a painless limp that progresses over

several weeks. Hip pain is usually felt in the groin inner

thigh or knee. Reduced range of motion in the hip may

be seen from inflammation of the hip.

Allison’s condition created many challenges for her

sport and every day life. She was not able to run, making

it difficult to compete in vault and a tumble pass for her

floor routines. Running wasn’t the only challenge; she

started walking with a limp and was in constant pain.

The earlier the child is at the onset of Perthes disease and

the earlier treatment is started, the better the prognosis.

Younger children have hips that can self-repair much

of the damage, while older children do not have the

remodeling ability in the bones to correct much of the

damage that occurs to the femoral head. Treatment

options are aimed at maintaining a round femoral

head and hip socket and may include traction, non

weight bearing, the use of casts or braces and range of

motion exercises. For more difficult cases, surgery can

be indicated to try and keep the femoral head in the hip

socket. Most children will recover good hip function,

often with slight shortening of the affected leg. They

can then lead a normal life; however, depending on

the degree of involvement, some will require a hip

replacement later in life (after age 40). Allison’s hip

however had severe damage and failed her previous

treatments, leaving her with significant hip deformity,

loss of function and constant pain.

Allison first received treatment from Dr. Carlos Berrios,

an orthopaedic surgeon at OrthoIndy and IOH. He

started Allison on crutches and ordered CT scans and

X-rays every four weeks to see if the bone’s blood

supply would return. In June, Dr. Berrios decided it was

best for Allison to see Dr. Fisher for a hip replacement.

To treat Allison’s condition, Dr. Fisher decided she

needed a hip replacement. Allison’s initial reaction to

the news was hard. “I cried a lot because I was told I

would never get to do gymnastics again,” she said. “I

also realized at that moment that I would never get to

compete in college.”

As a parent of a teenager, Allison’s parents were shocked

that their young daughter needed a hip replacement. “It

was a devastating blow for our daughter’s dreams,” said

Leslee Saylor, Allison’s mother. “We knew that her life

was going to change forever. Our family had to comfort

her a lot and have a positive outlook for her. We all

started looking into other sports that might appeal to

her. Then she realized that in diving she could use a lot

of her gymnastics skills.”

Allison’s condition was devastating to the entire family;

they knew she would no longer be in pain after she

had her hip replacement. Prior to surgery Allison

wasn’t nervous, until she was being wheeled into

the operating room. “I was somewhat excited about

surgery because I was going to be able to walk

normally again,” she said.

In the hip replacement surgery, which lasts one

hour, the surgeon will remove the damaged

cartilage and bone and then position an

artificial joint surface to restore alignment and

function of the hip. The artificial hip consists

of two components: the ball component


and the socket component. According to Dr. Fisher,

total hip replacements are man made devices that can

provide the same motion of the normal hip. However,

because they are mechanical devices, they are subject to

wear. The ball and socket component is the part that

wears and the materials we have to make these parts are

limited to plastics (polyethylene), metals, and ceramics.

“Most total hip replacements from the past had metal

and polyethylene bearings, but these can cause wear

that can lead to bone loss and loosening over time,

especially in younger patients,” said Dr. Fisher. “Metal

and ceramic implants have been available for a while

and show significantly decreased wear. However, metal

on metal implants can release metal ions that over long

periods of time, could have negative consequences.” A

few individuals have also been shown to have allergies

to nickel in the metal on metal bearings. Ceramic

bearings can have small chips on insertion that can

cause major problems. A small number of patients with

these devices have also reported squeaking in the hips.

Ceramic on metal bearings have been extensively tested

in the lab and show even lower wear, no insertional

chip fractures and no squeaking. “Many believe this

may be the best bearing combination to date, but this

couple has not yet been approved by the FDA and can

only be used in a humanitarian exemption, which was

used in Allison’s case.”

Allison’s experience with Dr. Fisher and his staff was

extremely positive. “My family and I loved him from

the moment he walked in,” she said. “He was very

personable, friendly and reassuring. His staff was also

kind throughout the entire process. We knew he was the

right doctor when he took the time to research the best

type of hip for me.”

Her parents were equally happy with the care their

daughter received at OrthoIndy. “Our whole experience

with Dr. Fisher and his staff was wonderful,” Leslee

said. “He was very thoughtful and caring during and

after surgery. I think that Dr. Fisher and his staff’s

helpfulness and compassion helped in the healing

process. Allison knows that this will have to be done

again sometime in her life and we know that OrthoIndy

is the place for her.”

After surgery, Allison is completely pain free. However,

because of her condition, she isn’t able to compete in

gymnastics. According to Dr. Fisher, Allison physically

may be able to perform gymnastic activities; however,

he has discouraged her from doing so to protect

her artificial hip. “She will need regular follow up

throughout her life to monitor the function of her hip

prosthesis, and may need additional surgery in the

future,” said Dr. Fisher.

While Allison has had to readjust to normal everyday

activities and give up a sport she loves, a year later,

she now lives pain free and has a job teaching younger

children at the gym she used to practice. She has also

found new sports to love, such as diving and possibly

cheerleading. She is living pain free because of her hip

replacement and she is very appreciative for all the

support during her treatment. “I just want my family to

know how much I appreciated their support and care

throughout the whole process. They were awesome,

especially my Acros Gymnastics family.”

For more information on Dr. Fisher or other total joint

specialists at OrthoIndy, please visit OrthoIndy.com/

findadoc

At Sullivan County Community Hospital, we offer both inpatient and outpatient

PHYSICAL AND OCCUPATIONALTHERAPY SERVICES

• Fractures & Joint Replacement• Back & Neck Problems• Wound Care (Post-surgical, Diabetic, Circulatory)• Joint Injuries• Daily Living Skills after illness or injury• Industrial/Sports Rehabilitation• Sports Training

For More Information Contact the Rehab Services Department at SCCH

(812) 268-4311, ext. 2291 Phone(812) 268-2687 Fax

Sullivan County Community Hospital2200 North Section Street

Sullivan, IN 47882www.schosp.com


Improving Patient Outcomes

Spine Study

Many surgical treatments of the spine often require the use of a bone

graft. A bone graft is when new bone is placed into spaces around a

broken bone or bone defect. There are two types of bone graft: autograft

and allograft. An autograft is new bone taken from the patient’s own

healthy bone supply and an allograft is donated bone. Bone grafts

promote growth of new bone for long-term stability. New bone grows

and matures over the span of a year or more, depending on the specific

surgical procedure and the individual patient. The ORF is currently

involved in a clinical evaluation that uses an allograft in procedures that

require bone grafting.

OrthoIndy Spine surgeons Drs. David Schwartz, John Dietz, Gabriel

Jackson, Joseph Riina and Terry Trammell are involved in an evaluation

of an allograft cellular bone matrix, known as Osteocel® Plus. Osteocel

Plus was developed by Osiris® Therapeutics and is distributed by

NuVasive®, Inc. According to Dr. Schwartz, a cellular bone matrix can

serve many functions, such as providing support and anchorage for

cells, segregating tissues from one another, and regulating intercellular

communication (ECM). “The ECM regulates a cell’s dynamic behavior,”

said Dr. Schwartz. “In addition, it sequesters a wide range of cellular

growth factors and acts as a local depot for them. Changes in

physiological conditions can trigger several different activities. This

allows the rapid and local growth factor-mediated activation of cellular

functions such as new bone formation. Formation of the extracellular

matrix is essential for processes like tissue growth and healing.”

By: Kasey Prickel

The Orthopaedic Research Foundation, Inc. (ORF) functions as the research and education arm for the

physicians of OrthoIndy. Founded in 1986, its mission is “to advance the scientific body of knowledge

associated with musculoskeletal disorders, for the scientific and public communities, through research and

education.” The ORF represents the research interests of more than 56 musculoskeletal specialists. Currently,

more than 25 nationally and internationally recognized physicians participate in over 30 investigational

studies, resulting in the publication of more than 15 peer review scientific manuscripts annually.

If you are interested in learning more about research and education opportunities, please feel free to contact

the foundation at (317) 802-2880.

Dr. David Schwartz


Used in procedures that require

bone formation such as spinal

fusions and surgery to heal fractures,

Osteocel Plus provides a complete

bone graft, since it contains all of

the necessary components for bone

growth, promoting your return to daily

activities. Osteocel Plus was developed

to mimic the patient’s own bone by

providing all of the necessary bone-

growing components: cells, signals and

scaffold. Osteocel Plus contains living

bone cells, including mesenchymal stem

cells from adult tissue donors, avoiding

the concerns associated with embryonic

cells. These bone cells are naturally

present in our bodies and are essential

for bone tissue formation and healing.

“Mesenchymal stem cells are multipotent

stem cells that can differentiate into a

variety of cell types,” said Dr. Schwartz.

“Cell types that mesenchymal stem

cells have been shown to differentiate

to include osteoblasts (bone cells) and

chondrocytes (cartilage cells).”

Osteocel Plus is an advanced form of

allograft bone graft, which differs from

traditional allograft (bone graft from

a tissue donor) in that the native

bone cells are preserved. Due to

strict attention to FDA and American

Association of Tissue Banks standards,

recorded allograft-related infection

rates have been much lower than

those associated with the surgical

procedures themselves. Over 1.5

million allografts are now implanted

annually, with no recorded disease

transmission since 2002.

Because Osteocel Plus contains

living cells, specific processing

techniques have been developed

to support acceptance and

incorporation of the graft to

the graft site. Tissue donors

are thoroughly screened and

tested to meet or exceed safety

standards mandated by the FDA and

the American Association of Tissue

Banks. Tissue is carefully cleaned

and specifically processed to deplete

components that could be rejected by

your body and retain only elements to

support bone growth. Each and every lot

of Osteocel Plus is meticulously tested,

not only for safety, but also to confirm

the presence of active cells for forming

new bone.

The standard against which all bone

grafts are measured is an autograft, which

is the patient’s own bone. An autograft

contains all of the components for

natural bone healing, including living

cells. However, because a second incision

is typically necessary to harvest enough

bone, some potential drawbacks exist,

including a longer surgical procedure,

harvest-site infection, increased recovery

time and long-term pain. “I use Osteocel

Plus so my patients won’t have to

undergo a painful harvesting of bone

graft from their hip,” said Dr. Schwartz.

According to Dr. Schwartz, patients

involved in this clinical evaluation have

been invaluable to the spine surgeons

at OrthoIndy who are advancing the

practice of medicine and leading the way

with new and improved treatments for

our patients. “I have seen fantastic results

with the use of Osteocel Plus in my

patients,” he said. “Spinal fusions, which

previously took six to nine months to

heal with other sources of bone graft, are

healing within three months. Osteocel

Plus is commercially available for use.

The purpose of the current evaluation is

to show the superiority of Osteocel Plus

to other bone grafting substances when

used for spinal fusions.”

For more information about fusion

surgery, Osteocel Plus, or the current

evaluation at ORF, please email questions

to [email protected].


Physical Therapy and Low Back PainIf you have experienced low back pain, you are not

alone. Approximately one out of four Americans report

experiencing low back pain within the past 3 months,

according to Spine. Low back pain often occurs due to

overuse, strain and sprain, or injury. This includes too

much bending, twisting, lifting, and in some cases, even

too much sitting.

Physical Therapists, who are experts in restoring and

improving motion in people’s lives, play an important

role not only in treating persistent or recurrent low

back pain, but also in prevention and risk reduction.

According to the American Physical Therapy Association,

Physical Therapists are highly-educated, licensed health

care professionals who can help patients reduce pain and

improve or restore mobility.

Belinda Hays, PT and owner of Progressive Physical

Therapy Clinics in Columbus, Seymour, and Greensburg,

Indiana reports, “Low back pain is the most common

complaint treated in our outpatient physical therapy

clinics. We treat low back injuries across all ages from

the young athlete to older adults. Prevention of back

pain is important to learn and practice.”

How Can You Prevent Low Back Pain?

• Keep your back, stomach, and leg muscles strong and

flexible



• Keep your body in alignment, so it can be more

efficient when you move

• Don’t slouch – keep good posture

• Use good body positioning at work, home, or during

leisure activities

• When lifting, keep the load close to your body and use

your legs to lift

• Avoid twisting and turning while lifting

• Ask for help or use an assistive device to lift heavy

objects

• Maintain a regular physical fitness regimen. Staying

active can help to prevent injuries

What to Do When You Have Low Back Pain

In most cases, low back pain is mild and will disappear

on its own. However, for some people, back pain can

return or persist, leading to a decrease in quality of life

or even disability.

Stay active and do as much of your normal routine as

possible when you have low back pain. Bed rest for

longer than a day can slow down your recovery. If your

pain lasts more than a few days or gets worse, then you

should schedule an appointment with your physician.

See a health care professional immediately if you

experience the following symptoms:

• Loss of bowel or bladder control

• Numbness in the groin or inner thigh

• Pain that does not change with rest

How a Physical Therapist Can Help

Not all back pain is the same and your treatment should

be tailored to suit your specific condition. You should

expect the following from a Physical Therapist:

• Individualized assessment: Your physical therapist

will ask you a number of questions about your

specific condition and will thoroughly examine you

for problems with posture, flexibility, strength, joint

mobility, and movement. Attention will be given to

how you use your body at work, home, during sports,

and at leisure.

• Individualized treatment plan: Once your assessment

is complete your physical therapist will develop a plan

designed for your specific type of back problem. This

may consist of:

• Treatment to decrease pain and restore mobility

• Manual therapy techniques to improve mobility

of joints and soft tissues

• Specific strengthening and/or flexibility exercises

• Education about care of your back and training

for proper lifting, bending, sitting, sleeping, and

doing chores both at work and at home

“Many cases of low back pain can be treated conservatively

with physical therapy,” states Hays. “However, when

surgery is required, physical therapy can help patients

regain their mobility and strength and help them return

to their normal activities. The physical therapist will

work closely with the referring physician to give a

comprehensive treatment plan.”

For more information about physical therapy, visit the

patient information website of the American Physical

Therapy Association at www.moveforwardpt.com.

Acknowledgment: E. Anne Reigherter, PT, DPT, OCS and Ellen Hamilton, PT, OCSAmerican Physical Therapy Association

Spine November 2006


OrthoIndy’s new docs and locations are here to fix it!

Founded over 45 years ago, OrthoIndy is one of the most

highly respected orthopaedic practices in the Midwest.

With over 70 physicians providing care to Central Indiana

residents at 14 convenient locations, OrthoIndy provides

leading-edge bone, joint, spine and muscle care.

OrthoIndy and the Indiana Orthopaedic Hospital (IOH)

continue to grow to provide patients with proven quality

orthopaedic outcomes. OrthoIndy added three new

physicians in 2009, Drs. Benjamin Justice, Matthew Lavery

and Joshua Salyer. In fall of 2009, OrthoIndy and IOH

broke ground on a new clinic and outpatient facility to

accommodate the residents south of Indianapolis.

Broken? By: Kasey Prickel


Dr. Benjamin JusticeDr. Justice graduated from Indiana

University in Bloomington in 1999

and Indiana University School of

Medicine in Indianapolis in 2003.

He completed his orthopaedic

residency at St. Mary’s Hospital, San

Francisco, California in 2008 and a

total joint replacement fellowship in

2009 at University of Louisville/Jewish

Hospital in Louisville, Kentucky.

In 2008, Dr. Justice received the Garnett F. Wynn Award,

awarded to the outstanding resident each year at the San

Francisco Orthopaedic Residency Program.

He has special training in muscle-sparing hip and knee

replacement as well as hip resurfacing arthroplasty, an alternative

for young, active patients.

Practice Focus

• Anterior Approach Hip Replacement

• Muscle-sparing Knee Replacement

• Revision Surgery

• Hip Resurfacing Arthroplasty

• Unicompartmental Knee Replacement

• Total Shoulder Replacement

• General Orthopaedics, including:

• Factures

• Ligament and Tendon Injuries

• Infections

Locations

• OrthoIndy South

• OrthoIndy Greenfield

To schedule an appointment with Dr. Justice, please call

(317) 884-5169.


Meet our Newest Physicians

Q&A with Dr. Justice

What made you want to be a physician?

I had a shoulder injury in high school tennis that required

arthroscopic surgery. It seemed like a great way to solve

problems and help people.

What is your favorite part of your job?

Seeing satisfied patients get back to their normal lives after

recovering from surgery.

What types of activities do you enjoy?

Mostly, I just hang out with my wife and daughter, who

provides hours of entertainment. Otherwise, I watch IU

basketball and the Colts. I also listen to audio books while

I’m driving.

Favorite sport?

Baseball (I like the Reds, but they’ve been very hard to

watch the last few years).

Favorite TV Show?

“Lost” and “How I Met Your Mother”

Favorite Movie?

Easy: “Star Wars”

Favorite singer or group?

So many to choose from… I’d have to say the Beatles and

Pearl Jam.

If you could meet anyone dead or alive who would it be

and why?

George Washington. I really enjoy American history, and

I think he would have a lot of interesting stories about the

Revolutionary War and the founding of our nation.

What is something about yourself that not many people

know?

I’m actually a pretty good amateur artist. I sold an acrylic

painting of downtown Indianapolis for $100 at a charity

auction when I was in med school.

Favorite place in Indy to hang out?

I love to eat at the Milano Inn. I also like to just walk

around downtown and enjoy the hustle and bustle.


Dr. Matthew LaveryDr. Matthew Lavery graduated magna

cum laude from Millikin University,

Decatur, Illinois in 1998. He was a

three-year letter winner on the varsity

football team at Millikin. In 2003,

he received his medical degree from

Southern Illinois University School of

Medicine, Springfield, Illinois.

In 2008, Dr. Lavery completed his

residency in orthopaedic surgery at

University of Iowa Hospitals and

Clinics in Iowa City. He completed a fellowship in sports

medicine at the Southern California Orthopedic Institute in Van

Nuys, California in 2009. Dr. Lavery is an associate member of

the Arthroscopy Association of North America and the American

Orthopaedic Society for Sports Medicine.

Dr. Lavery had the opportunity to work with the University of

Iowa men’s baseball, football and gymnastics teams, as well

as the women’s basketball team. During his sports medicine

fellowship he provided team coverage for several high schools

and the Los Angeles Valley College football team.

Dr. Lavery’s work has been published in professional journals,

including: Iowa Orthopaedic Journal, Clinical Orthopaedics &

Related Research and The Journal of Orthopaedic Research.

Dr. Lavery’s hospital affiliations include: Community Hospital

South, St. Francis and Hancock Regional Hospital.

Practice Focus

• Sports Medicine

• Arthroscopic treatment of shoulder, hip, knee and ankle

injuries

• General Orthopaedics

Locations

• OrthoIndy South

• OrthoIndy Greenfield

To schedule an appointment with Dr. Lavery, please call

(317) 884-5170.

Q&A with Dr. Lavery


I decided to become a physician later than many people. In

college, I took a course in comparative vertebrate anatomy the

same semester that I was taking a cell biology course. I was

fascinated by the amazing complexity of interactions between

human macro and micro structure. I knew I wanted a career that

allowed me to learn about and treat people given these wonderful

complexities. The challenging nature of a career in medicine really

appealed to my competitive spirit.


The operating room. The OR is unlike any other place I know.

Surgeons are given the privilege of performing invasive procedures

on other people with the goal of improving their quality of life. I

can’t imagine a more challenging or more enjoyable place to work.


In my free time I train for and race in triathlons. Due to a busy

schedule, I typically only get to participate in a few races each

summer, but I like to stay competitive. The races provide me with

motivation to exercise during the long winter months!

Favorite sport?

Football or Triathlon.

Favorite TV Show?

I don’t watch much TV, but “Iron Chef” is pretty good.

Favorite Movie?

I don’t really have one favorite – I like lots of different movies. If

I had to pick: an oldie, but a goodie… “The Usual Suspects.” One

other recommendation: “So I Married an Axe Murderer” – I won’t

say how many times my roommates and I watched that movie in

college.


Green Day or U2 (probably a tie)

If you could meet anyone dead or alive who would it be and why?

With billions of choices, it would be tough to choose just one

person. Too many choices amongst the dead, so I’ll pick someone

living… I think it would be fun to have a beer with Warren Buffett.

Buffett has proven that he is a financial genius, yet he always comes

across as a very down to earth human being during interviews. I

like intelligent, yet approachable people.

What is something about yourself that not many people know?

I’m mostly an open book, but I am not sure that a lot of my

co-workers know that I am a twin.


Either the couch in my living room or on the seat of my bike –

depending on the day.


Dr. Joshua SalyerDr. Joshua Salyer graduated from

Purdue University in 1996 with a

bachelor’s degree in neurobiology

& physiology and psychology. He

received a master’s degree from

Indiana University in counseling

psychology in 1999, then in Biology at

Purdue University in 2000. Dr. Salyer

received his doctorate of osteopathic

medicine in 2005 from Midwestern

University.

Following medical school, Dr. Salyer completed an internship

at Westview Hospital in 2006. In 2009, he completed his

physical medicine and rehabilitation residency from the Indiana

University School of Medicine, where he was chief resident in

2008 and 2009.

Dr. Salyer is a member of the American Academy of Physical

Medicine and Rehabilitation, American Medical Association,

American Osteopathic Association and the American Board of

Pain Medicine.

Practice Focus

• Botox for Pain and Spasticity Management

• Electrodiagnostics

• Interventional Pain Management

• Non-operative Spine

• Pain Management

Locations

• OrthoIndy Downtown

• OrthoIndy Northwest

To schedule an appointment with Dr. Salyer, please call

(317) 802-2842.


I always thought it would be fun.


Meeting my patients.


Hanging out with my family and pets

Favorite sport?

Tennis

Favorite TV Show?

“Lost”

Favorite Movie?

“The Jerk”


Aimee Mann

If you could meet anyone dead or alive who would it be and why?

I‘m not sure.

What is something about yourself that not many people know?

I don’t like talking about myself


Outside at the Chatterbox

Q&A with Dr. Salyer


Orthopaedic Care Right Outside your Front DoorOrthoIndy and the Indiana Orthopaedic Hospital

(IOH) broke ground on a new facility, located at

1260 Innovation Parkway, (South of County Line, on

Graham Road) Greenwood, Indiana. Spanning 75,000

square feet, the state-of-the-art facility will provide

5-Star orthopaedic care to residents on the Southside

of Indianapolis. The facility is scheduled to open

October 25, 2010.

The new facility, OrthoIndy/IOH South, will include: 42

exam rooms, 4 operating rooms, physical therapy and

MRI, as well as over 20 OrthoIndy physicians, providing

a complete range of orthopaedic care.

“We are excited to offer more services to our already

existing presence on the Southside by building a new

state-of-the-art facility,” said John Martin, chief executive

officer at OrthoIndy. “As a member of the community of

Greenwood, our new facility will provide residents with

orthopaedic care that is nationally ranked.”

BSA LifeStructures designed the facility and Meyer

Najem will provide construction management

expertise. Hokanson Companies Inc. and McCormack

Development will oversee the process to completion.

“Meyer Najem is excited to have been selected as

the Construction Manager for the OrthoIndy/IOH

project,” said Tim Russell, President of Meyer Najem.

“We are honored to be a part of the growing presence of

OrthoIndy as they expand to meet the increasing demand

for orthopaedic services in the greater Greenwood area.”

A groundbreaking ceremony took place in the fall of

2009 at the facility’s site. Keynote speakers included:

OrthoIndy patient, Mayor Charles Henderson; John

Martin, CEO, OrthoIndy; Dr. Frank Kolisek, President,

OrthoIndy; Jane Keller, CEO, IOH; Dr. John Dietz,

Chairman of the Board of Directors, IOH.

Map


To provide more access to bone, joint, spine and muscle

care, OrthoIndy has expanded to four underserved areas

in Indiana. OrthoIndy physicians are now available in

Brazil, Fishers, Greenfield and Shelbyville, Indiana.

BRAzILThree OrthoIndy physicians are now accepting patients

in Brazil, Indiana. Drs. Chris Bales, Robert Falender

and Gabriel Jackson are available at the St. Vincent Clay

Hospital, located at 1206 East National Avenue.

Dr. Chris BalesOrthopaedic Specialties: Knee, Shoulder,

Sports Medicine

Wednesdays 8 am to 12 pm

To schedule an appointment with

Dr. Bales, please call (317) 268-3632.

Dr. Robert FalenderOrthopaedic Specialties: Hand, Shoulder,

Trauma

Wednesdays 1 to 5 pm


Dr. Falender, please call (317) 884-5167.

Dr. Gabriel JacksonOrthopaedic Specialties: Spine

Every-other Thursday 8 am to 12 pm


Dr. Jackson, please call (317) 802-2886.

FISHERSDr. Michael Thieken is now accepting patients at the St.

Vincent Medical Center Northeast, located at 13914 E.

State Road 238, Suite 301, Fishers, Indiana. Dr. Thieken

is available on Fridays from 8 am to noon.

Dr. Michael ThiekenOrthopaedic Specialties: Sports Medicine,

Shoulder, Hip, Knee


Dr. Thieken, please call (317) 802-2442.

GREENFIELDThree OrthoIndy physicians are now practicing in

Greenfield. Drs. Matthew Lavery, Benjamin Justice and

Gregory Reveal are now accepting patients three days

a week at the new location, located at One Memorial

Square, Ste. 2000, Greenfield, Indiana. The Greenfield

location is open Monday and Wednesday, 8 am to 12 pm

and Friday, 1 to 4 pm.

Dr. Matthew Lavery Orthopaedic Specialties: Sports

Medicine, General Orthopaedics


Dr. Lavery, please call (317) 884-5170.

Dr. Benjamin JusticeOrthopaedic Specialties: Total Joint

Replacement, General Orthopaedics


Dr. Justice, please call (317) 884-5169.

Dr. Gregory RevealOrthopaedic Specialties: Trauma,

Upper Extremity


Dr. Reveal, please call (317) 917-4389.

SHELBYVILLEDr. Michael Coscia is now accepting patients at the

Renovo Building, located at 275 West Bassett Road,

Suite 4, Shelbyville, Indiana. Dr. Coscia is available at

the clinic on Mondays from 8 am to 5 pm.

Dr. Michael CosciaOrthopaedic Specialties: Spine


Dr. Coscia, please call (317) 802-2874.

Outreach Locations


(Left to Right) Dr. Trammell, Sin Lizzie and Dr. Baele.


By: Lindsay McClure

Many people may not know that Indianapolis has a

roller derby team. The Naptown Roller Girls (NRG) is

a league that was formed to bring flat track roller derby

to Indianapolis. In 2006 the Tornado Sirens was created

and is one of more than 400 flat and banked track roller

derby leagues around the country. The NRG is a member

of the Women’s Flat Track Derby Association (WFTDA),

which is the national governing body for women’s

amateur flat-track roller derby in the United States.

Roller derby is considered an aggressive, full contact

sport, which requires protective gear. The girls are

required to wear a skate helmet, wrist, elbow and

mouth guards along with knee pads to help prevent

injuries. It is recommended that they wear tailbone and

hip pads as well. They practice several times a week

to keep their bodies trained for the grueling workout

they encounter during a “bout” (60 minutes of actual

playing time). Some common injuries that occur are

pulled muscles, sprains, strains, bruises, and/or broken

bones, so every precaution is taken.

Stacy Elliott aka Sin Lizzie has been an NRG since

February 2007. She became intrigued with roller derby

after watching a show on A&E about the Texas Rollergirls

in 2002 and at that time Indianapolis did not have a

team. Being part of the NRG involves not only practices

and bouts but also attending public community events

and fundraising. The NRG is a do-it-yourself league that

is own and run by the girls in the league. “Derby is one

of the most important things in my life,” said Stacy. “The

women on the team have become my family. The sport

we play makes any injury seem bothersome and the only

thing you want to do is heal and skate.”

Stacy has a long list of injuries, including: concussions,

sprained ankles, bruised ribs, torn back muscles, facial/

nasal fractures and her knee, which she finally had

surgery on in 2009. Stacy had both her surgeries done

at the Indiana Orthopaedic Hospital (IOH), where she

works as a surgical first assistant (CFA) in the OI CAF-

Pool. Dr. Sanford Kunkel performed her knee scope.

“Dr. Baele referred me to Dr. Kunkel for the surgery and

he was amazing,” said Stacy.

When injured, Stacy still attended every practice and

kept in shape by doing core and arm strengthening

exercises and helping the coaches. After her surgery her

knee pain was gone and she could land without having

excruciating pain. She recently underwent surgery in

January 2010 for exertional compartment syndrome

in her lower leg, which occurred when she fell at a

scrimmage practice.

Exertional compartment syndrome occurs when

pressure within the muscles builds to dangerous levels.

The pressure can decrease blood flow, which prevents

nourishment and oxygen from reaching nerve and

muscle cells. Stacy didn’t want her injury to keep her

from playing her sport. She wanted to be able to skate

for her next bout. Dr. Joseph Baele performed her

fasciotomies for her exertional compartment syndrome

to release the pressure. The fasciotomy involves making

an incision and cutting open the skin and fascia, which

is the tough membrane that covers the tissues in the

arms and legs. “Dr. Baele has been great,” said Stacy.

“He hears my pains about derby almost every time I see

him. He knew that I was pushing for time between the

surgery and our upcoming bout and how important it

was to me to be skating this season. He performed the

surgery in January and then I did my part to heal.” After

surgery, Stacy was able to return to the derby only eight

days later.

After playing in the February 6th bout, Stacy encountered

a few more injuries including a brachial plexus injury

and a subluxed bicep tendon when she landed on

her shoulder. The brachial plexus controls muscle

movements and sensation in the shoulder, arm and

hand. A brachial plexus injury is caused by damage

to the nerves in the brachial plexus network. Since

sustaining these injuries, Stacy has decided to retire

from the derby. Her brachial plexus injury has started

to make her lose function in her right arm. “It’s hard

to retire,” said Stacy. “Derby is who I am and what I

do, so much of me revolved entirely around it. When

I announced my retirement, the fans on facebook were

amazing--people who do not even know my real name

were so supportive over the last four seasons and were

so upset and saddened about my retirement along

with me. Reading the posts were heartfelt and I never

realized the amount of people you touch just by doing

something like this.”

OrthoIndy physicians, Drs. Joseph Baele and Terry

Trammell, are the NRG team physicians. As a team

physician, Dr. Trammell says his responsibilities include

attending the bouts with Dr. Baele to provide onsite

medical management. “The sport is very physical and the

skaters need a lot of medical support,” says Dr. Trammell.

“If one of the girls gets injured we help them obtain

timely and necessary orthopaedic care. If the injury

requires immediate care we assist with “packaging” the

patient for transport to the hospital and have a physician

to physician call to expedite care.” Most of the injuries

they treat are knee related; however, they are all mainly

musculoskeletal. As far as being prepared to avoid injury

Dr. Baele says, “They wear pads but the pads only help to

a certain degree. Hits come unexpectedly. The potential

for injury is high. These ladies are in great shape. I’ve

watched most all of them build muscle year after year.

I can only think practice and good strength keep them

from getting injured more than they do.”

NRG Tornado Sirens play at the Pepsi Coliseum at

the State Fairgrounds. For more information about

the Naptown Roller Girls visit their website at www.

naptownrollergirls.com.


Dr. Trammmell and Stacy. Naptown Roller Girls during a bout.


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The Declining Dollar:What It Really Means

By: David Webb, CFP® and Ted Christofolis, CFP®

No one can miss hearing about the decrease in the value of the U.S. dollar. Television and newspaper headlines are full of how recent government spending devalues our currency. You have probably heard that the U.S. dollar is losing credibility in the world or heard about debt risks associated with China. Undoubtedly, popular news sources, especially commercials, have suggested ways to protect yourself—buy gold! buy currencies!—all of which may make you worry even more. The value of the dollar is a very complex issue; sorting through the noise of the media can help you understand what it really means to you.

What do we mean by the “value” of the dollar and how is it measured?On one hand, it is purchasing power. We know that inflation creates negative purchasing power. For example, because of inflation what may have cost $1 twenty years ago now costs $2. In 2002, the cost of an espresso in Paris was $1.72; in 2009 it was $3.00. Relatively, the cost of 1 Euro in 2002 was $0.86; in 2009, it was $1.50. The U.S. Dollar Index measures the value of the U.S. dollar compared to a basket of foreign currencies. At its start, the value of the U.S. Dollar Index was 100.000. It has since traded as high as the mid-160s and as low as 70.698 on March 16, 2008—the lowest since the inception of the Index in 1973. As you see in

the chart below, the U.S. Dollar Index (the green line) fluctuates regularly and demonstrates some cyclical patterns, particularly when viewed in the context of the U.S. deficit (the gray bars). In addition to purchasing goods and services (such as espresso and taxis), the U.S. dollar is used as the standard unit of currency in international markets for commodities such as gold and petroleum. It also remains the world’s foremost reserve currency. Some countries tie their currency to the U.S. dollar. In all of these cases, the U.S. dollar is valued based on its perceived stability. Currently the U.S. dollar is rated AAA (highest possible) by S&P and the rating agency considers the outlook for that rating to be stable. Another way the U.S. dollar is measured is by the issuance of Treasuries, which are basically I-owe-yous issued by the U.S. government and payable in U.S. dollars.

What makes the U.S. dollar change in value?• Inflation. Inflation is caused by simple supply and

demand. Typically when there is more money to spend than goods available, prices go up. When the dollar is considered scarcer, it has a higher value.

• Federal Action. Recently The Federal Reserve has been adding to the supply of money in hopes of stimulating spending and growth. Increasing the supply of money can lead to a decrease in the dollar’s value. When the Fed wants to slow down the economy (typically to avoid high inflation), it will remove money from the system—making the dollar scarcer.

• Federal Deficit. Deficit spending on the part of the government also has an impact. This spending also adds to the supply of money and generally drives the value of the U.S. dollar down.

• Perception. Since a large portion of U.S. debt is held by foreign countries, international perception of U.S. credit worthiness and confidence in its strength also affects the value of the dollar.

WHY IS THE U.S. DOLLAR DECLINING? WILL IT HURT OR HELP THE U.S. ECONOMY?



This may leave you wondering, “Should I be doing something to ‘protect’ myself?” Next, we will help you understand what the declining U.S. dollar actually means to you, as an investor.

The Declining Dollar: What It Means to YouThe decline of the U.S. dollar over the last several years has garnered a lot of media attention. While many different factors have contributed to the decline, giving rise to various political and economic theories, most people wonder: What does it really mean to me?

What is the impact of a weaker U.S. dollar? When the U.S. dollar decreases in value, it can benefit the U.S. economy because American products are cheaper to export and that’s good for the U.S. trade deficit. It’s also good for U.S. companies that sell overseas. A weaker dollar is good for borrowers, as it lowers the cost of borrowing. A modest weakening of the dollar might be positive, since it would make U.S. goods less expensive to foreign buyers and therefore more attractive overseas. A weak U.S. dollar can negatively affect the U.S. because it becomes more expensive to buy commodities and foreign items (here or abroad), but only in some countries. When the dollar is weak, lenders (bond holders) earn low interest rates. However, if the U.S. dollar entered an extended downward trend, this would have significant negative consequences, as it would create import inflation and would impair the ability of the U.S. to issue debt at reasonable rates in the future. With the U.S. deficit ballooning and spending climbing sharply, the deficit is an important issue.

How ‘bad’ is it? Should I be afraid?Media coverage about the devalued dollar implies that this has never happened before, that it is in a freefall, and that we are facing a doomsday scenario. In reality, the value of the U.S. dollar fluctuates regularly. Some of this movement is predictable as the dollar’s value moves in cycles and in response to economic conditions that we’ve faced before. When the stock market started its dramatic decline, investors responded to their fear by rushing to the “safety” of the U.S. dollar, driving its value up pretty rapidly. A small part of the decline of the dollar is merely a return to more normal balance now that the financial crisis is pretty much behind us.

How does this affect you?You may have heard currency funds mentioned as one way to fight a sinking dollar. In the last few years there has been a dramatic increase in these products, which allow investors to purchase funds that try to capture gains in other currencies when the dollar is low. However, these funds are very risky and not a suitable vehicle for meeting long-term goals. We suggest extreme caution.

When the dollar is weak, foreign stocks can be an option for investors. Foreign stocks can play a significant role in a balanced portfolio, but they come with their own set of unique risks:

• Market Risk: Stock markets of many emerging economies are not subject to the same accounting standards or regulatory oversight as the U.S. That lack of oversight can make it difficult to accurately value a publicly-traded company.

• Political Risk: Civil or political unrest can affect the relative attractiveness of a country’s investment market. Even developed markets can undergo economic shifts due to international conflicts, sanctions, and more.

• Currency Risk: The returns of an international security can be affected by swings in currency exchange rates. It’s important that the value of the U.S. dollar will convert favorably when trades are made. Multinational companies who trade stock in the U.S. typically are at the core of a balanced portfolio. Much of these companies’ revenue comes from international sales, which may be immune from the effects of a weak dollar. The answer is that there is not a magic pill to protect against a declining dollar. The best defense is an investment strategy that provides some protection by being diverse and by adhering to your personal comfort level of risk. Importantly, don’t listen to the doomsday forecasters who say the sky is falling. Although the dollar has declined dramatically over the last seven years, it has not created a collapse. Such a collapse is not in the best interest of most countries in the world, as it would decrease the value of their dollar holdings.

In the end, a declining dollar doesn’t affect the day-to-day reality for most people. In many ways, there isn’t a need to worry about a declining dollar unless you’re traveling abroad or buying products overseas. We can answer any specific questions and help you diversify your portfolio to create a cushion against all market fluctuations, including the declining U.S. dollar.

David Webb has more than 25 years of experience providing individuals and families with comprehensive financial planning and investment management. He is a CERTIFIED FINANCIAL PLANNER® professional. He can be reached at: [email protected] or 317.635.3563.

Ted Christofolis is a founder of Redwood Investment Advisors, now StanCorp Investment Advisers. He has more than 20 years experience in investments and taxes. Ted is a member of the Indiana CPA Society, the American Institute of CPAs (AICPA), and the Financial Planning Association (FPA). He is a CERTIFIED FINANCIAL PLANNER® professional. He can be reached at: [email protected] or 317.635.3563.

© 2010, StanCorp Investment Advisers. All rights reserved.



OrthoIndy Opens Walk-in Clinics

By: Kasey Prickel

OrthoIndy has opened three walk-in clinics at

its OrthoIndy Northwest, OrthoIndy South and

OrthoIndy West facilities. The walk-in clinics

provide residents with immediate access to

bone, joint, spine and muscle conditions.

“The orthopaedic Walk-In Clinics at

OrthoIndy provide the community with

immediate access to physicians specialized

in treating acute injuries of muscles,

bones and joints,” said Dr. Chris Bales,

an orthopaedic surgeon at OrthoIndy

and the Indiana Orthopaedic Hospital

(IOH). “It provides quick and efficient

access to high quality specialized

orthopaedic care allowing patients

to avoid the longer waits seen at

emergency rooms.”


The OrthoIndy Walk-In Clinics will accept the following

injuries:

• Acute Pain

• Injury from an Accident

• Muscle Sprains/Strains

• Closed Fractures

• Tendonitis/Bursitis

• Finger/Toe Dislocations

• Back Pain

• Lacerations

• Work related Injury (if employer authorized)

Residents seeking care for the following injuries should

call ahead to the clinic to determine if the injury needs

treatment in an emergency room:

• Chronic Problems (problems lasting longer than

two weeks)

• Patient with previously scheduled appointment for

same injury

• Open Fractures

• Patients on gurneys or requiring transport due to

inability to walk

• Major joint dislocations (requiring anesthesia)

• Burns

The OrthoIndy Walk-In Clinics not only benefit patients,

but the community as well. “The clinic is cost effective

for patients as it avoids being seen at the emergency

room and then being referred to the orthopaedic doctor

for definitive treatment,” said Dr. Bales. “This not only

benefits the patients but the community and healthcare

system in general by avoiding expensive ER visits and

decreasing ER volume, which allows ER physicians to

focus on more critical patients.”

OrthoIndy Walk-In Clinic - NorthwestLocated at 8450 Northwest Blvd. Indianapolis, IN

The clinic is open Monday through Friday from

8:30 am to 4:30 pm. Call (317) 802-2000.

OrthoIndy Walk-In Clinic – SouthLocated at 1260 Innovation Parkway, Suite 100,

Greenwood, IN


8 am to 8 pm and Saturday from 9 am to noon.

Call (317) 884-5200.

OrthoIndy Walk-In Clinic - WestLocated at the corner of Dan Jones Road and

Northfield Drive in Brownsburg, Indiana.


8 am to 8 pm and Saturday from 9 am to noon.

Call (317) 268-3600.

Visit OrthoIndy.com for more information.


Helping Your HandsBy: Kasey Prickel

There are so many little things a person takes for

granted. Everything we do requires our hands and when

someone sustains a hand injury, the way of life is altered

to compensate. At OrthoIndy, our hand and upper

extremity specialists provide care to help restore the

function. Drs. Timothy Dicke, Robert Falender, Andrew

Vicar and Jeffery Whitaker are all fellowship-trained

hand surgeons. They are all members of the American

Society for Surgery of the Hand. They are trained in all

aspects of hand and upper extremity care available to

diagnose and treat injuries and conditions of the hand,

wrist and forearm.

According to Dr. Falender, the most common types of

hand conditions are overuse injuries. Overuse injuries

include: carpal tunnel, tennis elbow, golfer’s elbow and

tendonitis. Fractures, work related problems, rheumatoid

and osteoarthritis are also common conditions that

hand surgeons treat on a regular basis. “Many of these

conditions are treated conservatively with splinting,

proper body mechanics and therapy,” said Dr. Falender.

“When conservative treatment fails, surgical intervention

may be required, which is performed on an outpatient

basis with the goal of a safe return to work and activity.”

Common symptoms that bring patients into our office

are numbness in the hand, difficulty with dexterity and

pain in the arm with use. “People shouldn’t have to live

with pain and numbness,” said Dr. Falender. “All of us

at OrthoIndy strive to enable our patients to return to a

more active lifestyle, quicker and with no pain.”

Meet three women who have experienced the

inconvenience of a hand, wrist and elbow injury and the

hand specialists who treated their condition.

Morgan LewisTo high school student, Morgan Lewis, softball is one

of the most important things in her life. “Softball is

my whole life and I love it,” said Morgan. Morgan

started playing softball when she was five-years-old and

started pitching on a travel team when she was nine.

Unfortunately, early in her softball career at Lutheran

High School, Morgan suffered an injury, affecting her

game as a pitcher.

During her freshman year, Morgan started developing

pain in her right wrist, which is her throwing arm.

She came to OrthoIndy to enlist the help of Dr. Jeffery

Whitaker, an orthopaedic hand surgeon. “Morgan

presented with a repetitive overuse problem that lead

to joint inflammation called synovitis initially,” said Dr.

Whitaker, who then prescribed cortisone injections to

stop the pain. Morgan’s injury affected her life in a big

way. “I was in constant pain,” she said. “I couldn’t do

the one thing I loved because of my injury.” Because of

the pain in her wrist, Morgan struggled during softball

workouts and her daily activities.

Morgan’s pain was masked for almost two years. She

played through her freshman and sophomore year

pain free until the pain resurfaced her junior year and

became worse. She went back to Dr. Whitaker and an

Miss Softball – Morgan Lewis


MRI showed that she had a tear in her cartilage, but only

surgery would determine the severity of the tear.

“The forces across the wrist, particularly at the distal

radioulnar joint, during a high speed softball pitch

caused a small tear of the triangular fibrocartilage where

ligaments attach to it,” said Dr. Whitaker. “The high

speed and force of being a fast pitch softball player took

a toll on this small cartilage in her wrist.”

The surgery involved inspection of the joint with a small

arthroscope, which allows visualization of the inside of

the joint. That enabled Dr. Whitaker to see the problem

and repair the cartilage and tighten the ligaments around

the edge of the tear.

Morgan was nervous before

surgery, not only because she

hates needles, but also due to

the fact that the extent of her

injury was unknown. There

were two possibilities: one,

there was a partial tear and the

other was a complete tear and

unattachment. Dr. Whitaker

performed an arthroscopy to repair the cartilage tear and

fortunately he only had to replace a partial tear.

“There was some stretching of the dorsal ligaments

attached to the triangular fibrocartilage,” he said. “I

repaired those ligaments by tightening them up with

arthroscopic assisted placement of the sutures.”

Morgan was very pleased with the care she received at

OrthoIndy. “Dr. Whitaker was amazing,” she said. “He

always made me feel comfortable and made sure I knew

what he was going to do before he did it.”

Dr. Whitaker was honored to treat such a fine young

lady. “Morgan is one of the most aggressive high speed

softball pitchers I have had the opportunity to take care

of,” he said. “I am pleased with her treatment and excited

that she has the opportunity to continue her sport at the

college level.”

Life after surgery has been great for Morgan. After surgery,

she did experience a little pain, which Dr. Whitaker

corrected with a cortisone shot. “I received a cortisone

shot right before my softball season that year and that

was the last pain I felt in my wrist. I am throwing harder

than ever and have more spin and movement on the ball

than I ever thought I could have.”

Morgan had a great end to her high school softball

career. Her team finished Runners-Up in class A softball

with a record of 32-2. Morgan was named the Indiana

Gatorade Player of the Year, which is also associated

with the magazine, ESPN Rise. She was also named the

IHSAA mental attitude player for class A. In recognition

of that award, they gave a $1,000 to her high school

in her name. Morgan’s accomplishments don’t stop

there. She also got All-State, All-Marion County, Indiana

Crossroads Conference Academic All-Conference, All-

Indiana Crossroads Conference, District Player and Miss

Softball.

Morgan will attend the University of Tennessee at Martin

on a softball scholarship. OrthoIndy and IOH would

like to wish Morgan the best of luck in the rest of her

softball career.

Morgan pitching for Lutheran High School.

“Dr. Whitaker was amazing. He always

made me feel comfortable and made

sure I knew what he was going to do

before he did it.” – Morgan Lewis

Jeffery Whitaker, M.D.


Jayme ParrWhile Morgan was able to regain the full

function after her injury, sometimes some

injuries are so severe that one cannot

regain pre-injury function. One such

patient is Jayme Parr. Jayme is a clinical

social worker. Her organization provides

individual and group counseling to men,

women and children affected by violence

and or trauma. Jayme primarily works

with the children. In July 2009, Jayme

fell while running after a child at work

and suffered several severe injuries. Jayme

did not have her surgeries at OrthoIndy,

but she was fortunate to receive care from

hand surgeon, Dr. Andrew Vicar for post-

operative care.

Jayme’s injuries included a dislocated left elbow with a

shattered radial head, fractured humerus and a severe

fractured right wrist. According to Dr. Vicar, there are

three bones in the elbow: the humerus, the ulna (acts

as main hinge bone to allow flexion and extension) and

the radius (the part of the radius that is in the elbow

joint is known as the radial head, which is the bone

that swivels to allow us to turn our hands palm up or

palm down). “Jayme shattered the radial head when she

dislocated her elbow and we need that structure to be

as intact as possible so that she doesn’t redislocate her

elbow.” Dr. Vicar also adds that a fractured elbow is a

common injury, but a severe fracture dislocation of the

elbow is not a common injury that he sees in his office.

“We might see three or four a year,” he said. “It happens

when a patient falls on an

outstretched arm and there

is a force load from the hand

that goes right to the elbow.

We typically see this type of

injury from falls on the ice or

falling from a high object.”

To correct her injuries,

Jayme went in for emergency

surgery. She recalls that at the time of her injury she was

at a difficult point in her life, she was recently divorced

and trying to figure life out. That night, while being

wheeled into surgery, she thought her life was going

to be better. She had two surgeries in the matter of a

week. The first surgery cleaned up the left elbow and

put in a prosthetic radial head. Then a closed reduction

and manipulation of her fully displaced colles fracture

right wrist was performed. A week later she had another

surgery due to an infection.

Jayme’s injuries dramatically affected her life. She had to

recover simultaneously from a severe left elbow injury

and a severe right wrist fracture. Her mother came down

from Michigan to be with her during surgery and after to

help. “My mom stayed with me for three months after

my surgery,” said Jayme. “I couldn’t do anything on my

own. I needed assistance to eat, drink, bathe, use the

bathroom, dress, scratch my nose, everything. I couldn’t

drive or work for months. My mom and I went through

30 years of life in 3 months.”

Jayme’s injury occurred at work, and required emergency

surgery, which was handled through a different practice.

She was then referred by her workman’s compensation

insurance to Dr. Vicar for her post-operative care

because of his expertise in upper extremities. Jayme

saw Dr. Vicar every two weeks for about three months,

then just once a month for about five months. Dr. Vicar

prescribed three dynamic splints that Jayme used for

a few months. The first was for left elbow extension,

which Jayme slept in. The second was for right wrist

flexion, which she wore about three times a day for

about 30 minutes at a time. The third brace worked

on both supination and pronation for her right wrist.

Jayme also had a variety of tests and procedures to

gauge how well things were healing and if another

surgery would be in her best interest.

Andrew Vicar, M.D.

Jayme post-surgery with her cat, Nony.


In addition, she attended occupational therapy three

times a week for about four months, then two times a

week for another two months. Each session lasted about

two hours where she did a variety of exercises.

Since her release from care, Jayme has had a few problems,

but none that she says she can’t handle or wasn’t prepared

for. “Dr. Vicar projects that my elbow prosthetic will

need to be revisited in 15 to 20 years,” she said. “I’m not

looking forward to that, but as long as I have a doctor as

knowledgeable as Dr. Vicar, it will be fine.”

Jayme’s confidence in Dr. Vicar also comes from the care

she has received from everyone at OrthoIndy. She said, “I

had a great experience with Dr. Vicar as well as all of the

staff. I was greeted with a smile every time I walked in.

The front receptionist was always so kind! The cast techs

helped make me feel comfortable each time they changed

the casts. The radiology people were so kind and helped

make sure I felt comfortable and safe. Having my healing

arms out of the casts was a vulnerable feeling; they always

treated me respectfully and carefully. Dr. Vicar and his

nurse, Alice were always willing to answer my questions

and make sure things went as smoothly as possible.”

Today, Jayme cannot fully extend her left arm to the

“normal” 0 degrees, but does achieve about 35 degrees.

“My right wrist is still lacking a few degrees of normal

movement in various directions, but I am learning

to compensate for that. Pain in both arms is now

just a constant ache, which is pretty well managed by

pain relievers and moist heat. There has been a bit of

numbness in my fourth and fifth fingers on my left hand

due to an injured nerve in my elbow.”

Dr. Vicar believes that more surgical treatment won’t

improve the nature of Jayme’s complex injury. “Due

to the severity of her injuries, Jayme will have some

permanent pain,” said Dr. Vicar. “In cases where the

injury isn’t as severe, most people can expect to live a

pain free life.”

Jayme values Dr. Vicar’s opinion to not proceed with

surgery even though she isn’t back to 100 percent. “I

trust Dr. Vicar’s opinion and have confidence that he

is a great doctor,” said Jayme. “I’m disappointed that I

don’t have full range of motion in either arm, but trust

that he would do more surgery if he thought that would

definitely improve the situation. I strongly respect that

he weighs the potential risks and benefits and makes

decisions based on patients well being not necessarily his

or the hospital’s pocketbook.”

Due to the serious nature of her injuries, Jayme says it has

been interesting getting adjusted to her “new normal.”

However, since her injury, she has started a new journey.

“I have a fabulous boyfriend who has two wonderful

children,” she said. “They are three of my most favorite

people. This past summer they decided that my bum

elbow is like Nemo’s lucky fin, like in the movie ‘Finding

Nemo.’” While her injuries have created limitations,

her positive outlook on life helps her get through those

limitations. “I don’t take the use of my arms for granted.

I am thankful I can do what I can.”

Dr. Vicar is very pleased with Jayme’s progress. “Jayme

certainly worked very hard during therapy sessions and at

home,” he said. “With all the hard work she has put into

her recovery, she has done as well as can be expected.”

I trust Dr. Vicar’s opinion

and have confidence that

he is a great doctor.”

– Jayme Parr

Jayme and her mom in Brown County.


Amber and Dr. Dicke take a break from an exam to smile for a picture.

“When all other doctors just wanted to take

my arm off, he (Dr. Dicke) saw something that

could be fixed and did just that.” – Amber Bloomer


Amber BloomerOn June 17, 2007 in Palmyra, Maine, Amber Bloomer

was in a serious car accident. Her car flipped a number

of times and her left arm was pinned under the entire

weight of the car, completely crushing it. Amber’s arm

was 95 percent amputated from the elbow down. She

was life-lined to a hospital, where she spent the next two

months receiving a number of surgeries. Unfortunately,

the surgeries were not successful. A number of physicians

thought amputation was the best way to treat her

condition, but Amber felt something else could be done.

In April 2009, a screw in Amber’s arm from one of

her previous surgeries fell out and her arm began to

undo itself. The physicians weren’t sure what to do, so

Amber sought out her own physician, and she came to

OrthoIndy to see Dr. Dicke. “I had pretty much given

up on my arm and all things involved by this point, but

Dr. Dicke was sure he could fix it, she said. “Despite my

many disappointments and amputee attitude at the time,

I could see they really wanted to help me.”

According to Dr. Dicke, Amber initially presented with

a horrible problem in the left forearm. “From her

previous trauma, she had a complete loss of connection

of her hand to the elbow,” he said. “There was a chronic

infection in both forearm bones. There were plates and

screws at the forearm and wrist, but there was no fixation

or support of the bones and she had a flail arm. Besides

the complete loss of stability, she had chronic pain and

swelling from the fracture nonunion and infection.

Despite this, she still had a good remaining hand minus

the thumb. She had good sensation in most of the

fingers, good circulation and the ability to grasp with

the fingers.”

Being left-hand dominant, Amber’s injury prevented

her from doing day-to-day activities, ones that most

people take for granted. Besides not having a thumb, the

restrictions and pain of her arm, wrist and fingers made

it difficult to do the simplest things like tying her shoes

or opening doors. “My sense of self-sufficiency had been

lost, not only for myself, but my children as well,” she

said. “Just hugging them was a chore in itself.”

Since coming to OrthoIndy things have gotten so

much easier and better for Amber. “Dr. Dicke gave me

hope that had previously been lost,” Amber said. Dr.

Dicke began surgery to undo everything that had been

done and reconstruct her arm. Her reconstruction first

involved surgeries to clean out the infection from the

forearm including partial removal of the remaining

forearm bones. The forearm was stabilized on the inside

with plates to give her better support. After the infection

was under control, Dr. Dicke performed a surgery to

transfer a live bone graft to the forearm from her leg

using a vascularized fibula graft. “This is a difficult

microvascular procedure, but has a better chance of

healing in an area of severe damage because of its

retained blood supply,” said Dr. Dicke. “With her loss of

bone through the forearm, the graft was attached at the

upper forearm to the ulna bone and to the radius bone

at the wrist to create a one bone forearm and bridge the

defect and restore stability to the arm.

Amber is fortunate for the care she has received from Dr.

Dicke. “Dr. Dicke has not only given me my arm, but

new hope in life that had previously been lost,” she said.

According to Dr. Dicke, Amber now has stable healing of

the forearm bone with no evidence of recurrent infection.

She has good pain relief and her hand function is

much improved. However, Amber will undergo a few

additional surgeries to help reconstruct her arm, to

improve the appearance of the forearm by debulking the

soft tissue flap previously done at the time of her trauma.

Scarring on the tendons in the forearm will be loosened

to allow improved grasp. Dr. Dicke said, there is also

the possibility of reconstructing a thumb by transferring

a toe to her hand.

With all of the treatment Amber has already received

and with more on the way, she has full confidence in Dr.

Dicke. “I will forever be grateful to Dr. Dicke for all he

has done for me. When all other doctors just wanted to

take it off, he saw something that could be fixed and did

just that. Three years ago, I lost my arm. Today Dr. Dicke

has brought it back for me and given me life again. That

is something that will never be forgotten! My children

and I thank him so much for what he has done.”

Dr. Dicke is pleased with Amber’s progress and believes

her to be a positive individual. “Overall, she has been

incredibly brave through this ordeal and now she can see

the light at the end of the tunnel where she will able to

use her left hand again with restored function.”


OrthoIndy Trauma Department’s Study to Benefit Military

By: Kasey Prickel

OrthoIndy, will serve as one of 12 core clinical centers

in a newly established Extremity Trauma Clinical

Research Consortium. Funded by the Orthopaedic

Extremity Trauma Research Program (OETRP) of the

Department of Defense for $18.4 million over 5 years,

the Consortium will work closely with several major

military treatment centers and the U.S. Army Institute

of Surgical Research (USAISR) to conduct multi-center

clinical research studies relevant to the treatment and

outcomes of severe orthopaedic trauma sustained on the

battlefield. These studies will help establish treatment

guidelines and facilitate the translation of new and

emerging technologies into clinical practice.

“The need for such a consortium is evident,” said Ellen

MacKenzie, PhD, Director of the Coordinating Center

for the Consortium, located at the Johns Hopkins

Bloomberg School of Public Health. “Eighty-two

percent of all service members injured in Operation

Iraqi Freedom and Operation Enduring Freedom sustain

significant extremity trauma. Many sustain injuries to

multiple limbs. The research to be

conducted by the Consortium will

help us better understand what works

and what doesn’t in treating these

injuries and ensure that our service

members are provided with the best

care possible.”

Initial funding of the consortium will

help establish the network and provide

the resources to address some of the

critical needs in acute clinical care

identified by the military. “Obtaining

adequate funding to support these types

of research studies has been historically

problematic,” said Ms. Dana Musapatika,

MSC, Trauma Research Manager at

OrthoIndy. “This grant will provide the

resources necessary to accomplish this

type of research in a relatively short

period of time.”


Critical needs to be addressed include the reconstruction

of significant bone defects and the management of

musculoskeletal infections. Over time it will expand

and leverage its infrastructure to address many other

priority topics relevant to the long-term management

of severe extremity trauma, including the prevention of

osteomyelitis, chronic pain and disability.

“The staff and surgeons are very excited about the

opportunity to work with the other top centers in the

country on these research projects,” said Dr. Renn

Crichlow, an orthopedic trauma surgeon at OrthoIndy

and the Indiana Orthopaedic Hospital (IOH). “We are

hopeful that the findings will result in better treatment for

both civilian and wartime injuries.”

An important feature of the

Consortium will be its ability

to expand the number of

clinical sites participating in

any one clinical study. Over

30 trauma centers around the

country have pledged support

for the Consortium and are

eager to participate in one or

more of the studies sponsored under its umbrella.

“We are thrilled to be partnering with the Consortium

and the incredible team of investigators they have

assembled,” says Dr. Joseph Wenke of the USAISR.

“Together we will develop the infrastructure critically

needed to address some of the most pressing issues in

orthopedic trauma care. Without a large multi-center

effort such as this, many of these issues would never

be solved.”

MacKenzie concludes, “The Consortium is all about

providing the scientific evidence needed to establish

treatment guidelines for the optimal care of the wounded

warrior and ultimately improve the clinical, functional

and quality of life outcomes of both service members

and civilians who sustain major limb trauma”.

Renn Crichlow, M.D.

The twelve core clinical centers currently participating in

the Consortium include:

• Boston University Medical Center

• The Florida Orthopedic Institute

• Carolinas Medical Center, Denver Health and Hospital

Authority

• OrthoIndy®, Indiana Orthopedic Hospital® and Methodist

Hospital

• Orthopedic Associates of Michigan

• The Orthopaedic Trauma Institute at the University of

California at San Francisco

• San Francisco General Hospital

• The University of Maryland Medical Systems R Adams

Cowley Shock Trauma Center

• The University of Mississippi Medical Center

• The University of Texas Southwestern Medical Center

• The University of Washington Harborview Medical Center

• Vanderbilt University Medical Center


Meet Travis WelchTravis Welch is a physician assistant (PA) for spine

surgeon, Dr. John Dietz, at OrthoIndy. He is also a

Captain in the United States Army Reserves. While Travis

isn’t involved in the trauma consortium, he certainly saw

his share of soldiers who were injured during his tours.

Travis joined the army in 1995 as an enlisted combat

medic. He decided to join the Army because it was a

career path that was always in his mind, largely due

to the fact that his father and several other family

members served in the military. After serving as a

combat medic, working closely with PAs in the 101st

Airborne Division early in his career, Travis decided that

being a PA was a natural career progression for him.

After graduating from PA school in 2003, Travis became

a commissioned officer.

Travis has completed two tours, his first in Afghanistan

in 2004 and his second in Iraq in 2008. He was

deployed as a medical officer, practicing as a Physician

Assistant with focuses on emergency medicine and

general orthopedics. “I also spent time as an embedded

mentor for the medical providers within an Afghan

National Army brigade,” he said. “During my time in

Iraq, I lectured Iraqi physicians as part of a program

developed to bolster the Iraqi medical system.”

In his civilian job, Travis works closely with Dr. Dietz,

treating patients with spine injuries and conditions.

When deployed, the type of patients Travis treats is much

different. During both deployments he provided care

to US and coalition soldiers, civilian contractors and

host nation civilians; however he also treated few local

civilians while in Iraq, but treated local civilians on a

regular basis while deployed to Afghanistan.

During his time overseas, Travis says that while the

healthcare from these countries differs greatly from

the United States, there are even some big differences

between Afghanistan and Iraq. “The medical system in

Afghanistan is very rudimentary,” he said. “Resources

for healthcare are very scarce, and the level of training

of their physicians varies greatly. An example of this is

when Travis had the opportunity to assist in a surgery

with a prominent Afghan neurosurgeon performing

a procedure on a young Afghan child. “It allowed me

to see some of the stark differences in the capabilities

of the US medical system and that of the nation of

Afghanistan,” he said. “The technological and technical

differences between the experiences of operating in US

operating rooms and a leading Afghan hospital were

quite remarkable.”

Another major difference in their system and ours is

the lack of preventative care.” In Iraq, Travis says, “the

Iraqi healthcare system on the other hand is much more

mature, however with their centralized control of the

healthcare system and resources, getting care for the

general public can be far less straightforward than the

system that we are accustomed to.”

The most common types of injuries or conditions Travis

treated were primarily soldiers with general medical

illnesses and sports medicine injuries both in Iraq

and Afghanistan. Fortunately, non-battle injuries and

illness provides a much larger portion of the patient

load than battle injuries. In Afghanistan, Travis treated

a considerable number of burn patients from the local

population, and while working at the field hospital in

Bagram, Afghanistan, he also encountered several blast

wound patients from the local community. Among those

civilians, Travis was able to arrange surgical care for a

young Afghan girl with developmental hip dysplasia

by coordinating care at a children’s hospital in Kabul,

Afghanistan with technical assistance by the military

medical assets in the region. Additionally, Travis found

himself, at times, working very closely with some village

elders. He provided orthopedic care for a prominent

local businessman who sustained fractures during a

personal attack that reportedly occurred because of his

support for the US operations in the Kabul area.

Captain Travis Welch


Travis puts a cast on the wounded.

The major limitation that Travis encountered was

the limited access to diagnostic imaging. During his

Afghanistan deployment, it was somewhat challenging

to obtain labs, x-rays or CT scans in the country and

it was not possible to obtain an MRI. During the

deployment to Iraq, MRI access remained an issue

however he had better access to lab and CT scans and was

able to obtain most x-ray studies in his clinic. “Having

limited access to these tools makes you rely on your

physical examination techniques and clinical decision

making, however there are times that they were necessary

to provide a diagnosis.”

While Travis provides care to Indiana residents, he has a

much larger patient base because of the Army. He says,

“The Army allows me to work with some outstanding

people and provides me with challenges both in the

realm of leadership opportunities and providing medical

care that I would not find elsewhere.”

Travis believes the most important thing that people

should know about our troops is how what they do

makes a positive impact on a number of people. “There

are a lot of great things being done that really make

positive impacts on the lives of the local Iraqi and

Afghan citizens,” said Travis. “Unfortunately, these are

largely unreported in the media, but our soldiers are

doing great work in difficult situations that will leave a

lasting, positive impact.”

Hopefully the studies being conducted by the Extremity

Trauma Clinical Research Consortium will provide better

outcomes for severe orthopaedic traumas sustained on

the battlefield, traumas like those Travis has treated.

OrthoIndy and IOH would like to thank Travis, as well

as all the men and women in the military, for their

service to our country. Thank you! As Travis points

out, the troop’s efforts are “largely unreported.” If you

are interested in learning more about the troops, visit

www.dvidshub.net for military stories.

Travis review an X-ray in the desert.


Straightened Out:Young lady receives surgery to correct scoliosis

By: Kasey Prickel

According to the Scoliosis Research Society (SRS)

everyone has some natural spine curve when viewed

from the side. Scoliosis is an abnormal curve of the

spine when viewed from the front or back. Bad posture

is easily corrected with changing positions. Scoliosis is

a fixed and rigid deformity that cannot be changed with

posture. The shoulders or hips may not be level. The

spine bones rotate on one another like the crankshaft on

a car. The ribs attach directly to the spine and lie under

the back muscle. When the spine rotates the ribs “stick

out” most commonly on the right. Most patients with

scoliosis have only a mild cosmetic deformity that will

not impact any life activities. However, curves greater

than 40 to 45 degrees in a growing child deserve special

attention. Curves greater than 70 degrees may impact

lung and heart function; however, scoliosis usually does

not hurt at all!

Ariel Zhang and her parents had just moved from

Canada to the United States. Ariel was already heavily

involved in a career training as a runway model. She

was planning on studying dance, ballet and gymnastics.

Ariel is completely fluent in English, but English is a

second language for her parents. During a routine

school scoliosis screening, twelve year old, Ariel was

diagnosed with serious scoliosis. Ariel was referred

to Dr. Robert Huler, an orthopaedic surgeon with

subspecialty expertise in spine surgery. X-rays showed a

very serious 90-degree scoliosis.

“This was a serious, severe

and rapidly progressive

deformity, which clearly had

progressed quickly or else it

would have been discovered

at an earlier age,” said Dr.

Huler. He remembers Ariel as

an, “extraordinarily talented,

bright and extremely mature

young lady.” Her parents were not so good with English,

therefore, Ariel ended up being the translator during the

explanations about surgery. “I remember her reassuring

her parents that everything would be alright,” said Dr.

Huler. “I could not believe what I was hearing! She

carried herself like a mature 25 year-old lady.” Ariel

knew she had a serious spine condition, but could not

Rober Huler, M.D.


know all the implications. “It was really hurtful to hear

that my spine was curved that much because I liked

being active and knew that having spinal surgery could

possibly stop all of that,” said Ariel. However, she was

excited to finally know her diagnosis and to have a game

plan going forward.

Ariel was “prepped” for surgery to correct her spine

deformity. She took iron pills to “gear up” her blood

production so she could donate her own blood for

surgery. She read about scoliosis surgery on the Internet

and e-mailed Dr. Huler with questions nearly every week

leading up to surgery.

Before surgery, Ariel enjoyed tae-kwon-do and dance and

she worried surgery would keep her from participating

in her favorite hobbies. “The idea of surgery was scary,

especially with rods being placed in my spine,” she said.

“I thought it would be a limitation, but after Dr. Huler

explained the surgery, it didn’t worry me too much.”

Ariel needed surgery both from the front of the spine to

loosen up the curve and then from the back of the spine

to straighten the curve and hold the curve in place with

two titanium rods and 21 spine screws. Since titanium

was used she can still have MRI scans in the future. Also,

titanium won’t set off airport metal detectors.

Ariel’s spine before surgery. Ariel’s spine post-surgery.

Ariel believes her experience with Dr. Huler put her at

ease. “He is really friendly and he calmed me down

about everything,” she said. “He made the situation

lighter by making me laugh and explaining to me that I

was going to be taller and need all new clothes! He was

supporting and pushing me along the way.”

Ariel’s surgery was successful. After her two year follow

up appointment, Ariel’s severe deformity was nearly

completely corrected as shown in the before and after

X-rays. She says the surgery has changed her life, teaching

her discipline due to the discipline required of her

recovery. “It has taught me to see the bright side of

things,” she said. “I still dance and I am a black belt in

Tae-know-do.”

With the severity of her scoliosis, Ariel does have some

limitations post-surgery. “I have limitations now, but

I have found ways to work around them,” said Ariel.

Some of the limitations that she faces are not being

able to do abdominal workouts, certain dance positions

or rolling in Tae-kwon-do. “I thrive on challenges and

have actually started doing more physical activity since

my surgery,” she said. Ariel started participating in long

jump for her school’s track team. She also plans on

taking ballroom and horse riding lessons as she works

toward an early graduation at the end of her junior year.

While Ariel was extremely pleased with her physician,

Dr. Huler was equally impressed with Ariel. “Ariel’s

maturity is well beyond her years,” he said. “She was

asking questions at age 12 that an adult would ask. She

has a very high IQ. It was amazing how she held her

head up high. She is an unbelievable young lady.”

If you or someone you know suffers from scoliosis, please

call us at (317) 802-2490 to schedule an appointment

with an orthopaedic spine surgeon.

Dr. Huler with Ariel during a post-operative appointment.



Keeping You On Your ToesBy: Lindsay McClure

According to the American Academy of Orthopaedic

Surgeons (AAOS), more than 11 million visits were

made to physician’s offices in 2003 because of foot and

ankle related problems. The ankle is the joint between

the foot and the leg. It consists of three bones, the tibia

(shin bone), fibula (little bone on the outside of the leg

that runs next to the tibia) and the talus, which is the

bone in the foot that articulates with the tibia and fibula.

The main function of the ankle is to bend the foot up

and down. There are a number of injuries and conditions

that can affect the ankle including: joint pain, fractures,

arthritis and ruptures.

Ankle Arthroscopy (ankle scope)

An arthroscopy is a surgical procedure orthopaedic

surgeons use to visualize, diagnose and treat problems

inside a joint. It involves making a small incision to

insert the arthroscope, which is linked to a monitor for

the physician to see inside the surgical site. An ankle

arthroscopy is a minimally invasive technique that is used

to treat lesions (an injury; hurt; wound) of the ankle. If

a patient is experiencing pain, instability, persistent

swelling, catching and old

fractures, just to name a few,

they may need to undergo

an ankle arthroscopy. “The

advantages to having an ankle

arthroscopy is that one does

not need to open the whole

joint and can preserve the

intact structures,” said Dr.

Mihir Patel, an orthopaedic surgeon at OrthoIndy and

the Indiana Orthopaedic Hospital (IOH). Numbness,

tingling and persistent pain are some of the possible

complications a patient might experience after having

an ankle arthroscopy. The recovery that is involved with

having an ankle arthroscopy includes limited weight

bearing and physical therapy to help with getting the

patient better depending on the lesion.

Bill Barker who works for IPL trouble shooting electrical

problems had seen two other physicians for the pain

and limited movement he was experiencing in his ankle

before coming to OrthoIndy for a third opinion. One

of the options that Bill was given before coming to see

Dr. Patel was a fusion; something he did not want to

do at this time in his life. His pain affected all aspects

of his life including work, sports and socializing so

he wanted to see what other options were available.

He tried cortisone injections but they did not provide

permanent relief. Dr. Patel recommended that Bill

undergo an ankle arthroscopy. “After talking with Dr.

Patel I became convinced that he could help me,” said

Bill. Since having surgery with Dr. Patel, Bill’s pain has

been reduced significantly and his range of motion has

increased. “My experience with Dr. Patel was so good

that I recommended him to my wife,” said Bill.

Total Ankle Arthoplasty (TAA)

Some patients may undergo a total ankle arthroplasty

instead of having an ankle arthroscopy. “The total ankle

arthroplasty is similar to a knee replacement where it Mihir Patel, M.D.

76 l Bone,Joint,SpineandMuscleCare BeyondYourBones l 76

is resurfacing a device for the ankle,” said Dr. Michael

Shea, an orthopaedic surgeon at OrthoIndy and IOH.

When damage is done to the cartilage, a TAA may be

recommended to relieve the pain in the joint. A patient

that has been diagnosed with degenerative joint disease

of the ankle may qualify them for a TAA. Degenerative

joint disease of the ankle includes rheumatoid arthritis

and osteoarthritis. When compared to a fusion, TAA not

only helps with pain control but motion control as well.

“TAA is not for everyone as of now, but they are very

good for the right type of patient,” said Dr. Shea.

Dr. Jon Roberts came to see Dr. Shea when he started

experiencing pain while walking or standing on his

left ankle. “I am a dentist and one of the choices I was

facing was retirement which I did not want to do because

walking is a big part of what I do and it was extremely

painful,” said Dr. Roberts. He was unable to carry heavy

objects, go shopping or anything that required him to

be on his feet. Dr. Shea diagnosed Dr. Roberts with

osteoarthritis. Before considering a TAA he had seen

several physicians who prescribed steroid injections

and recommended an ankle fusion. “Since I was active,

I wanted more mobility so a fusion wasn’t an option,”

he said. “I wanted a normal ankle or at least one that

would perform close to normal.” After doing extensive

research he came across two options that gave him what

he wanted, amputation with a prosthetic ankle and foot

or an ankle replacement. Dr. Roberts’s recovery after Dr.

Shea performed a TAA was a straight forward process.

His pain was minimal and walking was returning to

normal. “Dr. Shea is fantastic. He is confident and

knowledgeable about the procedure and the product. He

is very personable, listens to his patients and is genuinely

interested in their problems,” said Dr. Roberts.

Achilles Tendon Rupture

The Achilles tendon is the tendinous attachment of the

large muscles on the back of the calf into the heel bone.

According to the AAOS, the Achilles tendon is the largest

Dr. Shea with his patient, Dr. Roberts.


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tendon in the human body and can

withstand forces of 1,000 pounds

or more but it is also the most

frequently ruptured tendon. The

Achilles tendon is important with

running, jumping and climbing. A

rupture can occur when there is a

sudden onset of pain in the back

of the ankle and it feels like you

have been kicked or hit over that

tendon. An Achilles tendon rupture

can be treated either surgically or

non-surgically. “There are a variety

of surgical procedures, which are

utilized but generally they involve

sewing the two ends of the tendon

together,” said Dr. Daniel Lehman,

an orthopaedic surgeon at OrthoIndy

and IOH. After surgery, patients

are placed in a splint to allow the

incision to heal and then they are

started on a range of motion program

two weeks later. Dr. Lehman says he

keeps patients non weight bearing until

four weeks

after surgery

and then

they can

start weight

bearing in a

CAM walker

boot, which

p r o m o t e s

q u i c k e r

healing of the tendon. “Strengthening

of the muscles that form the Achilles

needs to continue until the patient is

back to full strength and this typically

takes the better part of a year,” said

Dr. Lehman. If the rupture is treated

non-surgically by being placed in a cast

there is a longer recovery time.

OrthoIndy is the team physicians for

the Indiana Fever. Tamika Catchings,

who plays as a forward for the Indiana

Fever, suffered an Achilles tendon

rupture during a game when she went

to push off on her foot. “My Achilles

injury is definitely the most painful

injury that I have ever dealt with,”

said Tamika. She underwent surgery

at IOH to repair her ruptured tendon

with Dr. Lehman. After surgery, Tamika

was unable to play basketball for ten

months while she was recovering. “Dr.

Lehman has been super supportive in

my progress and in the steps that I had

to take to get to where I am today,”

said Tamika who is still playing for

the Indian Fever. Tamika is a two-

time Olympic gold medalist for the

United States. She medaled at the 2004

Olympics in Athens, Greece, and again

in 2008 in Beijing, China. Tamika was

named the WNBA’s Defensive Player

of the Year in 2005 and 2006. In 2009

the Fever advanced to the WNBA finals

against the Phoenix Mercury but fell

short of the championship.

To learn more about the Indiana Fever

please visit their website at http://www.

wnba.com/fever/

Daniel Lehman, M.D.

Tamika Catchings plays forward for the Fever.


Clinical Neurology in Spine Imaging Interpretation

Our current generation of clinicians are more

knowledgeable and technically proficient than their

predecessors. However the diagnostic tools at their

disposal have also become more complex and difficult to

master. This has resulted in an increased interdependence

between diagnostic and clinical specialist. Building a

bridge of shared clinical knowledge is required to fully

utilize the diagnostic advances at hand. The imagers

role in this partnership is one which will increasingly

emphasize clinical expertise and knowledge

Spine care is an excellent example. Structural

abnormalities of the spine can be demonstrated in

detail far better than ever before with MRI imaging.

However unlike the earlier methods of evaluation

MRI is a highly technical examination with many

special purpose sequences. Interpretation requires an

understanding of the physics underlying particular

appearances of pathology on each sequence as well

as numerous artifacts which can be confused with

pathology. The imaging specialist skills may be critical

in identifying potential sources of symptoms but the

relevance of these findings cannot be determined

without understanding the patients history and exam

and relating them neuroanatomically to the findings.

To do their job properly a spine reader must become

familiar with the clinical syndromes corresponding to

root compression at each level in the cervical and lumbar

spine. A large disc extrusion at L3-4 may be impressive

radiographically but if symptoms go down the posterior

leg with numbness of the lateral foot gastrocnemius

weakness and an absent ankle jerk it must be recognized

that this distribution does not correspond to L4 and there

is an absence of correlation. The case must be rethought

as to the cause of symptoms and the report must reflect

this so that the clinician may endeavor to resolve any

uncertainties prior to recommending treatment.

Myelopathy is perhaps the most important diagnosis

to be made on spinal imaging. Failure to diagnose

at an early stage may result in irreversible neurologic

defict even quadraplegia Causes of myelopathy include

neoplasm,compression, vasculopathy and demyelination,

which may, in certain circumstances, have a similar MRI

appearance. Familiarity with the varied clinical courses

such as the waxing waning of demyelination the chronic

progressive history of neoplasm and sudden onset

symptoms of vascular syndromes can aid the imager in

making the appropriate identification.

Various spinal cord syndromes may present with

symptoms which may be interpreted incorrectly. Central

cord syndrome is the most common and can result

from spondylosis particularly in a setting of trauma

with a hyperextension mechanism. Since the spinal

cord tracts are somatotopically arranged with upper

extremity fibers medial and sacral lateral a process in the

center of the cord may present with confusing upper

extremity symptoms which may prompt evaluation for

carpal tunnel, neuropathy or musculoskeletal injury. The

diagnosis of a serious spinal cord process may thereby


By: Malcolm Shupeck, MD, F.A.C.S.


be delayed or missed. Recognizing the association of

trauma, spondylosis and the characteristic symptoms

can help the imager make the proper diagnostic

recommendations.

Upper and lower motor neuron findings have to be

understood and recognized. Symptoms affecting the

lower extremities are often due to processes in the

lumbar spine. Cervical and thoracic etiologies however

can also manifest as lower extremity symptoms and

when they do are often more serious.

Compressive lumbar disease is usually accompanied

by pain. Weakness may not be present and if it is it

is usually in a radicular distribution and accompanied

by the atrophy and decreased reflexes of a lower motor

neuron lesion.

Spinal stenosis for example usually presents as pain on

walking relieved on rest or leaning forward. Even with

very severe radiographic stenosis actual weakness is a far

less common finding.

If severe stenosis is seen on MRI but the history is of gait

disturbance and/or progressive lower extremity weakness

rather than pain the suggestion of additional imaging of

the craniospinal axis rather than a diagnosis of causative

spinal stenosis is warranted. Exam findings such as

clonus or hyperreflexia are upper motor neuron findings

which if present suggest disease above the cauda equina.

Knowledge of treatment options and surgical approaches

is also essential. Lumbar disc extrusion is a very common

entity but the identification of a disc herniation at a

particular level is insufficient to provided guidance

for the surgeon. At each level there is an exiting and

traversing root which can be effected differentially

depending on whether the extrusion is paracentral,

lateral or superiorly migrated. The surgical approach

to the exiting and traversing root may differ with a

laminectomy approach needed if the disc is paracentral

but an extraforaminal approach required for pathology

affecting the exiting root. Failure to properly assess the

clinical level and correlate it with the particular disc

anatomy may result in a approach being used which

provides inadequate access to the pathology. Addressing

this limitation intraoperatively may necessitate increased

bone removal which can have a destabilizing effect on

the level in question.

As radiology residencies are required to spend even

more time and effort on technically complex areas such

as MRI the time remaining for clinical correlation and

experience has been restricted. Providing the spine reader

with the clinical know-how to provide the necessary

support to the clinician has become more difficult with

the consequence that this expertise is a rarer commodity.

Post residency fellowships have become more common

and may provide an opportunity to strengthen this area.

We believe strongly in the importance of clinical training

for imagers and have applied this principle in our own

fellowship.

The advanced imaging training program at Proscan

has long been recognized as one of the most rigorous

and distinguished in the nation providing a capstone

experience for already board certified radiologists

wishing to excel. Several years ago Proscan founder and

lead radiologist Dr. Stephen Pomeranz recognized the

importance of building the bridge between clinician

and radiologist in the increasingly complex medical

environment. A program of enhanced clinical learning

within the program, the first of its kind, was instituted

including the recruitment of several faculty with extensive

clinical backgrounds. Side by side clinician-radiologist

image interpretations and clinical correlation sessions

are now a regular feature of the program.

As the medical environment advances it is an increasing

challenge to master the new. At the same time the utility

of new techniques depend not only on the depth but

breadth of knowledge used in applying them .A solid

foundation in clinical neurology is indispensable to

the spine reader wishing to provide the highest level of

support to his/her referring clinicians and their patients.



Knee Osteoarthritis: MRI in the Landscape of Current and Potential Treatment

The enormity of knee OA as a population problem – the

scope of its occurrence, pathogenesis, and heterogeneity

– confounds a simplistic approach to therapy. Rather

than a single disease-modifying drug, surgery, or physical

therapy procedure, the idea that multiple influences lead

to a common endpoint of joint destruction means that

this multidimensional disease will, in most cases, always

require a multifaceted treatment approach.

How can MRI be used to grade the impact of therapies

– pharmaceutical, operative, physical therapy, and

behavioral interventions?

1. MRI can provide semi-quantitative assessment in

osteoarthritis because it can detail articular cartilage

integrity; subchondral bone- marrow pathology; edema

or cysts; subchondral bone attrition; marginally, centrally,

and posteriorly positioned osteophytes; meniscal and

ligament integrity; synovitis and effusion; and loose

bodies. Three commonly used whole-joint MRI imaging

assessments are:

a. Whole-organ MR imaging score (WORMS)

b. Knee osteoarthritis scoring system (KOSS)

c. Boston leads osteoarthritis knee score (BLOKS)

2. Cartilage can be reproducibly and accurately measured

by MRI. Cartilage morphology and trabecular bone

may be quantitatively measured in the research arena to

provide baseline and follow-up monitoring of treatment

in OA. In a clinical trial, cartilage thickness can provide

the same level of sensitivity as cartilage volume to

estimate cartilage loss.

3. MRI shows potential value as a biomarker, since

studies have indicated that the presence of either bone-

marrow lesions or meniscal disease is predictive of those

OA patients at greater risk for disease progression.

4. Very early changes in cartilage biochemistry, prior to

joint damage or pain, may be able to be measured by

experimental MRI methods of T1-rho and T2.


By: Stephen J. Pomeranz, M.D.


5. Specialized research MRI protocols of T2 mapping,

T1-rho, sodium MR, and delayed gadolinium-enhanced

MRI imaging to assess the macromolecular status of

cartilage may be useful in assessing disease-modifying

strategies for OA.

6. Molecular and functional techniques for imaging

early osteoarthritis include charged-based methods

such as delayed gadolinium-enhanced MRI of cartilage,

which is based on the negatively charged T1-shortening

agent gadopentetate dimeglumine. Hyaline cartilage

has negatively charged molecules, similar in charge to

gadolinium, and thereby repulses gadolinium when

the cartilage is normal and intact. Conversely, damaged

cartilage lacks the negatively charged hydrophilic

molecules, allowing the gadolinium into the cartilage

proper.

7. Sodium-23 MR spectroscopy also takes advantage of

the negative-fixed charged density (FCD) of cartilage. In

this technique, sodium-23 atoms, which are positively

charged, correlate directly with cartilage-fixed charged

density. Sodium-23, therefore, decreases in abnormal

cartilage.

8. In the research arena, cathepsin B-sensitive near-

infrared fluorescent probes have been used to image

osteoarthritic knees in animals. Since damaged cartilage

may release proteases such as cathepsins, this method is

used experimentally to image matrix-degrading enzymes.

9. Since OA is widely thought to result from local

mechanical factors in people with systemic susceptibility,

the influence of biomechanics in osteoarthritis, and the

imaging quantification of them, is both interesting and

important. Joint kinematics assessed with MRI imaging

have been performed with patients supine in the magnet,

with some recent work attempted in open-configuration

scanners with vertical gaps, which allow standing.

What have we learned about OA progression from MRI?

1. Patients with knee OA who display MRI evidence of

meniscal damage or extrusion, as assessed by WORMS

score, show association with cartilage loss over a

30-month period.

2. In a 2009 study from the Multicenter Osteoarthritis

(MOST) study group (a longitudinal study of people

with, or at high risk for, knee OA), those subjects who

had minimal baseline cartilage damage but high body-

mass index, meniscal damage, synovitis or effusion, or

any baseline severe MRI lesion, had a strongly increased

risk of fast cartilage loss.

3. The finding of MRI-evident bone-marrow lesions

(BMLS) shows association with change in knee cartilage

over two years in asymptomatic subjects. As the size of

the BMLS increases, there is increased progression of

cartilage defects. The 2008 study included 271 healthy

adults with no history of knee injury, knee pain, or

clinical knee OA, who underwent knee MRI at baseline

and two-year follow-up to study the relationship between

presence of BMLS at baseline and cartilage change over

two years.

4. The role of alignment and biomechanics in

osteoarthritis underwent review this year in Radiologic

Clinics of North America. Valgus and varus malalignment

were reported as increasing risk for OA, with patellar

malalignment associated with patellofemoral OA

progression. MR imaging measurements of kinematics,

and measurements of contact area, were both discussed.

5. The incidence of degenerative cleavage trizonal body

tears in patients with moderate to advaced osteoarthritis

is over 50 percent in patients over age 50 (personal

observation by Dr. Stephen J. Pomeranz).

Conclusion: The complexity of knee osteoarthritis

etiologies complicates the search for a single disease

modifying therapeutic approach. Current treatment

emphasizes conservative management including

mechanical joint preservation measures. MRI depicts

the whole joint nature of the disease and serves as a

barometer of its time course.

Sources available upon request.



MRI is King in Imaging of the Ankle and Foot

Among diagnostic imaging studies for the ankle and foot, there is a

higher diagnostic yield and greater specificity with MRI than with any

other imaging modality. Certainly, x-rays can provide some basic

information regarding bony structures in a quick and inexpensive way,

particularly in the case of fractures and arthritis, and remain the first

step in imaging evaluation of many patients which help direct the

initial treatment algorithm. But in the soft tissues, MRI is king for such

diagnoses as tendon and ligament tears, soft tissue masses and most

other soft tissue pathology.

Although CT may have historically been considered the first choice

for suspected fracture, MRI actually outperforms CT in detecting early

stress fractures and nondisplaced traumatic fractures, due to its ability

to demonstrate associated bone marrow edema signal and surrounding

soft tissue inflammation. MRI is therefore a better choice when a

fracture is suspected but not readily apparent on x-ray. MRI provides

the additional benefit of evaluating associated soft tissue damage in

cases of traumatic injury, such as ligament sprains and tendon tears.

Occasionally, preoperative CT evaluation of a radiographically evident,

comminuted fracture may be helpful to assess the number and position

of fracture fragments, particularly in the distal tibia and calcaneus. CT

is also sometimes more helpful than MR in demonstrating the extent

of solid bony bridging or osseous union at the site of a healing fracture.


By: Richard J. Rolfes, M.D.

When evaluating for osteomyelitis, MRI is again strongly

favored over CT or x-rays, since bone marrow edema

signal due to osteomyelitis will appear long before

detectable x-ray or CT changes. Furthermore, the osseous

changes alone, such as early periosteal reaction and

cortical erosion, are subjective and are often confused

with chronic cortical changes. Nuclear medicine bone

scan can be a specific and less expensive test in some

cases, as long as high-resolution images are obtained

in proper projections, but should be correlated with

radiographs and interpreted by an experienced reader.

However, nuclear medicine scans lack specificity,

since positive scans demonstrating tracer uptake can

represent a number of diagnoses, including fracture and

arthritis. In addition, bone scans are unable to effectively

demonstrate soft tissue involvement by infection, such as

abscess formation or septic tenosynovitis, and the large

field of view typically used for foot and ankle bone scan

images may not allow for confident assessment of the

full extent of the infection within smaller bones such as

phalages, or to detect the presence of septic arthropathy.

For bone lesions, MRI has an edge on CT and is

the first choice, by allowing characterization based on

signal rather than density. This

permits confident differentiation of

cystic from solid or fibrous lesions,

helping to narrow the differential

diagnosis. CT is sometimes helpful

in addition to MRI, particularly for

fine bone detail and demonstration

of faint calcification, although these

fine features are often demonstrable

on x-ray. Marrow-replacing or infiltrating malignancy

such as metastases or myeloma are best demonstrated on

MRI, and can be inapparent on either x-ray or CT.

3D imaging is one of the newest techniques for evaluating

the musculoskeletal system, including the foot & ankle.

This technique permits ultrathin slices of 1-2 mm,

and allows for reformatting of images in multiple

planes without any additional scan time. These thin

slices provide enhanced visualization of the smaller

structures about the foot and ankle, such as the sesamoid

bones and plantar plate, and are particularly helpful in

augmenting the diagnostic yield on exams performed on

low field MRI systems.

In the foot and ankle, proper patient positioning and

MR imaging protocols are more important than magnet

field strength. For example, a tendon tear may be more

conspicuous on low-field MR images performed with the

ankle properly positioned, than on a 1.5 or 3.0 T high-

field MRI scan performed with the ankle improperly

positioned. Furthermore, an experienced reader with

demonstrated knowledge and expertise in the foot and

ankle can extract much more relevant information from

a low-field MRI scan than a reader lacking such expertise

can glean from a high-field study.

Direct consultation with one of our foot and ankle

imaging experts may be helpful in unusual cases, or in

determining the best study for your patient. Richard

Rolfes, MD, senior partner with Proscan Radiology

and fellowship-trained musculoskeletal radiologist,

subspecializes in foot and ankle imaging, is co-author

of the book “Foot and Ankle MRI: Pearls, Pitfalls

and Pathology”, and lectures frequently at local,

state and regional podiatric association events. He is

available locally at each of our three imaging centers in

Indianapolis for direct consultation, or can be reached at

any time for questions on your foot and ankle imaging

needs at 317-874-0000.



Advanced OrthoPro, Inc.

BSA Lifestructures

CDI

Custom Publisher’s Group, Inc.

Healthcare Therapy Services, Inc.

Hokanson Companies, Inc.

Huntington Bank

Independence Rehab

Meyer Najem

OSSUR

Progressive Physical Therapy

ProScan Imaging

StanCorp Investment Advisors

Stryker

Sullivan County Community Hospital

The Shoe Fits

We would like to thank all the sponsors for making our educational publication possible.Please support our advertisers.

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2010Physician Directory


OrthoIndy Physicians

Joseph R. Baele, MDSpecialties:Trauma

Locations:Downtown

P: (317) 917-4360 • F: (317) 917-4190

Chris P. Bales, MDSpecialties:Shoulder, Sports Medicine and Knee

Locations:West and OrthoIndy at St. Vincent Clay

P: (317) 268-3632 • F: (317) 268-3695

Carlos R. Berrios, MDSpecialties:Sports Medicine, Botox, Pediatrics and General Orthopaedics

Locations:Northwest and Downtown

P: (317) 802-2847 • F: (317) 802-2868

David S. Brokaw, MDSpecialties:Trauma, Foot and Ankle and General Orthopaedics

Locations:Northwest and South

P: (317) 917-4388 • F: (317) 917-4190

Robert T. Clayton, MDSpecialties:Sports Medicine, Total Joint and General Orthopaedics

Locations:North Meridian and Lebanon

P: (317) 569-2511 • F: (317) 575-2713

John W. Dietz, Jr., MDSpecialties:Spine

Locations:Northwest and West

P: (317) 802-2875 • F: (317) 802-2405

Michael F. Coscia, MDSpecialties:Spine

Locations:Northwest and Shelbyville

P: (317) 802-2874 • F: (317) 802-2405

Renn J. Crichlow, MDSpecialties:Trauma

Locations:Downtown

P: (317) 917-4384 • F: (317) 917-4190

Timothy E. Dicke, MDSpecialties:Sports Medicine, Hand and Upper Extremity and Trauma

Locations:Fishers and Northwest

P: (317) 802-2808 • F: (317) 802-2868

Mark J. DiLella, DOSpecialties:Sports Medicine, Shoulder and General Orthopaedics

Locations:South

P: (317) 884-5165 • F: (317) 884-5360

Daniel W. Dro, MDSpecialties:Shoulder, Hip and Knee

Locations:North Meridian and Northwest

P: (317) 569-2512 • F: (317) 575-2713

Robert H. Falender, MDSpecialties:Trauma, Shoulder and Hand and Upper Extremity

Locations:South and OrthoIndy at St. Vincent Clay

P: (317) 884-5167 • F: (317) 884-5360


Edward J. Hellman, MDSpecialties:Total Joint, Knee and Hip

Locations:Fishers, North Meridian and Northwest

P: (317) 802-2844 • F: (317) 802-2868

Robert J. Huler, MDSpecialties:Spine

Locations:North Meridian, Northwest and West

P: (317) 802-2876 • F: (317) 802-2405

Jack Farr II, MDSpecialties:Sports Medicine and Knee

Locations:South

P: (317) 884-5163 • F: (317) 884-5360

David A. Fisher, MDSpecialties:Total Joint, Knee and Hip

Locations:Northwest

P: (317) 802-2828 • F: (317) 802-2868

Vincent L. Fragomeni, MDSpecialties:Non-Operative General Orthopaedics

Locations:Northwest Walk-in Clinic

P: (317) 802-2460 • F: (317) 802-2868

Scott D. Gudeman, MDSpecialties:Shoulder, Knee and Sports Medicine

Locations:South

P: (317) 884-5161 • F: (317) 884-5360

Timothy A. Hupfer, MDSpecialties:Sports Medicine, Shoulder and Total Joint


P: (317) 802-2839 • F: (317) 802-2868

Gabriel E. Jackson, MDSpecialties:Spine

Locations:South and OrthoIndy at St. Vincent Clay

P: (317) 802-2886 • F: (317) 802-2405

Bradley A. Jelen, DOSpecialties:Trauma and General Orthopaedics

Locations:Downtown and West

P: (317) 917-4268 • F: (317) 917-4190

David M. Kaehr, MDSpecialties:Trauma and General Orthopaedics

Locations:Downtown and West

P: (317) 917-4367 • F: (317) 917-4190

Corey B. Kendall, MDSpecialties:Knee, Shoulder and Sports Medicine

Locations:West

P: (317) 268-3634 • F: (317) 268-3695

Benjamin J. Justice, MDSpecialties:Total Joint and General Orthopaedics

Locations:Greenfield and South

P: (317) 884-5169 • F: (317) 884-5360




Stephen L. Kollias, MDSpecialties:Sports Medicine, Shoulder and Knee


P: (317) 802-2817 • F: (317) 802-2868

Michael L. Kramer, MDSpecialties:Shoulder, Knee and Sports Medicine

Locations:West

P: (317) 268-3635 • F: (317) 268-3695

Sanford S. Kunkel, MDSpecialties:Shoulder, Sports Medicine and Knee

Locations:Northwest

P: (317) 802-2845 • F: (317) 802-2868

Frank R. Kolisek, MDSpecialties:Total Joint, Knee and Hip

Locations:South

P: (317) 884-5160 • F: (317) 884-5360

Matthew R. Lavery, MDSpecialties:Shoulder, Sports Medicine and General Orthopaedics

Locations:Greenfield and South

P: (317) 884-5170 • F: (317) 884-5360

Daniel E. Lehman, MDSpecialties:Foot and Ankle

Locations:Northwest

P: (317) 802-2818 • F: (317) 802-2868

Mihir M. Patel, MDSpecialties:Knee, Shoulder, Foot and Ankle

Locations:Fishers, North Meridian, Northwest and South

P: (317) 569-2513 • F: (317) 575-2713

Joseph C. Randolph, MDSpecialties:Sports Medicine, Shoulder and Knee


P: (317) 802-2822 • F: (317) 802-2868

Greg T. Reveal, MDSpecialties:Trauma

Locations:Downtown and Greenfield

P: (317) 917-4389 • F: (317) 917-4190

Eric A. Monesmith, MDSpecialties:Total Joint, Knee and Hip

Locations:South

P: (317) 884-5166 • F: (317) 884-5360

Scott A. Lintner, MDSpecialties:Shoulder, Sports Medicine and Knee

Locations:Northwest

P: (317) 802-2820 • F: (317) 802-2868

Dean C. Maar, MDSpecialties:Total Joint, Knee and Hip

Locations:Downtown and Northwest

P: (317) 917-4361 • F: (317) 917-4190



Joseph Riina, MDSpecialties:Spine and Trauma

Locations:Fishers and South

P: (317) 802-2882 • F: (317) 802-2405

Bruce T. Rougraff, MDSpecialties:Bone Tumor and Soft Tissue Oncology and Trauma


P: (317) 802-2824 • F: (317) 802-2868

D. Kevin Scheid, MDSpecialties:Total Joint, Trauma and Hip

Locations:Downtown, Northwest and West

P: (317) 917-4363 • F: (317) 917-4190

John K. Schneider, MDSpecialties:Shoulder, Knee, General Orthopaedics and Sports Medicine


P: (317) 268-3631 • F: (317) 268-3695

Michael P. Shea, MDSpecialties:Foot and Ankle


P: (317) 802-2821 • F: (317) 802-2868

David G. Schwartz, MDSpecialties:Spine and Trauma

Locations:Fishers

P: (317) 802-2883 • F: (317) 802-2405

Jonathan B. Shook, MDSpecialties:Sports Medicine, Shoulder, Hip and Knee

Locations:North Meridian

P: (317) 569-2514 • F: (317) 575-2713

Jeffery J. Soldatis, MDSpecialties:Sports Medicine, Shoulder and Knee

Locations:Fishers and North Meridian

P: (317) 569-2515 • F: (317) 575-2713

Mark R. Stevens, MDSpecialties:Sports Medicine, Pediatrics, General Orthopaedics and Botox for Pain Spasicity Management

Locations:Greencastle, Northwest and Putnam County

P: (317) 802-2848 • F: (317) 802-2868

Michael T. Thieken, MDSpecialties:Sports Medicine, Shoulder, Hip and Knee

Locations:Fishers and OrthoIndy at St. Vincent Medical Center Northeast

P: (317) 802-2863 • F: (317) 802-2868

Thomas F. Trainer, MDSpecialties:Total Joint, Shoulder and Knee

Locations:North Meridian

P: (317) 569-2516 • F: (317) 575-2713

Terry R. Trammell, MDSpecialties:Sports Medicine, Spine and Trauma

Locations:Northwest

P: (317) 802-2885 • F: (317) 802-2405



Timothy G. Weber, MDSpecialties:Foot and Ankle, Trauma and General Orthopaedics


P: (317) 917-4369 • F: (317) 917-4190

Andrew J. Vicar, MDSpecialties:Hand and Upper Extremity

Locations:Downtown, Northwest and West

P: (317) 802-2825 • F: (317) 802-2868

H. Jeffery Whitaker, MDSpecialties:Shoulder, Hand and Upper Extremity and Sports Medicine

Locations:Fishers and South

P: (317) 884-5168 • F: (317) 884-5360

Thomas S. Woo, MDSpecialties:Sports Medicine, Hand and Upper Extremity, Foot and Ankle and General Orthopaedics

Locations:South

P: (317) 884-5162 • F: (317) 884-5360


Pain Management and Physiatry Physicians

Meredith L. Langhorst, MDSpecialties:Non-Operative Spine and Interventional Pain Management

Locations:Fishers

P: (317) 802-2879 • F: (317) 802-2405

Virgilio N. Chan, MDSpecialties:Muskuloskeletal, Electrodiagnostics and Pain Management

Locations:South

P: (317) 802-2859 • F: (317) 802-2405

Jonathan E. Helvie, MDSpecialties:Interventional Pain Management

Locations:South

P: (317) 884-5164 • F: (317) 884-5360

Vince S. Hume, DOSpecialties:Muskuloskeletal, Electrodiagnostics and Pain Management


P: (317) 802-2866 • F: (317) 802-2405

Bianca S. Ainhorn, MDSpecialties:Non-Operative Spine, Pain Management and Musculoskeletal

Locations:North Meridian, Northwest and West

P: (317) 802-2849 • F: (317) 802-2405

John R. McLimore, MDSpecialties:Non-Operative Spine, Interventional Pain Management and Musculoskeletal


P: (317) 802-2870 • F: (317) 802-2405

Ronald S. Miller, MDSpecialties:Electrodiagnostics, Musculoskeletal, Non-Operative Spine, Sports Medicine and Interventional Pain Management

Locations:Fishers, North Meridian and Northwest

P: (317) 802-2871 • F: (317) 802-2405

Joshua C. Salyer, DOSpecialties:Electrodiagnostics, Musculoskeletal, Non-Operative Spine, Interventional Pain Management, Pain Management and Botox


P: (317) 802-2842 • F: (317) 802-2405

Charles R. Smith, MDSpecialties:Interventional Pain Management

Locations:West

P: (317) 802-2070 • F: (317) 268-3695

Kevin K. Sigua, MDSpecialties:Electrodiagnostics, Musculoskeletal, Non-Operative Spine, Sports Medicine, Interventional Pain Management and Pain Management


P: (317) 802-2872 • F: (317) 802-2405

David I. Steinberg, DOSpecialties:Non-Operative Spine, Interventional Pain Management and Electrodiagnostics

Locations:Fishers, Northwest and South

P: (317) 802-2873 • F: (317) 802-2405


Anesthesiologists

Michael T. Gilpatrick, MDLocations:South

Robert S. Griffin, MDLocations:South

Jonathan E. Helvie, MDLocations:IOH West and South

David L. Farr, MDLocations:IOH and IOH West

Joe Lafnitzegger, MDLocations:IOH

Robert P. Marske, MDLocations:IOH

David E. Pennington II, MDLocations:IOH

Seung B. Sim, MDLocations:IOH

Peter R. Steiner, MDLocations:IOH

Robert J. Trout, MDLocations:IOH

Clement D. Wang, MDLocations:IOH

Charles R. Smith, MDLocations:IOH

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