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Page 5–7: AONA Case Report—Correction of Asymmetric Retrognathia Using a Combined Costochondral Graft and Curvilinear Mandibular Distraction
Page 8:Save the Date—One AO 2015
and
NEWSFebruary 2014 | Issue 36
AOCMF AOSpine AOTrauma AOVET
AO North America | 1700 Russell Road | Paoli, PA 19301
EDUCATION
MEMBERSHIP
RESEARCH
FELLOWSHIPS
From the Editor’s Desk
Welcome to first quarterly edition of AONA News for 2014. The articles in this edition highlight the dynamic nature of our organization and its specialties. As we continue to highlight clinical content, we invite all members to submit interesting clinical cases. Case topics can range from innovative to simple underlining basic AO principles. Education continues to be a key pillar of AONA. Our educational offerings are top notch, and in coming years our subspecialty education committees will be working to refine and further document the outcomes of these programs. In the article entitled, “AONA 2020,” I outline some of the initiatives that AONA is pursuing in advancing our educational programs. While techniques evolve, and technology advances, the core basis for our educational success, namely our skilled and committed faculty, will continue to drive the success of our organization.
I hope that you enjoy this issue of AONA News. As always we welcome your suggestions, contributions and story ideas for future editions. Please send them to [email protected].
David J. Hak, MD, MBAEditor-in-Chief AONA News
Editor-in-ChiefDavid J. Hak, MD, MBA
Contributing Authors
Derek M. Steinbacher, MD, DMDTerry Stanton, senior science writer for AAOS NowMichael G. Fehlings, MD, PhD, FRCSC, FACS
Managing EditorMelissa J. D’Archangelo
Editorial AssistantJessica Romero
Production ManagerPhillip Litchfield
Your Voice Counts; Your Opinion Matters Suggestion BoxSubmit your suggestions for content for the AONA quarterly newsletter. Suggestion Box is an evaluation tool to find what types of articles, activities, events or practices AONA surgeon members seek to read in order to advance patient care. Submit your Suggestion Box ideas to [email protected].
Call for Clinical ContentHave an interesting case to share? One that went well, or even one that did not go so well but illustrates an important learning point? Develop a novel approach to a difficult or common problem? Have a really unique case that no one else will ever see? If so, we’d like to feature it in future editions of AONA News. Not sure whether your case is what we are looking to publish? Just send us a quick note, and we’ll review it with you. Please send your cases to [email protected].
Table of Contents 4 AONA 2020
5 – 7 AONA Case Report—Correction of Asymmetric Retrognathia Using a Combined Costochondral Graft and Curvilinear Mandibular Distraction
8 Save the Date—One AO 2015
8 2014 Webinar Schedule
9 – 11 AAOS—“Horsing Around” to Improve Arthroscopic Techniques
11 AOSNA Joins the Council of Surgical Spine Specialties (COSSS)
11 Visit AOVet at VOS
4 AO North America News February 2014 Issue 36
AO North America 2020—The Vision for AO North America Education
The coming years will be exciting times for AO North America as we work together to advance our educational mission. While our core principles will remain unchanged, we will expand on our current strengths as leaders in surgical education.
What is our vision for the future of AONA Education? I propose naming this initiative AONA 2020. The number 2020 refers not only to a specific year 6 years from now, but also to an ideal future vision, just as 20/20 refers to perfect vision. How will we advance AONA educational programs? Six years from now, what should our educational programs look like?
Our focus will be directed to the individuals who participate in our educational programs. In the coming years we will work to better understand how our current participants learn best. We can then tailor our instructional methods to better match their optimal learning style.
We will continue to refine our assessment of the needs of our participants. We will develop educational programs that not only meet, but exceed these educational needs, and provide ongoing opportunities for life-long learning. The ultimate goal for all our educational programs is to improve patient care. Measuring such changes, while a significant challenge, will be an important means of evaluating our effectiveness. By addressing documented improvements in patient care and overall clinical quality we will contribute to fulfilling the new ACGME milestones requirements along with evolving board certification and licensure requirements.
While surgeons will continue to lead these efforts, we will also partner with Academic education specialists, who can help us test, document, and publish our outstanding educational offerings. AONA leadership is currently working to identify such an individual who will assume the role of Chief Learning Officer for AO North America.
The changing regulatory and financial environment will continue to influence future decisions. Some recurring courses may be centralized in dedicated educational venues that offer a state-of-the-art learning environment.
Regardless of what our future may hold, our main strength will continue to be the dedicated commitment of our faculty. AO has had a great past, but our future is even brighter as we develop a united vision in establishing AO North America as the gold standard in surgical education. In 2014, we’ll begin to strategize on how to achieve these goals through discussions within the CMEAB and the AONA leadership.
5AO North America News February 2014 Issue 36
The patient is a tracheostomy dependant 5-year-old boy with extended spectrum bifacial microsomia (Figure 1). 3D maxillofacial CT scan was obtained (Figure 1), documenting microretrognathia and occlusion of the oral airway at the base of tongue. Morphologically he exhibited a type III left mandible, without a functional condyle or glenoid, and a type IIa right mandible. A sleep study was performed showing significant desaturation and obstruction. He could not tolerate having his tracheostomy capped. Fiberoptic nasal and laryngeal evaluation excluded obstruction at these sites.
Simulated planned/surgeryThe 3D CT scan was manipulated using a surgical planning software (Materialise CMF). The mandible was digitally segmented and rotated transversely at the functional right joint
until the chinpoint was centralized and the dental midlines were coincident. This occlusal position was used to fabricate a surgical splint using CAD/CAM technique (Figure 2). This manipulation created a larger gap at the left ascending ramus that was filled with a digital reproduction of a costochondral graft, placed up to the neoglenoid fossa. This mandibular position represented the starting point for distraction. On the left side an osteotomy was created in the native mandible, anterior to the angle and plated rib-mandible interface. The right osteotomy was planned similarly, through the antegonial notch, being mindful of tooth buds. The distal segment of the mandible was then placed in an overcorrected position (class II, anterior crossbite) and the arc and distance of distraction was reverse engineered. A curvilinear trajectory was chosen to provide both ramus height and anterior elongation. Guides were created as intraoperative aids designating both screw and osteotomy location.
Correction of Asymmetric Retrognathia Using a Combined Costochondral Graft and Curvilinear Mandibular Distraction
Derek M. Steinbacher MD, DMDCraniomaxillofacial SurgeryAssistant Professor Plastic SurgeryYale University School of Medicine
Figure 2a
Figure 1
Figure 2b
Figure 2c Figure 2d
6 AO North America News February 2014 Issue 36
Operative procedure A scalp flap was designed taking care to avoid tissue to be used for future ear reconstruction. The zygomatic arch and posterior stop of the neo-TMJ was constructed from above using a rib bone graft. Fixation occurred anteriorly along the native, abbreviated arch, and posteriorly along the temporal bone, after partial posterior reflection of the temporalis muscle. A standard submandibular approach was performed exposing the angle and lateral face of the left mandible. Aberrant, lateral mandibular bone was ostectomized (Figure 3). A pocket contiguous with the neoglenoid fossa above was dissected bluntly. The oral cavity was accessed and the previously fabricated dental splint was placed into maxillomandibular fixation to centralize the chin. A costochondral graft was then fashioned, maintaining 1.5 cm of cartilaginous cap (for the neocondyle) and placed to fill the left ramal gap from the submandibular approach (Figure 2). Once visualized from above as occluding with the skull base and neo-glenoid it was fixed to the native mandible with bicortical positioning screws (Figure 4).
The right mandible was accessed through a standard subman-dibular approach. The fabricated placement guide was laid along the anteogonial notch. Corresponding screw holes were placed and the inferior aspect of the osteotomy performed. The device was placed and fixed with unicortical screws, 3 per side (Figure 5). The activation arm was allowed to exit posteriorly percutaneously. The osteotomy was completed superiorly and buccal and lingual corticotomies along the middle third of the mandible. The identical procedure was performed on the left hand side. The osteotomy was placed anterior to the position of the rib graft, though the posterior fixation incorporated the graft. The devices were activated symmetrically, completing the osteotomies, and demonstrating a free movement of the distal segment without interferences. Activating the left device demonstrated seating of the neocondyle against the skull base. The devices were turned back to neutral and the wounds closed. Intermaxillary fixation was left in place for five days, which was followed by active distraction that was carried out for 33 days (Figure 6). Plain films were obtained each week during active distraction. Consolidation then was held for 54 days, at which time the devices were removed and a postoperative CT was obtained.
ResultsCephalometric analysis showed improvement in all mandibular values (Table 1) (Figure 5). Mandibular volumetric analysis also demonstrated significant increase in structure (Table 1) (p values < 0.05). Post-operative sleep study showed a significant improvement even with the tracheostomy capped (Table 2). Repeat laryngoscopy and bronchoscopy showed no blockage or other abnormalities and hence his tracheostomy was decannulated and closed at a total of 7 months post operatively.
Figure 3 Figure 4
DiscussionHemifacial Microsomnia (HFM) is characterized by mandibular deficiency with retrognathia, deviation, and can’t on the affected side. The Pruzansky classification characterizes the mandibular deformity based on the degree of proximal mandibular hypoplasia (grades I, IIa, IIb, III). The most severe form being a type III mandible with considerable loss of the ramus-condyle unit and a non-existent TMJ. The original mandibular score was based on plain films, but recent evaluations have corroborated the system with improved visualization and quantitative documentation (Steinbacher, Gougoutas & Bartlett; 2011). The sagittal and vertical mandibular deformity in HFM can also lead to glossoptosis with airway obstruction, especially in bilateral cases. Prior to the advent of mandibular distraction, severe upper airway obstruction often necessitated tracheostomy. Mandibular distraction is an effective method to elongate the mandible, and can obviate tracheostomy or allow for decannulation (Steinbacher, Kaban, Troulis; 2005). However, a prerequisite for mandibular distraction
Figure 5
Figure 6
Case Report: Simultaneous Costochondral Grafting for Proximal Mandibular Reconstruction and Curvilinear Sagittal Mandibular Lengthening using Distraction
7AO North America News February 2014 Issue 36
Figure legendFigure 1: postoperative CT scan with the reconstructed proximal ramus and condyle
on the left (costochondral graft); and bilateral curvilinear distractors in place.
Figure 2: Simulated plan to centralize chin point, reconstruct proximal ramus and
condyle (with costochondral graft), and place bilateral curvilinear distraction devices.
Figure 3: Costochondral graft harvested with cartilaginous cap.
Figure 4: Distraction device in place, spanning the mandibular corticotomy.
Figure 5: Distraction device in place, spanning the corticotomy and fixated to the
costochondral graft proximally.
Figure 6: Zygomatic arch and geldnoid reconstruction on the left.
BibliographyBradley J, Wan D, Taub P et al ‘ Distraction osteogenesis of costacartilaginous rib grafts and treatment algorithm for severely hypoplastic mandible’ JPRS 2011; May; 127 (5) 2005-13
Bouletreau PJ, Warren SM, Paccione MF; ‘Transport Distraction Osteogenesis; a new method to heal adult calvarial defects’, Journal of Plastic and Reconstructive Surgery 2002; March; 109 (3) 1074-84
Kaban, ‘ Mandibular Asymmetry and the 4th Dimension’, JCFS 2009; Sept; 20 (5) 1629-30
Mulliken, Labrie et al, ‘ Omens-plus: analysis of craniofacial and extracraniofacial anomalies in hemifacial microsomnia’, CPC journal; 1995 Sept; 32(5) 403-12
Pruzansky S, ‘ Growth of mandible in infants with micrognathia; clinical implications’ AMA AMJ Dis Child 1954; July; 88 (1) 29-42
Santamaria, Morales et al ‘Mandibular Microsurgery reconstruction in patients with HFM’, JPRS 2008; Dec; 122 (6) 1839-49
Steinbacher, Gougoutas, Bartlett ‘An analysis of Mandibular volume in Hemifacial Microsomia’ JPRS 2011; June; 127 (6) 2407-12
Steinbacher, Kaban ‘ Mandibular advancement by distraction osteogenesis for tracheostomy dependent children with severe micrognathia’, Journal of Oral Maxillofacial surgery; 2005; Aug; 63(8), 1072-9
is the presence of a functional TMJ to serve as an intact proximal stop, against which the distal mandible can be moved. Therefore, traditionally a type III mandible requires proximal mandibular reconstruction with restitution of an intact TMJ as a distinct, separate stage prior to implementing distraction. Options to reconstruct the proximal mandible in a type III deformity include: transport distraction, vascularized bone transfer, or bone grafting. Transport distraction, to elongate the ramus, entails movement of the nub of ramus through space toward the skull base (Bouletreau, Warren, Paccione; 2002). However, this proximal bone transport segment can be difficult to control and enough bone stock behind the tooth-bearing mandible is a prerequisite. A vascularized osseous transfer (i.e., free fibula) is also an effective means to reconstruct a severely deficient proximal HFM mandible (Santamaria et al; 2008). This technique is most amenable to cases of near total aplasia of the proximal ramus, with little or no structure proximal to the dental bearing segment. Traditionally the costochondral graft has been considered the gold-standard for ramus-condyle reconstruction in the pediatric mandible when appropriate. The rib is placed as an onlay, tunnelled proximally to the neoglenoid base of skull. A cartilage cap is preserved to rest on the articular surface, and the bone-cartilage interface serves as a new growth center. Some studies cite growth unpredictability and ankylosis as concerns with rib. However, aberrant growth seems to be minimized by limiting the amount of cartilaginous component to 1 cm–2 cm ( Kaban et al; 2009) Typical protocols entail at least 4 weeks of intermaxillary fixation postoperatively, with a posterior open bite established to allow the rib graft to “settle.”
Three-dimensional planning was a critical portion of this case. The movement in space of the manipulated mandible was complex. We began with digitized chinpoint centralization by rotating around the functional right TMJ. From this position a CAD/CAM occlusal splint was fabricated to be used intraopera-tively to achieve the same position. This also represented the starting position for both proximal rib graft reconstruction of the left ramus, and institution of distraction. The gap formed by centralizing the chin was filled with a simulated rib graft. The distal mandibular segment was then osteotomized and moved into the ideal planned, over-lengthened position. The proper device was then chosen to achieve this planned advancement and intraoperative placement guides fabricated. We chose a curvilinear device to assist in generating increased vertical ramus length, in addition to sagittal projection, and preventing formation of an anterior open bite. Following successful reconstruction and distraction, repeat sleep study and normal evaluation of the nasal and laryngeal airways allowed for tracheostomy decannulation.
ConclusionSimultaneous costochondral grafting for proximal mandibular reconstruction and curvilinear sagittal mandibular lengthening using distraction can successfully achieve the goals of a more normal mandibular morphology and tracheostomy decannulation. Advantages include a shorter total surgical duration, with quicker time to decannulation, possibly minimized stress-shielding with decreased resorption of the graft site, and an obviated requirement for long period of intermaxillary fixation.
Table 1 Pre Post P value
Mandibular volume (Mm3) 33479.22 44560.84 <0.05
SNB* 58.71 65.57 <0.05
ANB* 14.81 6.96 <0.05
Mandibular length^ (average Right/Left)
80.09 92.01 <0.05
* Steiner analysis
^ Harvold analysis (Condylion to midpoint of lower mandible)
Table 2 Pre Post P value
SaO2 avg Not tolerated 96% n/a
AHI Not tolerated <5
8 AO North America News February 2014 Issue 36
Save the Date February 5–7, 2015JW Marriott Las Vegas Resort & SpaLas Vegas, Nevada
and Coming Soon! Call for Abstracts — April 2014
2014 Webinar Schedule
AOSNAComplex Cervical Spine SurgeryMarch 177 PM EST
AOTNA FellowsComplex Elbow, Shoulder and Wrist FracturesMarch 268 PM EST
AOSNAMinimally Invasive Spine Surgery – Case PresentationsApril 88 PM EST
AOTNACurrent Management of Proximal Humerus FracturesApril 168:00 PM EST
AONeuroPediatric NeurotraumaMay 28:00 PM EST
AOTNA FellowsDefect ManagementMay 21
8 PM EST
Mark your calendar for the 2015 AO North America Multispecialty Meeting. Planning has already begun for One AO. This meeting is uniquely designed to bring together the AONA clinical divisions—AOCMF, AOSpine, AOTrauma and AOVET to understand the commonalities and solutions to musculoskeletal disorders and fracture management. The meeting will include a program of guest speakers and scientific papers, along with networking opportunities across specialties. AONA will seek exhibitors and sponsors to support the meeting. Check out www.oneao.org soon for more information, meeting updates and reminders.
9AO North America News February 2014 Issue 36
As a boy growing up in New Zealand, C. Wayne McIlwraith, DMED, DVM, PhD, would ride his bicycle to a track marked out over a sheep pasture and watch the horse races. Although hisparents thought that the rough-and-tumble contests had a bit of an unsavory tint, he was fascinated.
Dr. McIlwraith pursued his passion for horses, combining it with medicine and research to develop groundbreaking approaches in arthroscopic surgery and in the treatment of cartilage, bone, soft tissue injuries. From his post at Colorado State University (CSU), where he is a University Distinguished Professor and oversees the Equine Orthopaedic Research Center, he regularly travels to southern California as well as to Europe to treat racehorses.
Just as advances in arthroscopic surgery and other joint-repair procedures have enabled human athletes to return to competi-tion after injuries that once would have permanently hobbled them, so are many Thoroughbreds able to return to the track rather than retire to the pasture, thanks to innovations achieved by Dr. McIlwraith and his colleagues in veterinary medicine. And although certain fracture and soft-tissue injuries still portend inevitably fatal outcomes for horses, progress is being made in repair techniques and postoperative therapy andrehabilitation.
“The biggest advances have been in arthroscopic surgery,” Dr. McIlwraith said. “We can remove fragments, treat meniscal tears, and perform internal repair of fractures all the way into the joint—and we can do it arthroscopically.”
A “close second” to the benefits brought by arthroscopy has been the development of better internal fixation techniques. “There is a crossover with arthroscopy,” he noted, “because with condylar fractures and slab fractures, we use screws under arthroscopic guidance rather than opening the joint up.”
The shared characteristics of the horse’s stifle and the human knee mean that the challenge of restoring damaged cartilage in a
racehorse and a football player is similar. “We have a way to goin cartilage repair,” Dr. McIlwraith said. “Microfracture—although still the standard of care—is useful and has helped many human athletes, but it has limitations.”
New approachesHe and his colleagues are focusing on biologic therapies that may yield better results than mechanical procedures. In this realm, treatment methods for horses may outshine those available for humans, in no small part due to regulatory divergencies. “For horses we are pretty flexible in what we can do, but in humans we face more restrictive regulations,” Dr. McIlwraith said.
Among the promising biologic agents being used and evaluated in horses are IRAP (interleukin-1 receptor antagonist protein therapy, also known as Orthokine®) and bone-marrow derived stem cells (BMDSCs)—neither of which is approved for human use in the United States.
Dr. McIlwraith said that, he’s seen promising results using stem cells used to treat injuries in Western cutting and reining horses, which are prone to trauma in the femorotibial joints.
“Repair techniques are limited,” he said. “In the horse, we can do resection for grade 1 and 2 tears, but in grade 3, the tear ‘disappears’; we can’t get access to the whole tear.” In a papercurrently in press, Dr. McIlwraith reports results that show “injecting 20 million BMDSCs into the joint can result in getting back 60 percent athletic soundness—versus zero without.”
That study was developed and led by David Frisbie, DVM, PhD, also of CSU; the idea came from “quite remarkable regrowth of meniscal tissue in goats,” Dr. McIlwraith said.
Regulatory restrictions and the reluctance of pharmaceutical companies to invest large sums in the sorts of trials that would be required to obtain approval for the use of stem cells in
“Horsing Around” to Improve Arthroscopic Techniques
Arthroscopic pioneer C. Wayne McIlwraith, DMED, DVM, PhD helps equine atheletes return to the track
Terry Stanton
10 AO North America News February 2014 Issue 36
humans may be confining such advances to veterinary science. Dr. McIlwraith, an associate member of the Academy, recalled an orthopaedic colleague who observed, that “I can use a 15-year-old slide to show what is available for cartilage repair in humans,” but also noted that cross-pollination between veterinary and human medicine is occurring.
Although both branches are exploring the effectiveness of platelet-rich plasma (PRP), the results in humans and horses continue to be inconclusive. “In horses, we have used it quite a bit, including for acute tendon injury, but without not much proof of efficacy yet,” said Dr. McIlwraith. “We need a better definition of which product is best. With flexor tendon andsuspensory ligament injuries, our study shows more success with stem cells. PRP possibly supports the therapeutic effect.”
He noted that the Food and Drug Administration (FDA) takes a more permissive stance in allowing use of PRP versus stem cells, due to its definition of “minimal manipulation.” Creating PRP is a rather simple process. “You are not manipulating anything,” said Dr. McIlwraith. “Stem cells have to be cultured. Bone marrow is spun down to isolate stem cells; then the stem cellsare cultured, which is above the level of minimal manipulation.”
Daunting challenges The well-known susceptibility of horses to devastating consequences from racetrack injuries remains a daunting hurdle for equine surgeons.
“The limitation is that our patients have to stand up after anesthesia,” Dr. McIlwraith said. “Upper limb fractures are challenging. Distal limb fractures can be protected in a cast, but may still involve so much soft-tissue injury and blood supply loss that avascular necrosis or osteomyelitis develops.”
Distal limb injuries can be especially grave in horses. “As with distal tibial fractures in humans, the problem is the blood supply,” Dr. McIlwraith said. “The horse doesn’t have a lot of blood supply in the distal limb. If an infection often develops, we can amputate in humans, but not in horses.”
Another lethal threat to the horse with limb injury is laminitis, which is what ultimately took the life of the Kentucky Derby winner Barbaro, who sustained multiple hind leg fractures during the Preakness Stakes in 2006. Although he seemed to be healing from the injuries, laminitis—an affliction in the hoof that occurs when excess weight is shifted to a noninjured limb—developed and led his owners to the difficult decision to euthanize.
“The big hurdle is that we have to get the horse weight-bearing on that [injured] limb,” Dr. McIlwraith said. “So we still lose many horses to laminitis, which can be triggered by a numberof factors, including excess weight bearing, endotoxemia, stress, and a high level of carbohydrates. As the laminae break down, inflammation and necrosis cause it to come apart, and the distal
phalanx (third phalanx or coffin bone) ends up rotating through the sole of the hoof,” he explained.
“These cases will make you cry. They break your heart. The good news is that we are saving horses that could not be saved before. Fracture repair has come a long way in 30 years,” he said.
Dr. McIlwraith—who received his veterinary degree from Massey University in New Zealand, continued his training in the United Kingdom and the United States, and has a PhD in arthritis research from Purdue University—finds many similarities between his equine cases and those his human orthopaedic surgery colleagues manage.
“We use a lot of the same equipment and we have to be relatively fast and efficient. Vets take out more fragments, and don’t want our patients on the table for too long. Equine patients riskmismatch of ventilation and perfusion of the lungs and can get muscle damage if they are down too long,” he noted.
“Surgical techniques are very similar, but afterward, horses are going to stand on their legs, without protection, unlike humans. The horse recovers in a padded stall and, if it was a fracture repair, will have an assisted recovery. Otherwise the animal gets up on its own,” he said.
In one area, humans have an advantage. “We are catching up with human aftercare,” noted Dr. McIlwraith. “Most of my patients do time on an underwater treadmill. They need exercise to reconstitute their bone mass and tissue strength. We start hand-walking them and put them into rehabilitation therapies.”
A troubled industryAlthough Barbaro received excellent care, both as an active racehorse and after his breakdown on the track, his injury drew new scrutiny to the horse racing industry and its treatment ofanimals, especially those on the lower rungs. The industry, squeezed by vastly expanded gambling options, shifting public tastes, and numerous economic pressures, is foundering, andmany question whether owners and trainers are misusing horses by running them too often, when they are unsound, or with the use of ill-advised or illegal medication.
“The racing model is a challenge,” Dr. McIlwraith admitted. “Many races involve journeymen horses that owners have to keep going. When racing was the only form of gambling, the tracks were full. With expanded gambling, only the big races fill the tracks. We have seen the golden days of horse racing.”
Yet Dr. McIlwraith still believes that racing can be conducted in a way that befits its sobriquet as the “Sport of Kings.” He would like to see a more unified and resolute system of regulation inthe United States, replacing the current scattershot state-by-state approach and imposing a uniform standard for drug testing. The Racing Medication and Testing Consortium has been existence for 12 years with representatives from all parts of the industry and has achieved a considerable degree of uniformity among states with regard to medication, Dr. McIlwraith said.
“Horsing Around” to Improve Arthroscopic Techniques
11AO North America News February 2014 Issue 36
“Ultimately horse racing will be a more selective industry with fewer tracks,” he said “We have to do right by the horses. I hate having to put a horse down. Most people in the industry want to look after the horse, but there are trainers who don’t care about the horses much.”
The love of racing and the animals that compete motivates Dr. McIlwraith to travel every other week to an equine facility by Los Alamitos Race Course in Orange County, Calif., and to other far-flung locales, where he operates on these four-legged athletes who are paid in oats and apples.
He and his wife, Nancy Goodman McIlwraith, a veterinarian herself whom he met while she was working at Los Alamitos 30 years ago, currently keep nine horses of their own. Dr. GoodmanMcIlwaith exhibits show hunter horses and assists her husband during surgery.
“These horses are great athletes,” Dr. McIlwraith said. “I like them a lot. They are great to work with. The ultimate reward is to see a horse have a pain-free existence and to see them comeback to full competition.”
Terry Stanton is a senior science writer for
AAOS Now. He can be reached at [email protected]
© 2014 American Academy of Orthopaedic Surgeons. Reprinted from AAOS Now.
Michael G. Fehlings, MD, PhD, FRCSC, FACS, Chairman, of AOSpine North America is pleased to announce that AOSNA has accepted an invitation to join the Council of Surgical Spine Specialties (COSSS) as one of their founding members. Other societies represented in COSSS include: Cervical Spine Research Society (CSRS), American Association of Neurological Surgeons (AANS), Lumbar Spine Research Society (LSRS), Congress of Neurological Surgeons (CNS), Scoliosis Research Society (SRS), and the AANS/CNS Joint Section of Disorders of the Spine and Peripheral Nerves. Drs. Paul Arnold and Norman Chutkan will represent AOSNA as the 2013/14 COSSS Representatives.
This is an important milestone for AOSNA, giving us a place among several well-respected spine organizations. This responsive organization allows rapid communication with insurance companies, policy makers, etc. in responding to issues important to practicing spine surgeons, including authoring rebuttals to coverage denials for surgical procedures.
We look forward to future collaboration with these organizations.
AOVet North America is looking forward to 2014’s VOS Conference and World Veterinary Orthopedic Congress in Breckenridge, Colorado — March 1st – 8th. There will be nearly 1,000 Veterinary Orthopedists from 44 countries attending
this year. To enhance World Congress, several new events will be included that AOVet is sponsoring. The Bloomberg Resident Research Award features much of the best science and many of the best presentations of the meeting. In
addition to the Bloomberg session, the World Congress will host the International Resident Research Session during which residents from around the world will present their research and vie for top presentation honors.
Visit AOVet’s Booth at VOS!
AOSNA Joins the Council of Surgical Spine Specialties (COSSS)
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NEWSFebruary 2014 | Issue 36
