Orthopaedic InstitutePerformance. Movement. Proven Specialists.

A Letter from the Chairman ............1

Growth and Improvements..............2

Sports Medicine ..............................5

Pediatric Orthopaedics....................8

Orthopaedic Trauma: Patients.......12

Geriatric Fracture .........................14

Total Joint Replacement ...............16

Our Mentoring Pledge .................18

Game-Changing Research ............19

Professional Staff ..........................20

Table of Contents

A Letter from the Chairman

Mission The Mission of GeisingerOrthopaedic Institute is toprovide the highest qualitypatient care, improve mobility,and enhance the quality of lifefor all, while advancing thescience of orthopaedic surgeryand its related disciplinesthrough research andeducation. Excellencepervades our patient care,teaching, learning,opportunities, and diversity.We stand ready to achieveprominence by engaging amind-set of all things possible.

January 3, 2012 was an important dayfor me – it’s when I officially joined theGeisinger family and began myleadership role in the GeisingerOrthopaedic Institute. Exactly oneyear later, Geisinger Health Systemreached another important milestone– we were now five hospitals, underthe umbrella of a ubiquitous caredelivery system.

We have a mission to deliverexcellence. Whether it’s providing

care to patients in Africa or serving as physicians to UnitedStates sports teams, we feel honored to deliver Geisingerexcellence at such high levels…and to provide that samelevel of care at the local level, especially to our schools anduniversities through our athletic collaboration.

It is a personal and professional goal of mine to heal everybone – without deformity and without complication. OurLevel 1 and Level 2 trauma centers allow us to treat themost complex and life-threatening injuries in the area, andpatients receive the same level of care in outpatient andinpatient units, system wide.

Excellence is the end result when you combine stellar staff,fine facilities and evidence-based practices. The GeisingerOrthopaedic Institute boasts all of these, and I am so veryprivileged to be a part of this fine family. My vision is forthe Geisinger Orthopaedic Institute to continue to be thearea’s orthopaedic destination of choice through the nextdecade and beyond.

I hope you enjoy reading about our accomplishments andabout the programs and people that make the GeisingerOrthopaedic Institute one of the finest around.

Warmest regards,

Michael Suk, MD, JD, MPHChairman,Department of Orthopaedic SurgeryGeisinger Health System

On the CoverDaniel Horwitz, MD, Chief, Orthopaedic Trauma at Geisinger Medical Center

Wilkes-Barre

Danville

Geisinger Orthopaedic Institute

2 3

Growth and Improvements Growth and Improvements

Geisinger Health System serves more than 2.6 million residents in 44 counties as a not-for-profit, fully integrated health service organizationthat is dedicated to excellence in care, education,research, and service. Our physician-led systemincludes a multidisciplinary physician grouppractice with system wide aligned goals,successful clinical programs, a sophisticatedinformation technology platform, a robustresearch program, and an insurance provider,Geisinger Health Plan.

A health system that had two sites for many yearsbecame a system with five sites over the course ofone year. “Each site is intended to have the sameGeisinger Orthopaedic Institute standardsregardless of which location patients go to fortheir orthopaedic care,” says Michael Suk, MD,JD, MPH, chairman, department of orthopaedicsurgery at Geisinger Health System.

Geisinger–Shamokin Area Community HospitalGeisinger-Shamokin Area Community Hospital (G-SACH) joined Geisinger HealthSystem on January 1, 2012. “Most patients wholive in the Shamokin and Coal Township regionwant to receive their care there as well,” says G. Dean Harter, MD, director of orthopaedics at G-SACH. “Our goal was to keep their careconvenient, but improve the level of care so it is up to the standards of a major medical centersuch as Geisinger.”

A total joint class has even been added at G-SACHfor joint replacement patients. “The class is taughtby a multidisciplinary team that reviews topics suchas surgical risks, exercises to do pre- and post-surgery and signs and symptoms of problems theycould encounter,” says Stacey Winner, RN andorthopaedic total joint care coordinator.

“The Geisinger Orthopaedic Institute hasexpanded the scope and availability ofcomprehensive orthopaedic services in the G-SACH service area,” says Thomas Harlow, ChiefAdministrative Officer at G-SACH. “Extended andevening clinic hours have provided patientsgreater flexibility in obtaining the orthopaedicspecialty care they need, when they need it.”

G-SACH, also offeres other orthopaedic careincluding general orthopaedics, hand services andamputation care.

Geisinger-Bloomsburg Orthopaedics

On July 1, 2012, Bloomsburg Hospital and itsaffiliates merged and integrated into GeisingerHealth System. When this occurred, ZeferinoMartinez, MD, orthopaedic surgeon, joined theGeisinger Orthopaedic Institute and brought with him more than 20 years of orthopaedicsurgical experience.

As a fellowship-trained spine surgeon, Dr.Martinez offers a specialized service to theBloomsburg community, as well as generalorthopaedic procedures, including total jointreplacement, arthroscopy, neck surgery andlower back surgery.

“The merger with Geisinger allows BloomsburgHospital to be modernized and improved,” saysDr. Martinez. “And the partnership enables myBloomsburg patients to still have quality hospitaland outpatient services close to their home, yetbe under the Geisinger umbrella of excellence.”

Geisinger Orthopaedics at Geisinger Wyoming Valley Medical Center

In July 2012, the Geisinger Orthopaedic Institutein Wilkes-Barre moved to an expanded 25,000-square-foot facility. “We were in a 7,500-square-foot space that simply could no longer

accommodate ourcurrent volumes,” saysWilliam Krywicki, MD,director of orthopaedicsat Geisinger WyomingValley Medical Center.“We were going to be agroup of sevenphysicians, or more, bythe end of 2013 andneeded a space thatwould allow us toprovide patients withthe full spectrum oforthopaedic care.”

The new facility has 33exam rooms and allowsfor an additional 7,800

patient visits and 400 surgical proceduresannually. Physical therapy and occupationaltherapy rejoined the new clinic with a 2,000-square-foot physical therapy suite that includestwo treatment rooms and a hydrotherapy room.Also on the premises is a 2,500-square-footfitness center for pre- and post-rehab patients.

The new facility makes it easier for subspecialtyorthopaedic doctors, including pediatricorthopaedics, spine and oncology, to seepatients close to home in northeastPennsylvania, adding another level ofconvenience for patients.

Geisinger Medical CenterHospital for Advanced Medicine Inpatient Unit

Much of 2012 was spent planning and building anew inpatient unit in the Hospital for AdvancedMedicine in Danville. The new space boasts 30 private inpatient rooms.

Each room in the new unit includes pull-outbeds for family members and full glass doors so nurses have direct patient monitoringcapabilities from outside the patient room. The state-of-the-art rooms are all-inclusive— anysupplies a caregiver may need are already in theroom— increasing efficiency.

Communication is improved with an informationcenter for family members, a conference roomwhere the surgeon can meet with family andfriends about the patient, and a larger meetingspace for physicians so they can more effectivelydiscuss patients as a team prior to rounding.Michael Suk, MD. and Nathaniel Wingert, MD, orthopaedic surgery resident.

G. Dean Harter, MD

Joel Klena, MD

William Krywicki, MD

The Past, the present and the future

4

“In addition, the inpatient rehabilitation gym is on the same floor with the physical therapists,”says Patrice DeBach, RN, orthopaedic inpatientoperations manager. “The new space has somany great features that it is going to increasepatient and visitor satisfaction, as well as staff satisfaction.”

Geisinger Medical CenterOutpatient Surgery-Woodbine Lane

The Sports Medicine program at GeisingerWoodbine Outpatient Clinic started with theidea that the program would be dedicated todiagnosing, treating and rehabilitating patientswith sports-related injuries.

“Now many orthopaedic physicians utilizeWoodbine to care for their hand, foot, ankle – even amputee and orthotics – patientsbecause of ease of access,” says DanielFeldmann, MD, chief of sports medicine atGeisinger Medical Center.

The outpatient clinic at Woodbine also housesstate-of-the-art MRI and CT, as well as in-house musculoskeletal radiologists to readMRIs and arthograms.

The sports medicine group, comprised of board-certified orthopaedic surgeons,fellowship-trained primary care sports medicineproviders, physical and occupational therapists,physician assistants, athletic trainers and otherorthopaedic subspecialists, continue to perfectcare delivery for injury diagnosis andmanagement. The sports medicine group alsooffers Speed and Agility Camps for studentathletes and is looking at ways to increaseeducation opportunities.

Division of Podiatry

In 2012, the Division of Podiatry became part ofthe Geisinger Orthopaedic Institute, addingthree podiatrists to the current orthopaedicteam. Podiatry includes surgical and nonsurgicalservices providing the spectrum of foot andankle surgery and routine care.

“Podiatry will continue to grow,” says Barry Bernstein, DPM, director of podiatry atGeisinger. “We still care for outpatient problemslike bunions, Achilles tendon issues and generalfoot care, but we also work closely with otherspecialties to treat inpatient limb-threateningconcerns.”

At Geisinger, podiatrists work cooperatively withorthopaedic surgery, vascular surgery, infectiousdisease and the hospitalists to ensure thatpatients receive the care they need.

Growth and Improvements

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Sports Medicine

Geisinger Surgeon Renowned for Treating Multi Ligament Knee Injuries

Geisinger orthopaedic surgeon, Gregory Fanelli,MD, has specialized in multiple-ligament kneeinjuries for 23 years. He recently published hisfourth textbook; in fact, his are the onlytextbooks on the subject.

Dr. Fanelli is a prolific writer and presenter on thetopic, in large part because he has dedicated hiscareer to the injury. Over the past 20 years, Dr.Fanelli has developed and refined the surgicaltechnique for repairing multiple-ligament tears.In addition, he has developed instrumentation toaide in the procedure.

“Multiple ligament knee surgery is high risksurgery and unless you perform a lot of theseprocedures it’s difficult to get excellent results,”said Dr. Fanelli. Dr. Fanelli and long-timeGeisinger physical therapist, Craig Edson, haveworked together to pre-operatively and post-operatively evaluate multi-ligament instabilitywith up to 22 years of follow-up.

Dr. Fanelli’s experience comes, in large part,from the fact that he’s been perfecting theprocedure for over two decades. It also comes asthe result in building a name for himself in thefield. He receives referrals from all over theUnited States, even internationally. Referringorthopaedic surgeons have learned about Dr.Fanelli’s work through his published papers, hismeeting presentations and the teaching courseshe’s conducted.

“When I get a referral from a colleague who hasseen my data, I call them after I’ve seen thepatient to let them know how I plan to care for

the injury. My goal is to quickly get the patientback to the referring physician for rehabilitationand future care.”

Presently, Dr. Fanelli is able to perform a majorityof his multiple ligament repairs as an outpatientprocedure, which is quite unique. Withsuccessful rehabilitation his patients are able toreturn to a high level of activity.

Concussion CareThe Safety in Youth Sports Act, passed in 2012, requires concussion education for allcoaches – whether paid or volunteer. Geisinger recently developed a course – approved bythe Department of Health, the Brain Injury Association of Pennsylvania and the PennsylvaniaAthletic Trainers’ Society – and is offering it to area coaches, nurses and athletic trainers.Attendees receive a certificate of completion which they must present to schooladministrators in order to coach in any capacity.

Gregory Fanelli, MD, visits with a patient pre-operatively.

Inpatient unit in the Hospital for Advanced Medicine

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Sports Medicine

Providing Unique Service to Schools

Geisinger Sports Medicine is the official sportsmedicine provider to 24 school districts, sevenuniversities and the Wilkes-Barre/ScrantonPenguins American Hockey League team. Thosecollaborations provide a much needed service and peace of mind for athletes, their families, and coaches.

Geisinger’s 42 athletic trainers work in clinic eachweek to keep their clinical skills sharp, and thenjoin student athletes on the field during practicesand games. The athletic trainers who work withthe universities are full-time staff of the universityathletic training staff.

“A leading edge program like ours – whichemphasizes the continuing education ofpractitioners – provides assurance that athletes will

receive the care they need, when they need it,“says Daniel Feldmann, MD, chief of sportsmedicine at Geisinger Medical Center.

Athletic trainers not only triage athletic injuries,they are trained in concussion management,issues specifically related to women in sports, aswell as sports psycho-social intervention. And aspart of Geisinger Health System, they can pick upthe phone and call a surgeon or therapist in amoment’s notice.

“The thing that really sets this model apart iscommunication,” says Dr. Feldmann. “From anacademic perspective, all of these team membersare on the same wavelength; the trainer knows thesurgeon’s and the therepist’s perspective,enhancing care delivery to student athletes.”

Geisinger athletic trainer Gina Marotta, MS,ATC, CSCS has cared for the studentathletes at Bloomsburg Area High Schoolin Bloomsburg, Pennsylvania for nine years,so she knows most of them and theirfamilies. One family in particular, the Rankinfamily, had four athletes come through thesports program in the time that Marotta hasbeen there, and she was now training theiryoungest – Blake.

“Blake was the Bloomsburg High Schoolquarterback, and a very good one,” saysMarotta. “In his junior year he had alreadysecured a scholarship to play football atRutgers University.”

But a game-changing event occurred in thefirst drive of the first playoff game of hissenior year. A tough hit left his anklebroken and dislocated. Blake knewimmediately he had suffered a seriousinjury; he wondered if he would ever playfootball again.

Marotta was at that game as the teamathletic trainer and provided immediateassistance to Blake. She made sure he gotrapid transport to Geisinger MedicalCenter in Danville.

Meanwhile, Blake’s mom and familywatched the events unfold before theireyes. “Blake is our youngest, and to seesuch an injury was just devastating,” saysKim Rankin, Blake’s mom. “I saw his dreamof playing football at the collegiate andprofessional level stripped from him in one moment.”

But in the end, this dream was never injeopardy thanks to Gerard Cush, MD,fellowship-trained orthopaedic foot andankle surgeon at Geisinger Medical Center,performed an intricate surgical procedureknown as a plate and screw fixation withligament repair.

For Blake’s full story visitgeisinger.org/ortho.

Facilitating a Football Dream

Geisinger: Serving Our National PastimesNot only do Geisingerdoctors serve local andregional communities, butthey are represented atthe national andinternational level. GlenFeltham, MD, and Matt McElroy, DO,sports medicine andorthopaedic specialists,received the prestigiousappointments for theWomen’s National SoccerTeam and the UnitedStates Ski Team,respectively.

As team physicians they are in charge of allmedical care for players, staff and personnel(about 30 individuals) when traveling to gamesand events. They are also responsible forcoordinating care, including emergency care and facilitating a return to the United States for treatment.

Dr. Feltham played three to four different sportsin high school and soccer in college. The interestin sports led him to an interest in orthopaedicsurgery and sports medicine. He applied to the

United States National Soccer Team as a teamphysician to stay in touch with a sport he loves.“It’s an honor to be able to serve the teams,” saysDr. Feltham. “It gives me an opportunity to servethe country through a national team, which I feelgood about.” Dr. Feltham has been a teamphysician for eight years and has been headphysician for the U20 Women’s National SoccerTeam on two occasions.

Dr. McElroy has served asa team physician for theUnited States Ski Team forfive years. The position isvoluntary, but to beconsidered, one must becompetent in the sportbeing covered and haveconsiderable medicalexperience and training.“It’s a really a rewardingexperience and Geisingerhas been very supportiveof my participation,” says Dr. McElroy.

“We are quite proud to have them representingthe Geisinger Orthopaedic Institute,” says Dr. Suk.

Glen Feltham, MD at theWorld Cup Championship.

Blake Rankin, patient of Gerard Cush, MD.

Matthew McElroy, DO atthe Alpine Championshipsin Colorado.

The Beachel family of dairy farmers drinks a lot ofmilk, but even a calcium-rich diet cannot alwaysprotect the bones of a very active four-year-old.

Young Denyn Beachel of Danville had beenplaying with his new puppy when he accidentallykicked a storage trunk and then fell onto a rockingchair. With no more than a tiny bump, his parentsfigured it was probably just a slight injury. But thatnight Denyn would cry with even the slightestmovement of his leg. The next morning hisparents rushed him to the Emergency Room at

Geisinger Medical Center in Danville where an X-ray revealed he had a fracture across his entiretibia. Denyn was referred to Stacy Frye, MD, anon-operative pediatric orthopaedist.

“Denyn had a routine fall and a small bump thatturned into a really impressive fracture across themiddle of his tibia,” says Dr. Frye. “I put him in along leg cast that ran from the top of his thigh tohis big toe, but it didn’t seem to slow him down.”

For Denyn’s full story visit geisinger.org/ortho.

Active Four-Year-Old Carries on with Crutches

Pediatric Orthopaedics

The team of three fellowship-trained pediatricorthopaedists, two physician assistants and onenurse navigator is able to provide the fullspectrum of care for pediatric patients innortheast Pennsylvania— not just in Danville, butalso in clinics throughout the region.

“For me, the most thrilling part of our team is thatwe interact very frequently and very comfortablywith one another,” says William Mirenda, MD,chief of pediatric orthopaedics. “Our skills andinterests are complementary, so we are able toserve quite a large patient population.”

In addition to fractures and ligament tears, theteam treats a host of congenital anomalies, suchas clubfoot, hip dysplasia and scoliosis. And,patients who come in with orthopaedic traumaare treated through a team approach with theorthopaedic traumatologists.

“Sometimes the hardest part of treating childrenis determining whether there really is a problem,”says Dr. Mirenda. “It takes experience and solid

training to be able to make a judgment aboutwhether a pediatric orthopaedic issue will resolveitself with growth and development.”

Growing pains are certainly par for the coursewith pediatric patients, but the pediatricorthopaedic team at Geisinger is well positionedto care for any of them.

Specialized Care for Our Smallest Patients

The addition of acertified child lifespecialist dedicated topediatric orthopaedicpatients is a level ofcare not available atother hospitals in theregion.

A certified child lifespecialist promoteseffective copingthrough play therapyand offers activities thathelp normalize the

treatment environment and create diversions.“We know children don’t always understand whythey are undergoing tests and procedures,” saysSarah Hoffman, certified child life specialist fororthopaedics.

“One of the things we do is medical play,familiarizing the child with the equipment theymight see in their treatment; for example, wehave a doll the patient can use to put a cast onits arm or leg,” says Hoffman.

As a developmental specialist, she will assess thepatient early on to determine what level ofsupport the child might need. She then gleansinformation about what the child is interested inand uses that information to help the patient inclinic appointments or procedures.

Hoffman provides continuity of care because sheis available to patients from diagnosis torecovery. She is especially relevant for childrenwith underlying cognitive or developmentaldisabilities; these patients might have a hardertime understanding and dealing with treatmentor with different environments.

Play is a Powerful Tool in Treatment

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Sarah Hoffman

William Mirenda, MD and Caden Temple, patient.

Denyn Beachel, patient of Stacy Frye, MD.

Last March, ten-year-old Aaron Knauss wasrounding second base during a recess game of kickball when the class was called in. Hesuddenly stopped and turned to head into the school, but his knee “popped” and reallystarted to hurt. Aaron began to complain more about his knee, so the next day Aaronwas referred to pediatric orthopaedic surgeon Meagan Fernandez, DO, at Geisinger Medical Center.

“We scheduled Aaron for an MRI and took himto see Dr. Fernandez, who confirmed he had atorn ACL,” says Josh Knauss, Aaron’s father.“We scheduled surgery and discussed thetypes of procedures that were possible forsomeone as young as Aaron.”

Dr. Fernandez used a physeal sparing ACLreconstruction technique, which would sparethe growth plate and allow Aaron’s bones tocontinue to grow and develop. Because theprocedure is so different, a surgeon’sexperience can make a big difference in thepatient’s outcome.

For Aaron’s full story visit geisinger.org/ortho.

Experience Critical in PediatricACL Repair

Physicians at Geisinger recently began employinga robot system to surgically treat patients withscoliosis. The Renaissance™ system is the onlysurgical guidance system for spine proceduresavailable today, and currently, Geisinger is theonly healthcare provider in Pennsylvania utilizingits technology.

“The Renaissance™ system has proven to providescoliosis patients with better outcomes whichresult in shorter hospital stays, quicker recoveriesand reduced intraoperative radiation exposure,”says Michael Suk, MD, JD, MPH, FACS, chairman,department of orthopaedic surgery at GeisingerHealth System. “The exceptional precision andsafety of the Renaissance™ system is a drasticimprovement over freehand surgery especiallyduring complicated spine procedures.”

The Renaissance™ system, which will be usedprimarily to treat scoliosis, utilizes a soda can-sized surgical robot guided along a rigidattachment by a 3D preoperative blueprint of the patient’s spine to treat the desired area of the spine within 1 mm accuracy. Computer techn ology synchronizes with the surgical

blueprint, to improve the safety and accuracy of the operation.

“The surgeon still performs 100% of the surgery,but the robot adds an extra layer of safety,” saysMeagan Fernandez, DO, pediatric orthopaedicsurgeon, Geisinger Medical Center. “Thetechnology behind this system has beenrigorously tested and the results have beenremarkable in terms of safety, accuracy and theeventual end result.”

Geisinger is Exclusive Pennsylvania Provider of Robotic Scoliosis Treatment System

Pediatric Orthopaedics

On a Mission of CaringWhen W. Fred Hess, MD, orthopaedic surgeon atGeisinger Medical Center, was first asked toparticipate in a medical mission trip to Ecuador in1993, he did not think he was interested in takingcare of patients in a third world setting. But, heagreed and went to Ecuador to treat a little girlwith Marfan syndrome.

Fast forward several years and Dr. Hess is stillactive in medical missions, one specifically withthe Foundation of Orthopaedics and ComplexSpine (FOCOS).

“Our mission is to take care of complex spinedeformities for the underserved in Africa,” saysDr. Hess. “These are things you will see in theUnited States, but they would never get to thedegree of deformity that we see in Africabecause of earlier intervention.”

The organization brings in groups of highlyskilled orthopaedic surgeons for two weeksseveral times a year. They work hand-in-hand to take care of patients, and provide training to local doctors so they can help take care ofbasic needs.

Until last year they operated at the main teachinghospital for Ghana. The rooms were clean, butoften equipment was not available andprocedures had to be cancelled. In April 2012,FOCOS opened a 50-bed single specialtyhospital to provide comprehensive orthopaedicservices in this underserved area.

“My goal is to provide quality care to as manypeople as I can,” says Dr. Hess. “There is nothingbetter than knowing you made a difference insomeone’s life.”

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Renaissance™ computer image of spine.

Aaron Knauss, patient of Meagan Fernandez, DO.

Patient Gets a Fresh Start Thanks to a New ProcedureForty-six-year-old Robert Waite has lived andworked on a farm for nearly 30 years inNorthumberland, Pennsylvania. He and his familyknow no other lifestyle than the hard work anddedication of running their farm, caring for itscrops and raising its animals. But on what was atypical Tuesday afternoon, February 21, 2012, theunexpected happened; Robert’s entire lifestyle wasthrown into doubt when he was attacked by a1,500-pound bull on his family’s property.

Despite multiple attempts to escape, Robert was left in the pen with catastrophic injuriesto his chest. He was found by his wife and anotherfarm worker and flown to Geisinger MedicalCenter via LifeFlight®. Robert was suffering from acondition known as bilateral flail chest – whenmultiple ribs fracture in multiple locations, leavinga freestanding portion of the

ribs that moves inversely with the rest of the ribsduring breathing.

“Robert came to the hospital facing significantamount of time on a ventilator because his chesthad caved in; his chest wall literally went back andhit his spine,” says Michael Suk, MD, JD, MPH,FACS, chairman, department of orthopaedicsurgery at Geisinger Health System.“This level of injury had the potential of being a lifetimeproblem in terms of Robert’s ability to take deep breaths.”

Dr. Suk believed Robert was a prime candidate for a new procedure known as rib fixation, whichinvolves fixing the ribs back together using plates and screws. Robert was the first patient at Geisinger Medical Center to undergo this new procedure.

For Robert’s full story visit geisinger.org/ortho.

A Shoulder that’s No BurdenFor Pennsdale, Pennsylvania’s Elayne Greenburg, nothaving to be aware of her artificial shoulder is morethan she ever could have hoped for. Elayne, 70, fell inher home and essentially crushed her shoulder joint.After several opinions gave her little confidence, shemet with Geisinger orthopaedic surgeon G. DeanHarter, MD who recommended a reverse total shoulderreplacement, a procedure performed at few otherhospitals in this area.

“I actually thought my life was over when he showedme the pictures,” Elayne says. “But then he explainedthat there was a prosthesis that would make my armmore stable than before and that I should be able tofunction pretty normally within a year.”

A reverse total shoulder replacement involves inversingthe shoulder joint with the insertion of a metal ball inthe place of the natural shoulder socket andimplanting an artificial socket at the top of thehumerus, or upper arm, bone.

For Elayne’s full story visit geisinger.org/ortho.

Elayne Greenburg, patientof G. Dean Harter, MD.

Robert Waite, patient of Michael Suk, MD.

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In 2012, The FiscalTimes reported that 5%of the population usedhalf of the healthcaredollars, and most of thatpopulation is 65 years ofage or older.

“These compellingstatistics demonstratethe need of an improvedgeriatric care modelemphasizing value,”says Anthony Balsamo,MD, orthopaedicsurgeon and director of

the Geriatric Fracture Care Program at GeisingerWyoming Valley Medical Center (GWV) in Wilkes-Barre. “For Geisinger, it’s even more importantbecause we have a higher percentage of babyboomers in the population we serve.”

In August 2010, Dr. Balsamo began implementing the

Geriatric Fracture Care Program at GWV. “We tookaction because we want our patients to live the rest of their lives, not just exist for the rest of their lives.”

The goal of the program was to supply better valueand results, while reducing costs and readmissionrates, and to control separate-but-related medicalissues prior to surgery to incorporate early dischargeplanning.

The results were very impressive. The length of stay ofgeriatric patients has improved by 14%; readmissionrates were reduced by 28%; and the percentage ofpatients discharged to an acute inpatient rehab facilityincreased by 19.3% (with the expectation to return totheir home environment).

“The aging population will continue to consume alarger proportion of healthcare resources for treatingosteoporotic fractures in the coming years,” says Dr.Balsamo. “The ability of healthcare institutions and theentire interdisciplinary team to deliver cost-effective,patient-centered quality healthcare will be critical tothe future economic viability of healthcare systems.”

Geriatric Fracture Care Program – Better Care, Better Value Despite Geriatric Fracture,98-Year-Old is on the MoveEtta Shuman, 98, was excited about spendingthe summer with her husband at their lake homein Fritzinger Town, Pennsylvania. But on June 17,2012, Etta fell and fractured her femur, putting anend to those plans.

“Etta had a geriatric fracture of her femur,” saysAnthony Balsamo, MD, orthopaedic surgeon anddirector of the Geriatric Fracture Care Program atGeisinger Wyoming Valley Medical Center.“Since she had previously undergone a total hipreplacement and total knee replacement on thatsame leg, we needed to put a plate on the boneto ensure it would heal properly.”

Etta has previously had two hip replacementsand two knee replacements at Geisinger MedicalCenter in Danville, as well as three operations onher spine. Geriatric fractures are among the mostcomplex, which often complicates recovery.

For Etta’s full story visit geisinger.org/ortho.

Geriatric Fracture

Evidence-Based Medicine at GeisingerWith the future of healthcare increasinglybecoming evidence-based medicine, GeisingerHealth System has been highly regarded becauseof its ProvenCare® programs.

“The bottom line for ProvenCare® is to becomemore efficient with healthcare delivery by reducingvariation in care, complications and cost, butmaintaining or improving quality,” says DavidKolessar, MD, orthopaedic surgeon at GeisingerWyoming Valley Medical Center (GWV).

The Geisinger Orthopaedic Institute has justinitiated its own ProvenCare® Hip Fractureprogram, an outgrowth of the success of theGeriatric Fracture Care Program at GWV.

“ProvenCare® for a high volume problem like hipfractures is really perfect,” says Daniel Horwitz,MD, chief of orthopaedic trauma at GeisingerMedical Center in Danville. “With ProvenCare® HipFracture there is a high degree of predictability, soit lends itself well to creating a reproducible

systematic approach to treatment that is asefficient as possible.”

In the short time since the program has been rolledout, it is proving successful in terms of expeditingpatients to the operating room. The process issmoother and all team members are on board withknowing what they need to do and how to do it. Infact, the commitment of all team members is oneof the cornerstones of ProvenCare®. Everyone -from the nurse to the surgeon - is held accountablein the patient’s outcome.

The electronic medical record (EMR) is also a cost-saving measure because it helps prevent duplicateor unnecessary tests. The EMR is indispensablebecause all practitioners can access the patient’srecord at any Geisinger hospital or more than 40 clinic sites.

“With the so-far successful implementation ofProvenCare® Hip Fracture, we are looking at otherorthopaedic issues that could lend themselves tothis model,” says Dr. Horwitz.

Etta Shuman, patient ofAnthony Balsamo, MD.

Anthony Balsamo, MD

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Total Joint Replacement

Performing Joint Replacement Procedures and Improving Outcomes

Geisinger Wyoming Valley Awarded Joint Commission Gold Seal of Approval

Surgeons in theGeisingerOrthopaedicInstitute regularlyperform the fullspectrum of jointreplacementprocedures,including hip,knee, shoulderand elbow.

“Our regionallocation and largepatientpopulation allowsus to maintain ahigh volume

practice per surgeon and institution,” says DavidKolessar, MD, orthopaedic surgeon at GeisingerWyoming Valley Medical Center. “Studiesroutinely show that experience counts; patientshave better outcomes and fewer complicationswhen their total joint replacement is performedby a skilled surgeon at a high volume center.”

“Our goal is to provide conservative treatmentmeasures first,” says Dr. Kolessar. “Conservativetreatments may include activity modification,arthritis medications, exercise programs,physical therapy and weight reduction. If thepatient’s symptoms continue to interfere withtheir function and quality of life, surgicaltreatment options may be considered.”

Geisinger uses contemporary techniques in theirjoint procedures, as well as advanced materials.Perhaps the biggest difference at Geisinger witha joint replacement procedure is the acceleratedrehabilitation process, shortening the length ofstay and improving the patient’s ability to returnto their home rather than an inpatientrehabilitation facility.

Geisinger performs revision total jointreplacement on a regular basis. These operativeprocedures vary in complexity and can requiremore resources. “We believe we are wellpositioned to provide high quality, value-basedcare to improve the quality of life and function ofour patients in the future,” says Dr. Kolessar.

Geisinger Wyoming Valley Medical Center (GWV) earned The Joint Commission’s Gold Seal of Approval™ Disease-Specific Care for Hip Fracture, Total Hip Replacement and TotalKnee Replacement by demonstrating compliancewith The Joint Commission’s national standardsfor healthcare quality and safety in disease-specific care.

At the time of certification, GWV was one of twohospitals in Pennsylvania with Hip FractureCertification, one of 20 with Hip ReplacementCertification and one of 47 with KneeReplacement Certification.

“Achieving this certification demonstrates that weare dedicated to continuously providing safe,

high-quality treatment and rehabilitation servicesto our hip fracture and total joint replacementpatients,” says Dr. Suk. “Our participation in thecertification process is not only an affirmation ofthe expert care available at GWV, but also helpsus identify opportunities for future improvement.”

Certification requirements for these programsaddress three areas: compliance with consensus-based national standards; effective and consistentuse of appropriate, evidence-based clinicalpractice guidelines; and collection and analysis offour performance measures specific to eachprogram certification. As a certified organization,GWV has been awarded certification for a two-year period. Regular reviews will be carried out inorder to maintain and renew certifications.

Double Knee Replacement Gives Patient New Lease on Life

Robert Kurtinitis of Dallas, Pennsylvania hadarthritic knees for eight years and wore a bracefrom his knees to his ankles. He lived in constantpain and was resigned to sitting for much of hislife because walking was so difficult.

Robert decided he had had enough, so just daysafter he turned 63 on July 24, 2012, heunderwent a double knee replacement.

“It is a bit unusual to do simultaneous kneereplacements, but Robert had relatively good

health and would benefit tremendously from theprocedure,” says William Krywicki, MD, directorof orthopaedics and sports medicine at GeisingerWyoming Valley Medical Center. “His knees wereseverely arthritic, so if we had done only one hewouldn’t have been able to take full advantageof function until the other was done, which wouldhave limited his rehabilitation of the first knee.”

For Robert’s full story visit geisinger.org/ortho.

David Kolessar, MD

Robert Kurtinitis, patientof William Krywicki, MD,and his wife.

Game-Changing Research

The orthopaedic residency program at Geisingerhas a goal of producing not only the mostknowledgeable and clinically competentorthopaedic surgeons, but also the best preparedto enter the workforce. We achieve this goal, inpart, through comprehensive and ongoing self-evaluation, even beyond that required byaccreditation agencies.

“The program has been around since the1960’s,” says Gerard Cush, MD, orthopaedic foot and ankle surgeon and residency director for orthopaedics at Geisinger Health System.“We have over 100 graduates who went intogeneral practice or a fellowship and now practiceas orthopaedic physicians throughout the United States.”

The strong education program recently movedfrom two residents per year to three, as a directresult of the learning opportunities that are

present at Geisinger. The program continues toattract prime candidates from the nation’s finestmedical schools, because they know that theGeisinger program offers one-on-one educationopportunities between the resident andattending physician, and the ability to providecontinuity of care by following patients fromdiagnosis through recovery.

“Our preceptorship model is different from mostprograms because residents are paired with aphysician for direct interaction and supervision. Inour opinion, it presents a strong, longitudinallearning opportunity for residents who work withone attending for a three month rotation; overfour years they have a total of 16 rotations,” saysDr. Cush.

“It’s a wonderful way to teach residents andbetter evaluate them along the way,” says JessicaTemple, residency program coordinator. “Itfacilitates gradual responsibility, so residents haveautonomy earlier in their training.”

This model has propelled Geisinger to one of thetop programs in the country based on academicachievement as measured by the NationalOrthopaedic In-Training Exam. Geisinger residentsare consistently above the 95th percentile.

Residency Program Among the Best, and Growing

Geisinger Health System offeres a Primary Care Sports Medicine Fellowship to provideprimary care physicians with expertise in medical care of the active patient. “The fellows have an opportunity to work with the sports medicine clinicians and even serveas team physicians for school districts, local colleges and professional teams,” says DavidRoss, MD, sports medicine physician and fellowship program director. Fellows are taught by Geisinger’s outstanding orthopaedic and sports medicine specialists,and leave the program with experience in an array of sports medicine activities.

Primary Care Sports Medicine Fellowship

Our Mentoring Pledge

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The scientist/clinician partnership at the GeisingerOrthopaedic Institute facilitates research indiscovering the best applications of, improvementsto, and innovations for the latest orthopaedictechnologies in development. The basic researchand clinical trials aim to develop the best implants,finest biomaterials and cutting-edgepharmaceuticals for musculoskeletal patient care.

“We are a dynamic orthopedic translationalresearch center,” says Michael Suk, MD, JD, MPH,FACS, chairman, department of orthopaedicsurgery at Geisinger Health System. “Our affiliationwith various groups prove that Geisinger is a majorcontributor to orthopaedic research.”

The most impressive research initiatives of 2012 include:

AOCSC Platinum CertificationIn April 2012, the Geisinger Orthopaedic Institutewas the second site in the United States to receivethe certificate indicating that it is now anArbeitsgemeinschaft für Osteosynthesefragen (AO)Clinical Study Center (AOCSC) site, and wasawarded the Platinum status, the highest level ofcertification offered.

“This certification will reflect our quality standardsand abilities to participate in and manage clinicalstudies (not only with the AO but with industry aswell),” says Dr. Suk. “AO Centers will be thedestination of choice for implant testing,comparative research projects and innovations inbiologic materials. It promises to open animportant pipeline to sponsored research.”

METRC Satellite Clinic SelectionThe Geisinger Orthopaedic Institute was approvedas a Major Extremity Trauma Research Consortium(METRC) Satellite Clinical Site in July 2012, andhopes to soon be participating in two METRCclinical studies: the Antibacterial Plate Sleeves(APS) Study and the OUTLET study.

METRC was established in September of 2009 withfunding from the Department of Defense (DOD). Itconsists of a network of clinical centers and one

data-coordinating center that works together withthe DOD to conduct multicenter clinical researchstudies relevant to the treatment and outcomes oforthopaedic trauma sustained in the military. Theoverall goal of the consortium is to produce theevidence needed to establish treatment guidelinesfor the optimal care and outcomes of servicemembers and civilians who sustain high-energytrauma to the extremities.

Function and Outcomes Research forComparative Effectiveness in Total JointReplacement (FORCE-TJR) Project“Each year, more than 700,000 adults in the UnitedStates elect Total Knee Replacement (TKR) or TotalHip Replacement (THR) surgery to restore physicalfunction and eliminate the persistent pain ofadvanced knee or hip arthritis,” says Dr. Suk. “By2030 primary and revision TKR and THR use isprojected to grow significantly, especially amongpatients under 65 years of age.”

Presently there is wide variation in TKR and THRimplant selection, surgical approach, post-surgeryfunctional improvement and implant revision rates.

The majority of existing research is retrospective and limited to the Medicare population.

Geisinger Orthopaedic Institute Research Report

The Geisinger Orthopaedic Institute research team.

Orthopaedic surgery residents participate in the daily directed academic review.

Geisinger Exam Results• 2012-100%• 2011-96%• 2010-98%• 2009-98%• 2008-98%

• 2007-98%• 2006-99%• 2005-99%• 2004-95%• 2003-99%

Game-Changing Research

The FORCE-TJR project focuses on working adultsunder 65 years of age. Its goals are to:

1) guide decisions on optimal implant timing,surgical approach, implant selection and peri-operative management,

2) decrease complications and to improve implantlongevity and function following surgery, and

3) inform policy to reach currently underservedminority populations.

Geisinger has enrolled 690 patients by the end of2012 for this project.

Geisinger Poised to Conduct Musculoskeletal Outcomes Research Through the 2010 Affordable Care Act, legislationestablished the Patient-Centered OutcomesResearch Institute. It is anticipated that much offuture research will be orthopaedic in nature, so it isimportant to be able to provide critical input on theclinical effectiveness and appropriateness of medicaltreatments and services. Dr. Suk is the lead author ofone of the only textbooks of musculoskeletaloutcomes, instruments and measures, positioningGeisinger to quickly establish a Center forMusculoskeletal Outcomes Research.

“We can harness the electronic medical record forepidemiologic data to help identify trends inmusculoskeletal disease, track clinical outcomes anddevelop registries,” says Dr. Suk. “These are just a

few obvious things that can be a critical componentof our efforts to continually seek ways to improveand maximize Geisinger’s competitive edge.”

The following research efforts were funded in 2012: • Thomas Bowen, MD, orthopaedic oncology

surgeon, has joined with Drs. Kennedy andEbenstein, professors of Biomedical Engineeringat Bucknell University, on a study entitled“Determination of Localized Bone Quality:Correlation of Bone-Screw Pullout and BoneMicro-Indentation to the Bone Mineral Density.”He is also the principal investigator on the Eli Lilly GHDQ study, a phase 3 multicenter,multinational study.

• Matthew McElroy, DO, primary care sportsmedicine physician is undertaking a study entitled,“Ultrasonography Versus MRI in the Diagnosis ofTibial Stress Fractures.”

• Daniel Horwitz, MD, chief orthopaedic trauma atGeisinger Medical Center, received funding for hisstudy, “Vitamin D Deficiency and Low EnergyFractures in Adolescents.” He also serves as aprincipal investigator of “Lidocaine Analgesia for Removal of Would Vacuum Assisted Closure Dressings.”

• The OMEGA Medical Grants Association offered agrant to support a Geisinger trauma skills lab forresident education.

ChairmanMichael Suk, MD, JD, MPH

Attending OrthopaedicSurgeonsAdult ReconstructionDavid J. Kolessar, MD

Foot and AnkleGerard J. Cush, MD

General OrthopaedicsAnthony J. Balsamo, MDG. Dean Harter, MDSteven A. Lillmars, DOJohn A. Lynott, MD

Hand and MicrovascularJoel C. Klena, MDDavid Chan, MD

Orthopaedic OncologyThomas R. Bowen, MD

OrthopaedicTrauma/FractureDaniel S. Horwitz, MDMichael Suk, MDJames C. Widmaier Jr., MD

Pediatric OrthopaedicsMeagan M. Fernandez, DOStacy A. Frye, MDWilliam M. Mirenda, MDJohn M. Parenti, MD

PodiatryBarry G. Bernstein, DPMLucia K. T. Nguyen, DPMSandra L. Pensieri, DPM

Non-Operative PrimaryCare Sports MedicineMark D. Brayford, DOSergio R. Buzzini, MDMatthew T. McElroy, DODavid S. Ross, MD

SpineDavid A. Andreychik, MDW. Fred Hess, MDZeferino Martinez, MD

Sports Medicine andArthroscopyGregory C. Fanelli, MDDaniel D. Feldmann, MDGlen T. Feltham, MDWilliam J. Krywicki, MDHans P. Olsen IV, MDJason C. Phillips, MD

Fellows, Primary CareSports MedicineRyan Roza, MDJason Scotti, MD

Residents, OrthopaedicSurgeryAndrew L. Cornelious, MDBlake E. Moore, MDNathan L. Cafferky, MDRobert B. Jones, MDAndrew Lehman, MDJustin G. Brothers, MDAmy L. Speeckaert, MDElvis Xhaferi, MDL. Christopher Grandizio, DOAdam K. Lee, MDNathaniel C. H. Wingert, MDDaniel P. Deasis, MDJames C. Huston, MDCory T. Walsh, MD

Advanced PractitionersBeth Baylor, PA-CKathryn Cawley, PA-CTimothy Egan, PA-CRobert Emery, PA-CJulie Farrow, PA-CLarry Gerhard, PA-CMichael Hufnagle, PA-CNicole Knight, PA-CWalter Koss, PA-CErin Liss, PA-CStacy Lockuff, PA-CBrooke Maloney, PA-CSteven Milewski, PA-CDonald Miller, PA-CAnn Patterson, PA-C

Amy Patynski, PA-CAlexander Piczon, PA-CMichael Podobinski, PA-CDiana Rhoades, PA-CNancy Rowlands, PA-CJenna Shappell, PA-CJohn Snurkowski, III, PA-CAlyssa Tewksbury, PA-CNicole Tobias, PA-CStephanie Wolfe, PA-CKaren Mettler, CRNPDavid Hoffman, CRNP

Nursing StaffDavid Meredick, RNBarbara Smith, RNJanice Heimbach, RNShawna Meighan, RNRachel Frabel, RNSandy Pearse, RNMelinda Pick, RNStacey Winner, RN

Professional Staff

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The experts of the Geisinger Orthopaedic Institute care for patientsthroughout northeastern and central Pennsylvania.

BerwickGeisinger–Berwick220 West Front StreetBloomsburgGeisinger–Bloomsburg Hospital549 Fair StreetGeisinger–Orthopaedics480 Central RoadDallasGeisinger–Dallas114 Lt. Michael Cleary DriveDanvilleGeisinger Medical Center100 N. Academy AvenueGeisinger–Woodbine115 Woodbine LaneLewisburgGeisinger–Lewisburg250 Reitz BoulevardMontoursvilleGeisinger–Lycoming780 Broad Street, Suite 4

ScrantonGeisinger–CommunityMedical Center1800 Mulberry StSelinsgroveGeisinger–SusquehannaUniversity**620 University Avenue

ShamokinGeisinger–Shamokin AreaCommunity Hospital**4200 Hospital RoadCoal TownshipState CollegeGeisinger–State College200 Scenery Dr

TunkhannockGeisinger–Tunkhannock110 Treible Road, Suite 1

Wilkes-BarreGeisinger–Orthopaedics*1175 East Mountain BoulevardGeisinger South Wilkes Barre25 Church StreetGeisinger Wyoming ValleyMedical Center1000 East Mountain Boulevard

*A service of Geisinger Wyoming Valley Medical Center.**A service of Geisinger Medical Center