Dallas Veterans Affairs Medical Center
Orthopedic Section

The Orthopaedic Service staffs the largest outpatient clinic at the VAMC. The residents are supervised in clinic by Drs. John Neufeld, Marvin Van Hal, Michael Huo, Pamela Sherman and Michael Browne. Dr. Neufeld is Chief of the Orthopaedic Surgery Department at the VA and is responsible for the day-to-day management of the complex service.  Drs. Neufeld and Van Hal supervise the residents in the management of patients with general orthopaedic conditions, while Dr. Huo (associate professor of orthopaedic surgery at UT Southwestern) coordinates the joint reconstruction service.   The hand service is coordinated by Dr. Sherman, and the shoulder service is coordinated by Dr. Browne.  Drs. Jim Brodsky and Chris Royer, and their fellow, provide foot and ankle care in conjunction with the residents.

The Orthopaedic Service runs two operating rooms, three days a week.  Operative cases are in the range of 500-600 per year. The patient load is typical of a general hospital, but is skewed toward the older Veteran population. Disease of attrition such as osteoarthritis hip fractures and hand and shoulder condition are commonly encountered as well as a full range of low energy trauma injuries.

Weekly rounds are held, as well as morbidity and mortality conferences and quality control conferences with pre-operative x-ray evaluation and templating, and post-operative follow up.

Resident education is a high priority at the Dallas VAMC.

Goals and Objectives

1. Understand the basic science of bone, cartilage, ligaments, tendons, and muscle with respect to cellular structure, anatomy, and pathophysiology.
2. Understand the inflammatory response with respect to soft tissue injury and healing.
3. Perform a focused history and physical examination of the involved areas and present the pertinent positive and negative findings.
4. Review and point out important findings on plain films and MRI studies.
5. Formulate a differential diagnosis for the patient in the order of likelihood.
6. Institute an appropriate course of physical therapy, rehabilitation, and bracing for the given condition AND understand the rationale for doing so.
7. Understand when surgical treatment may be indicated and support a decision for surgery with a pertinent review of the literature.
8. Know the common surgical approaches to the involved extremity as well as the routinely used open and arthroscopic techniques.
9. Be able to identify and address common complications and discuss them at a weekly Morbidity & Mortality conference.
10. Apply the principles of rehabilitation and supervise a postoperative physical therapy program to achieve the optimal result.
11. Understand when an athlete may return to play or when a given patient may resume his/her activities of daily living.

The residents will also gain procedural and surgical training in the following areas:

1. Aspiration/injection of joints, tendon sheaths, and bursae of the upper and lower extremity.
2. Routine arthroscopy of the shoulder and knee, and to a lesser extent, the elbow, hip, and ankle.
3. Appropriate positioning of patients for arthroscopic procedures and knowledge of the necessary equipment/implants for each case.
4. Arthroscopic debridement and repair of meniscal injuries.
5. Arthroscopic treatment of chondral injuries in the knee.
6. Repair and reconstruction of the following ligaments in the knee: ACL, MCL, LCL, PCL, and posterolateral ligamentous complex.
7. Understand orthopedic restoration techniques for total joint arthroplasty. Evaluate appropriate patients and be aware of complications and their management.
8. Thoroughly understand the rehabilitative process and complications thereof.
9. Be able to perform routine total joint arthroplasty and manage complications of this surgery.
10. Understand basic principles of revision total joint arthroplasty and be able to accomplish expected levels with educational training level.
11. Thoroughly understand evaluation management of specialty areas of foot, ankle, hand and shoulder/elbow in accordance with assigned faculty.

last edited: June 12, 2008