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OneThousandOne represents the amount of time, verbally, that it takes to count to one second. In this one second of time, a great thing happened at Nebraska Medicine. In fact, several great things probably happened. A patient was cured, a researcher found the missing link, a nurse treated an injury, a doctor comforted a family or maybe a child just smiled.
MOMENTS IN MEDICINE
Fall | Winter 2009

Finely Tuned

Beverly Lightner

As a retired teacher, an avid musician, pianist and conductor, and an adoring grandmother, Beverly Lightner should have been having the time of her life.

Instead, she was having pain.

Arthritis that had attacked her left shoulder was making it difficult for the 75-year-old Lightner to do just about everything she loved.

“The last two and a half years, my movement had become more and more limited,” she says. “The joint had deteriorated to where I didn’t want to straighten out my arm or move it horizontally.

“The pain was excruciating. I couldn’t hug my grandbabies, at least not with both arms. I couldn’t pick them up. I couldn’t play the piano. Even driving was a challenge.”

When a fellow pianist and friend recommended the orthopaedic surgeon who had operated on her shoulder, Lightner made an appointment to see Edward Fehringer, MD, shoulder and elbow surgeon in the Department of Orthopaedic Surgery and Rehabilitation at the University of Nebraska Medical Center (UNMC) and its primary teaching hospital, The Nebraska Medical Center.  

“He said he couldn’t guarantee me 100 percent improvement,” Lightner recalls, “but that he could make it considerably better.”

So Lightner put her faith and her care in the surgeon’s skillful hands.

“Our team works diligently every day to make the proper diagnosis and prescribe an appropriate and comprehensive course of treatment. Patients can rely on that.”
Kevin Garvin, MD

Staffed by experienced surgeons, specialists, scientists, biomedical engineers and researchers, and teams of dedicated nurses, therapists and support personnel, the Department of Orthopaedic Surgery and Rehabilitation provides top-quality care to more than 35,000 patients each year.

They come from around the corner and around the world because the department has built a reputation for being at the forefront of orthopaedic surgery, research and rehabilitation, says Professor and Department Chair Kevin L. Garvin, MD.

“Our department’s clinical faculty has grown from six people to 15 (see sidebar on page 39) since 2000, making it the largest and most comprehensive orthopaedic group in the state and region,” Dr. Garvin says. “The department is a top-tier educational resource, and when it comes to research, our Biomechanics Lab has become a premier implant testing facility that is directly impacting design and testing standards for total joint implants. Our Nano-Biotechnology Lab is making great strides building tougher, ‘smarter’ implants for future generations.

Kevin Garvin, MD

“When you need advanced orthopaedic treatment, this is the place.”

The Nano-Biotechnology Laboratory, at the Scott Technology Center on the Aksarben campus, is producing nanocrystalline structures intended to improve the longevity of artificial joint implants. Working with other UNMC researchers from the departments of genetics, cell biology and anatomy, and pathology and microbiology, they are developing durable coatings that promote bone marrow stromal cell growth while reducing the possibility of infections.

“We hope these advanced technologies will enhance bone growth and reduce patient recovery time, will be instrumental in prolonging the life of orthopaedic prostheses, and will have many other scientific and biomedical applications,” Dr. Garvin says.

By collaborating with each other and across fields, orthopaedic department members offer a total team approach to orthopaedic care.

“Our clinical faculty are skilled in the prevention, diagnosis and treatment of musculoskeletal disorders, ranging from minor injuries to the most complex surgical cases,” he says, “and for all ages, from pediatrics to the elderly.”
Treatment can range from physical therapy or minor surgery to complete joint replacement.

“Our team works diligently every day to make the proper diagnosis and prescribe an appropriate and comprehensive course of treatment,” Dr. Garvin says. “Patients can rely on that.”

Left to Right: Anthony Lauder, MD,
Edward Fehringer, MD, and
Kevin Garvin, MD

One of these team members is Anthony Lauder, MD, a hand and upper extremities specialist in the Department of Orthopaedic Surgery and Rehabilitation, who treats many types of problems, including carpal tunnel syndrome, wrist and hand pain, arthritic conditions and tendinitis.

“I enjoy the challenge of diagnosing and treating complex hand and wrist problems,” he says. “I find most issues can be treated by conservative means, but certain problems require a comprehensive surgical approach.”  

Many orthopaedic injuries are the result of common, involuntary reactions, like when people stumble and begin to fall, they stretch out their hands. Afterward, if they’ve been lucky enough not to break any bones, they probably wipe the dirt from their palms and look to see if anyone was watching.

If they did fracture their hand or wrist, they’d come to see Dr. Lauder.

“By restoring the joint surface, I try and prevent the need for replacement due to fractures,” he says. “However, I do perform wrist fusions, the removal of bones, joint reconstruction and arthroplasty of the basal joint of the thumb to relieve pain and restore stability. With distal radius fractures, my goal is to get the joints put back together as closely as possible to the way they were. I do everything I can to make things heal as one.”

Dr. Lauder also treats a great deal of hand and wrist trauma. He sees young people injured in high-speed automobile accidents, and he sees elderly hurt in ground-level falls.

“Because we are a designated trauma center, we receive a lot of the worst cases that come along,” he says. “We also treat difficult cases that require particular expertise.”

“I focus the operation to address the pathology at hand and preserve as much of the anatomy as possible.”
Edward Fehringer, MD

While Dr. Lauder hasn’t seen any recent trends concerning the injuries he treats, he does note that they often come in cycles. “In the winter we get fractures from snowboarding; in the summer, it’s skateboarding.”

Whatever the cause, Dr. Lauder says a growing number of the injuries are being successfully treated operatively rather than conservatively.

“Patients tend to do better because of the surgical treatments we employ,” he says. “They experience less pain and often recover more rapidly, and they get their range of motion back more quickly.”

The opportunities to teach and conduct research are prized by the orthopaedic department members.

Dr. Fehringer, a native of Newman Grove, Neb., who grew up in Columbus, Neb., completed his fellowship in shoulder and elbow surgery at the University of Washington in Seattle and entered private practice. But he decided within a few months it wasn’t a good fit at that point in his career.

“I missed the academic environment,” he recalls. “I wanted to return to a place where I could perform surgery and also teach and pursue my research interests.”

That place is the Department of Orthopaedic Surgery and Rehabilitation at UNMC, where Dr. Fehringer became the first shoulder and elbow fellowship-trained orthopaedic surgeon in Nebraska.

His clinical interests include shoulder and elbow arthritis, dislocations, fractures and rotator cuff tears. His research focuses on rotator cuff tears and their relationship with aging, as well as shoulder socket reconstruction in joints affected by arthritis.

In performing rotator cuff repairs, Dr. Fehringer has been able to apply his knowledge of the disease process to his surgeries.

“I focus the operation to address the pathology at hand and preserve as much of the anatomy as possible, to better aid reconstruction efforts in the future should the repairs fail,” he says. “Because of the comprehensive approach of clinical care, research and teaching, I’ve gained a better appreciation for the patients who are most likely to benefit from rotator cuff surgery.”

Regarding shoulder replacement surgery, Dr. Fehringer says that historically, hip replacement principles were applied to shoulder replacements because they are both ball and socket joints. “In reality, the shoulder and hip are dissimilar and therefore have different reconstruction principles.”

Shoulder replacement surgery
allowed Beverly Lightner to
resume many of the activities
she had given up due to pain and
limited join mobility.

Along with other medical professionals at UNMC and the Veterans Administration Medical Center in Omaha, Dr. Fehringer is investigating methods that are hoped to make shoulder replacement surgery possible without the use of bone cement.

“We’re using nanotechnology to improve the bone incorporation onto our orthopaedic shoulder implants so that bone cement isn’t necessary,” he says.

When used in high volumes, bone cement, or poly (methyl methacrylate), can induce shoulder socket bone death, he says. Nanotechnology can allow for the incorporation of a coating on orthopaedic implants that will encourage peripheral stem cell adhesion and growth.

“This coating actually prompts the patient host bone to grow onto the prosthesis,” Dr. Fehringer says. “It may shorten the operation but also improve the replacement’s longevity and maintain the patient’s existing bone. That’s important because bone loss and loosening can be a problem following shoulder socket replacement.”

It’s also important, Dr. Fehringer says, because the rate of shoulder joint replacement “continues to rapidly rise, possibly due to an increase in diagnoses but also because of better treatments available.”

Treatments that helped put Beverly Lightner’s  mind at ease.

Lightner says Dr. Fehringer and the others involved in her shoulder surgery took the time to explain the procedure in detail she could easily understand.

Among the many instructions she received, Lightner was told she wouldn’t be allowed to drive for at least three weeks. Living independently for years, she was fearful she would have to disrupt the lives of her grown children to take her from her home in Lincoln to Omaha for physical therapy after surgery.

“I did exactly what he told me to. I followed his orders to the last letter.”
Beverly Lightner

“Dr. Fehringer told me not to worry,” she recalls. “He said I could do my therapy on my own; that I would be responsible for it.”

Lightner underwent shoulder replacement on July 1, 2008. She was discharged on July 3 and did physical therapy by herself in her home five times a day for the first six weeks. “I did exactly what he told me to,” she states emphatically. “I followed his orders to the last letter.”

A light-hearted woman who punctuates nearly every sentence with a laugh, Lightner says her surgery was a complete success. “It’s like I have a whole new arm,” she says. “I can play my piano. I can pick up my grandkids when they run to me.

“My children think I look younger because my face isn’t lined with pain anymore,” she says, smiling. “They say it’s nice to have their mother back.”

Skilled Specialists

The Department of Orthopaedic Surgery and Rehabilitation is a dynamic team of medical professionals who take pride in providing the best in patient care, orthopaedic education and training, and embarking upon innovative and vital research.

The department clinical faculty, each fellowship-trained, consists of:

Chairman Kevin L. Garvin, MD; whose specialty is adult reconstructive surgery;

Miguel S. Daccarett, MD; sports medicine and orthopaedic traumatology;

Mark E. Dietrich, MD, sports medicine and general orthopaedics;

Paul W. Esposito, MD, pediatric orthopaedic surgery;

Edward V. Fehringer, MD; shoulder and elbow surgery;

Glen M. Ginsburg, MD, pediatric orthopaedic and spine surgery;

Curtis W. Hartman, MD, adult reconstructive surgery;

Brian P. Hasley, MD, pediatric orthopaedic and spine surgery;

Beau S. Konigsberg, MD, adult reconstructive surgery;

Anthony J. Lauder, MD, hand and upper extremity;

Sean V. McGarry, MD, musculoskeletal oncology;

Matthew A. Mormino, MD, resident program director, orthopaedic traumatology and lower extremity;

N. Åke Nyström, MD, PhD, upper extremity and microvascular surgery;

Lori K. Reed, MD, foot & ankle and general orthopaedic surgery; and Susan A. Scherl, MD, pediatric orthopaedic surgery.

The department includes the following research faculty:

Hani Haider, PhD, director of Biomedical Engineering Research and Advanced Surgical Technologies; and Fereydoon Namavar, ScD, director of the Nano-Biotechnology Laboratory.

Next article in the Fall | Winter 2009 issue of One Thousand And One:
Picking up the Pace