This basic science course is designed to provide the participant with an outline of normal growth and development, the pathophysiology of the categories of disease, and related treatment principles. A lecture series on interpretation of radiographs reinforces the concepts of clinical, radiologic, and pathological correlation. Lectures, hands-on pathology laboratory sessions, and clinical case examples provide a comprehensive learning experience. The material should allow one to develop lasting conceptual models for the musculoskeletal system.
The goal of the course, then, is to provide the orthopaedic surgeon with a solid set of information on which to base thought processes throughout his or her career.
Module 1 – The Basics of Orthopaedic Basic Science
| Histology Boot Camp | Microscopy, preparation, stains, basic identification of cells & surrounding structures. Main purpose is to teach residents how to read the slides |
| Skeletal Cell Biology & Growth factors | Osteoblasts, osteocytes, chondroblasts, chondrocytes, etc. Role, function, life cycle, and quickly important growth factors (e.g. Vit D, PTH, estrogen, etc.) that act on them |
| Orthopedic Embryology | Mesenchymal stem cells, germinal layers, important genes and their clinical mutations(HOX, Wnt, etc.), zone of polarizing activity, chondro & osteoblasts differentiation, limb bud development |
| Osteogenesis | Enchondral and intramembranous ossification, woven bone, circulation of long bones, distraction osteogenesis, fracture healing but only simplified since it will be given during the fracture healing talk |
| Growth plate & Remodelling | Growth plate formation, maintenance, ossification, impact of loading and remodelling, Wolff’s law, clinical implications of blood supply. Role of biphosphonates. senescence and death of growth plate, remodelling especially of diaphyseal vs. metaphyseal layer, periosteum implications |
| Functional Anatomy: Bone | Type of bone (cortical, vs. cancellous, lamellar vs. woven, red vs. yellow marrow, endosteal vs. periosteal, aging changes (e.g. porosity, GAGs, etc.), composition, structure, nutrition, bone formation and resorption, mechanisms of bone formation and deletion, mechanisms of bone growth, matrix vesicles, modeling and remodelling, coupling, bone formation and resorption disorders |
| Functional Anatomy: Cartilage & Menisci | Types of cartilage, composition, nerve and vascular supply, collagens, proteoglycans, nutrition, matrix hemostasis, Cox genes, cell biology, cartilage repair |
| Functional Anatomy: Joints | Joint structure and function, types of Joints (synovial fibrous, etc.), histology of synovium, synovial cells and matrix, joint lubrication, synovial fluid, clinical implications (e.g. rheumatoid, PVNS, joint contractures, etc.) |
| Functional Anatomy: Muscle & Tendon | Function, types, structure, metabolism and repair. Mention of muscular dystrophy, Marfan, Ehler-Danlos, MCL vs. ACL healing, tendons and ligaments metabolism, loading, grafting and repair options, role of inflammation |
| Biostatistics | Introduction to statistics relevant to orthopedic literature interpretation |
| Functional Anatomy: CNS | Development, anatomy of cord, classification of injuries, important reflexes (e.g. bulbocavernosus), myelopathy, neurogenic shock, spinal shock, autonomic dysreflexia |
| Functional Anatomy: PNS | Peripheral nerves and function, Wallerian degeneration, injuries (stretch, laceration, compression), classification of injuries (neuropraxia, axonotmesis, neurotmesis), treatment, prognosis, effects of Botox, tetanus and local anaesthetics |
| Nerve Injury Repair | Nerve conduction studies and repair. Ideally include intraoperative monitoring |
Module 2 – Non-neoplastic Conditions
| Skeletal Dysplasias | PFFD, epiphysiodysplasia, achondroplasia, dystrophic dysplasia, spondyloepiphyseal dysplasia, mucopolysaccharidosis, Blount’s |
| Metabolic Bone Diseases – Part I | Calcium homeostasis, PTH, Vit D, calcitonin, renal osteodystrophy, osteomalacia, rickets |
| Metabolic Bone Diseases – Part II | mineralization disorders, osteopetrosis, Paget’s, osteoporosis |
| Radiography – Common Interpretive Errors | Approach to radiographs, approach to trauma, fat pad sign, rarefaction, stress shielding, screw loosening, sclerosis. radiation exposure |
| Radiology – MRI | Interpretation, gadolinium, phases, basic knee and shoulder interpretation |
Module 3 – Orthopaedic biomechanics
| Biomechanics – Part I | Freebody diagrams, definitions of pressure, elasticity, plasticity, failure, Young’s modulus, forces, moments, instant center of rotation, torques, dynamics, strength, load deformation, stiffness, yield, force, failure, stress-strain curves, fatigue, loading, beam analysis, torsion |
| Biomechanics – Part II | Fracture patterns, healing (e.g. atrophic vs. hypertrophics), load bearing vs. load-sharing devices, bone properties (shear, tension, compression). Clinical implications. locking vs. non-locking, screw principles (e.g. pitch, cut-out, cannulation, tapping, etc.) |
| Kinematics | Normal gait, gait cycle, amputee gait, prosthetics & orthotics, amputations effects on energy/work load, crutches, etc. |
| Biomechanics – Upper limb | Shoulder, elbow, hand tendons (Excursion, etc.) |
| Biomechanics – Foot & Ankle | Foot, Ankle |
| Biomechanics – Hip & Knee | Hip, Knee |
| Arthropathies | Pathology in relation to osteoarthritis, rheumatoid, seronegative arthropathies, gout, pseudogout, AVN |
| Radiography of Arthritis & Arthropathies | Radiography of arthritis and arthropathy for orthopaedic surgeons |
| Biomaterials | Tribology, ingrowth vs. ongrowth, metabl-body interactions, rejection, metallurgy (immune reactions), corrosion, degradation resistance, strength of materials, failure (creep, hysteresis, relaxation, wear), metals used in orthopedics (steel, titanium, cobalt alloys), cements, ceramics. will incorporate clinical cases |
| Arthroplasty | Metal, polyethylene, ceramic, cement implications, hinged vs. non-hinged |
| Biomechanics – Spine | Column theory, saggital balance, coronal balance, spondylolisthesis and spondylolysis |
| BioEquipment | Sterilization, OR equipment, electrocautery principles, suture types and selection (contraindications), anchor selections, tables (Jackson, Beach chair, traction table, implications like hypotension / perineal nerve injuries, venous pooling, etc), padding and positioning to prevent nerve injury / ulcers |
| Biology & Biomechanics of Fracture Healing | Fracture healing, primary vs. secondary bone healing, myosific ossificans, stress fractures. Histologic and radiographic appearances |
| Bone Grafting | Bone grafting (allograft, autograft, synthetic graft), biocompatibility, donor site morbidity |
Module 4 – Neoplastic Conditions
| Radiology – Approach to Tumors | pathologic signs (e.g.. onion peeling, moth-eaten pattern, etc.) |
| Radiology – Common Tumor Differentials | |
| Trauma – DCO | Post-traumatic bone loss, masquelet technique, size of bone loss defect and management options, when to operate for open fractures, damage control orthopedics, basic science markers |
| Infections | Pin tract infections, infected non-union, acute vs. chronic osteomyelitis, Brodie’s abscess, and antibiotics |
| MRI part II | |
| Neoplasia – Introduction | General concepts (including tumorigenesis, metastasis mechanisms, how chemo and radiation work. Their implications to surgery (e.g.. fractures, skin dehiscence, infections, etc.) |
| Osseous Neoplasia | osteosarcoma, high and low grade, Ewings sarc |
| Cartilage & Fibrous Neoplasia | Chondrosarcoma high and low grades, enchondroma, fibrous dysplasia |
| Neoplasia – Other Part I | Multiple myeloma, lymphoma and giant cell tumor, Cystic (UBC, ABC) |
| Neoplasia – Other Part II | Chordoma, soft tissue sarcoma and other interesting pathologies (adamantinoma, etc.) |
| Neoplasia – Metastatic | Metastatic disease, basic science of metastatic disease, role of bisphosphonates. |
| Neoplasia – Treatment & Complications | Chemotherapy, radiotherapy, sequela of neoplasia treatment |
| Vasculopathies – Part I | Virchows triad, epidemiology, prophylaxis (mechanical, pharmacological), medications (Warfarin, ASA, heparin, LMWH, Factor X inhibitors), clotting cascade, duration of prophylaxis, diagnosis of VTE, HITT, PE diagnosis and treatment |
| Vasculopathies – Part II | DM and traumatic angiopathies, including amputations ABI and PPPG (e.g. calcification, microangiopathy, macroangiopathy) |
| Pharmacology – Analgesics | Focus on analgesics in relation to pain management, bone healing and heterotopic ossification. Also complications of usage (non union, nephrotoxicity, mortality) |