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Curriculum

Course Objectives

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.



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
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
Radiology - Approach to Tumors pathologic signs (e.g.. onion peeling, moth-eaten pattern, etc.)
Radiology - Common Tumor Differentials  
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
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)