Pre-Conference Workshop
Wednesday, August 7, 2002

Hands-on Workshop:
Upper & Lower Limb Casting Applications, BSN Medical
Bobbi Charlesworth, OTC, RTR & Carl Johnson, OTC
BSN sponsored a casting Hands-on workshop on Wed. which had a great turn out. Carl Johnson OTC came from England to share his expertise with us here in the US. His techniques were very unique. He talked about the mere basics of casting from fiberglass material to the indications for each cast. Johnson demonstrated each cast and everyone had time to try his technique. We applied a short arm cast, thumb spica and a short leg cast.

20th Annual Clinical Symposium
Thursday, August 8, 2002

Pediatric Scoliosis: A Unique Patient Profile and Orthosis
John Mezurecky, OTC
John Mezurecky, OTC from Santa Ana, California, presented this lecture. John was the winner of the BSN call for papers and he was awarded $500 cash plus his all expenses paid trip to Washington D.C. for his paper. His paper described the history of pediatric scoliosis and then he gave a patient profile of an eight-year-old female. The paper also shows and depicts a unique orthosis fabricated for this young child. For further information regarding this presentation you can find the complete article in "The Journal of the National Association of Orthopaedic Technologists" Spring 2002 Volume 8, No. 1.

Current Concepts in Management of PCL Injured Knee
Christopher Annunziata, MD
Dr. Christopher Annuziata spoke about the current concepts in treatment of patients with PCL deficient knees. He discussed both the surgical and non-surgical options. Dr. Annuziata discussed two surgical options Single bundle vs. Double bundle. Also discussed was using either allograft or autograft (SimiTendonosis). We also got some insight to the future treatment of this injury, and the fact that at this time there have been very little studies done of the PCL deficient knee.

Hands-on Workshop:
Basic Splinting Techniques, DeRoyal
David Marshall, OTC, OT-SC
David's experience in the field of orthopaedics for more than 35 years were evident as he sharedhis techniques to make splinting easier for the applicator and patient. Throughout the morning workshop, David's expertise was invaluable in the application of plaster of paris splints.

Total Contact Casting, BSN
Michael Gill, OTC

Splinting and Casting the Child with an Anomaly
Caroline Chester, MD
The speaker went into depth, touching on a wide variety of congenital had anomalies. Dr Chester described the type of anomaly and then the treatment, most of which were surgical. She stressed the importance of us, the OTC's, in the role of these patient's recovery. All of these patients need some sort of splinting or casting through their postop recovery and physical therapy. Without our knowledge and expertise as OTC's the patients outcome would be less than optimal.

Tennis Elbow, “A New Technique”
Frank Pettrone, MD
Dr. Pettrone carefully outlined a new technique called, Extra Corrareal Shock Wave Therapy.

Articular Cartilage Lesions in Young Athletes
Frank Pettrone, MD
The complex microstructure of this type of cartilage, which is divided into four zones (based on the distribution of cells, proteoglycan and orientation of collagen fibers) allows it to carry out its functions. When a lesion is found in young athletes, non-operative treatment may be an option.

Advancements in Treatments in Chondromalacia
Peter Solan, OTC
The overall objective of this presentation was for us to become familiar with the assessments and classification of chondral defects, and to help us understand and assist in determining what course of treatment is appropriate for the patient with these problems. An initial review of the knee was done, followed by chondral defect classifications and their evaluations. Mr. Solan then went through the alternative treatments for chondromalacia including injectable agents, microfracturing, allograft vs. autologus transfers, and osteotomys. The various treatment levels were highlighted by slides of the actual treatments, O.R. procedures, and final outcomes, giving us an informative dialogue on the advancements now being done in this field.

Documentation & Charting
Joyce Benton, RN, MSA, ARM
The purpose of this presentation was to help understand the risks associated with patient care, and to help develop strategies to manage these risks. It stresses the importance of a patient medical record, including communication, documentation, legal defense, reimbursement, peer review, teaching, research, and improvements. It reviewed common documentation problems and their possible outcomes, and what could be done to correct them. Ms Benton also reviewed Standards of Care on the national, state, and local levels and how each facilities Policy and Procedures need to emphasize and follow their documentation guidelines in reference to charts, telephone conversations, discharge instructions, charting, late entries, corrections, alterations, and additions. An overview of organization approved formats and institution approved abbreviations, as well as subjective and objective charting guidelines, made this a very informative expose, geared to identify and reduce potential problems within the work place.

Hands-on Workshop:
Functional Cast Therapy, BSN
Bobbi Charlesworth, OTC, RTR and Cindy Henderson, OTC
Functional Cast Therapy Cindy Henderson and Bobbi Charlesworth conducted the breakout BSN sponsored. Cindy went over the properties of the polyester and the very many uses. She applied a short arm cast and a humeral fracture cast and demonstrated how to break down the cast to use as a splint. She went over the importance of coding for this technique in order to get proper reimbursement.

Hands-on Workshop:
Focused Rigidity Casting- DePuy
Michael Gill, OTC, OT-SC
The FRC workshop was an opportunity to see what is the most revolutionary Techniques for the orthopaedic technologist since the invention of Fiberglass. With this product we have learned how to keep some of the money going out of the clinic, in the clinic. With the hands-on portion of this workshop, we learned how to apply this product for a custom fit thumb spica splint that could be removed with a pair of scissors.

Friday, August 9, 2002

Pediatric Spinal Evaluation
Mark Romness, MD
Dr. Romness stressed how important patient and family history is to evaluating a child. It is important to realize they are children and not "little adults". Deformities are seldom noticed by parents, usually are picked up by coaches, teachers or school nurses in screenings. It is very important for the physician to gage the relationship between the parent and child.

Neural Vascular Assessment and Compartment Syndrome In Pediatric Fractures
Bill Martin OPA-C/OTC
Mr. Martin talked about non-accidental trauma, child abuse and mandatory reporters. He gave an overview of neural vascular compromise, with a review of symptoms, signs and patient assessment in the young patients that cannot verbalize their complaints. Martin provided a nice review of growth plate injuries, Salter-Harris classifications and epiphyseal injuries, and compartment syndrome in children.

Patient Care Before & After Cast Application: Preventing Additional Problems
Suzanna Klyber, OT/L
Klyber involved the audience by having them do the basic stretches she teaches her patients to do. The problems that patients can have in casts were discussed and she gave tips to help patients deal with them. Exercises that are prescribed post cast were demonstrated and everyone in the audience tried them. She had just been to a meeting called Scar Wars...she shared some ideas on massage to scars and the care of scars.

The Shoulder in Sports
Samuel Matz, MD
Dr. Matz gave a very informative presentation including slides of the anatomy and function of the shoulder joint. He explained the importance of a good physical exam to evaluate the shoulder injury. We learned about static stabilizers and dynamic stabilizers for the shoulder. The impingement signs: Hawkins & Neer and stability tests. Various classifications of dislocations were explained the slides demonstrated the different treatment modalities.

Hands-on Workshop: Difficult Casts/PTB
Tony Campagna, 3M
Campagna discussed rthe eason and indications for proper casting materials and technique. Step by step demonstration of PTB cast was presented. Interaction with audience encouraged for questions and comments. Hands on workshop, audience participation, to focus on PTB and proper casting.

Hands-on Workshop: Advanced Splinting
Ken Hawkins, BSN Medical
Ken held an interesting hands-on class using Ortho-Glass padded fiberglass splinting. He began by showing some easy ways to measure the Ortho-Glass to make sure you use the right size and cut the right length to prevent waste. He followed by showing some commonly used splints but using special "tricks" to make them easier to apply. These tricks usually involved cutting the Ortho-Glass in a way that it almost holds itself to the patient so the Ortho. Tech. is able to use both hands for applying the elastic wrap, thus enabling a better fitting splint. Sugar tong, thumb spica, lower leg, and hand/wrist splints were demonstrated.

Ken also demonstrated an excellent splint to be used in the place of an off the shelf knee immobilizer. The splint stays in place better than immobilizers. When utilizing Ortho-Glass and elastic wrap, splint codes can be used to bill for the patient instead of a durable medical goods code, which many insurance companies will not cover. Attendees of the class were then invited to practice the tricks that Ken shared and ask him specific questions about splinting problems they have encountered in their practice.

Saturday, August 10, 2002

OSHA Bloodborne Pathogens
Ralph Falvo, RN
Infection control is THE most important thing YOU can do for yourself and your patients according to Ralph Falvo who spoke on OSHA blood borne pathogens. Using "Universal Precaution" is the best way to control infection. Universal Precaution is treating ALL body fluids as if they are infected. Ralph reviewed how infections are spread in clinical settings and how to avoid common mistakes in the work place. "It seems your mother was right when she insisted you wash your hands. This is the first weapon in the fight against the spread of infection," Ralph said. He recommended singing, "Twinkle, Twinkle, Little Star" while washing your hands between each patient. "This gives you the 15 seconds of time needed to properly wash your hands." Ralph spoke about the standard protections needed for your patients. He also stressed the need for self-protection, not only with protective equipment such as gloves, gowns and goggles, but also having hepatitis and flu shots. Guidelines to follow if you are exposed to blood borne pathogens were reviewed. It was an informative talk where Ralph related exposure problems he has encountered in his 27 years of nursing and administrative experience.

Women and Orthopaedic Surgeons: Enhancing the Relationship
Laura Tosi, MD
Another in a long line of excellent speakers for the 20th Annual Symposium, Dr. Laura Tosi spoke on a topic near and dear to anyone involved in the care of patients with osteoporosis. I left Dr. Tosi’s talk not only more informed on the subject, but also with the feeling that I had just been entertained for the last thirty minutes. It was a very important topic, covered by an excellent speaker.

The Cast Treatment of Club Feet
John E. Herzenberg, MD
An introduction to idiopathic clubfoot was presented regarding identification, historical treatment, and modern treatment. Ms. Hicks and Dr. John E. Herzenberg prefer the Ponseti method of treatment that includes serial casting of the forefoot, followed by Achilles tendon tenotomy, and additional casting. Post cast correction is obtained and maintained by usage of Dennis Brown splints. For more information contact www.aaos.com.

Limb Lengthening
Dror Paley, MD
Dr. Paley, a recognized expert in limb lengthening, started his lecture off with a brief history of the methods that originated in Russia and Italy. He explained, in depth, each how each procedure was performed and the complications associated with each. Dr. Paley described the Ilizarov technique and the “lengthening over nail” technique using an external fixator in conjunction with an inter-medullary rod and the implantable limb lengthening techniques that are available today. The procedures to reduce pin-track infections include a daily shower or swim followed by drying thoroughly and debriding. He described the importance of having a large support team involved to get the best results. The patients’ attitude and motivation play a key role in the amount of success achieved. Dr. Paley also stated that the patients who did not come to his clinic faced a 99% chance of having their limb amputated. Studies are ongoing and the field is evolving in leaps and bounds.

Joint Replacement Deformity
David Silber, MD

Orthotic Tricks of the Trade
Greg Banks, CPO

Round Table Forum: Bracing
Moderator, Jim Pelletier, OTC, OTS/C, COF

3:00 pm - 5:00 pm
Round Table Forum: Coding
Moderator, Kathy Covington, OTC
There were approximately 15 people that attended. Most of those present had specific questions for the group, and wanted opinions on what other people thought about how to code specific things. Topics included coding the Focused Rigidity Cast application, proper use of modifiers and where to get information on how to code specific bracing appliances. It was the general consensus of the group that there is no actual authority on coding specific bracing and splinting applications. Suggestions such as calling the manufacturer and checking with the local Medicare and specific insurance carriers were discussed.