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Textbooks used throughout the nation, San Antonio's Emergency Medical Service (EMS), and research efforts that may eliminate the use of metal and plastic in joint replacement surgeries are among a few of the accomplishments of the department of orthopaedics at the Health Science Center.

When James D. Heckman, MD, professor/chairman and holder of the John J. Hinchey, MD, Chair in the department of orthopaedics, says the Health Science Center wrote the book on fracture care, he means it literally. Now in its fourth edition and first published in 1975, Drs. Rockwood and Green's Fractures in Adults has become the standard textbook in the United States for management of fractures and is used by every orthopaedic residency program in the country.

"It's how we're known on a national level--we're the fracture place," said Dr. Heckman. "Many of us have written extensively on specific fractures, and in our research lab there's a major push on the study of fracture healing--the books and the research all kind of fit together."

Two Health Science Center orthopaedists, Charles A. Rockwood, Jr., MD, professor and chairman emeritus, and David P. Green, MD, clinical professor, had the idea for the text--a review of the entire literature about every fracture. Drs. Rockwood and Green penned the adult edition; later, Kaye E. Wilkins, MD, DVM, clinical professor of orthopaedics, wrote the pediatric edition. The department currently is working on a compendium.

"Dr. Rockwood [first chairman of the department] and I both feel that a strong, clinical program is necessary in addition to academics--each faculty member has an active, vibrant practice," said Dr. Heckman. "As a result, we serve as a referral center for colleagues outside the Health Science Center."


Other milestones were reached by the department of orthopaedics in the 1970s, including the development of the emergency medical service (EMS) program for San Antonio. "In the 1970s, Dr. Rockwood and Dr. Jack Williamson [formerly of orthopaedics] founded EMS," Dr. Heckman said. "For years we ran EMS out of these campus offices, and until very recently we were the online radio control officers for trauma for the city of San Antonio.

"Before EMS," Dr. Heckman explained, "ambulance drivers were hired on the basis of how quickly they could get to the accident, retrieve the victim, and get him or her to the hospital without having an accident. EMS changed all that--our approach was to get there fairly quickly, but then to stabilize the victim in the field, so the drivers didn't necessarily have to race back to the hospital." San Antonio and Bexar County's Emergency Medical Services System became fully operational March 1, 1974.

"Out of the EMS effort came another book--Emergency Care and Transportation of the Sick and Injured--which is the emergency medical training manual published by the American Academy of Orthopaedic Surgeons," Dr. Heckman added. "The academy put an orange cover on it, so it's been called the 'orange' book. There have been other texts, but ours has about a third of the market in this country--there are about 2 million in publication. It's something we're very proud of."

Dr. Rockwood wrote and edited the first and second editions of the textbook; Dr. Heckman was responsible for the next three. Arthur S. McFee, MD, PhD, professor of surgery, was among the authors for all five editions.

Donald J. Gordon, MD, PhD, professor and chairman of the department of emergency medical technology in the School of Allied Health Sciences, now oversees the training for emergency medical technicians. Dr. Gordon also co-authored the last three editions of the emergency care textbook.

The department presents more than 11 types of courses for EMS technicians and fire fighters, and each year approximately 200 certificates are granted to participants who complete the numerous programs. Through the department of emergency medical technology, the Health Science Center produces more paramedics than any other university in the United States. Also, the department serves as a National Registry Testing Center—tests for national certification in various programs are administered on campus. In addition, the department provides basic and advanced life support courses to more than 1,100 professional Health Science Center students annually.

Dr. Gordon, who serves as chairman of the ACLS (advanced cardiac life support) advisory board for the Texas Affiliate of the American Heart Association, noted that, "We have come a long way and now will lead the way for the next 25 years."

While the 25th anniversary of the Health Science Center brings numerous past accomplishments to the fore, the next 25 years for the department of orthopaedics are likely to be even more dynamic. "There's a big, exciting frontier in orthopaedic research." Dr. Heckman said. "There's a move away from metal and plastic to biological replacement of joints--we'll be using tissue regeneration and gene therapy. We are already seeing the beginnings of it.

"For example, we now use metal and plastic to restore joints affected by degenerative arthritis--restoring them with biological material is a better idea," he added. "But, an awful lot of work in basic research has to be done to figure out how to make musculoskeletal tissues repair and regenerate.

"We will also be accelerating fracture healing--making the process more robust," explained Dr. Heckman. "Again, we will be doing that with biology." He with others working in his laboratory have developed stimulation modalities which have cut the fracture healing time by 25 percent. This research group includes Barbara D. Boyan, PhD, professor of orthopaedics and director of the Health Science Center's Industry-University Cooperative Research Center, and Kyriacos A. Athanasiou, PhD, and C. Mauli Agrawal, PhD, both associate professors of orthopaedics.

They hope one day to supplement the repair processes in patients with bone morphogenetic proteins, proteins that can accentuate fracture healing by making the process faster and yielding a more solidly healed bone.

The other major focus of this research group is the repair of articular cartilage through the use of genetically engineered cells, growth factors and biodegradable scaffolds in cartilage and bone.

The orthopaedics department also boasts of the largest continuing education course at the Health Science Center--sports medicine. Every year approximately 550 trainers, team physicians and coaches from school and professional programs attend the offering which focuses on sports-related injuries and rehabilitation. This year marks the 25th anniversary of the course.


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