UPMC Mercy Hospital Foot & Ankle Orthopedic Surgery .
UPMC Mercy HospitalFoot & AnkleOrthopedic SurgeryRotation Guidelines:Alan Y. Yan, MDCell: 917-902-5435Kristi Price, PA-CCell: 516-506-5641https://52BonesMD.comOffice: 412-232-9080Dear Residents & Fellows:Hey YOU!Welcome to UPMC Mercy Hospital Foot & Ankle Orthopedic Surgery Rotation. If this is your firstadventure into orthopedic surgery and the wonderful foot and ankle world or your last stop before youbecome a big shot foot and ankle orthopedic surgeon yourself, this rotation will ROCK YOUR WORLD.Goals for your rotation:For the interns – understand and familiarize yourself with the following: The principles of orthopedic surgery applied in foot ankle surgeryFoot and ankle surgical and imaging anatomyThe outpatient practice flow and tasksOutpatient and inpatient perioperative managementOperating room flow & basic skillsLocation of our clinics:
Mercy Main Office (Wednesday Clinic):Mercy Hospital Professional Building1350 Locust Street, Suite 220Pittsburgh, PA 15219Mercy Comprehensive Foot & Ankle Center (Monday & Friday Clinic):1515 Locust St. Suite 350Pittsburgh, PA 15219Location of our surgery centers: Mercy Main O.R. (Tuesdays): Mercy Hospital 3rd Floor Main O.R.Montefiore O.R. (Thursdays): Montefiore Hospital 5th Floor Main O.R.Shadyside Ambulatory Surgery Center (ASC) (4th Monday of the month): Shadyside East Wing,2nd floorSchedule of our practice: Mondayo Every other Monday: Clinic @ Mercy Comprehensive Foot & Ankle Clinic, 11:30 am –2:30 pmo 4th Monday of the month: Surgery @ Shadyside ASC, 7:30 am first case startTuesday Surgery @ Mercy Hospital Main O.R., 7:30 am first case startWednesday Clinic @ Mercy Main Orthopedic Office, 8:30 am to 4:00 pmThursday Surgery @ Montefiore Hospital Main O.R., 7:10 am first case startFriday Clinic @ Mercy Comprehensive Foot & Ankle Clinic, 7:30 am – 2:30 pmPlease arrive 15 mins earlier @ clinic except for Wednesday after clinical education day for the interns.Please arrive one hour earlier on surgery days to greet the surgical patient, check all pre-op labs, placerelevant orders, and prep the O.R. room (see below).Please familiarize yourself with our Clinic Manual and use it for reference as ---------------Intern Tasks & Responsibilities: Clinic:o The priority is to see the new patients and get the detailed and accurate informationrelevant to the patient’s visito We use templates on clinical notes Please import Epic SmartPhrases from Dr. Yan’slist: .YANNEWGENERAL, .YANFOOTANKLEEXAM) Dr. Yan typically selects the billing codeso Enter relevant orders for the patient
o Assist in splinting, casting, and reduction maneuvers as needed. Occasionally it may behelpful for you to help the MA’s or Kristi with suture removal, wound care, etc.In-Patient Rounding:o Patients admitted to our service (most commonly 23-hour observation status versusinpatient) need overnight or inpatient care after surgery (see attached sheet from Kristiregarding orders)o Round daily before clinic or O.R. if there will be any admitted patientso Sign out appropriately to on call night ortho PA or resident (see attached sheet fromKristi regarding contacts)Surgery Days:o Prepare/read relevant anatomical and technical information prior to plannedprocedureso Attend pre-op conference with attendingo Verify and complete H&P when needed in the PACUo Prep and drape the patient in the O.R. (see attached sheet from Kristi regarding ORprep)o Assist and observe in surgeryo Assist in closure, dressing, and splinting of the patiento Take patients to the PACU recovery area and deliver a hand-off report to PACU nurseo Enter Immediate Post-Op Noteo Perform post-operative neurovascular status check and document as addendum toImmediate Post-Op Note if patient requires post-operative nerve block or nerve blockcatheter dosingo Place admission orders when patient being admitted (see attached sheet from Kristiregarding orders)o Kristi typically puts in Depart information for patients that are being discharged thesame day but you should know how to do this as well (see attached sheet from Kristiregarding Depart information)Required Reading - Papers: see links on websiteReference Books: Orthopaedic Knowledge Update: Foot and Ankle 6: Print E book (AAOS - AmericanAcademy of Orthopaedic Surgeons) 6th Edition by Loretta B. Chou M.D. (Editor)
Foot & Ankle (Orthopaedic Surgery Essentials) Second Edition by DavidThordarson (Author) Handbook of Foot and Ankle Orthopedics 1st Edition by Rajiv Shah (Author) Surgical Exposures in Foot & Ankle Surgery: The Anatomic Approach Illustrated Editionby Piet deBoer MA FRCS (Author), Richard Buckley MD FRCSC (Author), StanleyHoppenfeld MD (Author), Hugh A Thomas (Illustrator)Online Resources: Orthopedic Knowledge Quick References: www.orthobullets.comAOFAS Official Website: www.aofas.orgOrthopedic Operative & Clinical Video References: www.vumedi.com
Foot Ankle Specialist Operative & Clinical Video References: www.footinnovate.comMinimal Invasive Foot Ankle Surgery Society: www.grecmip.orgFoot Ankle Information for Patients: www.footcaremd.orgAAOS Official Website: www.aaos.orgOnline e-learning Orthopaedic Atlas of Surgical Procedures www.orthoracle.comSociety of Skeletal Radiology: www.skeletalrad.orgDr. Alan Y. Yan Personal Site hub for all links & info: www.52BonesMD.comAdditional Online Resources: Additional Links - THE FOOT AND ANKLE RESOURCE(footankleresource.com)Pre-Op Conferences: It is the responsibility of residents and fellows to present cases in short concise PowerPointformat for conferences for the upcoming week as well as past major surgical cases orcomplicationsPerks & Activities: Cadaver Lab monthly or bimonthly pending arrangements that are madeDr. Alan Y. Yan’s Clinical & Anatomical Picture Gallery @ Mercy Comprehensive Foot AnkleCenter Provides Key Information to learn & enjoyRemind Dr. Alan Y. Yan for your exit conclusion discussionResident Talks: Choose an interesting clinical/surgical topic of the foot/ankle and present by the end of enior Resident or Fellow Tasks & Responsibilities: Clinic:o The priority is to see the new patients and get detailed and accurate informationrelevant to the patient’s visit. Formulate your plan to present to attendingo We use templates on clinical notes Please import Epic SmartPhrases from Dr. Yan’slist: .YANNEWGENERAL, .YANFOOTANKLEEXAM) Dr. Yan typically selects the billing codeso Enter relevant orders for the patiento Assist in splinting, casting, and reduction maneuvers as needed. Occasionally it may behelpful for you to help the MA’s or Kristi with suture removal, wound care, etc.In-Patient Rounding (assisting Intern or Junior Resident on team):o Patients admitted to our service (most commonly 23-hour observation status versusinpatient) need overnight or inpatient care after surgery (see attached sheet from Kristiregarding orders)o Round daily before clinic or O.R. if there will be any admitted patients
o Sign out appropriately to on call night ortho PA or resident (see attached see from Kristiregarding contacts)Surgery Days:o Prepare/read relevant anatomical and technical information prior to plannedprocedureso Discuss and verify implants and options and pre-operative preparation with attendingo Verify and complete H&P when needed in the PACUo Prep and drape the patient in the O.R. (see attached sheet from Kristi regarding ORprep)o First assist in surgeryo Assist in closure, dressing, and splinting of the patiento Assist intern or junior resident in: Taking patients to the PACU recovery area and delivering a hand-off report toPACU nurse Entering Immediate Post-Op Note Performing post-operative neurovascular status check and document asaddendum to Immediate Post-Op Note if patient requires post-operative nerveblock or nerve block catheter dosing Placing admission orders when patient being admitted (see attached sheet fromKristi regarding orders) Kristi typically puts in Depart information for patients that are being dischargedthe same day, but you should know how to do this as well (see attached sheetfrom Kristi regarding Depart information)Required Reading - Papers: see links on websiteAdvanced Reference Books: Mann's Surgery of the Foot and Ankle: Expert Consult Operative Techniques in Foot and Ankle Surgery Second Edition by Mark E. EasleyMD (Editor), Sam W. Wiesel MD (Editor)
Sarrafian's Anatomy of the Foot and Ankle: Descriptive, Topographic, Functional ThirdEdition by Armen S Kelikian MD (Editor), Shahan K. Sarrafian MD FACS (Editor) Manual of Fracture Management - Foot and Ankle Illustrated Edition by StefanRammelt (Editor), Michael P. Swords (Editor), Mandeep S. Dhillon (Editor), Andrew K.Sands (Editor) Drennan's The Child's Foot and Ankle by James J. McCarthy, James C. Drennan, et al.
Ankle Arthroscopy: Techniques Developed by the Amsterdam Foot and Ankle Schoolby C. Niek van Dijk Foot & Ankle Arthroscopy by Richard D Ferkel MD Imaging Anatomy: Knee, Ankle, Foot by Julia R. Crim MD, B. J. Manaster MD PhDFACR, et al.Online Resources: Orthopedic Knowledge Quick References: www.orthobullets.comAOFAS Official Website: www.aofas.orgOrthopedic Operative & Clinical Video References: www.vumedi.comFoot Ankle Specialist Operative & Clinical Video References: www.footinnovate.comMinimal Invasive Foot Ankle Surgery Society: www.grecmip.orgFoot Ankle Information for Patients: www.footcaremd.orgAAOS Official Website: www.aaos.orgOnline e-learning Orthopaedic Atlas of Surgical Procedures www.orthoracle.comSociety of Skeletal Radiology: www.skeletalrad.org
Dr. Alan Y. Yan Personal Site hub for all links & info: www.52BonesMD.comAdditional Online Resources: Additional Links - THE FOOT AND ANKLE RESOURCE(footankleresource.com)Key General and Specialty Foot & Ankle Journals: FAI: Foot & Ankle International Foot & Ankle International: SAGE Journals (sagepub.com)FAO: Foot & Ankle Orthopedics Foot & Ankle Orthopaedics: SAGE Journals (sagepub.com)Foot & Ankle Clinics of North America Home Page: Foot and Ankle Clinics (theclinics.com)TFAS: Techniques in Foot and Ankle Surgery Techniques in Foot & Ankle Surgery (lww.com)JOT: Journal of Orthopaedic Trauma Journal of Orthopaedic Trauma (lww.com)JAAOS: Journal of AAOS JAAOS - Journal of the American Academy of Orthopaedic Surgeons(lww.com)Responsibilities: Guiding and teaching interns or junior residents on rotationAssume intern responsibilities if intern or junior resident will be absent in clinic, rounding,conferences, or O.R.Perks & Activities: Cadaver Lab monthly or bimonthly pending arrangements that are madeDr. Alan Y. Yan’s Clinical & Anatomical Picture Gallery @ Mercy Comprehensive Foot AnkleCenter Provides Key Information to learn & enjoyRemind Dr. Alan Y. Yan for your exit conclusion discussionPre-Op Conference: It is the responsibility of residents and fellows to present cases in short concise PowerPointformat for conferences for the upcoming week as well as past major surgical cases orcomplicationsTalks (Optional): Choose an interesting clinical/surgical topic of the foot/ankle and present by the end of ords of Wisdom on Doctoring: Do the Right Thing. Do Things Right. --- Ko, Wen-je MD (Taiwan)Nobody cares how much you know, until they know how much you care. ---Theodore RooseveltThe secret of patient care is that you really CARE. --- A. Y. Yan, MDSafe Practice is Happy Practice. --- A. Y. Yan, MDDr. Yan’s 3 Key Questions to ask yourself before you sign up patient for surgery:1. Is the surgery going to make the patient ANY better than not having surgery?2. Do ANY of the risks of the surgery outweigh the benefits?3. Do the procedures you plan to do have ANY salvage options?
Dr. Yan’s Non-Op Criteria:1. Non-compliant patients refusing or unable to make peri-operative changes for modifiablesurgical risks.2. ANY of the surgical related risks outweigh the benefits.3. Any doubts on secondary gain for the surgery.4. ANY unrealistic expectations from the patient.Communication, Communication, Communication.On time, accurate and precise to your care team and your patients. --- A. Y. Yan, MDAny great initiatives need perfect follow ups. Never leave an open end in your work. --- A.Y. Yan,MDIt is much easier to stay out of the trouble then later get out of the trouble you have alreadymade. --- A.Y. Yan, MDNo acceptance of any compromises on patient safety or care. No acceptance of any deviation onyour standards of practice. Let your patients and staff know clearly. Inside or outside of O.R.Remember, YOU ARE THE BOSS in patient care team.YOU ARE THE ONE TO BE SUED if anything goes wrong. --- A.Y. Yan, MDTry your best to find the simplest solution for the most complicated situation. K.I.S.S. it. (Keep itsimple and stupid) --- A.Y. Yan, MD (design principle noted by the U.S. Navy in 1960)Pay 120% attention to details in surgery and on your top of the game in the O.R. Do anythingnecessary to achieve the best result you have in your mind while still in the O.R. The clinic willbe a time for celebration instead of time of regret and remorse and hard time talking to yourpatients. --- A. Y. Yan, MDREMEMBER It is your responsibility to pass down to your next rotation resident or fellow for this keyinformation and orientation.REFER to all links on www.52BonesMD.com if you feel lost and ask Dr. Yan directly.Enjoy learning and have fun.Alan Y. Yan, MD
OR Prep, Orders, Contacts, & Depart InformationOR Room Prep Bring up pertinent imaging on computer Write your name and glove size on the white board – grab your gloves for 1st case! Collect specific prep supplies (if not already done by RN/surgical tech)o Patient positioning 2 blankets for hip bump Ankle fracture, supine: bone foam Basically any foot procedure or prone ankle fracture: stack of 5 or so blanketso Blue chucko Clear U-drapeo 2 Chlorohexidine sponges wet with normal salineo Purple 34” tourniquet (larger if needed)o Steri 1000 drapes x 4 if getting BMACImmediate Post-Op Note Residents are responsible for completing this note post-operatively (or if you are busy, I cancomplete!) For patients needing post-op nerve blocks or dosing for their nerve block catheters, you mustdocument a NV check as addendum to Immediate Post-Op Note For inpatients, also need to addend post-op note with a brief A&P so overnight PA’s can haveidea of our plan for the patient and can copy over for next dayInpatient Post-op Info Post-op orders can be placed pre-operatively (with exception of consults to other services whichshould be placed post-operatively so that service can see the patient once they receive notificationof consult) Admission Med Reconciliationo Generally d/c NSAIDs, especially for fractures, fusionso Generally d/c post-op BP meds other than beta-blockers if volume-depleted Admission order:o Status: 23-hour observationo Location: Unit 11E (if @ Mercy) Medicationso Dr. Yan prefers Lovenox 40 mg QD on POD#1 at 6 AM (never POD#0) as DVTprophy for nearly all inpatientso Post-op Abx for all in-patients, 1st dose 8 hours after dose administered by anesthesia preop Ancef 2 g Q8H x 24 hours PCN allergy or suspected infection: Vanco 1 g Q12H x 24 hours Consult Services at Mercyo PTo OTo Hospitalist consults: Consult Hospitalists (MER) order – no specific doc For patients with many medical co-morbidities or unable to manage on our owno ID: Consult Infectious Disease – no specific doco Cardiology: Consult MD order: Dr. John Wardo Vascular surgery: Consult MD order: Dr. Samuel Simoneo Medtrak if unable to determine physician to consult or contact ortho PA to inquire
Generally no post-op films needed unless Dr. Yan indicates otherwiseOther helpful inpatient info for Mercyo Mercy PA’s cover overnight: Pager # 412-602-0074, I generally give them a sign-offbefore I leave via phone, text, or in-person in Office at Mercy in Suite 220o 11E Nurse’s station: 412-232-7131o 11E Case Managers Marian: 412-439-4587 Debby: 412-639-3109 Stephanie: 412-815-9547Depart Information General infoo I usually do the Departs for our outpatient surgeries but will have you assist if neededo I prescribe all these medications (pain, DVT prophy, anti-constipation, and anti-nausea)unless the patient requests otherwiseo Also, we generally discontinue any NSAIDs after fractures/fusions to promote bonehealing. Other procedures such as arthroscopic debridement only, Brostrom internalbrace, ROH, may continue/prescribe NSAIDso No antibiotics needed for outpatient procedures unless Dr. Yan indicates otherwise orsuspected infection Dr. Yan Post-Operative Medication Preferences1. Extra strength Tylenol 500 mg tablets 2 tablets by mouth every 8 hours x 10 days #120, 1 Refill Other notes Not to exceed 3,000 mg per day Generally not PRN, patient should take scheduled2. Oxycodone 5 mg tablets #20 (if Q6H) or #30 (if Q4H) depending on invasiveness of procedure, 0 Refills Other notes Should be PRN pain and wean off as quickly as possible Patients are usually prescribed either Q4H or Q6 hours Usually only 5 day course prescribed. Will occasionally refill if within 2weeks of surgery.3. Xarelto OR Aspirin (OR Lovenox if insurance does not approve Xarelto or patientcannot afford): ALL PATIENTS ARE PRESCRIBED A MEDICATION FOR BLOODCLOT PREVENTION IF IMMOBILIZED IN SPLINT/CAST/BOOT No risk factors for DVT Wt 200#: Aspirin 162 mg QDo Two 81 mg tablets by mouth once dailyo #120, 1 Refill Wt 200#: Aspirin 325 mg QDo 1 tablet by mouth once daily Risk factors for DVT or previous DVT or clinical decision Xarelto 10 mg tableto 1 tablet once daily with foodo #30, 3 Refills Lovenox 40 mg SQ QDo Usually Rx x 14-21 days4. Docusate (Colace) 100 mg capsule
1 capsule by mouth 2 times per day as needed for constipation #205. Senna 8.6 mg tablet 2 tablets by mouth at bedtime as needed for constipation #206. Ondansetron (Zofran) 4 mg ODT (oral disintegrating tablet) 1 tablet by mouth every 8 hours as needed for nausea or vomiting #10Follow-up Information - most patients should follow-up within 2 weeksBraces/Binders/Splints/Pin Site Care Information (see below)BULKY JONES - NWBPlease keep splint clean, dry, and intact.Please do not get splint wet. You may sponge bathe, hang splint out of tub, or wrap in trash bag and sealat top with duct tape.Please do not remove splint. It will be removed at your first post-operative clinic visit in about 2 weeks.Please do not bear weight on your splint. Use crutches as directed.KEEP LEG ELEVATED to level of your heart as much as possible for the 1st two weeks after surgery.Move your knee and wiggle your toes frequently.You may ice under the knee of your surgical leg for 20 minutes every 2 hours with a towel between yourskin and the ice to prevent cold burns.SCOPE ONLYWBAT in CAM BootYou may bear weight as tolerated in your CAM boot on the surgical leg and to use crutches for assistance.Whenever you are walking or are up and about your home or if you leave your home, you MUSTwear your CAM boot.Please keep dressings clean, dry, and intact. Do not remove dressings for the first 10 days followingsurgery.Please do not get dressings wet. You may sponge bathe, hang splint out of tub, or wrap in trash bag andseal at top with duct tape.You may remove dressings 10 days following surgery and shower. Please do not scrub or soak theincisions but you may allow water to run over the incisions. Please pat dry and re-dress with clean, drygauze and wrap with clean ACE wrap. Your sutures will be removed 2 weeks after surgery in the office.KEEP LEG ELEVATED to level of your heart as much as possible for the 1st two weeks after surgery.Move your knee and wiggle your toes as frequently.You may remove the CAM boot to ice over the surgical area for 20 minutes every 2 hours with a towelbetween your skin and the ice to prevent cold burns. Put the CAM boot back on after icing.ROHYou may bear partial weight ( 50% of weight) on your surgical leg in your CAM boot, using crutches forassistance for 1 week. Then, 1 week after surgery, may weight bear as tolerated on surgical leg in CAMboot.Please keep dressings clean, dry, and intact. Do not remove dressings for the first 10 days followingsurgery.Please do not get dressings wet. You may sponge bathe, hang splint out of tub, or wrap in trash bag andseal at top with duct tape.
You may remove dressings 10 days following surgery and shower. Please do not scrub or soak theincisions but you may allow water to run over the incisions. Please pat dry and re-dress with clean, drygauze and wrap with clean ACE wrap. Your sutures will be removed 2 weeks after surgery in the office.KEEP LEG ELEVATED to level of your heart as much as possible for the 1st two weeks after surgery.Move your knee and wiggle your toes as frequently.You may remove the CAM boot to ice over the surgical area for 20 minutes every 2 hours with a towelbetween your skin and the ice to prevent cold burns. Put the CAM boot back on after icing.PIN SITE CAREBegin pin site care 3 days after surgery.Mix normal saline with hydrogen peroxide in a 50/50 mixture.Dip a Q-tip or clean gauze into solution and wipe around pin sites twice daily.
Handbook of Foot and Ankle Orthopedics 1st Edition by Rajiv Shah (Author) Surgical Exposures in Foot & Ankle Surgery: The Anatomic Approach Illustrated Edition by Piet deBoer MA FRCS (Author), Richard Buckley MD FRCSC (Author),
UPMC for You Advantage. Effective January 1, 2013, UPMC added the UPMC . Community Care plan and updated the UPMC for Life Options and UPMC for You Advantage benefits. These three plans comprise UPMC Health Plans Special Needs Plan lineup. UPMC for You Advantage (HMO SNP) UPMC for You Advantage offers enhanced dental benefits for dual .
PARTIAL LIST OF EXTREMITIES ICD-9 CODES FOR SUPPORTIVE TREATMENT TO THE FOOT OR ANKLE: 714.7 Rheumatoid Arthritis, Ankle/Foot 715.7 Osteoarthritis, Ankle/Foot 718.87 Joint Derangement, Ankle/Foot 726.70 Enthesopathy of Ankle 727.68 Rupture of Tendons, Foot/Ankle 726.73 Calcaneal Spur 727.1 Bunion 728.71 Plantar Fibrometosis
In November 2020, UPMC Pinnacle unveiled the new UPMC Children's Harrisburg inpatient unit, bringing UPMC Children's Hospital of Pittsburgh's nationally ranked specialty care to the southcentral PA community. "Since Pinnacle hospitals were merged into the UPMC network in 2017, UPMC has invested 910
ankle foot orthosis, multiligamentus ankle support, prefabricated, off-the-shelf l1907 ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated l1910 ankle foot orthosis, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes
Handbook of Foot and Ankle Orthopedics 1st Edition by Rajiv Shah (Author) Mann's Surgery of the Foot and Ankle: Expert Consult . by Ruth Solomon, John Solomon, et al. c. Arthroscopy Foot Ankle . External Fixators of the Foot and Ankle
stabilizers for the lateral ankle, and are L ateral ankle sprains or "sprained ankles" are among the most common lower extremity injuries treated in a sports podia-trist's office. 30% of all sport inju-ries involve the ankle and 15-20% are sprains.1 On any given day, one person in 10,000 sustains an ankle sprain.1 Ankle sprains are more com-
related foot surgery. Risks and Benefits of Surgery The purpose of treatment is to decrease your pain and improve the function of your foot. We do not offer surgery for cosmetic reasons. The foot and ankle is a complicated area of our body. Many conditions affecting the foot and ankle may cause discomfort. Initial treatment is usually non .
CCSS Checklist—Grade 2 Writing 1 Teacher Created Resources Writing Text Types and Purposes Standard Date Taught Date Retaught Date Assessed Date Reassessed Notes ELA-Literacy.W.2.1 Write opinion pieces in which they introduce the topic or book they are writing about, state an opinion, supply reasons that support the opinion, use linking words (e.g., because, and, also) to connect opinion and .
