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Hand Surgery Fellowship Curriculum

Clinical Component

The four hand surgery fellows rotate through various institutions in four equally divided rotations. At each institution, the fellow works with assigned clinical attendings. The fellow assumes progressive responsibility and accountability, applicable to all clinical settings, including inpatient, outpatient, operating rooms, emergency room, and private office.

During the year, each fellow achieves clinical competence in the full breadth of hand and microsurgery under the guidance of faculty from both Plastic Surgery and Orthopedic Surgery who are fully trained in hand surgery. This training includes skeletal and soft tissue trauma, peripheral nerve, brachial plexus and microvascular surgery, congenital, pediatric, and adolescent surgeries, Dupuytren contracture, posttraumatic contractures, elbow and wrist instabilities, minimally invasive and arthroscopic procedures, as well as degenerative and rheumatoid arthritis.

Microsurgery Training

Irrespective of the background training of the fellow, all fellows attend the week-long microvascular skills course early in the training year- this includes live animal surgery for end-to-end artery and vein anastomosis, interposition vein graft, and free flap transfer.

Anatomy Skills

Opportunities arise throughout the year for fresh cadaver dissection for understanding general basic upper extremity anatomy and soft tissue flap design. In addition to the annual flap course, there are other opportunities in bioskills sponsored by industry and orthopedic device companies. These allow fellows to become familiar with specific orthopedic devices and endoscopic equipment and provide anatomy skills, extensile exposure, and carpal kinematics.

Rotations

There are four rotations (currently for each of the two orthopedic and two plastic surgery hand fellows which have been combined into one full year fellowship). Each rotation is designed to be a continuum; for example, one of the rotations focuses on congenital and pediatric hand problems. Another rotation deals mainly with the spectrum of adult hand and upper extremity problems in the private setting (both clinic and operating room), and the remaining rotations have the fellow primarily at the two public institutions, namely VA Medical Center and Ben Taub Hospital.

Didactic Curriculum

There are two regularly scheduled weekly conferences that are Zoom meetings.

Core Curriculum Didactic Hand Conference

Time: 6.30 a.m. (Monday)

Plastic Surgery residents, hand fellows, rotating residents, hand therapists and hand faculty attend this conference. It covers the hand and upper extremity core curriculum in a systematic manner, starting with applied anatomy and principles and progressing through the full spectrum of conditions. Lectures are given by experts in their respective fields.

Problem Case Management/Journal Club

Time: 6.30 a.m. (Tuesday)

The goals of the case management conference as well as the monthly journal club are to put into practice what was learned in a recently preceding didactic lecture. This converts the passive learning into active clinically based application. This conference has a smaller audience comprising fellows, rotating hand residents and hand surgery faculty and therapists. Fellows are assigned to each conference with a designated moderating faculty. 

  • Orthopedic and Plastic Surgery Grand Rounds
  • Morbidity and Mortality Conference

The fellowship provides funds for hand fellows to attend the ASSH Annual Scientific Meeting. Additional industry-supported conferences include those sponsored by AO trauma, Acumed and Arthrex.

Immediately upon starting fellowship, each Fellow must become a candidate member of both ASSH and AAHS. A letter of recommendation is provided by the program director. This gives direct access to the Journal of Hand Surgery, Hand, Young Members Forum, Hand-e and many other online learning resources.

Hand Surgery Fellowship Research

This program strongly encourages research activity. Research may involve direct participation in clinical or anatomic projects, helping with writing book chapters, or technical articles, and case reviews.

A research project is required of all hand fellows before completion of the fellowship. The research manuscript must be completed and acceptable for submission to a journal for publication. Fellows are required to prepare and make a formal presentation to the orthopedic faculty at the Scientific Program each year.

Pederson

  1. Trost J, Abu-Ghname A, Davis, MJ, Maricevich, RS, Pederson, WC, and Maricevich, M Arteriovenous Malformations of the Hand:  Optimizing Outcomes with Palmar Arch Reconstruction, Plas Reconstr Surg  150(5):1059-1069, 2022.  PMID 35998124
  2. Wagner, R, Yang, J, Pederson, WC, and Izaddoost, S. Free latissimus dorsi flap for upper extremity reconstruction in a 9 month-old. Case Reports Plast Surg Hand Surg 2:8(1):105-109, Jul 2021  PMID:34263010
  3. Pederson, WC, Phillips, W, Jalalabadi, F, White, LE, and Reece, EP. Sirenomelia:  Review of a rare syndrome with case report, review of anatomy, and thoughts on management. Plastic and Reconstructive Surgery, 150(6): 1321-1331, 2022. PMID: 36126198
  4. Raj V, Koshy J, Bell B, Pederson, WC, and Reece, EM. Operative pediatric hand infections:  A retrospective review. J Pediatr Orthop 2021 May 13. PMID: 33999563.
  5. Pederson, WC, Killion, E, and White L. Reconstruction of a portion of the articular surface of the distal radius with a vascularized osteochondral graft from the proximal phalanx of the great toe. J Hand Surgery Global Online May 3, 2021.   PMID:35415553
  6. Kaplan, J, Wagner, R, White, LE, Pederson, WC, Recurrent Brachial Artery Aneurysm Repair in a Child Managed with Gore-Tex Conduit Reinforcement, J Vasc Surg Case InnovTech 7(2):295-297, 2021. PMID 33997577
  7. Colen, DL, Kania, KE, Levin, LS, Reece, EM, Pederson, WC, Innocenti, M, and Kovach, SJ. The medial femoral condyle flap in the pediatric patient. Plastic and Reconstructive Surgery.  147: 613e, 2021. PMID 33775035
  8. Abu-Ghname, A, Luu, BC, Trost, J, Davis, M, Pederson, WC, Maricevich, R, and Maricevich, M. The Challenges of Upper Extremity Intramuscular Hemangioma: a Case Study and Systematic Review, Plast Reconstr Surg 150(2):367-376, 2022.. PMID: 35671450
  9. Larkins, CG, Tannan, S., Burkett, AE, Mithani, S. Srinivasan, R, and Pederson, W.C.Autologous Osteoligamentous Reconstruction of Scaphoid Proximal Pole with Metatarsal Head and Collateral Ligament – Cadaver Anatomic Description of Novel Surgical Technique.  Hand (N.Y.) 2020 Jan 22:15589. PMID: 31965865
  10. Srinivasan, R.C., Pederson, W.C., Morrey, B.F.  Distal Biceps Tendon Repair and Reconstruction.  J Hand Surg 45:48-56, 2020. PMID: 31901332
  11. Grome, L, Koshy, J, Schultz, K, Bell, B., Reece, E, and Pederson, WC.  The Epidemiology of Operative Pediatric Hand Trauma: A Retrospective Chart Review.  Hand (NY) 2019 Dec 17:1558944719893037.  PMID: 31847596
  12. Dibbs, R, Grome, L, and Pederson, WC. Free Tissue Transfer for Upper Extremity Reconstruction, Seminars in Plastic Surgery, Ducic, Y (ed), 33(1):17-23, 2019. PMID: 30863208
  13. Covelli, j, Schallert, EK, Kan, JH, and Pederson, WC  Hamate-pisiform coalition complicated by fracture in a pediatric patient. Radiol Case Rep 13(6):1163, 2018. PMID: 30233751

Bell

  1. Adindu E, Head B, Bell B. The Effect of Joining the ASSH Hand Trauma Center Network on the Volume and Severity of Pediatric Hand Trauma Transfers. J Hand Surg Glob Online. 2023 Jul 22
  2. Chhabra B, Phillips T, Mitchell T, Gattu N, Ezeokoli E, Bell B. Pediatric Hand and Wrist Fractures in Osteogenesis Imperfecta: An Analysis of Incidence, Patient-Specific Risk Factors, and Fracture-Specific Characteristics. J Pediatr Orthop. 2023 (Online ahead of print)
  3. Bratsman A, Cano M, Phillips T, Schallert E, Bell B. Surgical Excision versus Ultrasound-Guided Treatment of Symptomatic Wrist Ganglia in Pediatric Patients. JPOSNA. 2023 Feb 1.
  4. Dibbs RP, Mitchell TW, Baumgartner RE, Koshy JC, Bell BR. Complication rates in patients with classic and radiographic variants of Seymour fractures. J Pediatr Orthop. Online only. 2022 Nov 28.
  5. Sheth M, Mitchell S, Bell B, Wu C. Essex-Lopresti Lesions and Longitudinal Radioulnar Instability: A Narrative Review. JBJS Reviews. 2022 Mar 3;10(3).
  6. Grome L, Raj S, Abu-Ghname A, Bell B, Reece E, PedersonW, Koshy J. Operative Pediatric Infections: A Retrospective Review. J Pediatr Orthop. 2021 May 13
  7. Sharareh B, Hicks J, Castro E, Bell B. Neuromuscular Choristoma Variant in the Forearm Presenting as a Posterior Interosseous Nerve Palsy: A Case Report. JBJS Case Connect. 2020 Jan-Mar;10(1):e0525.
  8. Koshy JC, Grome LJ, Schultz K, Bell B, Reece E, Pederson WC. The Epidemiology of Operative Pediatric Hand Trauma: A Retrospective Chart Review. Hand (N Y). 2019 Dec Online ahead of print.
  9. Koshy J, Bell B. Hand Infections. J Hand Surg Am. 2019 Jan;44(1):46-54
  10. Ditzler MG, Kan JH, Artunduaga M, Jadhav SP, Bell BR, Zhang W, Orth RC. Modified Friedman technique: a new proposed method of measuring glenoid version in the setting of glenohumeral dysplasia. Pediatr Radiol. 2018 Nove;48(12): 1779-85

Mitchell

  1. Ghali, A, Venugopal V, Montgomery N, Cornaghie M, Ghilzai U, Batiste A, Mitchell S, Dawson JR.  Infectious profiles in Civilian Gunshot Associated Long Bone Fractures.  Int Orthop. 2023 Jun 19. doi: 10.1007/s00264-023-05870-2. Online ahead of print. PMID: 37336798.
  2. Momtaz D, Ahmad F, Cushing T, Gonuguntla R, Ghali A, Jabin M, Miggins J, Mitchell S.  Radiocapitellar Arthroplasty: Systematic review.  Journal of Shoulder and Elbow Arthroplasty.  2023 Jan 26;7. PMID: 36727141
  3. Mitchell TW, Mitchell SA, Wu C.  Radial collateral ligament injuries of the thumb metacarpophalangeal joint.  Current Reviews in Musculoskeletal Medicine.  Published online Oct 28, 2022. DOI: 10.1007/s12178-022-09805-z. PMID: 36303098
  4. Sheth M, Taylor T, Price, M, Mitchell SA. Outcomes of elbow fracture-dislocations treated with and without an Internal Joint Stabilizer (IJS-E): A retrospective cohort study.  Shoulder & Elbow.  Published online, March 21, 2022. doi: 10.1177/17585732221088290.
  5. Binz DD, Mitchell TW, Mitchell SA.  Accuracy and Safety of Non-Image Guided Trigger Finger Injections: A Cadaveric Study.  Hand (NY). 2022 Jun 3:15589447221093676. doi: 10.1177/15589447221093676. Online ahead of print.  PMID: 35656857
  6. Sheth M, Mitchell SA, Bell B, Wu C. Essex-Lopresti lesions and longitudinal radioulnar instability: a narrative review.  JBJS Reviews. 2022 Mar 3;10(3).  PMID: 35263316
  7. Vanorny D, Price M, Mitchell SA, Wu C.  Hamate body fractures: A comprehensive review of the literature.  Current Reviews in Musculoskeletal Medicine. 2021 Dec; 14(6):475-84.  PMID 34932201.
  8. Sheth MM, Price MB, Mitchell SA. Novel Use of a Medially Applied Internal Joint Stabilizer for Recurrent Elbow Instability After a Terrible Triad.  JBJS Case Connect. 2021 Apr 8;11(2). doi: 10.2106/JBJS.CC.20.00725.  PMID: 33830959.
  9. Sharareh B and Mitchell SA.  Radiographic outcomes of dorsal spanning plate fixation for treatment of comminuted distal radius fractures in non-elderly patients.  Journal of Hand Surgery Global Online.  2020 March; 2(2): 94-101.  PMID 35415482
  10. El Naga AN, Jordan ME, Netscher DT, Adams, BD, Mitchell SA.  Reliability of the dorsal tangential view in assessment of distal radioulnar joint reduction in the neutral, pronated, and supinated positions in a cadaver model.  Journal of Hand Surgery.  2020 Apr;45(4):359.e1-359.e8. Epub 2019 Sep 17. PMID: 31537400.
  11. Walker M, Sharareh B, Mitchell SA.  Masquelet reconstruction for posttraumatic segmental bone defects in the forearm.  Journal of Hand Surgery.  2019 April;44(4): 342.e1–342.e8. PMID: 30146386. 

Netscher

  1. Amin TJ, Hendrick R, Netscher DT.  The dorsal aponeurosis of the thumb.  J Hand Surg 2018; 43 (6): 567.e1 – e7.
  2. Bernstein DT, Alexander JJ, Petersen NJ, Lambert BS, Noble PC, Netscher DT. The impact of suture caliber and looped configurations on suture tendon interface in Zone 2 flexor tendon repair. J Hand Surg 2019; 44A: 156, E1-E8
  3. Berstein DT, Linnell JD, Pettersen NJ, Netscher DT.  Correlation of Lateral wrist radiograph to ulnar variance: A cadaveric study. J Hand Surg 2018; 43A: 951 e9
  4. Jordan M, El Naga A, Mitchell S, Adams B, Netscher DT. Assessment of distal radioulnar joint reduction with the dorsal tangential view in the neutral, pronated and supinated positions. J Hand Surg 2019; 43A
  5. Bernstein DT, Gonzalez MA, Hendrick RG, Petersen NJ, Nolla  JM, Netscher DT. Impact of septated first dorsal compartments on symptomatic de Quervain disease. Plast Reconstr Surg; 2019, 144: 389-393
  6. El Naga AN, Jordan ME, Netscher DT, Adams BD, Mitchell SA. Reliability of the dorsal tangential view in assessment of distal radioulnar joint reduction in the neutral, pronated and supinated positions in a cadaver model. J Hand Surg.45A:359,2020
  7. Grome L.J., Agrawal NA, Wang E., Netscher DT. Targeted muscle reinnervation for symptomatic neuromas utilizing the terminal anterior interosseous nerve. Plast Reconstr Surg Global, 2020. Published online. 8: e2979. PMID 32802671
  8. Nicolescu R, Agrawal N, Petit RW, Netscher DT. Recurrent Schwamomatosis of the hand. Hand 15: 732-738, 2020. PMID 31948274
  9. Wagner RD, Carr L, Netscher DT.  Current indications for abdominal based flaps in hand and forearm reconstruction. Injury 51: 2916-2921, 2020. PMID 32151424
  10. Bernstein DT, Alexander JJ, Peterson NJ, Lanhert BS, Noble PC, Netscher DT. The impact of suture caliber and looped configurations on the suture-tendon interface in Zone 11 flexor tendon repair J Hand Surg. 44: 156. El – 8, 2019, PMID 29891271
  11. Lekic N, Scheker L, Netscher D.  Secondary management of nonnail perionychial deformities: Restoring aesthetic and functional subunits. Hand Clin. 37: 77-96, 2021
  12. Meyerson J, Liechty A, Shields T, Netscher DT. A National Survey of Hand Surgeons: Understanding Rural Landscape. Publication in HAND. September 16, 2021
  13. Netscher D, Wu-Fienberg Y. Discussion: An outcomes study of proximal interphalangeal joint silicone implant arthroplasty using the volar approach.  Plast Reconstr Surg 150: 352-355, 2022
  14. Netscher D.T. Agrawal. N, Fiore N. Hand Surgery ( CHP 74) In Sabiston Textbook of Surgery ( 21st Ed) CM Townsend, R Beauchamp, M Evers, K Mattox ( eds), Elsevier, Philadelphia, 2021
  15. Netscher D.T., Nguyen JL, Kuhlman-Wood. K, Tenolysis following injury and repair of digital flexor tendons ( chp 54), In Operative techniques in Orthopaedic Surgery ( 3rd Ed) Wiesel S, Albert T ( Eds. Wolters Kluver, Philadelphia 2021
  16. Netscher D.T., Kusic J. Staged digital flexor tendon reconstruction ) Chp 55) In Operative techniques in Orthopaedic Surgery ( 3rd Ed) Wiesel S, Albert T ( Eds. Wolters Kluver, Philadelphia 2021

Training Sites

While emergencies are admitted, this is not a level-one trauma center. However, upper extremity acute infections are admitted, some of which may be limb-or life-threatening as well as traumatic fractures and tendon injuries. A large amount of elective hand and upper extremity surgery is performed, primarily at the McNair campus.

This is a level one trauma hospital, where fellows become skilled at treating all aspects of skeletal trauma from the elbow distally as well as soft tissue trauma of nerves, tendons and cutaneous avulsions. Houston is not a heavily industrialized city and replantation is relatively uncommon, but mangled extremity injuries, amputations and revascularizations do occur with sufficient regularity for fellows to become highly skilled at replantation flap, coverage and microvascular surgery.

Fellows have a busy elective surgery schedule with some trauma such as tendon and nerve injuries, as well as hand and distal radius fractures. This is one of the biggest and busiest VA hospitals in the country. However, there is a wide spectrum of pathology ranging through wrist and hand arthritis, chronic wrist instability, entrapment neuropathies and tendon transfers, Dupuytren contracture and spinal cord injury tetraplegia. The fellow has an opportunity to make independent clinical and operative decisions, but always with close attending supervision. Physician assistants help in preoperative and postoperative clinics and three skilled certified hand therapists help provide comprehensive patient care.

This is the largest Children’s Hospital in the country and also has satellite hospitals removed from the Texas Medical Center. Fellows gain experience in the treatment of pediatric and adolescent musculoskeletal trauma, brachial plexus problems, congenital differences and spastic and movement disorders.

Fellows also work on an elective basis at this large group orthopedic private hospital as well as at the Kelsey Seybold managed care facility. Skilled hand surgery attendings marshal patients efficiently and effectively in these private settings.