Together, with the team at Gulf Orthopaedics, these experienced and trusted physicians will provide the latest, most advanced surgical and non-surgical treatment methods, specializing in trauma and sports medicine, shoulder replacement, hip replacement, knee replacement, spine, foot-ankle treatment and interventional pain management.
“In 2021, Infirmary Health partnered with some of the best orthopaedic surgeons in the region, and we are excited to grow and extend that partnership by adding the physicians and team from Bayside,” said Mark Nix, President & CEO of Infirmary Health. “Through partnerships like this one, Infirmary Health continues to fulfill its vision as the FIRST CHOICE for healthcare in the Gulf Coast region.”
“After 45 years, this seems a natural growth in our long time philosophy of patient care,” said Bayside Ortho’s Jason Determann, MD. “Leading edge treatment and technology take a joint effort, and we couldn’t have a better partner than Gulf Ortho.”
Gulf Orthopaedics now offers nine locations in
Fairhope
Foley
Brewton
Daphne
Midtown Mobile
Hillcrest Road
Tillman’s Corner
Saraland
Jackson
To schedule an appointment please call (251-435-BONE) or (251) 928-2401. Learn more about the physician team and services offered at gulfortho.com and baysideortho.com.
Gulf Orthopaedics is an affiliate of Infirmary Medical Clinics (IMC). IMC serves the entire Gulf Coast region with more than 60 medical clinics covering more than 50 specialties. IMC continues to expand its network of quality physicians and medical clinics in an effort to further bolster Infirmary Health’s position as the FIRST CHOICE for healthcare in the region.
(Fairhope, AL) Bayside Orthopaedic Sports Medicine & Rehab welcomed new members to the team this summer with the addition of Leslie V. Rush III, DO and CRNP Amy Stanley.
Dr. Rush graduated from the West Virginia School of Osteopathic Medicine in 1996 and completed a Physical Medicine & Rehabilitation residency at UAB in 2000. Unlike other medical specialties that focus on a medical cure, the goals of a physiatrist are to maximize a patient’s independence in daily living and to improve quality of life. For the past 15 years, Dr. Rush has specialized in Interventional Spine medicine, utilizing minimally invasive procedures and special imaging technology to not only pinpoint the location of pain, but treat it right at the source. Patients with back pain whether herniated disc, sciatica, and lumbar stenosis are a particular focus with treatment through injections, radiofrequency neurotomy, and spinal cord stimulation.
“Broadening our practice to specific spinal treatment has been a goal for the past few years, realizing how many of our patients need solutions short of surgery,” said practice administrator Bob Stanley. “Dr. Rush brings an important level of care and some of the most advanced medical techniques to restore quality of life.”
Amy Stanley, CRNP joins Bayside Orthopaedic’s Bone Health Clinic. She completed her bachelor’s degree in nursing from the University of Alabama and obtained a master’s degree in nursing from the University of South Alabama. She is board certified with the American Association of Nurse Practitioners as an Adult Gerontology Nurse Practitioner and brings more than 20 years of healthcare experience to serving Baldwin County’s bone health needs.
Both are taking new appointments at the Fairhope clinic: 251-928-2401.
Regular exercise has been part of my life since college. As part of a nationally ranked soccer team at William & Mary, we ran drills every afternoon. And on weekends, I hit the trails around Williamsburg as a great stress release from class. My routine over the last 20 years has grown from roads to reps – with circuit training, yoga, and paddle boarding thanks to life here on the Gulf Coast.
College of William & Mary Women’s Soccer Team 1999- Joanne Elston #23
We all know the benefits of exercise, like improving muscle strength and endurance, reducing risk of stroke or heart disease, and preventing unhealthy weight gain. But exercise isn’t just a value-add to life. For women, exercise and bone health are inseparable. Regular physical activity is essential to building and maintaining healthy bones. In fact, we’re losing bone strength every day if we’re inactive. Sedentary isn’t an option.
Our bones are naturally growing weaker over time if we’re not doing something to maintain bone density. Osteoporosis is a condition that leads to fragility and the potential for fracture, most prevalent in women after menopause. This bone-thinning disease creates risk of broken bones, which can seriously limit mobility and independence. We also tend to lose muscle as we age – a conditioned called sarcopenia. Those who develop osteoporosis or sarcopenia are considered frail: more likely to fall and more likely to break a bone.
Bone Health – Use it or Lose It
Our bones benefit from exercise just as muscles do – it makes them stronger. Young girls and teens should begin exercising and eating well to build strong bones. As we age, we focus on maintaining bone strength. Because a bone is a living tissue, it changes over time in response to the forces placed on it. How does bone density grow? As muscles move over bones when you exercise, they get the signal to produce more bone mass. Consider it a healthy nudge! Bones build and become denser – a benefit that increases as you add good nutrition, including adequate calcium and Vitamin D.
Yet another benefit of exercise is better balance and coordination. As we age, balance helps to prevent falls and the broken bones that may result. Studies find one fracture (not caused by trauma like a car accident or blow) often leads to another. The “fragility cycle” is the downward slide we all want to prevent.
What’s the Best Exercise for Strong Bones?
Most all exercise offers positive health benefits. Yoga and Pilates lengthen muscles and boost mental health and focus. Swimming, kayaking, hiking, or anything outdoors soaks up healthy Vitamin D while toning muscles, too.
The two types of exercise we recommend most for building strong bones are weight-bearing exercise and strength-training exercise. Improving bone strength is site-specific. For instance, walking boosts bone strength in arms and spine but not the wrist. For stronger hands, wrists and arms, resistance bands are a better option.
Have you ever had a Pilates instructor remind you to “keep your shoulders in your back pockets”? Women tend to slump as we age, yet good posture is essential to the health of our entire musculoskeletal system. Postural stretching and strengthening not only prevents slumping, but the spine fractures some older people may suffer from simply bending over to tie shoes or pick up something off the floor.
Weight-Bearing Exercise
Weight-bearing doesn’t mean lifting weights, but any activity you do on your feet that works your bones and muscles against gravity. When your feet and legs carry your body weight, more stress is placed on your bones, making your bones work harder. Pushups and plank position are easy (equipment free!) options with great results.
Examples of weight-bearing exercise include:
Brisk walking and hiking
Jogging/running
Dancing
Jumping rope
Hopscotch
Tennis, pickleball, and ping pong
Team sports, such as basketball, soccer, and volleyball
Stair climbing
The more weight you place on bones, the greater the bone-strengthening benefits. Jogging and jumping rope would top the list. However, if you’ve been diagnosed with thinning bones or qualify as frail speak to your doctor about what type of physical activity is best for you.
Strength-Training Exercise
During strength-training activities, resistance is added to movement to make muscles work harder and, over time, become stronger. Even though muscle mass is the primary focus of resistance exercises, the stress on bones results in bone-building capacity.
Common types of strength training include weight machines, free weights, and exercises (such as push-ups) that use your own body weight. Elastic bands are inexpensive, travel easily, and can also be used to add resistance to exercises.
A general guideline for strength training is to exercise each major muscle group at least twice a week. Be sure to rest for a full day between strength sessions.
Other Forms of Exercise
I encourage my patients to add non-impact exercise to the mix not only for strength but balance training benefits. Did you know the top complaint that sends a patient to their doctor is dizziness? Followed quickly by… lack of energy. Menopause again is a primary culprit. A body in motion stays in motion, and a body at rest stays at rest. That old physics lesson applies to our lives today, and the need for healthy movement to fuel the energy to… keep moving! Building flexibility and balance not only feels good, but strengthens muscles, heart, and lungs. If you have a musculoskeletal condition, such as arthritis, that limits your weight-bearing activities, swimming, cycling, and chair exercise are great alternatives.
How Do I Start a Bone Health Exercise Plan?
Thirty minutes of weight-bearing activity, four or more days a week, is an effective gameplan for bone health. Choose something you enjoy! You won’t stick with it otherwise. Those 30 minutes of exercise can be done in one stretch or broken up into shorter intervals. A 10-minute brisk walk three times a day (if that fits your scheduled) is a smart way to get started. Have a dog? She’ll love it!
If walking outdoors isn’t an option, climbing stairs indoors or even walking in place qualifies, too.
To really reap the benefits of exercise, flexibility and balance training should be in the mix. Just as I’ve added strength training and yoga to my passion for running, you should commit to plenty of time for stretching and balance-building moves to the end of your workout. Not only will you reduce the risk of injury but taking time to stretch thoroughly clears the mind before you hit the rest of your day.
Don’t let your aspirations get ahead of your capabilities. Before choosing any activity, consider your risk of falling. Talk to your doctor or physical therapist before developing an exercise program, especially if you’ve been diagnosed with severe osteoporosis. Spine compression can happen with upright weightlifting, and you should avoid any exercise that bends or twists the back. Stationary bikes and rowing machines are not the best options. Opt for chair and corner wall exercises instead.
Age and Bone Health Fitness
Adolescents and Young Adults
Healthy bones start in the lunchbox. Childhood is the age when bones are building, and it’s critical we fuel our children’s bone density during these years of rapid growth. A diet rich in Vitamin D and C from leafy greens, veggies and dairy is key. The skeleton that lasts our lifetime is essentially developed between the ages of 10 and 18 years old! In fact, our peak bone mass in maximum strength and density is reached in our late 20’s.
Weight-bearing exercise during the teen years is essential to reach maximum bone strength. A teen’s physical activity should include 20 to 30 minutes of weight-bearing exercise at least 3 to 4 days each week.
Adults
By our mid-20’s, physical activity alone can no longer increase overall bone mass dramatically. Exercise now is all about preventing or slowing bone loss, maintaining muscle mass to preserve and strengthen surrounding bone, and reducing the risk of falling. Both men and women also need good nutrition, calcium, and Vitamin D to preserve their bone mass.
Women and some men in middle age may require hormonal supplementation (estrogens or androgens) to improve or maintain bone mass as they age. For older people, however, these hormones are generally not recommended. Typically, bone-building medications are better options for those with significantly weakened bones.
Fractures in elderly adults are most common in the wrist, spine, and hip. All can have long-term consequences that may include permanent disability. The statistics are troubling. Six months after a hip fracture, only 15% of those over 50 can cross the room without assistance. And of that same age group, one in four of those who fracture a hip will die within the following year. *
Body Weight and Bone Health
When people lose weight, they also lose bone. Low body weight at any age is associated with a greater risk for bone problems and fractures.
Very low body weight has serious red flags for women. While sports and exercise are healthy activities for girls and women of all ages, too much of a good thing can quickly become health-threatening. Is your daughter too focused on being thin? Consumed with exercise? Have a friend who fits this description? Long-term health problems and bone damage could be at risk without intervention.
If young women exercise excessively, they can lose enough weight to cause hormonal changes that stop menstrual periods (amenorrhea). This loss of estrogen — the hormone that is necessary for maintaining bone mass — can cause bone loss at just the age when young women should be adding to their peak strength.
A woman who misses several menstrual periods, sustains a stress fracture in sports, continuously focuses on her weight, or has a distorted body image should see her doctor right away.
Conclusion
Exercise and healthy bones are a winning combination at every age. While bone-building for children and adolescents and bone-preserving for adults, exercise is just one element of a program to prevent bone loss and reduce the risk of fracture. Make sure you understand your individual risk for osteoporosis (Bone Density Scans should start by age 50), know your genetic factors and family history, and feed your body what it needs. A balanced, calcium-rich diet, adequate Vitamin D, and a healthy overall lifestyle (limited alcohol or nicotine) are key ingredients in bone health for a lifetime.
(April, 2021) Need a sure sign of spring? You’ll find it on Saturday mornings at the ballpark and soccer fields these days. Some of these young athletes may be playing not just during a traditional season but year-round, with club travel leagues starting as early as 7. But is sports specialization in children a healthy choice?
What is Sports Specialization?
The past twenty years have brought a significant shift from unstructured free play and school-based sports to what’s called “sport specialization.” The numbers are astounding: close to 30 million children between the ages of 6 and 18 and close to 60 million in organized programs are participating in year-round sports.
Participation in intense training and/or competition in their sport more than eight months per year.
Participation in one sport to the exclusion of others or free play.
Playing their sport for more hours per week than their age.
Do any of these hit close to home? Overuse injuries we see in young athletes include knee disorders with soccer, basketball, and volleyball players. Shoulder injuries include “Little League Shoulder” due to repetitive pitch counts for pitchers and the intensity of throws catchers must make during a game. “Little League Elbow” often results from high-throwing volume. Racket sports and gymnastics also fall into the year-round sport specialization/overuse injury loop.
Mix it Up – and Don’t Forget Free Time Too
Finding the right balance in training and competition is a tough topic for coaches and parents, who may feel pressured to keep up… and keep their child’s spot on the team. Clearly, our children find enormous benefit from individual and team sports – with physical development, socialization, teamwork, and a strong work ethic. But too much of a good thing also leads to psychological burnout and loss of motivation. What’s the answer? Limit practice, ensure plenty of rest, and keep it fun! Mix up other sports, and find time for free play, too. We all want our children to succeed on the field of play – without preventable injuries.
(February 2021) Training for early spring sports unfortunately brings some quite common injuries. We see ankle strains and sprains in children and teens whether from overuse, lack of conditioning, or just because they are back on the field of play again!
What Sports Produce the Most Strains?
Ankle sprains are common, especially in sports that involve cutting like soccer or lacrosse. In addition, these ankle-impacting sports usually involve uneven ground. A sprain occurs when the strong ligaments in the ankle stretch beyond their limit and tear.
Most ankle sprains are minor and will heal with home treatment including rest, ice and elevation. If serious swelling and pain make it too painful to walk, seek medical attention. Severe sprains that are not properly treated early on and rehabilitated appropriately can potentially weaken the ankle and make it prone to reinjury.
How Do I Know if I Have an Ankle Sprain?
The lateral ligaments on each side of the joint are impacted in ankles strains and sprains as the foot or ankle twists unexpectedly. We grade sprains on the amount of tearing, from mild and microscopic to high ankle sprains that may require surgery.
Symptoms:
Swelling
Bruising
Tenderness to the touch
Instability – when there is a complete tear of the ligaments
May hear or feel a “pop”
A severe sprain may feel much like a fracture or broken bone, and you should have a physician examine the ankle as soon as possible. How much can you move? Where is it tender? A physician may call for X-rays to rule out a fracture.
How Do I Treat a Sprained Ankle?
Most ankle strains and sprains are treated successfully without surgery – even a complete tear. Home treatments include the RICE protocol:
R = Rest your ankle by not walking on it. Crutches may be recommended for a few days.
I = Ice immediately to help with swelling. Use 20-30 minutes, three to four times a day, do not apply ice directly on the skin.
C = Compression dressing with bandages or ace wraps to immobilize and support the ankle.
E = Elevate the ankle above the level of the heart as often as able in the first 48 hours.
Non-steroidal anti-inflammatory medications, like ibuprofen or naproxen, can help alleviate pain and swelling. For moderate or severe sprains your doctor may recommend a removable boot or air-cast and sometimes a cast may be recommended. Physical therapy and rehabilitation exercises are important to prevent stiffness, improve strength and prevent chronic ankle problems. Balance training – or proprioception – will ensure a steady return to action. No need to just grin and bear it– we’re here to help!
Joanne Baird, MD talks orthopaedic issues unique to women during pregnancy and early motherhood – with Devon Walsh on WKRG’s “The Doctor is In” (March 2021)
(November 2020) Amidst this ongoing pandemic, fall sports are back in full swing. With the disruption of our routine training and activities during the last several months, we are seeing an unfortunate increase in injuries in our athletes across all age groups. Knee pain in female athletes is especially common.
What Kinds of Knee Pain are There?
Anterior knee pain is one of the most common complaints with one of every ten musculoskeletal patients to our office. Adolescent anterior knee pain often occurs in healthy athletes, and can be extremely common in females. Typically athletes complain of pain in the front of the knee, usually underneath the kneecap (patella). Pain more distally (upper shin bone area) or proximally (lower thigh) are different conditions related to the tendons or secondary growth centers (apophyses) of the leg including quadriceps or patella tendinitis or Jumper’s Knee, Osgood Schlatter Disease, or Sinding-Larsen-Johansson syndrome.
Adolescent anterior knee pain is particularly common after changes in training routine without adequate stretching or strengthening. Fortunately, there is usually no physical abnormality and in most cases it will improve with simple treatments.
What are the Symptoms of Anterior Knee Pain?
Dull, achy activity-related pain that begins gradually
Popping when climbing stairs or standing from sitting
Pain at night
Pain during activities that involve repeated knee bending (jumping , squatting, running, weight-lifting)
What to do? If your knee pain will not go away after and interferes with activity, see your doctor to examine the knee and rule out other problems with X-ray and potentially MRI if internal joint problems are suspected.
How do I Treat Anterior Knee Pain?
Stop and limit the activities that make your knee hurt until the pain goes away
Change training routines
Pursue low-impact activities that put less stress on the knee joint (biking, swimming)
Weight loss may help if overweight
Change training techniques with the guidance of a certified trainer or physical therapist
Gradually return to higher impact sports and activities
Physical therapy exercises may be recommended to help improve your range of motion, strength, and muscle endurance. Additionally, ice may relieve discomfort after activities and over-the-counter nonsteroidal anti-inflammatories such as ibuprofen and naproxen may help alleviate pain .
In sum, knee pain in female athletes is common but preventable and usually improves with simple treatments. Make sure to condition muscles with changes to training and activities to keep the pain at bay. Whether evaluation, treatment or physical therapy is needed – we’re here to help.
* American Academy of Orthopaedic Surgeons: orthoinfo.org
(August, 2020) While more common in adults, pediatric low back pain is almost equally prevalent in younger patients. Common causes include a variety of diagnosis; from muscle strains to scoliosis to disc problems. A pertinent history and physical exam can rule out most serious causes of low back pain. In most cases of nonspecific back pain, home-based exercise, physical therapy, and anti-inflammatory drugs can fix the problem.
Is That Heavy Backpack to Blame?
Does carrying a heavy backpack lead to back problems? Short answer is no. Nonspecific pediatric low back pain seems more influenced by psychosocial difficulties, conduct issues, and somatic disorders than it does mechanical problems, such as carrying a heavy backpack or long-term computer use. Nonetheless, the American Academy of Pediatrics recommends backpacks not to exceed 10-20% of the child’s body weight.
What to Ask Your Child About Their Pain
As a parent, the first step is asking your child to try to
characterize the pain. Where is it located? When did it start and how long as
it been going on? Is it constant or intermittent? What makes it better or
worse? Also try to think if there any other symptoms that coincide with the
onset of pain – fevers, poor appetite, weight loss or other symptoms that may
or may not be related to your child’s aching back.
Acute back pain can be caused by muscle strains, herniated disks, and spondylolysis (a stress fracture or defect in the arch of the vertebral bone.) Chronic conditions can include inflammatory conditions, alignment problems (such as scoliosis or Schermann’s kyphosis.) Systemic symptoms can be associated with some rare causes of back pain, such as tumors or infections.
When to Seek Help
It is recommended that you schedule an appointment with your
child’s healthcare provider if any of the following are present:
< 4 years old
Systemic symptoms (fever, malaise, etc.)
Nighttime pain
Neurologic symptoms (pain radiates into legs,
numbness, etc.)
Self-imposed activity limitations
With a physical exam, we consider spinal alignment and mobility, tenderness, and neurological aspects. Standard x-rays may be performed to help rule out any bony problem associated with your child’s condition. Depending on those results, bloodwork and other analysis may be involved. Not all pediatric low back pain involves this level of diagnosis, but serious conditions do exist. We’re here to help sort things out.
Dr. Determann received his MD from Louisiana State University in New Orleans, followed by residency in Orthopaedic Surgery at the University of Alabama in Birmingham. He is Board Certified and Fellowship Trained in Sports Medicine with a specialty in Shoulder & Elbow Surgery.
(July 2020) I dare say that you have not been reading this edition of Eastern Shore Parents the way that you thought you would a few months ago. This time of year is normally filled with anticipation of summer camps and activities and travel plans. And, while those things are not completely out of the question, we are all trying to adjust to the “new normal” … my family included!
When this all started back in March (yeah, I know … it feels
like longer) one of the first questions we asked ourselves as a group was how we
were going to take advantage of this time to challenge ourselves in new
areas. One of those that I hope you as
parents were able to take advantage of was a Facebook Live series that we
titled “Homeschool Rocks with the Bone Doc”.
Suzanne Crawley, PA-C and I had so much fun for 6 weeks giving online
lessons about the skeleton, bone health, muscles, tendons and ligaments, and
one day we even played with some power tools!
For us, this was a way to try to use our time to give some
educational content to you guys as we were all stuck at home. And even now, on rainy or just plain hot
summer days that lie ahead, if you are looking for something educational and
hopefully funny and entertaining for your children, then you can access those
video lessons on our practice Facebook page.
For some really well done educational content, I would also point you to a couple of resources on YouTube from ”Nemours KidsHealth” and “Operation Ouch”. Each of these inspired much of our content. Another wonderful educational website called “BrainPop” is also offering free access to their entire content. They have great material on health and the human body, but also many other topics that kids would enjoy.
Finally, I want to encourage everyone that if you are
successful in getting your family to spend some time continuing to learn and
find new things that interest them during this time, you are doing a great
job. Keep up the good work. This time isn’t just a crisis for us to
manage our way through, but one to find new ways to thrive in. We can do it if we share our successes, and
even our failures, with one another. We all have a certain number of days to be
parents and we don’t get that time back, even though it feels like this pandemic
owes us one!
So as the psalmist wrote years ago and it still rings true today, “Teach us to number our days, that we may get a heart of wisdom”.
Dr. Savage received his MD from the University of Alabama at Birmingham, followed by residency at the UAB Department of Orthopaedic Surgery. He is Board Certified and Fellowship Trained in Sports Medicine
(May 2020) Coronavirus (COVID-19) has thousands of Baldwin County children suddenly “schooling” from home. And that means thousands of Baldwin County parents are unexpectedly at home alongside them. Avoiding the physical pitfalls of working from home takes some planning.
Fortunately, technology and new software platforms like Zoom and
Google Classroom keep us connected to teachers and co-workers. But those same tools come with pitfalls, when
we’re suddenly on a keyboard or tablet several hours a day. Overuse of handheld devices can lead to
unintended problems with the hand, wrist and arm. And poor desk posture without
breaks to stretch can leave you slouched and strained with the potential for
musculoskeletal injuries.
Tips for a Healthy Home Work Space
If you’re working from home for the first time, it’s important to
set up a healthy work space:
Check the height of your desk – should be elbow level when sitting
Make sure you have a natural posture – no
hunching or twisting
Find a chair that adjusts and supports the
curve of your lower (lumbar) back
Good posture is essential:
Spine: Keep ears in line with tops of
shoulders and shoulders in line with hips
Shoulders: Upper arms hang relaxed and close
to the body
Wrists: Hands are in straight lines with lower
arms
How Do I Know if I Have Carpal Tunnel Syndrome?
Repetitive use of a computer keyboard
and mouse can sometimes lead to Carpal tunnel syndrome. Symptoms are tingling
or numbness in the fingers, caused by pressure on your median nerve. This nerve
gives you feeling in your thumb and all fingers (except the pinky). When the median nerve goes through your
wrist, it passes through a narrow path – the carpal tunnel – that’s made of
bone and ligament. If you have any swelling in the wrist, this tunnel gets
squeezed and pinches the median nerve, which causes your symptoms.
While there’s no surefire way to prevent Carpal tunnel, a lighter
touch helps. Keep your fingers relaxed
while typing and using a mouse. Avoid
holding a pen or anything else in your hands while you type. Keep
your hands stretched and relaxed: make a tight fist then relax your fingers and
spread them out. Repeat 5-10 times.
Your Smartphone May Be the Culprit
You might be surprised how many patients we see with
“smartphone tendinitis” – caused by repetitive typing and swiping that
irritates the thumb flexor tendon. Did
you know many of us type hundreds of text messages a day? Not exactly what our
hands were designed to do. Holding a
smartphone with the wrist in an awkward position for a prolonged period of time
can irritate forearm tendons and lead to a painful condition known as
“DeQuervain’s tendinosis.”
The primary treatment includes common sense changes like
texting less frequently, improving posture, and modifying the way you hold your
phone or tablet. If symptoms don’t
improve with rest, options include splints, medications, hand therapy or a
cortisone injection.
Using a laptop?
Its design can be inherently problematic for our posture. Either your head/neck bends to see the screen
or your hands/wrists use poor posture at the keyboard. If your laptop has become the “home office”,
consider buying either an external monitor or keyboard.
Remember, our bodies weren’t designed to sit still – even in correct position – for long periods of time. Take a break! Change your seated position occasionally, stand up and stretch every 30 minutes or walk around outside. These are challenging times – staying home means staying well for all of us.
Dr. Carter received his MD from the University of Mississippi School Of Medicine in Jackson, MS. He is Board Certified in Orthopaedic Surgery and a Fellow of the American Academy of Orthopaedic Surgeons.
