orthoATnews Magazine Premier Issue by orthoatnews

NEW MAGAZINE PUBLICATION: orthoATnews.com

N E W S M AGA Z I N E F OR AT H L E T IC T R A I N E R S T H ROUGHOU T ORT HOP E DIC S

Collaborative Care

R E I M PR E E I S SU

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CONTENTS IER PR E M E I S SU

Welcome Message from the Editor-in-Chief

10 14 18 28 31

N EWS M AGA Z I N E F OR AT H L ET IC T R A I N E R S T H ROUGHOU T ORT HOPE DIC S

Collaborative Care Scott Mullett M.A., AT, CEFE

Increasing your marketability by multitasking Charles Barocas CEO and Director of ASOP

A New Device for Reinforcing a Bivalved Fiberglass Short Arm Cast. A. Alhandi1; N. Lekic1, A. Patel1, M. Lee2, E. Milne3, L. Latta3 CEO and Director of ASOP 1.Orthopaedic Surgery, University of Miami; 2. Herbert Wertheim College of Medicine, Florida International University; 3.Max Biedermann Institute for Biomechanics.

Chevron: An old padding technique is reviewed Charles Barocas CEO and Director of ASOP

Physical and Clinical Evaluation of Hip Spica Cast applied with Three-slab Technique using Fibreglass Material Bitar KM, DSC Orth, Ferdhany ME, MS Orth, Ashraf EI, MD Orth, Saw A, FRCS (Edin) Department of Orthopaedic Surgery, University Malaya Medical Centre, Petaling Jaya, Malaysia

24. REGIONAL NEWS 42. third party reimbursment 46. You’re invited in 2019! AT Faculty Casting Workshop

PTB Functional Cast — The Sarmiento Way Augusto Sarmiento (MD) and Loren Latta (PHD)

NEXT ISSUE: 3D Printing to assist in casting

CONTRIBUTORS Publisher Charles Barocas, CO Director and Founder of The American Society of Orthopedic Professionals Editor-in-Chief Keith A. Vanic, PhD, LAT, ATC, OPE-C, OTC Senior Director & Chair, ASOP Continuing Education & Credentialing Committee Co-Editor Gerard Rozea, PhD, LAT, ATC Co-Editor Douglas M. Kleiner, PhD, ATC, CSCS, NREMT, FACSM Art Director Mirald Cake Assistant Art Director Ledjon Cake Information Technology Jacob Nuddleman Research and Scholarship Committee, Associate Editor & Chair Emily E. Hildebrand, PhD, LAT, ATC Director, Athletic Training Program, Towson University Research and Scholarship Committee Thomas R. Campbell, MS, LAT, ATC Visiting Professor, Athletic Training Program, Bridgewater College Jeffrey Doeringer, PhD, ATC Asst Professor, Athletic Training Program, Nova Southeastern University Brett Winston, PhD, LAT, ATC Asst Clinical Education Coordinator, Springfield College Associate Editor, Third Party Reimbursement Brice Snyder, MSAT, ATC, OTC Atlantic Orthopedic Specialists, Virginia Beach VA

The American Society of Orthopedic Professionals (ASOP) specifically disclaims any and all responsibility for the contents, advertisements, and other material submitted to and contained in the orthoATnews publication. A reference to a commercial product in an article or in any advertisement does not, either expressly or by implication, indicate that ASOP endorses the product, its manufacturer or distributor. The information contained within orthoATnews is provided for educational purposes only. Moreover, ASOP does not guarantee that use of the orthoATnews website will be free from technological difficulties including, but not limited to, unavailability of information, downtime, service disruptions, viruses or worms, and visitors understand that they are responsible for implementing sufficient procedures and checkpoints to satisfy their particular requirements for accuracy of data input and output. PRODUCT DISLAIMER: orthoATnews makes no warranty, representation, or guarantee regarding the information contained herein or the suitability of products and services for any particular purpose, nor does orthoATnews assume any liability whatsoever arising out of the application or use of any product. It is the Buyer’s responsibility to independently determine suitability of any products and to test and verify the same. The information provided by orthoATnews hereunder is provided “as is, where is” and with all faults, and the entire risk associated with such information is entirely with the Buyer. orthoATnews does not grant, explicitly or implicitly, to any party any patent rights, licenses, or any other IP rights, whether with regard to such information itself or anything described by such information. Information provided is proprietary to orthoATnews, and orthoATnews reserves the right to make any changes to the information in this document regarding any products and services at any time without notice. MEDICAL DISCLAIMER: Because orthoATnews reports on emerging technologies, techniques and medical information, some print and online reports may discuss drug and device applications that either are not approved by regulatory agencies or are not considered to be within the standard practice of medicine. Always consult your state’s practice act. Articles are intended for informational purposes only and should not be used as the basis of patient treatment. All opinions expressed by authors and quoted sources are their own and do not necessarily reflect the opinions of the editors, publishers or editorial boards of orthoATnews. The acceptance of advertising in no way implies endorsement by the editors, publishers or editorial boards of orthoATnews.

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Welcome Message from the Editor-in-Chief

his month’s issue serves as the bi-monthly launch of the orthoATnews magazine. orthoATnews will strive to publish high quality original research, clinical case studies, practical tips from the field and ongoing updates for the healthcare provider throughout the orthopedic setting. I am honored to serve as the Editor-in-Chief and grateful to the American Society of Orthopedic Professionals (ASOP) for providing me this opportunity to contribute to its overall mission – share resources that enhance the ongoing marketability and foster the continued educational and professional advancement of the Athletic Trainer (AT) throughout the orthopedic discipline. Peer review will be a vital component of our assessment towards submitted articles. orthoATnews will strive to maintain a good balance of different article types within the magazine and strongly encourage high-quality, evidence-based clinical submissions. Undoubtedly, such articles are the most widely reviewed and can have major impact on clinical practice. The goal is to provide resources that truly benefit the readership and have the potential re/shape the thought process on your role in providing quality clinical care. I am fortunate to be supported by a highly effective editorial team which includes Gerard D. Rozea, PhD, LAT, ATC and Douglas M. Kleiner, PhD, ATC, CSCS, NREMT, FACSM, serving as co-Editors of the magazine. Emily Hildebrand, PhD, LAT, ATC will provide direct oversight of the research committee and guide the grant and scholarship submission process. Additionally, Brice Snyder, 8

November 2018

Virginia Athletic Trainers’ Association Third Party Reimbursement (TPR) Chair will lead the commentary and steer the ongoing and dynamic TPR conversation. The contributing group of Associate Editors have worked incredibly hard on this launch edition. We are fortunate to have them as ambassadors for the magazine. Lastly, orthoATnews has a dedicated and phenomenal graphic design team lead by Mr. Mirald Cake putting the entire project together and online for our readership. Once again, we invite new as well as experienced authors, researchers, clinical contributors to submit manuscripts, commentaries etc of clinical significance of both surgical/ non-surgical techniques for review. We are finalizing a new platform for author submissions and rest assured, submissions will receive a courteous and prompt response. I look forward to working with all of you in your role as an author, reviewer or editor to bring about the orthoATnews desired mission. As the Editor-in-Chief, I welcome suggestions, discussions and thoughts from both authors and readers to help us further the orthopedic advancement and clinical significance of our colleagues throughout orthopedics! 0 Yours in Service! Keith A. Vanic, PhD, LAT, ATC, OPE-C, OTC Editor-in-Chief, orthoATnews

PHYSICIAN PRACTICE EFFICIENCY

PATIENT FLOW

ATHLETIC TRAINER

Collaborative Care Scott Mullett M.A., AT, CEFE

thletic trainers

settings reports that the val-

achieve in the physician prac-

are an essential

ue of AT services stretches far

tice setting:

component of

and wide from many different

risk reductions

angles including: reducing lost

for athletic

work-time, unnecessary visits to

PE, the sports medicine

programs, military personnel,

the ER, hundreds of thousands

practice analyzed in the

industrial workers, the perfor-

of dollars saved annually on

study added 3 to 4 pa-

mance industry, and public

medical costs, and increasing

tients per clinic day and

safety. Programs across the

health care efficiency. One such

increased collections by

country place a high priority

setting that is producing over-

$200 to $1200 per day.

on the health and well-being

whelmingly positive metrics is

of individuals by employing, or

the physician practice setting.

working with an athletic trainer. The cost benefit ratio reported across several different

November 2018

The metrics have much

•• By utilizing an ATC as a

•• Researchers saw an 18% average increase in pro-

to say regarding what athletic

ductivity when physicians

trainers are, and will continue to

used athletic trainers.

•• Orthopedists see 15–30%

musculoskeletal skills

athletic training services.

which translates to an av-

were “very good” com-

erage additional through-

pared to those of phy-

a long and rich history, which

put of 10 patients when

sician assistants and

essentially developed from

athletic trainers staff a

nurse practitioners.

experiences during wartime.

full-day physician clinic. Physicians reported that

Orthopedic medicine has

Early written accounts depict When analyzing the data,

the first orthopedic surgeons

residency-trained AT-PEs

a strong correlation is pres-

tending to injuries on the bat-

were “very well” prepared

ent with the athletic trainer

tlefields of Medieval Europe.

for integration into

improving patient flow and

Splints made from dried horse’s

physician practice efficiency

blood were crafted to set bone.

(figure 1-1). With this, an in-

As the practice evolved, the

herent value exists regarding

focus was correcting musculo-

•• their clinical operations and that their clinical

orthoATnews.com

November 2018

skeletal deformities in children.

while collaborating with or-

with a physician, the one-on-

Modern orthopedics

thopedic physicians. From

one education I received was

expanded after the first World

an athletic trainer’s perspec-

priceless. I had the opportu-

War where the implementation

tive, what makes this part-

nity to read more X-rays and

of orthopedic military hospitals

nership so effective? What

MRI’s, I understood more about

paved the way for improving

value can athletic trainers

medication, and learned how

treatment and adding effi-

obtain from collaboration

to apply and remove casts.

ciency to the practice. Around

with orthopedic physicians?

With this opportunity, my

this time, sports medicine

To best answer these

skill set increased and added

was beginning to organize. In

questions, a perspective from

1911, the first sports medicine

the business side of athletic

establishment took shape in

training is necessary. Lori Oda,

ning! Henry Ford once said, “If

Dresden, Germany and other

MS, AT is the manager of Day-

everyone is moving forward

investigations and innova-

ton Sports Medicine Institute

together, then success takes

tions developed later in the

(DSMI). She oversees 17 athletic

care of itself.” This is much

decade. The primary idea was

trainers who provide services

bigger than athletic training or

to provide medical care spe-

to secondary schools, public

orthopedic medicine. With the

cifically to Olympic athletes.

more value to my practice. This is only the begin-

safety, and YMCA’s. She has

right combination, this collabo-

Early accounts of athletic

extensive experience collab-

ration can improve health care.

trainers and physicians collab-

orating with the orthopedic

If we work together educating,

orating is not clearly record-

physicians who oversee DSMI’s

developing relationships, and

ed, but by the 1950’s with the

program. When looking at the

adding value to this practice,

establishment of the NATA, and

partnership between athletic

then the need continues to

in 1954 with the emergence of

trainers and physicians, the

grow creating more opportu-

the American College of Sports

effectiveness is found in the

nities for athletic trainers. 0

Medicine, one could say the

versatility of the profession:

timing was more than just a

The education and guid-

coincidence. From there, the

ance an athletic trainer pro-

world of present day sports

vides is another means to make

medicine exploded. With insti-

this an effective partnership.

tutions, fellowships, and profes-

An athletic trainer is able to

sional organizations to provide

assist in guiding patients to

further growth and develop-

achieve their goals before and

ment within this profession.

after surgery. Athletic trainers

The face of sports medicine is

are great at following up and

without a doubt the orthope-

reporting to the physician how

dic physician. From world-re-

the patient is recovering.

nown facilities like the Andrews

Building off that as-

Sports Medicine and Orthope-

pect, the value athletic train-

dic Center, to the high empha-

er receives from working

sis placed on athletes receiving

directly with a physician is

the best care after an injury,

priceless. Through her ex-

Athletic trainers have seen and experienced much

perience, Lori discussed: When I worked directly orthoATnews.com

MARKETABILITY NEWS

Increasing your marketability by multitasking Charles Barocas CEO and Director of ASOP

have always believed that

rehab within the practice. That

dures.

patient continuity of care

is true continuity of care. It is

thopedic practice, radiology is

is best served if the same

efficient and provides a per-

a profit center. It is a common

health professional who

ception of care to the patient

belief that years of schooling

performs the original

that cannot be duplicated

and stringent state licensing

radiographic exam demon-

with multiple staff preform-

is required to operate imag-

strating the fracture, can then

ing multiple procedures.

ing equipment, when in fact,

assist in the reduction of the

One way to provide con-

For the standard or-

forty (40) states mandate less

fracture and applies the cast.

tinuity of care AND increase

than the standard 2-year aca-

And that same health profes-

your salary in the orthopedic

demic program requirement.

sional removes the cast and

physician practice is to exam-

However, in ten (10) of those

might even apply a brace and

ine the profit centers in your

states, including the District

instruct the patient in a home

office setting and determine if

of Columbia, no licensing is

rehab regimen or provide the

you can perform those proce-

required at all. The other thir-

November 2018

Charles Barocas Take a look at the proceeding page for a state-bystate illustration and links to facilitate your research on your home state’s requirements for a “limited x-ray machine operator” to perform office radiology procedures. In our initial launch and throughout future issues of orthoATnews, our readership will be introduced to a myriad of value-added considerations that will increase your marketability and reinforce your inherent value within the ty (30) states have a “limited

staff, it is extremely important

orthopedic physician practice

license” which will allow an

that you cross-train and multi-

setting. Now, some of the in-

individual to operate an office

task your clinical abilities. Your

formation provided in upcom-

(not hospital) x-ray machine

value to the practice increases

ing issues may be contrary to

and take standard orthopedic

exponentially if you are able to

contemporary thinking, but our

radiographic images. In order

perform x-ray and then initiate

mission is to challenge pres-

to obtain a state radiologic

the procedural care for your

ent day thought process and

technologist license only ten

patient population, under the

triangulate the opportunities

(10) states require completion

physician’s instructions. In the

available to our orthoATnews

of an approved two -year pro-

smaller more rural populated

subscribers. Keep alert for

gram and successfully passing

areas, a multifaceted approach

our January issue and anoth-

the ARRT certification exam.

to your clinical competency

er value-added perspective

could mean considerable mon-

to enhance your professional

etary value to the office setting.

worth in the orthopedic setting!

For example, in the smaller physician offices with less

orthoATnews.com

Listed below are links to each stateâ&#x20AC;&#x2122;s information regarding radiologic technologist licensure, certification or recognition. For states that do not license personnel, you can refer to the stateâ&#x20AC;&#x2122;s radiation control program for information on radiation safety.

WY NE

CA AZ

Due to the transitional nature of the internet, hyperlinks may change. If the links on this page are broken, please let us know by emailing contact@orthoATnews.com. 0 Useful links: American Society of Radiologic Technologist - ASRT.ORG American Registry of Radiologic Technologist - ARRT.ORG

MN ME

VT MI

NH MA CT

PA IL

NJ DE

AR SC MS

States Requiring Two Year Degree for RAD Tech Limited X-ray Machine Operators (32 States) (None or Less Schooling Required No Standards for Radiography

MARKETABILITY NEWS

A New Device for Reinforcing a Bivalved Fiberglass Short Arm Cast. A. Alhandi1, N. Lekic1, A. Patel1, M. Lee2, E. Milne3, L. Latta3 1.Orthopaedic Surgery, University of Miami; 2. Herbert Wertheim College of Medicine, Florida International University; 3.Max Biedermann Institute for Biomechanics. Introduction: Cutting a

Clickmedical Inc. Denver, CO)

cadaver served as its own

short arm cast is an acceptable

for reinforcing a cut short arm

control. Casting and Ace wrap

form of practice for dealing

cast and comparing it to the

application were done by one

with ensuing edema after sus-

current standard (Ace wrap).

registered orthopaedic tech-

taining a fracture. An ace wrap

Castfit™ uses a wire system

nologist to minimize technique

is usually applied to hold the

that can be wrapped around

variability. Pressure readings

cast in place. Zaino et al. com-

the cast and the wire length

under the cast were recorded

pared three methods of cutting

can be adjusted to tighten or

using a method comparable

the cast in a clinical study and

relax the cast. We will compare

to Zaino et al.’s study by using

concluded that cutting the cast

the pressure measurements

an empty intravenous fluid

along with the webril on two

of Ace wrapping a cast to this

bag (100 mL) with its two ends

sides and spreading the cast

new method. We hypothe-

pointing distally. The bag was

eliminates all relevant skin pres-

size that Castfit™ can achieve

placed on the dorsal side of

sure. Ace wrapping has proven

consistent pressure readings

the cadaver wrist with its two

to be inconsistent and unreli-

at a specified tension level in

ends protruding and not cov-

able at times as well as subject

the device across all samples.

ered by the cast. After casting,

to easy patient modification.

Methods: Tencadavers

a calibrated pressure trans-

The purpose of this study is to

were used to test pressure

ducer (Deltran®, Utah Medical

test a new device (Castfit™;

readings under the cast. Each

Products Inc. Midvale, UT) was

November 2018

Figure 1: A. Fiberglass cast, B. Saline bag, C. 15 gauge needle, D. Pressure transducer, E. 60 mL syringe.

Figure 2: Castfitâ&#x201E;˘ device fasted on a bivalved cast. The device was aligned with the third metacarpal bone, and was always 6 cm away from the base of the thumb.

MARKETABILITY NEWS attached to the bag (Fig.1). Ten

recorded. Two more pressure

College, PA) by comparing the

milliliters of water were infused

readings were taken, one after

variance of the two interven-

in the bag through one of the

the Ace wrap was applied and

tion samples. Levene’s test was

two ends using a 60 mL syringe

another after applying the Cast-

used to assess hypotheses of

to record a baseline pressure,

fit™ device (Fig.2). The Castfit™

equal variance. A paired Stu-

50 more mL were added to

was fully tightened on all sam-

dent t test was performed to

reach a maximum of 60 mL and

ples to test its consistency.

assess significance of pressure

record a maximum pressure of

All pressure readings

changes throughout the exper-

simulated edema. The cast was

were taken after one minute

iment. P value of 0.05 was used

cut on two sides along with the

to achieve a stable baseline.

as a cutoff for significance.

webril underneath and spread,

Analysis was done using Minit-

and the pressure reading was

ab® software (Minitab Inc. State

Significance: This study tests a new device for reinforc-

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www.esu.edu/atep 20

November 2018

Figure 2: Castfit™ device fasted on a bivalved cast. The device was aligned with the third metacarpal bone, and was always 6 cm away from the base of the thumb.

ing a forearm bivalved cast,

Discussion: This study’s

to the patient’s comfort. We

and compare its results to

experimental data on cadavers

decided to tighten it to its max

the current standard provid-

shows closely similar results to

setting and test its variability,

ing more options to patients

those of other clinical studies in

which was the most reliable

and health professionals.

the literature. The 10 ml pressure

option on a cadaver model.

of 13.7mm Hg was close to those

The Castfit™ showed similarly

pressure under the cast at 10 mL

of other studies that measured

consistent results to using Ace

infused water was 13.7mmHg,

pressure under cast. The max-

wrap, but its application is easier

and the average pressure in-

imum pressure of 73.9mm Hg

and the patient can adjust its

creased at 60 mL infused water

was less than what is reported

tightness to their comfort. And

to 73.9mmHg (p<0.0001). Af-

by Zaino et al.’s clinical data

although it’s average maxi-

ter cutting the cast the pres-

(92.5mm Hg) but still high

mum pressure of 33.9mm Hg

sure dropped to an average

enough to be in the range of the

resulted in pressure levels in

of 9.6 mmHg (p<0.0001) (Fig.

pressure needed to occlude skin

the range of arteriolar capillar-

3). Ace wrap caused the pres-

microcirculation causing skin

ies occlusion (30 to 60mm Hg),

sure to increase to an average

necrosis (60 – 75 mm Hg). Finally

it is safely under the range of

of 24.4mmHg and the Castfit

Ace wrapping the bivalved cast

occluding the skin’s microcir-

at its max tension caused an

resulted in pressure readings

culation (60 – 75 mm Hg). 0

average pressure increase to

very similar to Zaino et al.’s (our

33.9mmHg (p<0.0001, p<0.0001).

average: 24.4mm Hg, Zaino

The increase in pressure in the

et al.’s study average: 21.1mm

two interventions was signifi-

Hg). As our samples cannot

cantly higher than the baseline,

gauge “pain” or “comfort” level

(Ace wrap: p<0.0001, Castfit™:

we relied on pressure readings

p<0.0001). Levene’s test of Ace

published in the literature to

wrap versus Castfit™ resulted in

guide our interpretations.

Results: The average

a p value of 0.222 showing equal variability in both interventions.

The Castfit™ can be adjusted (tightened and loosened) orthoATnews.com

ASOP Research ASOP Student Mini-Grant Awards 2019 2019 Request Scholarship for Proposals

ASOP has instituted a scholarship program in an effort to recognize outstanding students who have excelled academically and clinically in their Athletic Training Programs.

ASOP is pleased to announce that the Research and Scholarship Committee will be accepting proposals for Mini-Grants up to $1,500.00. Proposals will be accepted beginning January 2019. The principal investigator must be a member of the American Society of Orthopedic Professionals. All applications must be submitted electronically. Please look in the upcoming orthoATnews January issue for research categories, submission guidelines and application process.

w w w. a s o p . o r g

ASOP will award two (2) $500 scholarships to students currently matriculating through an entry-level athletic training program. These awards are meant to support the student in their professional degree pathway and final awards will be strongly considered to those students interested in pursuing a career in orthopedics, particularly in the orthopedic physician practice setting. Applicants must be enrolled in an Athletic Training Program that is currently recognized as an ASOP Approved Orthopedic Physician Extender (OPEÂŠ) Program. Please look in the upcoming orthoATnews January issue for the student scholarship application process. In the meantime, Athletic Training Program Directors may seek additional information on approval process by visiting www.ASOPorthoExtender.info

T H E A M ER I C A N S O C I E T Y O F ORTHOPEDIC PROFESSIONALS

ATTENTION AT PROGRAM DIRECTORS! Are you ready for Standard “78”” -- Orthopedic Casting Instruction -Let ASOP Support your path towards compliance As an ASOP Orthopedic Physician Extender Program Your will have the ROADMAP for Clinical Specialty!

CLICK HERE and Become an Approved ASOP OPE Program

THE A MERICAN SOCIET Y OF ORTHOPEDIC PROFESSIONALS

The ASOP OPE curriculum is a comprehensive educational program that enables the athletic training student the opportunity to demonstrate competency in select orthopedic related areas. A primary outcome of the ASOP OPE curriculum is to: • Further the career advancement for athletic trainers in orthopedics . • Empower your AT Program to deliver a challenging academic program that is competency - and evidenced-based . • Provide knowledge and skills that lead to potential candidacy for other value-added cert ifications as an Orthopedic Physician Extender , OPE.

Orthopedic Physician Extender Program

The ASOP OPE program design will allow your athletic training faculty to facilitate a challenging program that leads your students towards value added certification within the orthoped ic discipline the Orthopedic Physician Extender (OPE) examination. In today's economy. ASOP continues to advocat e for the at hlet ic trainer in the orthoped ic physician setting.

ASOP PROJECT 78 - Practical Exam Skill Sheets, Workshop Agendas , Course Syllabus Templates , Textbook Reference materials All casting and bracing instruction taking place on your campus. NO workshop travel!

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REGIONAL NEWS

January 25â&#x20AC;&#x201C;27, 2019 GATA Annual Meeting & Symposium The 2019 GATA Annual Meeting and

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biologic medicine, psychological first aid,

the Atlanta campus of Mercer University. This

casting techniques, and other subjects relevant

yearâ&#x20AC;&#x2122;s symposium provides attendees important

to varied settings in athletic training.

educational opportunities, business meeting, a social, and networking opportunities.

November 2018

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REGIONAL NEWS

East Stroudsburg University’s AT Student Club East Stroudsburg University’s Athletic Training Student Club participated in many volunteer and fundraising events in the early Fall months. These events included the borough wide “Pick up the Poconos” where they spent multiple hours on a Sunday morning picking up litter all across East Stroudsburg. The honors student club hosted a Homerun Derby to raise money for Chronic Traumatic Encephalopathy (CTE) research and donated all proceeds to Boston University’s research team.

Maryland - TU ATS community service event The Towson University Athletic Training Program provided medical coverage alongside other health care professionals in the annual Baltimore Running Festival on October 20, 2018. A total of 20 athletic training students and 2 athletic training program faculty partnered with MedStar Sports Medicine and Emergency Medicine Departments to serve as the official medical team for the event. Over 18,000 runners and countless spectators were served with 501 participants receiving care. The event offered an opportunity for physicians, residents, fellows, nurses, physician assistants, physical therapists, emergency medical technicians, and athletic trainers to work together and provide best patient care to the community.

November 2018

The American Society of Orthopedic Professionals

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CASTING NEWS

CHEVRON: An old padding technique is reviewed Charles Barocas CO, ROT

here are many ways to apply padding. Almost all padding is now applied in a spiral application. However, there are several other methods that can be used for specific casting or splinting applications. The â&#x20AC;&#x153;CHEVRONâ&#x20AC;? method is used when

swelling is anticipated and the cast is uni or bi-valved. The chevron method can also be use in splinting. The tears allow for increase in limb circumference that comes with swelling. Along with the following pictures, click on the video link to see the padding applied in real time. If you have any special techniques you use in casting, please email me at contact@orthoatnews.com. Use casting technique in the subject line. 0

November 2018

CLICK HERE FOR VIDEO (https://orthoatnews. com/73935-2/)

Practicing Hip Spicas on pediatric simulators at ASOPâ&#x20AC;&#x2122;s Advanced Casting Workshop in Las Vegas.

INTERNATIONAL CASTING NEWS

Physical and Clinical Evaluation of Hip Spica Cast applied with Three-slab Technique using Fiberglass Material Bitar KM, DSC Orth, Ferdhany ME, MS Orth, Ashraf EI, MD Orth, Saw A, FRCS (Edin) Department of Orthopaedic Surgery, University Malaya Medical Centre, Petaling Jaya, Malaysia Malaysian Orthopaedic Journal 2016 Vol 10 No 3 http://dx.doi.org/10.5704/MOJ.1611.008

ABSTRACT

Methodology: A

an average age of 2.2 years.

retrospective review of

The most common indication

casting is an important

children with various

for spica immobilisation was

component of treatment for

conditions requiring hip

developmental dysplasia of

spica immobilisation which

the hip. One child had skin

the hip (DDH) and popular

was applied using our

irritation after spica application.

treatment method for femur

method. Study duration

No spica breakage was noted.

fractures in children. Breakage

was from 1stof January 2014

at the hip region is a relatively

until 31st December 2015.

showed that the three-

common problem of this cast.

Our main outcomes were

slab method of hip spica

We have developed a three-

cast breakage and skin

cast application using

slab technique of hip spica

complications. For children

fibreglass material was

application using fibreglass

with hip instability, the first

durable and safe with low

as the cast material. The

cast would be changed after

risk of skin complications.

purpose of this review was to

one month, and the second

evaluate the physical durability

cast about two months later.

Introduction: Hip spica

of the spica cast and skin complications with its use.

Results: Twenty-one children were included, with

Conclusion: This study

INTRODUCTION Hip spica casting is a common treatment method orthoATnews.com

INTERNATIONAL CASTING NEWS for a variety of conditions

the stability for the whole

short term stability of the

that requires immobilization

spica cast. By modifying the

hip after removal of cast.

of the femur and pelvis. They

placement of these slabs,

include femur fracture in

we hoped to improve the

young children, proximal femur

strength of spica cast across

osteotomy, septic arthritis of

the femoral pelvic junction to

retrospective study on

the hip and developmental

protect against breakage.

consecutive cases of hip spica

dysplasia of the hip (DDH).

MATERIALS AND METHODS We performed a

Both plaster of paris

castings from 1st January

Successful treatment of these

(POP) and synthetic fiberglass

2014 until 31st December

conditions is dependent on the

material have been used for

2015. All children regardless

physical integrity of the spica

hip spica casting4. For the last

of age and indication for hip

cast, and morbidity related

three years, we converted to

spica casting were included

to its prolonged application.

using fibreglass material to

in the study. For children with

Most publications reporting

further improve the physical

hip instability, cast change

the use of hip spica cited

durability of the cast and

would be performed at about

the technique described by

reduce the weight of the whole

four weeks after application

Kumar in 1981 where multiple

construct. POP has good

to evaluate the hip stability

strips of plaster of paris

moulding capability, but has

both clinically and with C-arm

(POP) slabs were applied

been shown to be mechanically

imaging. The second hip spica

across the joints and limbs.

inferior compared to fibreglass.

would be removed about eight

Furthermore, attempt to

weeks later in the paediatric

especially at the femoral pelvic

increase itsâ&#x20AC;&#x2122; strength by using

out-patient clinic with no

junction, is a common problem

more cast material would

anaesthesia. We routinely

with the use of hip spica cast

result in a heavier cast which

performed plain radiography of

with POP material; this why

could be inconvenient to

the hips about two weeks after

some authors developed

the child and the parents.

cast removal, and review about

Breakage of the cast,

modifications of the standard

The purpose of this

6 months for the next one of

technique to improve the

study was to evaluate the

two years. We traced medical

durability, including application

physical outcome of hip spica

records for clinical review, and

of a cross bar connecting both

applied with our modified

evaluated plain radiographs

the lower limb components.

technique using fibreglass as

taken before and during hip

We modified the Kumarâ&#x20AC;&#x2122;s

cast material, and evaluate

spica cast applications, and

technique by using three-

the clinical outcome of

at least 2 weeks after cast

slabs across the hip joints

this procedure including

removal. Being a retrospective

and relied on them to provide

clinical complications and

study, we collect additional

Table I: Number of casts according to underlying conditions

November 2018

feedbacks via phone interviews

posterior aspect of the trunk

1.6: 1. (Table I). Forty-one hip

with the parents on problems

crossing the back ends of the

spica were applied for the 21

they experience during spica

U shaped slabs at right angle

children. The most common

cast application and overall

posteriorly, and swing across

indication for hip spica

satisfactions of the procedure.

lateral aspect of both hips to

application was developmental

the anterior aspects of the

dysplasia of the hip (DDH)

fabricated holder to position

groins. (Fig. 2c). After this step,

(n=15), septic hip dislocation

the trunk and limbs of the child

additional casts will be applied

(n=3), syndromic hip dislocation

before spica cast application

over both the lower limbs either

(n=2) and pathological

(Fig. 1). The foot holder would

to just above the knee for the

femur fracture (n=1). We

allow both the hips to be

unaffected side, or just above

included a child (case 17) with

positioned at 90 degrees

the ankle for the affected limb.

osteogenesis imperfecta who

flexion, and about 60 degrees

Additional cast may be used to

fractured her femur and was

on abduction, depending of

strengthen other parts of the

treated with hip spica cast

range of the safe zones. The

cast if necessary. In average,

application using the same

holder did not allow us to

for children below the age of 3

technique, except that we need

position the limbs in internal

years old, we used about 6 to 7

additional moulding for the

rotation. In general, hip spica

rolls of fibreglass cast material

affected thigh while the cast

cast application involved the

(3-inches or 5-inches width).

was setting. She has only one

We used a locally

use of 6 rolls of fibreglass cast

Children who requested

cast application for 2 months.

material. All the spica cast

for further follow up and

applications were performed

cast removal in another

breakage noted in this series.

under general anaesthesia. As

institution were excluded

One child had a pressure sore

the first step, a longitudinal

from this study. Main outcome

at her left groin due to skin

padding was placed along the

parameters included any form

irritation by the edge of the

chest and abdomen. The trunk

of skin complication, improper

cast at the perineal opening.

and limbs were covered with 2

fitting that requiring cast

This was noticed 3 days after

layers of webril with or without

modification or trimming and

spica application. The cast was

additional layer of stockinette

breakage of the cast. Failure

reapplied and subsequently

(Fig. 2a). The first layer of cast

of treatment was defined

the sore resolved uneventfully.

material was applied over the

as subluxation / dislocation

For the 20 children with hip

trunk. Next, two slabs were

of hip based on clinical and

instability, post-operative

applied across the anterior

radiological evaluations at

radiograph and clinical

and posterior aspects of both

least two weeks after cast

examination did not show

hips in the shaped of the

removal, and malunion.

any evidence of instability.

alphabet â&#x20AC;&#x153;Uâ&#x20AC;?. Front ends of both the slabs would cross the midline anteriorly at the level

There was no hip spica

Subsequent progress of RESULT Twenty-one children

the conditions was beyond the scope of this study.

of umbilicus, and the back

underwent hips spica

ends of these slabs would

application during the study

lie longitudinally along the

period. The mean age was 2.2

posterior aspect of the trunk

years (5 months to 4 years).

hip spica application using

cast (Fig. 2b). A third slab

There were 13 girls and 8 boys,

fibreglass material, we did

would be placed across the

with a female to male ratio of

not record any breakage of

DISCUSSIONS With our method of

orthoATnews.com

INTERNATIONAL CASTING NEWS

Fig. 1

Holder for the trunk and lower limbs for hip spica application in young children. Container box for the device was used as the platform to support the head and thoracic spine.

Fig. 2a

Two layers of inner liner applied before fibreglass cast. Yellow arrow indicate a spacer made from filling a narrow stockinette with multiple layers of cotton bandages. The spacer is used to ensure adequate room with the cast for abdominal expansion, and maintain adequate opening for perineum hygiene.

Fig. 2b

Anterior ends of the two slabs (1st and 2nd slabs) crossed the midline at the level indicated by the yellow arrow. Posterior ends were applied along the long axis of the trunk.

Fig. 2c

The long posterior slab (3rd slab) was applied superficial to the posterior ends of the first two slabs and wind around the body to end at the anterior aspect of the hips.

November 2018

the spica during the period of application. Mechanical

loads for at least two months. Skin irritation in the form

and radiological evaluations, subsequent subluxation or

failure of hip spica, especially

of abrasion, pressure sore,

dislocation may still be possible

breakage at the thigh-trunk

and infection / infestation are

with longer follow up. However,

junction is one of the most

common problems related

long-term outcome of unstable

common failures of this

to plaster cast application,

hip is influenced by many

treatment technique. In a study

especially for prolonged use.

other factors including type

comparing hip spica casts with

In a study on 297 patients

of underlying pathology, age

and without additional bar

with 300 hip spica cast for

at presentation, and type of

across the limbs, Hosalkar et al

femur fractures, DiFazio et

surgical intervention. This is

3 reported 11% of premature hip

al 8 reported that 77 (28%)

not the primary outcome we

spica breakage and all of them

patients had skin complication.

are investigating in this study.

were in the group without cross

Among these patients, some

bar. Although they reported

required unscheduled cast

that the cross bars did not

change under anestehsia (31%),

hamper toileting and handling,

early cast bivalving (44%),

the three-slab method of

time for cast application and

or cast trimming (25%). We

hip spica application using

removal might be longer, and

have one child (case 21) with

fibreglass material was reliable

more cast material might be

abrasion over the inner thigh

to provide immobilization

necessary. We decided to use

corresponding to the un-

for the femur and hip joint

fibreglass cast material due to

intentional edge inversion of

with low risk of cast breakage

its faster setting time, superior

the perineum opening. Since

or skin complications. Low

mechanical strength 4,5 and

trimming of the edge might

weight and radiolucency

ability to retain 70% to 90% of

end up with sharp edge of

were additional advantages

initial strength upon contact

fiberglass material, we decided

for this technique. 0

with water 6. Hybrid POP-

to reapply the hip spica under

fibreglass casts 7 have been

anaesthesia. Subsequent

recommended to improve

recovery has been uneventful.

the durability and reduce the

Our results showed a relatively

cost. However, they were still

low rate of skin complications

heavier and not as strong as the

within our method of hip

fibreglass only cast. In addition,

spica cast application.

radiolucency of fibreglass

CONCLUSION This study showed that

The main limitation

material allows more accurate

of our study would be the

assessment of hip stability after

small sample size. Being a

cast application compared to

retrospective study, possibility

POP only or hybrid casts. Our

of reporting bias for skin

study showed that combination

complications may be possible.

of the three-slab technique

However, it would be not very

and use of fiberglass material

likely for the primary outcome

could provide us with hip

of cast breakage to be missed.

spica casts that were light,

Although all the unstable

radiolucent and strong enough

hips were reduced after cast

to withstand physiological

removal based on clinical orthoATnews.com

FUNCTIONAL CAST TH 36

November 2018

HE SARMIENTO WAY Augusto Sarmiento (MD) and Loren Latta (PHD)

orthoATnews.com

Figure 4.4 a) Both legs should be exposed so angular and rotary deformities can best be identified and appropriately corrected. The hips and knees must be flexed to 90 degrees. b) A layer of stockinette extends to approximately two inches above the proximal pole of the patella, and the ankle help passively at 90 degrees. a

b Figure 4.5 After wrapping a thin layer of padding over the foot and ankle, and while an assistant holds the ankle at 90 degrees (avoiding forceful dorsiflexion) the casting material is wrapped from the toes to approximately three inches above the ankle. Firm molding of the arches is performed while avoiding pressure of the bony prominences.

Figure 4.6 a) As soon as the casting material has set, padding is wrapped over the extremity to the level of the tibial tuberosity. B) Then casting material is firmly molded overt the extremity. The firm compression of the soft tissues during this stage is essential. Figure 4.7 a) Upon completion of casting of the leg from the ankle to the level of the tibial tuberosity the patientâ&#x20AC;&#x2122;s heal should be placed on the lap of the applicator, and the patientâ&#x20AC;&#x2122;s quadriceps in a relaxed position. Patients must be frequently reminded of the need to maintain relaxation of the quadriceps. b) After applying a thin layer of padding over the knee, casting material is wrapped to approximately one inch above the proximal pole of the patella. At this time, the proximal portion of the material is firmly flattened posteriorly.

The above-the-knee cast is removed and replaced with a below-the-knee functional, cast or brace as soon as the acute symptoms and signs have subsided. This period of time varies from patient to patient and is influenced by the severity of the injury and individual personality and pain tolerance. The majority of patients, who suffered low energy injuries, find it possible to wear the brace before the end of the second post-injury week. However, if at that time there is still significant distal swelling and pain at the fracture site, an additional week of ambulation in the above-the-knee cast is recommended.

Application of the Below-the-Knee Functional Cast (PTB)

Once the casting material begins to set, the second stage begins: casting material is firmly wrapped over the leg overlapping the proximal portion of the cast over the ankle, and extending to just below the tibial tuberosity. It is during this time that exposure of the normal leg is essential in order to duplicate the shape of the normal leg on the fractured one. Any angulation or rotation seen during the below-the-

Let’s fast forward and assume that the

knee cast stage is gently corrected at this time.

above-the-knee cast is removed and the patient

The soft tissues of the extremity are firmly mold-

must sit with the hip, knee and ankle joints at 90

ed with particular attention being paid to the

degrees. The functional brace, mistakenly called

compression of the sub-popliteal space (Figure

a PTB cast because it resembles the molding of

4.6-4.8).

the PTB prosthesis worn by the amputee, should be applied in three stages: the first stage calls for

The Third Stage: once this segment of the

the application of a stockinet over the leg and

cast starts to set, the patient’s knee must be ex-

then covered with a thin layer of padding. Some

tended to a forty five-degree position of Flexion

people prefer a cast without padding that none-

and rested on the surgeon’s lap. The quadriceps

theless requires greater care during its removal

must be completely relaxed.

(Figure 4.4).

A roll of casting material is then molded lightly over the patella and femoral condyles. As

The ankle must be carefully molded with-

the material begins to harden, the patellar tendon

out any force needed to maintain the foot/ ankle

is lightly compressed, and the fiberglass over

complex at ninety degrees of dorsiftexion. If force

the condyles flattened carefully. The compression

is applied a recurvatum deformity at the fracture

over the patella tendon is accomplished not in

site can develop. It is not necessary at this time to

anticipation of weight bearing stresses concen-

pay attention to alignment or rotation of the frag-

trating on this area, as in the case of the prosthe-

ments.(Figure 4.5).

sis, but in order to obtain a surface against which firm pressure over the subpopliteal space can be sustained. (Figure 4.8)

orthoATnews.com

Figure 4.8 a) With the patientâ&#x20AC;&#x2122;s quadriceps relaxed, the lateral aspect of the femoral condyles is firmly compressed; and the patellar tendon compressed. Simultaneously; the posterior aspect of the proximal leg is flattened. The patellar tendon is not supposed to become a weight bearing structure through this mechanism. Its compression and firm molding of the proximal/posterior soft tissues and femoral condyles, enhance rotational and bending stability. b) Appearance of the cast prior to the trimming that would allow flexion and extension of the knee.

Figure 4.9 a) Drawing the lines that will be used to trim the cast. Anteriorly, to just above the proximal pole of the patella. b) Laterally, as far posteriorly as possible, in order to ensure that the femoral condyles are covered with casting material without impingement of the hamstrings muscles. c) Posteriorly, to a point opposite to the tibial tubercle, not the patellar tendon. D) Upon completion of the trimming procedure this should be the level of the trimming.

Figure 4.10 a and b) After the trimming is completed the knee should be able to flex and extend fully.

b Figure 4.11 a & b) Patient demonstrates the full extension and functional flexion of the knee.

VIDEO LINKS: Dr. Augusto Sarmiento PTB Cast -- PART 1 https://www.youtube.com/embed/acGMtpx3fKU

Dr. Augusto Sarmiento PTB Cast - PART 2 https://www.youtube.com/embed/beZjO2rajJA

Now, the cast is trimmed in such a manner

In conclusion, a rocker bottom cast shoe is

as to make possible full flexion and extension of

appropriate or a rubber heel can then be attached

the knee. The medial and lateral condylar wings

to the cast, being careful to avoid its position in

of the cast are reinforced if necessary. The cast

manners that produce undue varus or valgus

is also trimmed to cover as much as possible the

stresses on the knee joint. It is best not to allow

condyles without interfering with extension of the

patients to bear weight on the cast for 24 hours in

knee and pressure over the supra-patellar region.

order to permit complete dryness and strength of the material. The use of crutches is essential and weight bearing should be determined by the degree of symptoms. It should be increased gradually and not be permitted to become full unless it is not accompanied with pain. 0

orthoATnews.com

third party

Brice Snyder MSAT, ATC, OTC

ear Readers, my

Clinic, Vail CO that have allowed

years, the NATA has contin-

name is Brice

me to function at a high level in

ued to emphasize the need

Snyder and I

the orthopedic physician prac-

for more ATs in the secondary

am currently

tice setting.. I was contacted by

school settings, among oth-

employed as an

the editor to provide input and

er things. Those battles have

AT in an orthopedic physicians

develop a column on the topic

been backed by the NFL and

practice in Southeastern Vir-

of Third Party Reimbursement

other very influential organi-

ginia. My primary role is clinic

(TPR). It is both an honor and

zations. Though completely

based, as well as, the clinic’s

a pleasure to be able to share

justified and obviously serving

research coordinator for two

my trials and tribulations with

a great purpose, such efforts

high volume upper extremity

TPR and look forward to fur-

by major corporations and our

orthopedic surgeons. Through-

thering the conversation and

national organization have still

out the academic process, I

ongoing advancements we

left many high school systems

attribute the knowledge, skills,

make every day within this area.

without a full time AT in the

and abilities gained through my

Before I discuss specif-

United States. Those corpora-

Master’s degrees at Old Domin-

ics, I certainly want to be up-

tions have also provided grants

ion University followed by a res-

front and set the stage that

in the sum of several million

idency (then fellowship) in Ath-

in my opinion TPR should be

dollars for salaries and resourc-

letic Training at The Steadman

the NATA’s top priority. For

es that are unfortunately not

November 2018

a susceptible finite resource.

problem. Budget cuts equate

erable pushback on multiple

Eventually the buck will stop

to stagnant salaries. From my

fronts mostly because of the

(so to speak). As such, I can’t

perspective, TPR for the AT

lack of full understanding of my

express enough the alarming

would finally allow for those

educational background and

need for ATs to be paid for

settings mentioned above to

clinical skill set. Undoubtedly,

our services through TPR.

offset budget constraints which

there are multiple folks out

should ultimately provide much

there reading this section and

ion, TPR would solve a myriad

needed salary increases for

shaking their head in agree-

of problems that the athlet-

those healthcare providers.

ment! As an example, I have

In my professional opin-

ic training profession faces

TPR, as well as several

even had push back from our

across the industry. Once of

“indirect revenue generators”

malpractice insurer question-

the major considerations is

have helped plant the AT firm-

ing what “under the direction”

attributed to the individual’s

ly in the orthopedic physician

means for the Athletic Trainer.

salary. College/Universities and

practice setting. IAs an exam-

In its most direct interpretation,

High Schools are continuously

ple and in my current clinical

they originally thought that

subjected to budgetary cuts

practice, it has not been as an

this meant the physician would

and are still expected to func-

easy route to navigate to say

need to be in the same room in

tion at the same level of ser-

the least. There is no question

observation of my direct action.

vice with less. Therein lies the

that I have experienced consid-

There is no question this would orthoATnews.com

place a major hurdle in front of

PT/OT now have their own set

my efforts towards moving TPR

of CPT codes to express level

forward. Needless to say, that

of complexity in evaluations

experience afforded me an op-

and is very similar approach

portunity to travel to Richmond

to E/M codes for physicians.

to discuss this “interpretation”

The TPR topic is hot right

with the Virginia State Ath-

now. More practices are get-

letic Training Advisory Board.

ting with the script and making

Alongside my seasoned VATA

decent headway, which means

colleagues, we have success-

ATs are being hired in this phy-

fully moved towards further

sician setting at a considerable

clarification in our state’s prac-

pace. In future articles, I would

tice act and are openly defining

like to examine specific topics

“direction”. Additionally, the

such as rehab reimbursement,

BOC has provided model lan-

ortho office setting reimburse-

guage that we utilized for this

ment, and surgical reimburse-

initial dialogue with the state

ment. Throughout the social

board. This is available online

media platforms and “groups”,

as a resource and is beneficial

I routinely read the same ques-

for those ATs looking to revise

tions/inquiries being asked

their state’s practice act.

from our colleagues on TPR.

Other obstacles I en-

The time has come to answer

countered lead me to have

those questions and more! I

conversations with Joe Green

would also like to afford the

and Steve Allison. Both of these

opportunity in this bi-monthly

individuals are TPR pioneers

section a Q and A format for

in their own right. The insight

those ATs that have specif-

you can gain from them is a

ic TPR questions. If you have

lifetime’s worth of knowledge.

questions, please email them

Their knowledge and proven

to: contact@orthoATnews.com

track record on obtaining reim-

and they might just show up on

bursement in multiple settings

here! Looking forward to future

is very encouraging. Joe Green

articles, be well everyone! 0

has moved the TPR pilot study to a national level, while Steve Allison has been reimbursed for well over a decade in his practicing state of Wisconsin. Both utilize standard CPT codes in the physical medicine and rehabilitation section of the CPT book. We find that PM&R codes reimburse the same between AT and PT. AT/

November 2018

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You’re invited in 2019! AT Faculty Casting Workshop Come to St. Pete in 2019 and get FULL ACCESS to

Upcoming Workshop Dates – Located in down-

your complete guide for teaching those select or-

town St. Petersburg FL at ASOP’s 1500 sq ft. state-

thopedic competencies (i.e., casting techniques)

of-art education and research center [Space limit-

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ed to 16 attendees] January 18/19

ASOP has taken the reigns on the faculty instruc-

February 22/23

tion and training in orthopedic casting for the

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April 26/27

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have already verbally RSVP’d for our upcoming workshops that will focus on the “faculty instruc-

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tion” of casting techniques!

July 19/20 [Las Vegas, NV @ ASOP Annual Meeting and Clinical Symposium]

REGISTER HERE Workshop Highlights •• All instructional materials / supplies included •• Workshop attendees will have access to ASOP “Member Protected” download area •• All instructional materials provided to the teaching faculty (i.e., new textbooks & lab materials, assessment tools and competency checklists, outcome strategies, sample syllabi with course objectives for developing new curriculum, revised instructional PowerPoints ... ) •• Breakfast AND Lunch provided on Day 1 & 2 46

November 2018

•• 14 BOC Approved Category A CEUs for Athletic Trainers with an additional 13 Category A home study available for AT professional development •• Faculty attendee provided with ASOP professional membership along with access to challenge Orthopedic Physician Extender (OPE) credentialing examination. OPE-C credential and ASOP membership valid thru December 31, 2019. AT Program will receive institutional credentialing exam and CEU discounts for their athletic training students which includes the following: (1) OPE-C examination fee for $147 ($199 value), (2) a ASOP student membership

Following the workshop, you will return home with access to 27 Category A CEUs available for the reporting cycle; fully versed in select orthopedic casting techniques with the resources needed to seamlessly incorporate into your AT Program AND most importantly afford your athletic training students an opportunity to challenge ASOPs ORTHOPEDIC PHYSICIAN EXTENDER (OPE-C) Certification Examination.

ASOP DISCOUNT FOR HOTEL ACCOMMODATIONS AT HYATT IN DOWNTOWN ST. PETERSBURG

ASOP has worked diligently alongside your AT col-

BREAKFAST AND LUNCH ON WORKSHOP DAYS! (see below for additional details)

free to contact us for more information by email

leagues to ensure our program and certification process aligns with the career objectives for your future graduates. We welcome the opportunity to see you in St. Petersburg in 2019. Please feel cbarocas@asop.org or call us directly at (727) 394-1700.

Click here for downtown HYATT reservations

($200 value), (3) Access to ASOP preferred discount vendor for casting supplies purchases and (4) 13 Category A home study available for professional development as newly credentialed ATs •• Air Travel: ASOP recommends Tampa International Airport (TPA) for easy access to downtown location (attendee responsible for airfare and transportation to and from hotel)Hotel accommodations: •• Hotel Booking: ASOP discount at the Hyatt Place / Downtown St. Pete located at 25 2nd St N, St. Petersburg, FL 33701 [727-2200950].

•• Booking Link: https://stpetersburgdowntown.place.hyatt.com/en/hotel/home. html?corp_id=101002 [Attendees are also welcome to call 1-800-993-4751 and request the business/corporate rate for Veterans Orthopedic Training Center •• Attendee responsible for any other travel expenses and other associated arrangements •• Click here for Workshop Agenda

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Orthopedic Specialty Preparation for Athletic Trainers PROGRAM OVERVIEW FOR ATS: Advanced Casting Techniques Workshop Principles of Injection Techniques Suturing Skills Lab - Practical Simulation Orthopedic Clinical Case Review