Department of Orthopaedic Surgery

The Department of Orthopaedic Surgery offers services and programs through the following Divisions. Use these links to directly access all our Department sites.

Hand and Upper Extremity

Lisa Lattanza, MD directs a large research group focusing on different facets of hand, elbow and upper extremity injuries.  Through their research efforts, they are working towards improving our understanding of hand, wrist, and elbow injuries.  Their research focuses on evaluating the biomechanics of novel treatment strategies in wrist and elbow reconstruction techniques, and the clinical outcomes of a variety of treatment strategies for elbow, wrist and hand injuries.

Dr. Lattanza is performing multiple studies evaluating hand, wrist and elbow injuries in a biomechanics setting in collaboration with the Biomechanics Laboratory.  Their group has evaluated the reliability of the elbow pivot shift test as a diagnostic tool in determining the instability of the elbow following injuries to the ligaments about the elbow.  In a related study, they are evaluating a novel repair technique for reconstructing complicated ligament tears at the elbow, and evaluating a novel treatment strategy for repair of radial head fractures that would allow surgeons to forgo radial head replacement in younger patients.

They are also using 3D computer navigation to improve the placement of percutaneous, minimally invasive screws for fixation of scaphoid wrist fractures.  These studies should improve our understanding of wrist and elbow injuries, and will likely lead to better surgical procedures that will help patients regain use of their elbow following these complicated injuries.

Brachial Plexus Birth Palsy
Dr. Lattanza is also involved with research surrounding brachial plexus birth palsy.  The brachial plexus is a network of nerves which run from the cervical spinal cord to the muscles of the upper limbs.  Brachial plexus birth palsy refers to an injury to these nerves sustained during childbirth. The nerves of the brachial plexus may be stretched, compressed, or torn. This may result in loss of muscle function and subsequent paralysis of the upper limb. Injuries may affect all or only a part of the brachial plexus, resulting in varying degrees of upper extremity involvement.   Subjects with brachial plexus birth palsy undergo dynamic EMG of biceps muscle firing during multiple activities of daily living involving shoulder and upper extremity motion. EMG of the affected side versus the normal side will be compared.   EMG data will be correlated with 3-D motion analysis as well as video. The hypothesis is that continuous firing of the biceps muscle contributes to the formation of flexion contractures of the elbow in patients with brachial plexus birth palsy.

In collaboration with Tamara Alliston, PhD, the Hand and Upper Extremity Service has begun a line of research investigating the development, repair, and biology of tendons. Tendon injuries, such as flexor tendon lacerations in the fingers, Achilles tendon injuries, and rotator cuff tears account for hundreds of thousands of injuries per year. Very little is known about how tendons develop from embryonic precursors and which biologic factors are critical in tendon healing. They are using a variety of biochemical and biomechanical techniques including genetic analyses, materials science approaches, and transgenic mice models in order to elucidate pathways which will enhance our ability to treat tendon injuries. Currently, they are investigating the role of TGFβ and its downstream effectors in tendon development, gene expression, and maintenance of tendon material matrix properties. The goal of this work is to improve tendon healing in order to increase the strength of tendon repairs while decreasing scar and adhesion formation that can lead to significant loss of function.

Clinical Studies

The hand research group has many clinical studies that focus on the outcomes of different hand and elbow conditions. The group is involved in a multi-center clinical trial evaluating the outcomes of posterolateral rotatory instability of the elbow in pediatric patients. They are also evaluating the outcomes following contracture release (stiffness around the elbow) in both adults and children. Dr. Lattanza also collaborates with researchers at Shriners Hospital in Sacramento studying muscle imbalance and the development of elbow contractures in children with brachial plexus birth palsy.

In collaboration with Dr. Nadav Ahituv  from the Institute of Human Genetics at UCSF Dr. Lattanza is assisting in the study of mutations in DNA sequences that regulate genes that can lead to upper extremity limb malformations in children.

Nerve repair

At present, the best available treatment for segmental peripheral nerve injuries is nerve autografting—taking a nerve from another part of the body and placing it in the area of the injured nerve.  However, in many instances, sufficient nerve grafts may not be available.  This surgical procedure is also associated with substantial donor site morbidity, and inconsistent clinical results.   Hubert Kim is studying biodegradable polymers can be useful scaffold materials for tissue repair and regeneration, as there is growing interest in their use for the treatment of nerve injuries.  His group is evaluating aligned nanofiber scaffolds with adhesion and growth factors to produce a superior conduit for nerve repair and regeneration.   If successful, this technology would provide an effective, and hopefully superior, alternative to conventional nerve autografts for bridging peripheral nerve defects.