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MTBJ Donates 50 Thanksgiving Meals to Local Families

Posted by on November 22, 2022

November 21, 2022
Caroline McBroom, Marketing Manager
Contact: 931-982-4210, caroline@mtbj.net

COLUMBIA, TENN – Mid-Tennessee Bone and Joint Clinic staff donated over 1,200 food items to local Middle Tennessee families for The Family Center’s annual Thanksgiving Meal Giveaway.

“I cannot thank our Mid-Tennessee Bone and Joint Clinic staff enough for opening their hearts and contributing in such a generous and timely manner to make this year’s food drive such a success! We received a great response with 1,222 food items donated! With only a week’s notice, we estimated filling 10-15 boxes. We ended up with enough donations to fill 50 boxes to send to The Family Center and feed 50 local families for Thanksgiving,” says Lalana Brooks, Administrative Specialist at MTBJ, Chair of Community Service Committee, “I couldn’t be happier to be a part of the MTBJ family!”

“Mid-Tennessee Bone and Joint Clinic Physicians generously donated 50 turkeys from Tennessee Valley Packing Co. to ensure each family can enjoy a turkey this year. It was neat to see everyone come together on such short notice for a great community program” says Caroline McBroom, Marketing Manager at MTBJ.

Located in Columbia, The Family Center’s goal is to provide a Thanksgiving meal for every family that applies to the program. Examples of items included in each meal are 1 turkey, green beans, corn, stuffing, cranberry sauce and more.

Mid-Tennessee Bone and Joint Clinic is devoted to the quality care and health of our patients through focused attention on their orthopedic well-being.  Founded in 1975 in Columbia, Tennessee, Mid-Tennessee Bone and Joint Clinic provides a complete range of orthopedic services including the treatment of fractures, total joint replacement, arthroscopic surgery, spinal surgery, and sports medicine.

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MTBJ Covers Local High School Football Games

Posted by on November 8, 2022

Mid-Tennessee Bone and Joint Clinic is proud to continue partnering with middle Tennessee high schools to provide top-notch sideline care for your favorite football teams. For nearly 50 years, MTBJ has been the standard in orthopedic excellence regarding sports medicine treatment for local athletes. With three new physicians (Drs Pharr, Loftis, Strickland) recently added to the team, they provide an extensive amount of team coverage with a sideline presence totaling over 40 football games during the 2022 regular season. 

MTBJ understands the importance of athletes returning to sport in a timely fashion and prioritizes urgency in diagnosis and treatment. With x-ray, MRI, and physical therapy all at one location, they have the unique ability to provide a full comprehensive workup and treatment plan with expediency. In addition, no appointment is necessary with the OrthoQuick walk-in service available Monday through Friday and an additional Saturday clinic open throughout the TSSAA football season. 

“The Maury Regional Athletic Trainers enjoy the support of the MTBJ doctors. Their experience and expertise are very nice to have on the sidelines to help keep our student athletes safe.” – David Hightower, Spring Hill High School

“Being a small school, we often have to share an ambulance with the other schools in the county. Having both Dr. Adams and Dr. Loftis on the sidelines with us always put me at ease. We cannot thank them enough for helping to cover our games.” – Oakey Gaskill, Forrest High School

The physicians at MTBJ did a fantastic job serving our student athletes during the course of this past season.” – Shelby Waddell, Cornersville High School

“CA Athletics feels very blessed to have Dr. Cason Shirley on the sidelines supporting our varsity football program. Dr. Shirley is a phenomenal team doctor. He is professional, caring, knowledgeable and a team player. Dr. Shirley is selfless and sacrifices a lot of time to help our students, coaches and staff. We all love and appreciate his willingness to help CA Athletics.” – Pernell Knox, Columbia Academy

Mid-Tennessee Bone & Joint enjoys working with local athletes on the side lines and at the Clinic to get them back on the field as soon as possible! Mid-Tennessee Bone & Joint looks forward to continuing the partnership with Middle Tennessee high schools for many years to come.


Mid-Tennessee Bone and Joint provides specialized orthopedic care in a compassionate manner. Whether it’s a sports injury, a sprained ankle, or a major joint replacement, Mid-Tennessee Bone and Joint has top-rated surgeons, staff, and equipment needed to take care of any patient in any circumstance. 

Dr. Hunter publishes Supine Elbow Arthroscopy: A decade of results with a vertical humerus and a free forearm

Posted by on October 18, 2022


Written by Hunter, A. Lee. 2022. “Supine Elbow Arthroscopy: A Decade of Results with a Vertical Humerus and a Free Forearm.” Journal of Orthopaedic Experience & Innovation, September.

Abstract

Background

Elbow arthroscopy has been in existence for decades, but to date little innovation in elbow positioning for arthroscopy has occurred. After experiencing disadvantages with lateral decubitus, prone, and supine suspended positioning techniques, the author has changed to a supine positioning technique that stabilizes the humerus vertically while leaving the forearm free for all elbow arthroscopy procedures.

Methods

A retrospective review was conducted for arthroscopic elbow surgeries performed by a single surgeon in a single surgery center in the supine elbow arthroscopy (SEA) position from 2011 to 2021. Efficiency, safety, and versatility of elbow arthroscopy performed in the SEA position were analyzed.

Results

In 298 relevant arthroscopic surgical procedures performed on 289 patients, the average total procedural time was 52.2 minutes, with an average arthroscopic (surgical) time of 31.2 minutes. No complications were found in the review of medical records.

Conclusions

SEA promotes safe, technically easier, and more efficient elbow arthroscopy with improved surgical access, intraoperative flexibility, and accelerated procedural times compared with other current techniques.


INTRODUCTION

Elbow arthroscopy has been in existence for decades (Chen et al. 2017). With the advent of ever-improving technology, elbow arthroscopy should become technically easier to perform, and the indications broadened. However, there has been surprisingly little innovation in the elbow positioning marketplace in the last several decades. Surgical procedural inefficiency and variability in operative time for orthopaedic surgical procedures have been highlighted in the literature recently (DeCook and Statton 2022; Milone et al. 2019). Early in my career, I performed elbow arthroscopy with patients in the lateral decubitus, prone, and even supine suspended positions. Over a decade ago, procedural time inefficiency, along with the disadvantages that accompany each of these positioning techniques, led me to change to a supine positioning technique that stabilizes the humerus vertically while leaving the forearm free for all elbow arthroscopy procedures.

I refer to this technique as supine elbow arthroscopy (SEA) in order to differentiate it from supine suspended elbow arthroscopy (SSEA), in which a mechanical traction device captures the forearm and complicates intraoperative arm manipulation and positioning to various degrees.

This paper provides an analysis of the data from 298 fully arthroscopic surgical procedures performed using this SEA technique, along with a discussion of other current positioning techniques and the future of patient positioning for elbow arthroscopy.

METHODS

This was a retrospective review of arthroscopic elbow surgeries performed in the SEA position between 2011 and 2021. All surgeries were performed by the author at one multi-specialty surgical center. The physician’s private practice database, along with the surgery center’s patient database, were searched and reviewed to identify fully arthroscopic surgical procedures using current procedural terminology (CPT) billing codes. The CPT codes included in the search were the elbow arthroscopy codes 29830 through 29838. Only procedures that were performed fully arthroscopically were included in the study and reviewed. Surgical procedures that included arthroscopic CPT codes, along with any open procedural CPT codes, underwent additional operative note review and were excluded from this analysis if any component of the procedure was converted to “open.” Facility and physician medical record data were then reviewed for all relevant patient cases and analyzed. All procedural time data points were determined and recorded by the operating room (OR) circulating nurse in charge of the procedure along with the anesthesiologist and entered into the patients’ medical records at the point of care. The purpose of this study was to analyze procedural times (in-room to out-of-room), arthroscopic surgical times, International Classification of Disease (ICD-9 and ICD-10) diagnosis codes, CPT codes, as well as any patient complications. The goal was to analyze the efficiency, safety, and versatility of elbow arthroscopy performed in the supine position with the forearm free (SEA). The demographic data of this review are summarized in Table 1.

Table 1.Demographic characteristics of patients undergoing supine elbow arthroscopy (SEA)

SURGICAL TECHNIQUE

All surgical procedures were performed with the patient in the supine position under general anesthetic. Regional blocks, when administered, were performed in the preoperative holding area. A pneumatic tourniquet typically was applied to the upper arm when not contraindicated (dialysis shunt presence, etc.).

The upper extremity was prepared in a sterile manner, and a sterile arm positioner (ElbowLOC® Supine Positioner Assembly, Hunter Medical, LLC, Columbia, TN) was secured to the operative table railing over sterile drapes. The humerus was thus stabilized vertically, perpendicular to the floor, and the distal forearm was supported at the desired elbow position by the supine positioner component of the assembly. The humerus remained fixed in this perpendicular vertical position throughout the procedure. The forearm was left free to allow unrestricted forearm rotation and dynamic elbow motion (Figures 1A through C).

Figure 1.Medial (A), posterior (B), and lateral (C) views of supine elbow arthroscopy (SEA)

The elbow joint was distended with saline injected though the “soft-spot” area. A standard anteromedial portal was established first, then an anterolateral portal established with the assistance of a spinal needle to ensure ideal positioning. Additional anterior compartment working portals were established as needed. For posterior compartment arthroscopy, the height of the supine positioner component was adjusted by the surgeon as necessary to place the elbow in the desired degree of extension in order to relax the posterior capsule. A soft-spot portal was established along with posterior midline portals and posterolateral portals as needed. Static elbow extension was “dialed in” as needed during the procedure by the surgeon adjusting the height of the supine positioner component. Static elbow flexion was controlled likewise, with maximum hyperflexion achieved by resting the patient’s wrist on the chest. With the humerus stabilized vertically and the forearm free, the surgeon could easily manipulate the elbow into any desired position dynamically throughout the procedure. At the end of the procedure, the arm positioner device was removed, followed by the sterile drapes.

A surgical assistant was used occasionally during these SEA procedures. In these instances, the assistant’s task was to help with additional retractors or other surgical tools, not to hold the patient’s humerus or forearm in a certain static position, as that task was achieved by the positioner device.

RESULTS

Analysis of the surgery center and physician practice data revealed 298 relevant arthroscopic surgical procedures performed on 289 patients between 2011 and 2021. The demographic data are summarized in Table 1. Diagnoses for these surgical procedures, both preoperative and postoperative, are displayed in Supplemental Appendix 1 and cover the spectrum of elbow injuries including traumatic and degenerative conditions.

Notable findings include total procedural times (in-room to out-of-room) averaging 52.2 minutes and arthroscopic (surgical) time averaging 31.2 minutes. These data show that on average 20.5 minutes of the total in-OR procedural time of these cases were dedicated to nonsurgical patient care. Included in this time is anesthesia administration, patient positioning, sterile preparation of the operative extremity, awakening the patient from anesthesia, and patient preparations for the post-anesthetic care unit. No effort was made to carve out miscellaneous outlier reasons for delays. A review of operative notes and medical records revealed no evidence of complications. Specifically, no nerve palsies, unplanned returns to the operating room, arthrofibroses, complex regional pain syndrome, infections requiring an antibiotic prescription, or other complications were identified.

DISCUSSION

Elbow arthroscopy positioning techniques have changed very little over the last several decades, other than isolated, generally small, case study reports (Chen et al. 2017). I believe elbow arthroscopy using all four of the positioning techniques listed in Table 2 can be easily learned and scaled in cadaver labs for surgeon education. There seems to have been little effort to offer large-scale training in the technique of supine or supine suspended elbow arthroscopy such as in cadaver training courses sponsored by the American Academy of Orthopaedic Surgeons (AAOS) and the Arthroscopy Association of North America (AANA). Historically, surgeons in these labs have only been offered training in the lateral decubitus or prone techniques. Given the well-known patient advantages of supine positioning, I find the lack of training options in these courses to be a deficiency in our educational system, particularly for younger surgeons. I addressed this in a “Letter to the Editor” for Arthroscopy back in 2016 (personal correspondence from Hunter, L. to Editor of Arthroscopy, 2016 [copy available upon request]). As further evidence of the lack of promotion of supine or supine suspended elbow arthroscopy, the patient education portal of the AAOS, OrthoInfo, mentions only the lateral decubitus or prone positions in reference to patient positioning for elbow arthroscopy (Athwal and Keener 2021; Keener 2012).

Table 2.Comparison of factors of elbow arthroscopy techniques in the literature (Baghdadi et al. 2021; Camp, Degen, Sanchez-Sotelo, et al. 2016; Camp, Degen, Dines, Sanchez-Sotelo, et al. 2016; Camp, Degen, Dines, Altchek, et al. 2016; Chen et al. 2017; Gerken 2013b, 2013a)

The advantages and disadvantages of the various current patient positioning techniques for elbow arthroscopy have been well documented in the literature. The lateral and prone positioning techniques provide reproducible humeral stability, and thus a stable surgical platform for elbow arthroscopy. However, in my experience, both require laborious preoperative setup and have other significant limitations as other authors have pointed out (see Table 2, which shows a combined analysis from referenced sources). It is worthwhile to note that the Camp et al. articles (Camp, Degen, Sanchez-Sotelo, et al. 2016; Camp, Degen, Dines, Sanchez-Sotelo, et al. 2016; Camp, Degen, Dines, Altchek, et al. 2016), while excellent, do not differentiate between supine and supine suspended techniques. The “cons” of supine positioning that are listed in these articles are attributable to the positioning devices required to use the supine suspended technique. Devices such as the Trimano (Arthrex, Naples, FL) and the Spider (Smith + Nephew, Watford, UK), as well as overhead nonsterile traction devices, affix to the forearm or wrist and do not support the humerus in a reliably stable vertical position. I have found the drifting, swaying, or unstable humerus generally encountered in the supine suspended technique to be a significant distraction, requiring frequent intraoperative arthroscopic reorientation, thus unnecessarily complicating the procedure.

I performed a limited study roughly a decade ago that compared surgical positioning times in my patients who underwent supine elbow arthroscopy (SEA) with those who underwent arthroscopy using the lateral decubitus technique (Hunter 2014). I found the SEA technique remarkably more intuitive to learn and perform, and my data indicated a 20-minute additional positioning time requirement, on average, for the lateral decubitus procedures that I performed at the same facility. This operational inefficiency, in the absence of added value, along with the other benefits of supine positioning, led me to convert exclusively to the SEA technique. Extrapolating the 20 minutes average time savings from that original study to this current case series would suggest that 5,960 minutes or approximately 100 hours of surgical time were directly saved by making the switch to SEA. The downstream economic impact of this times savings to surgeons and facilities is significant.

The benefits of supine positioning to the patient are well-known and well-documented (Baghdadi et al. 2021; Gerken 2013b, 2013a; Wijeratna, Thomas, and Van Rensburg 2012). These include optimal airway access, fewer positioning complications, as well as less inhalational anesthetic load due to shortened overall procedural times versus the same procedure performed in the lateral decubitus or prone position. The benefits to the surgeon and operative team of supine patient positioning are also well-known and well-documented (Baghdadi et al. 2021; Camp, Degen, Dines, Altchek, et al. 2016; Chen et al. 2017; Wijeratna, Thomas, and Van Rensburg 2012). These benefits include accelerated procedural times due to more efficient patient positioning, as well as the ability to convert to an open procedure more quickly and easily if necessary. Experienced surgeons may have acquired the ability to convert to an open procedure with the patient in the lateral decubitus or prone position; however, the supine position provides the surgeon with the most flexibility, the best circumferential access to the elbow joint, and arguably more straightforward intraoperative fluoroscopy (Wijeratna, Thomas, and Van Rensburg 2012).

In my experience, intuitive and efficient SEA relies on creating a stable, vertical humerus oriented perpendicular to the floor. I have found no reason to encumber the forearm and have found that a supported but technically “free” forearm greatly simplifies and expedites both arthroscopic visualization and instrumentation of the elbow joint. Using this SEA technique, the humerus does not sway or drift, thus providing the surgeon with a stable, fixed reference point for orientation. Static positioning can be easily and incrementally adjusted by the surgeon throughout the procedure as the pathology or access dictates without changing the position of the perpendicular, vertical humerus. The surgeon can also range the elbow dynamically in whatever desired manner by manipulating the unencumbered forearm directly, allowing rapid and excellent visualization of large areas of the joint and the entire radial head as needed.

The various ICD codes listed in Supplemental Appendix 1 represent the various pathologies addressed in this case series using the SEA technique. Prior to developing this technique, I performed elbow arthroscopy with the lateral, prone, and even supine suspended position. Since developing this SEA technique over a decade ago, I have used it exclusively for all elbow arthroscopies and have found no contraindications or functional limitations of this positioning technique. Quite the contrary, I have found it improves visualization in both the anterior and posterior compartments and makes manipulating arthroscopic instrumentation easier than other positioning techniques while providing optimum positioning safety and airway access for the patient. Additionally, I personally found arthroscopic surgical orientation to be much more intuitive with a stable, perpendicular vertical humerus.

While many talented elbow surgeons have and will continue to perform elbow arthroscopy using the other techniques with excellent outcomes, I see the inherent limitations with, and well-documented shortcomings of, the other positioning techniques as a real barrier to the proliferation of elbow arthroscopy and arthroscopic innovation. I have found SEA to be safe and efficient, providing reliably excellent visualization and surgical access throughout the elbow.

The case series data in Table 1 demonstrate the safety, utility, efficacy, and efficiency of elbow arthroscopy performed in the supine position with a stable, vertical humerus and a free forearm. I believe the metrics regarding procedural times, arthroscopic surgical times, and nonsurgical times in the OR revealed in this case series would compare favorably to data from similar series with patients positioned in the lateral decubitus or prone position. I would encourage our professional societies and training institutions to consider offering SEA training to surgeons in residency, fellowship programs, and professional cadaver labs.

CONCLUSION

SEA promotes safe, technically easier, and more efficient elbow arthroscopy with improved surgical access, intraoperative flexibility, and accelerated procedural times compared with other current techniques. The author believes that this analysis should promote discussion among elbow surgeons regarding best practices in elbow arthroscopy and motivate consideration of incorporating SEA into their own practices as well as the training of future generations of surgeons performing elbow arthroscopy.


REFERENCES

Athwal, G., and J. Keener. 2021. “Elbow Arthroscopy.” May 2021. https://orthoinfo.aaos.org/en/treatment/elbow-arthroscopy.

Baghdadi, Soroush, Daniel Weltsch, Alexandre Arkader, Kathleen Harwood, and John T.R. Lawrence. 2021. “Open Reduction of Medial Epicondyle Fractures in the Pediatric Population: Supine Versus Prone Position.” Journal of Pediatric Orthopaedics 41 (5): 273–78. https://doi.org/10.1097/bpo.0000000000001794.

Camp, Christopher L., Ryan M. Degen, Joshua S. Dines, David W. Altchek, and Joaquin Sanchez-Sotelo. 2016. “Basics of Elbow Arthroscopy Part III: Positioning and Diagnostic Arthroscopy in the Lateral Decubitus Position.” Arthroscopy Techniques 5 (6): e1351–55. https://doi.org/10.1016/j.eats.2016.08.022.

Camp, Christopher L., Ryan M. Degen, Joshua S. Dines, Joaquin Sanchez-Sotelo, and David W. Altchek. 2016. “Basics of Elbow Arthroscopy Part II: Positioning and Diagnostic Arthroscopy in the Supine Position.” Arthroscopy Techniques 5 (6): e1345–49. https://doi.org/10.1016/j.eats.2016.08.020.

Camp, Christopher L., Ryan M. Degen, Joaquin Sanchez-Sotelo, David W. Altchek, and Joshua S. Dines. 2016. “Basics of Elbow Arthroscopy Part I: Surface Anatomy, Portals, and Structures at Risk.” Arthroscopy Techniques 5 (6): e1339–43. https://doi.org/10.1016/j.eats.2016.08.019.

Chen, Alvin Chao-Yu, Chun-Jui Weng, Chih-Hao Chiu, Shih-Sheng Chang, Chun-Ying Cheng, and Yi-Sheng Chan. 2017. “A Modified Approach for Elbow Arthroscopy Using an Adjustable Arm Holder.” Journal of Orthopaedic Surgery and Research 12 (1). https://doi.org/10.1186/s13018-016-0509-4.

DeCook, C., and J. Statton. 2022. “12 by 12: Obtaining True OR Efficiency with Radical Time Transparency and Operational Excellence.” J Orthop Exp Innov, January, 31769.

Gerken, S. 2013a. “Preventing Positioning Injuries: An Anesthesiologist’s Perspectives.” https://aaos.org/AAOSNow/2013/Jan/managing/managing7.

———. 2013b. “Lateral and Prone Positioning Risks in Orthopaedic Surgery: Views from an Anesthesiologist” 1 (February). https://aaos.org/AAOSNow/2013/Feb/managing/managing9/.

Hunter, L. 2014. “Economic Value: Increased Facility Capacity and Potential Cost Savings.” Hunter Medical, LLC. 2014. http://www.huntermed.net/product-page.

Keener, J. 2012. “Elbow Arthroscopy.” August 2012. https://orthoinfo.aaos.org/en/treatment/elbow-arthroscopy/.

Milone, Michael T., Heero Hacquebord, Louis W. Catalano III, Steven Z. Glickel, and Jacques H. Hacquebord. 2019. “Preparatory Time–Related Hand Surgery Operating Room Inefficiency: A Systems Analysis.” Hand 15 (5): 659–65. https://doi.org/10.1177/1558944719831333.

Wijeratna, MD, S Thomas, and L Van Rensburg. 2012. “The Supine Position for Elbow Surgery.” Annals of The Royal College of Surgeons of England 94 (6): 446–446. https://doi.org/10.1308/003588412x13373405386015n.


To learn more about Dr. Hunter, visit mtbj.net/physicians/a-lee-hunter-jr-md

Dr. Adams featured in Orthopaedic Research and Education Foundation Annual Report

Posted by on October 18, 2022


Written by OREF:

Orthopaedic Research and Education Foundation donors share a vision of a healthier, happier future for their patients, families, and friends. Meet Dr. Adams, who has built a legacy of giving back in order to create a future of better outcomes for patients and a solid foundation of support for musculoskeletal research. 

KNOWN TO GIVE

As he nears retirement, Jeffrey T. Adams, MD, wonders how he will occupy his time. He’s never been very good, he says, at slowing down. 

“My wife is very nervous about me retiring. She asks, ‘what are you going to do all day long?’ I’m used to going pretty much nonstop from sunup to sundown. It’s going to be a real adjustment.”

While Dr. Adams has a few years to contemplate whether he will travel more, play more golf, or teach a class at the community college, one thing he decided to do now was develop a means to better track and facilitate his philanthropic endeavors. He and his wife, Tina, who he calls “the most charitable person on this planet” and his adult children founded a family foundation. 

“We give $100,00 to $150,000 away every year,” Dr. Adams explained. “Once you are known to be somebody who gives money, you get asked to give continuously. We thought [a foundation] might be an easier way to keep track of everything.”

FAMILY FOUNDATION

The family meets once a year to decide where their money will do the most good. Among local as well as art and music organizations, OREF is a beneficiary, a tradition Dr. Adams says began when Edward N. Hanley Jr., MD, FAOA, his program chair as Carolinas Medical Center/Atrium Health in Charlotte, North Carolina where he completed his residency, instilled in his residents the importance of giving back. “If we weren’t going to be doing the research, we needed to be funding the people who were doing the research.”

Dr. Adams supports this belief. Playing sports in his youth led him to the field of orthopaedics after a plethora of orthopaedic injuries, from separating his shoulder, tearing his ACL, and experiencing spondylosis in his back. Going into orthopaedics made sense to him, especially since it meant performing surgery and making patients better rather than office work. “That’s what makes orthopaedics so special,” he said. During Dr. Adams’ residency, Dr. Don Dalessandro was completing a shoulder fellowship at Carolinas and his mentorship led Dr. Adams to focus on the same subspecialty. 

 

 

 

GIVING BACK FOR HEALTHIER PATIENTS

His love for the profession is what makes Dr. Adams choose to give back to it. Although his busy private practice means he does not do the research himself, he is sure to support it. He has been an Order of Merit donor for 29 years and a Sustaining Order of Merit donor, directing $1,000 to the OREF Annual Fund, for 17 years. He sees how research can be valuable to his practice, and he stays on top of the latest research findings by reading journal articles, not just on shoulder and elbow, but all orthopaedics. He feels this is so important that he acts as the unofficial librarian for his practice to ensure the latest journals are available to his colleagues. 

“You have to constantly be striving to get better at everything,” he said. “We all need to give back to keep advancing our chosen profession. We make a very good living and so the least I can do is give back and help not only fellow orthopaedic surgeons but also help my patients. If there’s something that is generated [from research] that may turn one particular disease around, I think it’s worthwhile. The more that we can learn, the better our society will probably be in the future. The healthier we can make patients, the better off we’ll be.”

Improving the lives of patients with musculoskeletal conditions is also part of OREF’s mission, and donors like Dr. Adams mean more support for research that has the potential to make improvements in patient outcomes as well as patient care, a reality. 

For the full report, visit bit.ly/oref-2021-annual-report


The Orthopaedic Research and Education Foundation (OREF) is a charitable 501(c)(3) organization committed to improving lives by supporting excellence in orthopaedic research. OREF is dedicated to being the leader in supporting research that improves function, eliminates pain and restores mobility, and is the premier orthopaedic organization funding research across all specialties.


To learn more about Dr. Adams, visit mtbj.net/physicians/jeffrey-t-adams-md

2022 Free Student-Athlete Sports Physicals

Posted by on April 25, 2022

Mid-Tennessee Bone and Joint Clinic has been providing free sports physicals for Maury County student-athletes since 1978, and this year they will be held the first two Mondays of May, 2022.  This will include all Maury County Public Schools, Zion Christian Academy, Agathos Classical School, and Columbia Academy.

Sports Physicals are scheduled for Monday, May 2nd for the boys and Monday, May 9th for the girls at our clinic in Columbia. All Cross Country Elementary and Middle School students need to be in line by 5:30 and all other students in line by 6:00 each night. Students, please wear t-shirts, shorts, and athletic shoes. Coaches are encouraged to attend for crowd control.

Student-athletes must bring the following signed paperwork with them for the physicals:

TSSAA Preparticipation Evaluation Physical Examination Form (link)
Students are to fill out their name and date of birth at the top of the form
The rest of the form will be filled out by the physician on site during the physical

MTBJ Preparticipation Physical Evaluation History form (link)
Parents/guardians and students MUST fill out the form in its entirety prior to the physicals
Parents/guardians MUST sign the bottom of the form. Without a signature, the student will not receive a physical

These are the only dates that MTBJ will provide for these physicals. If students are unable to attend, they will need to see their primary care physician to have their physical.

Please contact our office at 931-381-2663 with any questions. We are looking forward to continuing this important tradition with Maury County Schools!

Dr. Douglas Wilburn Retires

Posted by on October 9, 2020

After nearly 38 years of continuous orthopedic practice at Mid-Tennessee Bone & Joint, Dr. Doug Wilburn retired from our clinic at the end of April 2020.

From his first steps into the office to his last day here, Dr. Wilburn embodied an easygoing and poised presence at the Clinic. Always willing to stay until the very last patient has been seen, he was known for usually being the last doctor out the door at the end of his day. He considered himself an educator and worked to make sure patients knew what they could do in order to take care of themselves.

Dr. Wilburn graduated from Lipscomb University with a degree in chemistry, but it wasn’t until he was close to graduation before he began thinking about a career in medicine. “I was about to graduate from college and someone put the idea in my head that I ought to go to med school,” he said. “After mulling it over and realizing it would be a good job, I decided to pursue it.”

Dr. Wilburn received his medical doctorate from the University of Tennessee Health Science Center in Memphis and practiced at Centerville Medical Center. He completed his internship at Baptist Memorial Hospital in Memphis, TN, and later completed his residency at Baroness Erlanger Hospital in Chattanooga, TN.

“I was always interested in orthopedics,” he said. “I think one of the most interesting things about orthopedics is you get a chance to work with a wide variety of patients, a wide variety of diseases, so it’s never dull. You’re also working with a lot of things that people get over and get better from, so to be able to cure several of these orthopedic issues is a plus.”

Upon graduation from residency in 1982, Dr. Wilburn was faced with the question of where to begin his practice. At the time, Dr. Ken Moore and Dr. Eslick Daniel had established our Clinic and were looking for another partner. After meeting with them, Dr. Wilburn was convinced Columbia would be a great place to practice and raise a family. Time proved him right, and Dr. Wilburn has never regretted his decision. He feels very fortunate to have been here his entire professional career.

His practice through the years began with some trauma work and sports medicine, but eventually grew to include more patients with back and spine ailments. He always recognized that orthopedic diseases and injuries can be traumatizing to patients, both physically as well as psychologically.

“Someone with a broken hip thinks, ‘am I going to be able to walk again, am I going to be able to resume my independence,’ so being able to help those patients get back to their routine and the things they enjoy is very satisfying.”

Professionally, Dr. Wilburn is most proud of how the Clinic has grown over the years, both in the numbers of physicians on staff and in the types of services we provide to patients. And while orthopedics has changed a lot over the last 38 years, he recalls that we have continued our commitment to provide high quality care, provide a family atmosphere for our staff, and keep our patients happy. “The last three decades have brought rapid changes in orthopedics,” he said. “By keeping up with those trends, we’ve stayed at the forefront of providing unsurpassed care to the community.”

Associates who have worked closely with Dr. Wilburn over the years are quick to compliment him on his work ethic and genuine nature. One associate recalled that Dr. Wilburn was always the first to lead the prayer at the company Christmas party each year, kicking off the festivities with a blessing and genuine thanks for all that we have. Tina Faulkner, Director of Operations Support, says, “Dr. Wilburn is the kindest and best person that I know, and he was a joy to work with for 35 years.”

Along with the sincere memories comes at least one funny and memorable story shared by Dr. Jeffrey Adams. Several years ago, Dr. Wilburn left work at the end of the day and went to the gym, got on a stationary bike with a book, and managed to lose track of time. Dr. Wilburn’s wife became quite concerned well after midnight when he hadn’t come home and she couldn’t locate him. The Columbia Police found Dr. Wilburn still at the gym around 2:00 a.m. engrossed in his bike and still spinning the pedals!

Giving back to the community is a big part of the Clinic’s mission, and something that Dr. Wilburn emulated during his tenure. He was an avid supporter of Columbia Academy when his children attended, serving as a board member for 12 years and as Chairman of the board for four years. He also lent his medical skills as a football team physician for nearly 30 years with both Columbia Academy and Columbia Central High School.

Professionally, Dr. Wilburn served as Chief of Staff at Maury Regional Medical Center in 1995 and is a member of several medical groups, including the Maury County Medical Society, Tennessee Medical Society, American Medical Association, and American Academy of Orthopedic Surgeons.

Dr. Wilburn and his wife, Beth, have lived in Columbia since 1982. Together they raised three children, all having graduated from Columbia Academy. They also have four grandchildren, all of whom Dr. Wilburn is looking forward to spending more time with in retirement.

Dr. Wilburn had a few final words regarding his time at MTBJ. “I always thought Mid-Tennessee Bone & Joint was an enjoyable place to work. I have tried to provide a positive atmosphere for happy patients and maintain good working relationships with other doctors. I just always enjoyed the association with the staff who certainly make it easier to deliver medicine and for patients to receive care.”

Three Tennessee Orthopedic Clinics Merge

Posted by on August 21, 2020

NASHVILLE, Tenn.Tennessee Orthopaedic Alliance (TOA), Nashville, Tennessee Orthopaedic Clinics (TOC), Knoxville, and Mid-Tennessee Bone & Joint Clinic (MTBJ), Columbia, have signed a letter of intent to merge the three practices, making it one of the largest networks of orthopedic care providers in the country.

The announcement comes after months of planning and negotiations and will be effective Jan. 1, 2021. Combined, the group will have 104 physicians and a staff of more than 800, with 27 locations in 17 counties serving patients from the Great Smoky Mountains in Sevierville to the Tennessee River in Waverly.

Patients can expect the same level of exceptional care, and over the next few months they will see benefits such as increased access to technology and sharing of best practices. The groups will be able to collaborate and come up with new and innovative ways to deliver the highest standards of care to their patients. Each group will continue to focus on its local community, such as providing coverage to area high school and university athletic events.

“The opportunity to partner with TOC and MTBJ allows us to continue our path forward in creating innovative orthopedic care delivery models for the thousands of patients who span across our respective markets,” said Will Kurtz, M.D., TOA president. “We are excited to learn from one another and create high-quality, cost-effective patient outcomes. Ultimately, we feel this merger will accomplish this and much more for the many years to come.”

“A great advantage to this statewide partnership is the ability to collect and share clinical data leading to the continued enhancement of surgical outcomes,” said Mike Casey, M.D., TOC president. “We look forward to partnering with TOA and MTBJ in identifying and developing best practices while still offering the same focus on individual patient needs in the Knoxville and surrounding markets.”

“This partnership with TOA and TOC will further our goals of providing specialized, compassionate and exceptional orthopedic care to our patients in southern Middle Tennessee,” said Jonathan Pettit, M.D., MTBJ president. “We want to be in this community doing what we
do for a long time to come, and this partnership is an excellent way to help ensure the legacy of our clinic. It will facilitate innovation and present opportunities to practice medicine at a higher level. We cannot wait to see the advanced strategies and positive outcomes that will result from this merger.”

The practices will retain their individual names for now, and there are no plans for a reduction in the staff because of the merger.

TOA has 63 physicians and 22 mid-level providers on staff, including nurse practitioners and physician assistants, and a support staff of 473. It has 17 Middle Tennessee locations in Davidson, Williamson, Sumner, Rutherford, Putnam, Wilson, Montgomery, Dickson, Cheatham and Humphreys counties.

TOC has 32 physicians and 22 mid-level providers on staff, including nurse practitioners and physician assistants, and a support staff of more than 230. It has eight East Tennessee locations in Knox, Cumberland, Sevier, Anderson and Loudon counties.

MTBJ has 9 physicians and 5 mid-level providers on staff, including physician assistants, and a support staff of 75. Its main office is in Maury County, and it operates a satellite office in Marshall County.

For more information about the merger, please visit www.TNOrthos.com

Tennessee Orthopaedic Alliance (TOA) was established in 1926. TOA’s physicians include nationally and internationally renowned surgeons who provide specialized expertise in sports medicine, joint replacement, spine, hand, wrist and elbow, foot and ankle, shoulder, physical medicine and rehabilitation, and interventional pain management. TOA offers its valued patients the convenience of 17 locations (four of which include orthopedic urgent care clinics) and a full array of treatment and diagnostic imaging services including physical therapy, hand therapy, MRI, and durable medical equipment. TOA also has a Sports Performance Center with specialized sports performance training for teams and individuals. TOA is proud to cover more high school and college sports teams than any group in the state of Tennessee.

About Tennessee Orthopaedic Clinics: TOC has provided orthopedic excellence in East Tennessee for over 20 years with 32 board-eligible/board-certified physicians and locations in Crossville, Lenoir City, Oak Ridge, Knoxville and Sevierville.

About Mid-Tennessee Bone & Joint Clinic: MTBJ is devoted to providing specialized, compassionate and exceptional orthopedic care to the residents of Middle Tennessee. Founded in 1975, MTBJ provides a complete range of orthopedic services, including the treatment of fractures, total joint replacement, degenerative diseases, spinal surgery, sports medicine, physical therapy and interventional pain management.

Mako Surgeries Reach Milestone at Maury Regional

Posted by on July 22, 2020

Earlier this month, Dr. Scott McCall and Dr. Cason Shirley, along with Maury Regional Medical Center reached a significant milestone regarding surgeries performed with the assistance of robotic technology.

Surgeons utilizing the Mako robotic system for knee and hip replacement surgeries performed their 1,000th procedure recently. Mid-Tennessee Bone & Joint physicians perform these surgeries using the additional precision and guidance offered by the Mako, giving surgeons the ability to ensure exact cuts and sizing that were previously more challenging with traditional methods.

For more information on this important milestone, visit the Maury Regional News and Events page.

2020 Free Student Athlete Sports Physicals

Posted by on June 17, 2020

Every spring, Mid-Tennessee Bone and Joint provides free sports physicals for Maury County student athletes. Due to Covid-19, we had to delay the date of the physicals and change the way in which they are conducted.

Sports physicals for Maury County elementary and middle schools, including Zion, Agathos, and Columbia Academy, are scheduled for Tuesday, June 30th at our clinic in Columbia. This year, the boys and girls physicals are on the same day and no make up date is scheduled. Students, please wear t-shirts, shorts, and athletic shoes. Coaches are encouraged to attend for crowd control. We prefer the students wear masks but we will not be requiring them. Temperatures will also be taken of all students who enter the building for physicals.

• All elementary and middle school girls are scheduled at 4:30pm on Tuesday, June 30th.

• All elementary and middle school boys are scheduled at 5:30pm on Tuesday, June 30th.

• Any high school students who did not receive their physical on June 5th may attend.

Student athletes must bring the following paperwork with them for the physicals:

TSSAA Preparticipation Evaluation Physical Examination Form (link)
Students are to fill out their name and date of birth at the top of the form
The rest of the form will be filled out by the physician on site during the physical

MTBJ Preparticipation Physical Evaluation History form (link)
Parents/guardians and students MUST fill out the form in its entirety prior to the physicals
Parents/guardians MUST sign the bottom of the form. Without a signature, the student will not receive a physical

Please contact our office at 931-381-2663 with any questions. We are looking forward to continuing this important tradition with Maury County Schools!

Coronavirus Update

Posted by on March 12, 2020

August 7, 2020 update

We are now allowing all patients to bring one support person with them to the appointment, regardless of whether it is medically necessary.

June 29, 2020 update

Mid-Tennessee Bone & Joint is actively invested in the health and safety of our patients, associates, and the rest of the community. Beginning July 1, we will be implementing the following requirements to anyone visiting our office:

•  All patients age 3 and older are required to wear a mask while in our office, including MRI and Physical Therapy downstairs. If you do not have a mask when you get off the elevator, one will be provided for you.
•  Patients will be notified of this requirement at the time an appointment is made and also at reminder calls.
•  One support person will be allowed to stay with a patient, but only if medically needed or a minor is involved.

When you come in for an appointment, you will see our associates are masked throughout the Clinic and hand sanitizer is readily available in the front lobby, hallways, and patient rooms. Prior to your appointment, you will receive a call from us asking a series of questions about your health and any contact you have had with someone who tested positive for Coronavirus. Our associates will ask similar questions when you arrive and before you are checked in for your appointment.

Though patient volumes at the Clinic have increased to near normal levels, we remain vigilant in cleaning and sanitizing with the same level of urgency to keep everyone safe. Coronavirus cases in Maury County have continued to increase in recent weeks, so our response will be the same as in the early days of the outbreak.

We appreciate your trust in MTBJ as we all work through this new normal.


March 23, 2020 update

Beginning this week, Mid-Tennessee Bone & Joint will trim down our appointments to only the most necessary patients. This includes patients who have an acute injury and would normally qualify for OrthoQuck, patients who very recently had surgery and need to be seen for a post-op appointment, patients who have a bone break or fracture, and patients who suspect they may have an infection.

If your upcoming scheduled appointment is for any other reason than what is outlined above, you will be asked to reschedule.

We are still screening patients for fever, shortness of breath, flu like symptoms, exposure to a suspected or confirmed case of Coronavirus, or cough.

Thank you for trusting us with your care. We will continue to update as necessary.


March 18, 2020 update

Beginning March 19th, 2020, we will be screening patients before their appointments. These screenings will happen in two different ways:

• Over the phone two days prior to your appointment
• In the lobby of our building when you arrive for your appointment

When patients arrive in the lobby of our building, before proceeding upstairs for the appointment, they will be screened on the following measures by one of our associates:

• Fever (100.5 or above is considered a fever by the CDC)
• Shortness of breath
• Flu like symptoms
• Been exposed to anyone that has been diagnosed with or recently tested (within 3-5 days) for Coronavirus
• Cough

If a patient is positive for a fever and another symptom, we will contact the MTBJ physician you are scheduled to see and determine whether your appointment will proceed as normal, if you will be rescheduled, if you need to see your PCP, or if you need to go to Maury Regional Urgent Care or the Emergency Department.

Family members of patients will also be screened using the above. If a family member who is with you for your appointment has a fever, they will not be allowed to go up the elevator.

Please know that we are taking these measures with everyone’s health and safety in mind. Please reach out to us with any questions.


March 12, 2020 update

With so much sickness going around right now – flu, stomach bug, and the coronavirus – we wanted to give our patients and the community an update on what we’re doing to combat these germs.

• We’re increasing the presence and use of hand sanitizers in multiple locations around the office.
• We are doing more focused cleanings, over and above our normal sanitation process, in areas that see the most contact. This includes keyboards, door handles, phones, and most other hard surfaces.
• As a temporary precaution, your provider may not offer to shake hands when greeting you.
• Finally, if you’re feeling unwell, please contact your primary care physician and then give us a call to cancel your appointment. We will get you rescheduled as soon as you’re healthy again!

No matter what germs we’re talking about, staying healthy starts with these common sense measures. We’re doing our part to reduce illness in the clinic, and we welcome any questions or concerns you may have.