George V Russell

University of Mississippi Medical Center, Jackson, Mississippi, United States

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Publications (69)107.59 Total impact

  • Patrick F Bergin · George V Russell
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    ABSTRACT: Obesity is a costly, difficult, and increasingly prevalent challenge facing orthopaedic care. It adds complexity to caring for patients throughout all types and stages of treatment in all orthopaedic subspecialties. There are medical complications to mitigate, anesthetic challenges to meet, and surgical complexities to overcome. The financial implications of treating patients who are obese will continue to challenge surgeons, especially as new payment models are encountered. Research continues to provide more evidence of the unfavorable effects of obesity on outcomes after various orthopaedic procedures. An increasing awareness of the effects of obesity on patients undergoing orthopaedic procedures and educating orthopaedic providers on methods of countering the challenges associated with obesity should ultimately benefit both the provider and the patient.
    Instructional course lectures 03/2015; 64:11-24.
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    ABSTRACT: Background: Morbid obesity and osteoarthritis are conditions that place a significant burden on the US healthcare system. Acetabular fracture is a known cause of post-traumatic osteoarthritis (PTOA) and morbid obesity contributes to the development of osteoarthritis. This study aimed to determine the prevalence of PTOA in morbidly obese patients who underwent acetabular fracture fixation. Methods: A retrospective review of morbidly obese patients who underwent acetabular fracture repair was performed. Patient information included demographics, body mass index, patient age, and length of hospital stay. The prevalence of PTOA was determined by radiographic review with a minimum follow-up of 4 years. Results: There were 299 acetabular fracture fixations performed from 2007 to 2012 at our institution and 39 of these were in morbidly obese patients. One patient was excluded due to preoperative osteoarthritis of the hip. Of the 38 patients, 26 (68%) went on to develop PTOA after acetabular fracture fixation. This is significantly higher than previously reported rates of PTOA after acetabular fracture fixation. There was a higher rate of PTOA in morbidly obese males compared with females (P=0.008). Conclusion: Morbid obesity appears to pose a significantly increased risk for the development of PTOA after fixation of acetabular fractures.
    Journal of Long-Term Effects of Medical Implants 10/2014; 24(2-3):225-231. DOI:10.1615/JLongTermEffMedImplants.2014010505
  • International journal of radiation oncology, biology, physics 09/2014; 90(1):S684. DOI:10.1016/j.ijrobp.2014.05.2009 · 4.26 Impact Factor
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    ABSTRACT: Modifier 22 in the American Medical Association's Current Procedural Terminology (CPT(®)) book is a billing code for professional fees used to reflect an increased amount of skill, time, and work required to complete a procedure. There is little disagreement that using this code in the setting of surgery for acetabulum fractures in the obese patient is appropriate; however, to our knowledge, the degree to which payers value this additional level of complexity has not been determined. We asked whether (1) the use of Modifier 22 increased reimbursements in morbidly obese patients and (2) there was any difference between private insurance and governmental payer sources in treatment of Modifier 22. Over a 4-year period, we requested immediate adjudication with payers when using Modifier 22 for morbidly obese patients with acetabular fractures. We provided payers with evidence of the increased time and effort required in treating this population. Reimbursements were calculated for morbidly obese and nonmorbidly obese patients. Of the 346 patients we reviewed, 57 had additional CPT(®) codes or modifiers appended to their charges and were excluded, leaving 289 patients. Thirty (10%) were morbidly obese and were billed with Modifier 22. Fifty-three (18%) were insured by our largest private insurer and 69 (24%) by governmental programs (Medicare/Medicaid). Eight privately insured patients (15%) and seven governmentally insured patients (10%) were morbidly obese and were billed with Modifier 22. For our primary question, we compared reimbursement rates between patients with and without Modifier 22 for obesity within the 289 patients. We then performed the same comparison for the 53 privately insured patients and the 69 governmentally insured patients. Overall, there was no change in mean reimbursement when using Modifier 22 in morbidly obese patients, compared to nonmorbidly obese patients (USD 2126 versus USD 2149, p < 0.94). There was also no difference in mean reimbursements with Modifier 22 in either the privately insured patients (USD 3445 versus USD 2929, p = 0.16) or the governmentally insured patients (USD 1367 versus USD 1224, p = 0.83). Despite educating payers on the increased complexity and time needed to deal with morbidly obese patients with acetabular fractures, we have not seen an increased reimbursement in this challenging patient population. This could be a disincentive for many centers to treat these challenging injuries. Further efforts are needed to convince government payer sources to increase compensation in these situations. Level IV, economic and decision analyses. See Instructions for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 04/2014; 472(11). DOI:10.1007/s11999-014-3639-1 · 2.77 Impact Factor
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    ABSTRACT: To report the impact of computerized tomography (CT) based radiotherapy (RT) on heterotopic ossification (HO) outcomes. This is a single institution, retrospective study of 532 patients who were treated for traumatic acetabular fractures (TAF). All patients underwent open-reduction internal-fixation (ORIF) of the TAF followed by RT for HO prophylaxis. Postoperative RT was delivered within 72hours, in a single fraction of 7Gy. The patients were divided into 2 groups based on RT planning: CT (A) vs. clinical setup (B). At a median follow up of 8years the incidence of HO was 21.6%. Multivariate regression analysis revealed that group (A) vs. (B) had HO incidence of 6.6% vs. 24.6% (p<0.001), respectively. Furthermore, HO Brooker grade ≥3 was observed in 2.2% vs. 10.8% (P=0.007) in group (A) vs. (B), respectively. Thus, the odds of developing HO and Brooker grades ≥3 were are 4.7 and 4.5 times higher, respectively, in patients who underwent clinical setup. Our data suggest that using CT based RT allowed more accurate delineation of the tissues and better clinical outcomes. Although CT-based RT is associated with additional cost the efficacy of CT-based RT reduces the risk of HO, thereby decreasing the need for additional surgical interventions.
    Bone 08/2013; 57(1). DOI:10.1016/j.bone.2013.08.001 · 3.97 Impact Factor
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    ABSTRACT: Pregnancy is associated with maternal bone mineral density loss and modulation of calcium metabolism. We hypothesized that pregnancy may decrease the risk of heterotopic ossification (HO) after trauma. This is a single-institution, University of Mississippi Medical Center, retrospective study investigating the effect of pregnancy on the incidence HO after surgical repair (SR) of displaced acetabular fractures. Between January 1998 and 2010, 257 non-pregnant women (Group A) and 16 pregnant women (Group B) were identified. All the non-pregnant women received radiation therapy (RT) ± indomethacin. None of the pregnant women in group B received any prophylaxis. After a median follow-up of 6.6 years the incidence of HO in all patients was 27% (75/273). In Group A, non-pregnant, women who received RT ± indomethacin, 29% developed HO; HO risk was 0.4. In Group B, 16 pregnant patients, only one developed HO (6%); HO risk was 0.06. Thus, the risk of HO appears to be nearly six-fold higher in non-pregnant women despite prophylactic RT ± indomethacin. Our data suggest that pregnancy may be associated with a reduced risk of HO after SR of displaced acetabular fractures. Further analysis with a larger pregnant patient sample is necessary to confirm this finding. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
    Journal of Orthopaedic Research 06/2013; 31(6). DOI:10.1002/jor.22309 · 2.99 Impact Factor
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    Dataset: BMI HO
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    ABSTRACT: We describe the preliminary findings of seatbelt compliance among severely injured blunt trauma patients involved in motor vehicle crashes in Mississippi. Stratification of the sample size of 1,405 patients included obese versus the non-obese patients with sub-stratification of weight classes to include normal weight, overweight, obese and morbidly obese. An overview of the design of the study is included. The results demonstrate no significant difference between the numbers of restrained and unrestrained obese patients compared to their normal weight counterparts. Our findings suggest unrestrained patients regardless of weight class had higher ISS than restrained individuals. The data for Mississippi is similar to those reported nationally. Interestingly, we observed the injury severity scores in the restrained obese and morbidly obese patients were higher than the unrestrained motorists within the same weight cohort. This may reflect less movement within the vehicle resulting in less trauma.
    Biomedical sciences instrumentation 04/2013; 49:305-311.
  • C. Dulaney · G.V. Russell · S. Vijayakumar
    International Journal of Radiation OncologyBiologyPhysics 11/2012; 84(3):S623-S624. DOI:10.1016/j.ijrobp.2012.07.1666 · 4.26 Impact Factor
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    ABSTRACT: Increasing attention is being paid to the influences that the body habitus and weight of the pediatric patient impose upon the fixation methods for femur fractures. Of the widely accepted treatment options, little biomechanical or clinical data exist comparing flexible intramedullary nailing and locked plating. The aim of this study was to compare the mechanical stability of unstable pediatric diaphyseal femur fractures fixed with titanium flexible intramedullary nails or a titanium locking plate using a synthetic femur model. Fracture stabilization was carried out with either 4.0-mm titanium elastic nails or 16-hole 4.5-mm narrow titanium locking compression plates. Axial and rotational testing of each specimen was performed. The axial loading rate was 0.20 mm/s. The torsional loading rate was 0.1 degrees rotation per second. The axial compressive modulus was defined as the compressive stress divided by the compressive strain. The rotational stiffness was defined as the torque moment applied to the femoral head divided by the resulting rotational displacement (in radians). The yield point or load to failure of the simulated fracture constructs was recorded for each specimen. The modulus for comminuted fractures measured during the application of axial compression was 0.657 GPa for plate constructs and 0.326 GPa for elastic nail constructs (P=0.021). The modulus for oblique fractures during axial loading treated with plate fixation or titanium elastic nails was 1.63 and 0.466 GPa, respectively (P<0.0001). The yield point for comminuted fractures occurred at an axial load of 2304.7 N (SD ± 315.77) for plate constructs and 383.6 N (SD ± 139.2) for elastic nail constructs (P<0.001). For oblique fractures, the yield load occurred at 3111.9 N (SD ± 821.9) for plate constructs and at 1367.0 N (SD ± 98.9) for elastic nail constructs (P<0.0001). Locked plating provides a biomechanically more stable construct than elastic intramedullary nailing. Its use as part of the technique of indirect reduction and submuscular plating remain a viable alternative in the treatment of length-unstable pediatric femur fracture patterns. : Provide biomechanical evidence supporting the use of plating techniques in the pediatric femur fracture population.
    Journal of pediatric orthopedics 09/2012; 32(6):587-93. DOI:10.1097/BPO.0b013e31824b7500 · 1.47 Impact Factor
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    ABSTRACT: Obesity is associated with a chronic low inflammatory process that may act as common soil for the pathogenesis of obesity-related comorbidities including heterotopic ossification (HO). The purpose of this study is to compare the incidence of HO between patients with body mass index (BMI) <40 versus ≥40 after operative treatment of displaced acetabular fractures followed by radiation therapy (RT) ± indomethacin. This is a single institution retrospective chart review of 419 patients. All patients with well-documented BMI underwent operative treatment followed by RT ± indomethacin. All patients received 700 cGy to the soft tissues around the proximal femur and acetabulum without bone shielding. All RT were given postoperatively within 72 hours. The patients were divided into 2 groups: Group (A) BMI < 40 and Group (B) BMI ≥40. HO was assessed with X-ray. BMI was used as a surrogate measure to test the risk of HO despite prophylaxis. The incidence of HO among all patients is 21% (89 of 419), while among those in group A (BMI <40), 68 of 374 patients developed HO (18%); in the morbidly obese group (BMI ≥40) 21of 45 patients developed HO (47%). The difference between the rates of HO in the 2 groups was 29%; the χ(2) test showed a significant difference between the 2 BMI groups (P < .001 at α = 0.05). There is a higher incidence of HO among the morbidly obese patients despite RT ± indomethacin. RT doses for HO prophylaxis in morbidly obese patients need to be reassessed; also, understanding the signaling pathways in target tissues in obese patients at which adipokines control metabolism may reveal novel therapies. Higher radiation doses ± indomethacin may need to be considered and optimally evaluated in the context of a prospective, randomized clinical trial.
    Practical Radiation Oncology 07/2012; 2(3):e1-6. DOI:10.1016/j.prro.2011.11.003
  • Practical Radiation Oncology 04/2012; 2(2):151-4. DOI:10.1016/j.prro.2011.06.005
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    ABSTRACT: To ascertain whether the time from injury to prophylactic radiation therapy (RT) influences the rate of heterotopic ossification (HO) after operative treatment of displaced acetabular fractures. This is a single-institution, retrospective analysis of patients referred for RT for the prevention of HO. Between January 2000 and January 2009, 585 patients with displaced acetabular fractures were treated surgically followed by RT for HO prevention. We analyzed the effect of time from injury on prevention of HO by RT. In all patients, 700 cGy was prescribed in a single fraction and delivered within 72 hours postsurgery. The patients were stratified into five groups according to time interval (in days) from the date of their accident to the date of RT: Groups A ≤3, B ≤7, C ≤14, D ≤21, and E >21 days. Of the 585 patients with displaced acetabular fractures treated with RT, (18%) 106 patients developed HO within the irradiated field. The risk of HO after RT increased from 10% for RT delivered ≤3 days to 92% for treatment delivered >21 days after the initial injury. Wilcoxon test showed a significant correlation between the risk of HO and the length of time from injury to RT (p < 0.0001). Chi-square test and multiple logistic regression analysis showed no significant association between all other factors and the risk of HO (race, gender, cause and type of fracture, surgical approach, or the use of indomethacin). Our data suggest that there is higher incidence and risk of HO if prophylactic RT is significantly delayed after a displaced acetabular fracture. Thus, RT should be administered as early as clinically possible after the trauma. Patients undergoing RT >3 weeks from their displaced acetabular fracture should be informed of the higher risk (>90%) of developing HO despite prophylaxis.
    International journal of radiation oncology, biology, physics 03/2012; 82(3):e339-44. DOI:10.1016/j.ijrobp.2011.06.1981 · 4.26 Impact Factor
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    ABSTRACT: To analyze the impact of different body mass index (BMI) as a surrogate marker for heterotopic ossification (HO) in patients who underwent surgical repair (SR) for displaced acetabular fractures (DAF) followed by radiation therapy (RT). This is a single-institution retrospective study of 395 patients. All patients underwent SR for DAF followed by RT ± indomethacin. All patients received postoperative RT, 7 Gy, within 72 h. The patients were separated into four groups based on their BMI: <18.5, 18.5-24.9, 25-29.9, and >30. The end point of this study was to evaluate the efficacy of RT ± indomethacin in preventing HO in patients with different BMI. Analysis of BMI showed an increasing incidence of HO with increasing BMI: <18.5, (0%) 0/6 patients; 18.5-24.9 (6%), 6 of 105 patients developed HO; 25-29.9 (19%), 22 of 117; >30 (31%), 51 of 167. Chi-square and multivariate logistic regression analysis showed that the correlation between odds of HO and BMI is significant, p < 0.0001. As the BMI increased, the risk of HO and Brooker Classes 3, 4 HO increased. The risk of developing HO is 1.0× (10%) more likely among those with higher BMI compared with those with lower BMI. For a one-unit increase in BMI the log odds of HO increases by 1.0, 95% CI (1.06-1.14). Chi-square test shows no significant difference among all other factors and HO (e.g., indomethacin, race, gender). Despite similar surgical treatment and prophylactic measures (RT ± indomethacin), the risk of HO appears to significantly increase in patients with higher BMI after DAF. Higher single-fraction doses or multiple fractions and/or combination therapy with nonsteroidal inflammatory drugs may be of greater benefit to these patients.
    International journal of radiation oncology, biology, physics 02/2012; 82(5):e831-6. DOI:10.1016/j.ijrobp.2011.11.033 · 4.26 Impact Factor
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    ABSTRACT: We have shown that obese Zucker rats with orthopedic trauma (OZT) exhibit a loss of arteriolar tone in skeletal muscle. We hypothesize that the loss of arteriolar tone in OZT blunts vasoconstrictor responses to hemorrhage, resulting in an impaired blood pressure recovery. Orthopedic trauma was induced with soft tissue injury and local injection of bone components in both hindlimbs in lean (LZT) and OZT (11-13 wk). One day after the orthopedic trauma, blood pressure responses following hemorrhage were measured in conscious control lean, control obese, LZT, and OZT. In another set of experiments, the spinotrapezius muscle of control and trauma animals was prepared for microcirculatory observation. Arteriolar responses to phenylephrine (PE) or hemorrhage were determined. Hemorrhage resulted in similar blood pressure responses in control animals and LZT, but the blood pressure recovery following hemorrhage was blunted in the OZT. In the spinotrapezius, OZT exhibited decreased arteriolar tone and blunted vasoconstrictor responses to PE and hemorrhage. Treatment with glibenclamide improved the blood pressure recovery in the conscious OZT and improved the arteriolar tone, and PE induced vasoconstriction in the spinotrapezius of the OZT. Thus, ATP-dependent K(+) channel-mediated loss of arteriolar tone in OZT blunts the arteriolar constriction to hemorrhage, resulting in impaired blood pressure recovery.
    AJP Heart and Circulatory Physiology 01/2012; 302(1):H340-8. DOI:10.1152/ajpheart.00439.2011 · 3.84 Impact Factor
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    ABSTRACT: To evaluate the radiographic and computed tomographic reduction qualities after acetabular fracture repair in obese and nonobese patients. Retrospective review. University medical center. Two hundred forty-two patients were treated with open reduction internal fixation for displaced acetabular fractures. The nonobese group (Group 1) consisted of 149 patients and the obese group (Group 2) had 93 patients. A nonmorbidly obese group (Group 3 = 221 patients) and a morbidly obese group (Group 4 = 21 patients) were also created from the same patient population. Operative repair of acetabular fractures. Reductions on postoperative radiographs were classified as anatomic with less than 1 mm, imperfect with 2 to 3 mm, and poor with greater than 3 mm of residual displacement. On postoperative computed tomographic scans, reductions were considered nonanatomic with persistent gap or step displacements greater than or equal to 2 mm. Anatomic radiographic reductions were achieved in 72% of the nonobese patients, 70% of the obese patients, 72% of the nonmorbidly obese patients, and 61% of the morbidly obese patients. (P = 0.379) On postoperative computed tomographic scans, an acceptable reduction was obtained in 47% of the nonobese patients, 44% of the obese patients, 47% of the nonmorbidly obese patients, and 31% of the morbidly obese patients. (P = 0.232). Anatomic or satisfactory reductions can be similarly achieved in all classes of nonmorbidly obese patients who have sustained displaced acetabular fractures. In the morbidly obese, anatomic reductions may be more difficult to obtain.
    Journal of orthopaedic trauma 06/2011; 25(6):371-7. DOI:10.1097/BOT.0b013e3181f974f4 · 1.80 Impact Factor
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    ABSTRACT: To evaluate the validity of using lateral intraoperative fluoroscopic imaging to assess the reduction of the tibial plafond articular surface, two hypotheses were tested: 1) the distal tibial subchondral shadow on the lateral ankle radiograph is created equally by the medial, central, and lateral portions of the distal tibia; and (2) displacement of a 5-mm width osteochondral fragment is consistently recognizable on lateral fluoroscopic imaging. Six human fresh-frozen tibial plafond cadaveric specimens were sagitally sectioned in 5-mm increments after removal of the anterior soft tissue and stabilization of the position of the ankle through external fixation. To test the first hypothesis, a perfect lateral radiograph was taken after sectioning the specimens. The sagittal sections were then removed sequentially from medial to lateral. A perfect lateral radiograph was taken after each change. The sagittal sections were then removed beginning laterally and moving medially. A perfect lateral radiograph was taken after each change. The images were then compared with specific evaluation of the change in the subchondral shadow density. To test the second hypothesis, three malreductions were created by displacing a 5-mm osteochondral segment. After each malreduction, a perfect lateral radiograph was saved. These saved fluoroscopic images were placed in random order with lateral images of normal specimens. Four experienced ankle surgeons were then asked to determine whether the radiographs revealed displacement. Inter- and intraobserver reliability was then evaluated. First, the subchondral shadow of the distal tibia appears to be created by an equal confluence of the subchondral bone of the medial, central, and lateral aspects of the tibial plafond. Second, fellowship-trained observers experienced in pilon fracture treatment correctly identified malreduction only 45% of the time. Intraclass correlation coefficient revealed very poor interobserver reliability with an alpha reliability statistic of 0.183. Intraobserver reliability across all four observers yielded an alpha statistic of 0.474, indicating inconsistencies in observers' evaluation of identical images at separate viewings. It is difficult to discern rotational or translational displacement of a 5-mm osteochondral fragment on a perfect lateral fluoroscopic view of the ankle. Even with what appears to be a perfect lateral fluoroscopic view intraoperatively, displacement may still be present. When small osteochondral fragments are present, direct visualization of the articular surface is necessary to confidently establish that an anatomic reduction has been achieved.
    Journal of orthopaedic trauma 02/2011; 25(2):106-9. DOI:10.1097/BOT.0b013e3181e52ec5 · 1.80 Impact Factor
  • F Keith Gettys · George V Russell · Madhav A Karunakar
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    ABSTRACT: The open operative management of pelvic and acetabular fractures in the obese is technically demanding, with a significantly higher rate of complications compared with patients who are nonobese. The decision to perform surgery should involve a thorough understanding of risks, and patients should be counseled. Careful attention should be paid to patient factors; coexisting systemic conditions and patient positioning to reduce complications. Wound complications are most commonly seen, and techniques to reduce risk should be incorporated. When complications occur, aggressive management can result in successful salvage. Future areas of study should include methods to reduce risk of surgical site infections and improving our understanding of the physiologic alterations that occur with obesity. This article summarizes the current literature on open treatment of pelvic and acetabular fractures in the obese patient, reviews the physiologic adaptations of obesity as they relate to pelvic surgery, highlights risk factors for complications, and provides recommendations to reduce the incidence of complications.
    Orthopedic Clinics of North America 01/2011; 42(1):69-83, vi. DOI:10.1016/j.ocl.2010.08.006 · 1.25 Impact Factor
  • George V Russell
    Orthopedic Clinics of North America 01/2011; 42(1):ix. DOI:10.1016/j.ocl.2010.09.004 · 1.25 Impact Factor
  • George V Russell · Christine W Pierce · Loren Nunley
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    ABSTRACT: The obesity epidemic continues to grow. As the number of obese people increases, it is logical to expect an increasing number of obese patients and increasing costs to care for these patients. Orthopedic surgeons will see many of these patients who need treatment for injuries and chronic conditions. Care of obese patients requires more work and time in providing nonoperative and operative care. No system has been proposed to handle reimbursement disparities, particularly for providers. The model for health care will change and, along with it, should be all parties coming together to address inequalities and inequities in care for obese and morbidly obese patients.
    Orthopedic Clinics of North America 01/2011; 42(1):123-7, vii. DOI:10.1016/j.ocl.2010.09.003 · 1.25 Impact Factor

Publication Stats

428 Citations
107.59 Total Impact Points


  • 2002–2014
    • University of Mississippi Medical Center
      • • Department of Orthopedic Surgery and Rehabilitation
      • • Department of Radiation Oncology
      Jackson, Mississippi, United States
    • University of Washington Seattle
      Seattle, Washington, United States
  • 2000–2014
    • University of Mississippi
      • Department of Orthopedic Surgery and Rehabilitation
      Mississippi, United States
  • 2003
    • Swedish Medical Center Seattle
      Seattle, Washington, United States
  • 1999–2000
    • University of South Alabama
      • Department of Orthopaedic Surgery
      Mobile, AL, United States