- Adult Joint Reconstruction
- Foot & Ankle
- Hand and Upper Extremity
- Sports Medicine & Shoulder Elbow
One strength of this fellowship is the large and diverse surgical volume. Annually the OrthoCarolina Hand Center treats over 50,000 patients and performs over 7,900 surgeries including:
- Congenital hand reconstruction
- Brachial plexus reconstruction
- Upper extremity tumors
- Arthroplasty shoulder to hand
- Arthroscopy shoulder to hand
- Level I trauma reconstruction (including replants, free tissue transfers and nerve transfers)
- Elite athlete hand and wrist injuries
We have a separate congenital hand, brachial plexus, and amputee clinics.
Fellows will actively participate in the daily management of patients in the OR and clinic environment. The fellows will be involved in near-peer education of the residents from Carolinas Medical Center who will be doing their hand surgery rotations. Because of the large volume of attending physicians, both residents and fellows will have a one-on-one experience with a staff member each month; therefore, there is no competition between residents and fellows for elective cases. Residents and fellows will overlap in the Myers Park Clinic and on call at Carolinas Medical Center. Call averages 1 in 5 nights from home.
From a didactic standpoint, there are daily dedicated teaching sessions including cadaveric dissections, journal clubs, faculty lectures, one-on-one mentorship time, and microsurgical animal lab training.
One half day per week is set aside for clinical and/or laboratory research including combined projects with the attendings and independent research. The fellows are expected to complete one original research project with the goal of publication in a peer-reviewed journal. The OrthoCarolina Research Institute, a 501(c)(3) research organization with 16 full-time staff, provides fellows with the knowledge, skills, and ability to successfully fulfill the research requirements of their curriculum program.
The fellowship is ACGME accredited.
This fellowship participates in the NRMP match program.
The Program is under the direction and supervision of the Director, Glenn Gaston, MD.
OrthoCarolina Hand Center Physicians:
- Provide the best in both surgical and non-surgical evaluation and treatment and have become a center of excellence in the treatment of hand and upper extremity problems
- Have treated 50,000+ patients in the past year and performed 7,900+ surgeries
- Have been recognized with 25 “Top Doctor” awards including a Beckers’ recognition for the Top 45 Hand Surgeons to Know in the US
- Have been rewarded 4 of the last 6 years with the Faculty Teaching Award in Orthopaedic Surgery at Carolinas Medical Center
- Have been involved in resident education for 45+ years and are devoted to training orthopedic residents and fellows to be the very best in the hand and upper extremity service
- Speak at national and international scientific meetings including the ASSH every year since 2005
- All actively participate in clinical trials with the OrthoCarolina Research Institute including ASSU and NIH-supported trials
- Faculty Research and Podium Presentations:
- Peer-reviewed publications
- National & regional presentations
- Book Chapters
- Research - Multi-Center and Ongoing Trials
Hand and Upper Extremity Faculty:
Goals and Objectives
The educational goal of the Hand Fellowship Program at OrthoCarolina, P.A. is to prepare with the fellow with the fundamental skill set to become an upper extremity expert in a private or academic setting upon completion from the program.
The program affords a wide variety of exposure and instruction in all aspects of hand and upper extremity surgery. We have an extensive didactic lecture schedule including numerous clinical conferences. In the office, the fellows will gain insight into the evaluation, diagnosis, and clinical workup of patients presenting with the full spectrum of upper extremity disorders. With nine practicing hand surgeons involved in fellowship education, our group offers a very vast array of surgical and nonsurgical pathology. Annually the OrthoCarolina Hand Center treats over 50,000 patients and performs over 7,900 surgeries. We have a very diverse practice ranging from brachial plexus reconstruction to fingertip reconstruction. We take call at a level 1 trauma center and have extensive experience in the management of complex wounds.
Listed below are the educational objectives and required competencies as defined and outlined by the ACGME specific to the Hand Fellowship Curriculum. The sheer volume and very nature of our large hand practice will ensure these goals are met.
OrthoCarolina Hand Center
- Fellows will gain experience in history taking, physical examination of the upper extremity, injections, interpretation of radiographic studies, casting and other office-based procedures. Additionally, congenital hand clinic is held monthly in the office. Many didactic sessions from the lecture schedule are held here.
- All fellows will also attend the OrthoCarolina Congenital Hand Clinic which is held ½ day per month. There is 3 faculty devoted to this clinic that will be present at all times. Fellows will perform the initial evaluation, order necessary x-rays, and synthesize a treatment plan to present to the faculty. The team of attendings and fellows will jointly formulate a plan of care.
- Also, we have a dedicated brachial plexus clinic which is held ½ day per month. This will be run in the same fashion as the congenital hand clinic in terms of fellow responsibility.
Monthly Reconstructive Center for Lost Limbs Clinic: Fellows evaluate and treat upper extremity amputees ranging from partial hand amputation to shoulder-level amputees. Appropriate prosthetic fit and training as well as cutting edge surgery are discussed and performed.
Myers Park Clinic
- Myers Park is the second outpatient clinic, which is run by the fellows, where the fellows are able to make independent assessment and treatment decisions without an attending staff surgeon physically present. Fellows discuss cases encountered in this clinic with the attending surgeons and plan surgery accordingly. While independence is encouraged, attending surgeon availability for cases must occur 100% of the time. The residents on the hand service are also directly involved in the operation of the Myers Park Clinic. In this setting, the fellow serves as a faculty mentor for the residents and is expected to enhance the educational experience of all residents involved.
Carolinas Medical Center
- Fellows will gain experience in Level I trauma reconstruction, advanced microsurgical skills including replants, nerve and artery repairs, and free tissue transfers, arthroplasty of the shoulder, elbow, wrist, and hand, congenital hand differences, resident education and Myers Park Clinic.
Carolinas Medical Center - Mercy
- Fellows will gain experience in inpatient and outpatient surgical skills including arthroscopy, fractures and nerve and tendon repair. CMC-Mercy houses an anatomy lab and arthroscopic simulator that are used by the fellows.
- Fellows will gain experience in inpatient and outpatient surgical skills including arthroscopy, fractures, and nerve and tendon repair
Charlotte Surgery Center, Mallard Creek Surgery Center, and Matthews Surgery Center
- Exclusively outpatient ambulatory surgery centers. The majority of cases are carpal tunnel, trigger finger, CMC arthroplasty and other short duration common surgical hand procedures. Additionally, fellows will learn the pros and cons of the business side of hand surgery in terms of ownership
- Open surgery – trauma, reconstruction, nerve compression, arthritis, infections
- Arthroscopy of the shoulder, elbow, wrist, and hand
- Implants for the treatment of arthritis
- Brachial plexus, nerve transfers, stroke, CP, SCI
- Micro - flaps / replants
- Congenital hand surgery
- While this is not a strictly microsurgical fellowship, we believe that basic competence in microsurgical vessel anastomosis and a full array of free tissue transfer should be within the armamentarium of the graduating hand fellow.
- Fellows will be taking hand call on average 1 in 5 nights. Normal ACGME requirements are adhered to. For emergency room or inpatient consultations at CMC, the junior residents consult the senior residents, who then involve the fellow as appropriate. The fellow then involves the attending surgeon. For ER and inpatient consults at Presbyterian and Mercy, the fellow will evaluate the patient then discuss the case with the on call hand attending. Participation in general orthopedic trauma call is offered, but not mandatory (to maintain skills developed during residency)
- At the onset of the fellowship, fellows will take an all expenses paid microsurgical training course. Following that, fellows will have a ½ day per month set aside for additional training on animal models at the Carolinas Medical Center. This is under the direction of Dr. Ryan Garcia. Once fellows have gained microsurgical expertise they will serve as microsurgical instructors for the orthopedic residents at Carolinas Medical Center during that ½ day per month. These microsurgical skills will be used for on-call trauma cases such as revascularizations, digital replantation, and major limb replantation as well as for elective cases such as free fibular transfers, nerve repairs from brachial plexus to fingertips, free tissue transfers, and upper extremity vascular reconstruction.
- Didactic curriculum: All hand faculty presently dedicate 1 hr every morning to teaching. We have weekly grand rounds and M&M on Mondays. Wednesday morning conference includes faculty lectures on a variety of topics. Other sessions include hand journal club, research meetings, preoperative indications conference, and microsurgical skills taught at CMC utilizing animal models. There is an arthroscopic simulator that Fellows can use as well as access to cadaver lab to be used for anatomy teaching on a monthly basis. We have a separate Orthopaedic Research Institute (501C3) with dedicated training for Fellows in research.
- Mayo Clinic Microsurgery Course
- ASSH Fellows Flap Course / ASSH Annual Meeting
- One week traveling fellowship
- Industry courses available by request
Research is a priority of the fellowship. Fellows will devote at least one-half day each week primarily to clinical and laboratory research, including combined projects with the hand faculty and independent research. The fellow is expected to complete one original research project with the goal of publication in a peer-reviewed journal.
The fellows are supported in large part by the OrthoCarolina Research Institute, a 501(c)(3) research organization with 16 full-time staff. The staff is available to assist the fellows in understanding the research process, regulatory and compliance issues, and the complexities of managing and completing a scientific study. We also have a full-time dedicated hand research coordinator.
Laboratory and Research Facilities
- Cadaver bioskills lab
- Microsurgical lab on the Carolinas Medical Center Campus
- Dedicated fellows study area with work space and computer access
- A videotape library (at CMC) which includes educational DVDs on anatomical dissections and surgical procedures for instructional use by OrthoCarolina’s fellows
- Computer-aided instruction: OrthoCarolina’s IT Department, as well as the OrthoCarolina Research Institute, is available to provide assistance with computer graphics, PowerPoint presentations, scanning, digital photography. Other video editing and video productions are available to Fellows at Carolinas HealthCare System’s audio/video department
- Access to (a) a major medical library, (b) electronic retrieval of information and medical databases:
(a) The Fellow has full access to the Carolinas HealthCare System Medical Library. Located on the campus of Carolinas Medical Center the AHEC Library & Information Resource Center offers a comprehensive array of both print and online resources to satisfy the informational and educational needs of all healthcare providers in the Charlotte region
(b) The AHEC Digital Library is available for all North Carolina health care professionals. It includes hundreds of full-text journals and textbooks; electronic databases such as MEDLINE, CINAHL and Cochrane; comprehensive health information sites such as MDConsult; and other medical information links
Fellows / residents interact one-on-one with staff at all times in the office, OR and on call.
In the Myers Park Clinic setting the fellow serves as a faculty mentor for the residents and is expected to enhance the educational experience of all residents involved.
For emergency room or inpatient consultations at CMC, the junior residents consult the senior resident, who then involves the fellow as appropriate.
- Fellows will gain experience in history taking, physical examination of the upper extremity, injections, interpretation of radiographic studies, casting and other office based procedures. Additionally, congenital hand clinic is held monthly in the office. Many didactic sessions from the lecture schedule are held here.
Carolinas Medical Center:
- Fellows will gain experience in Level I trauma reconstruction, advanced microsurgical skills including replants, nerve and artery repairs, and free tissue transfers, arthroplasty of the elbow, wrist and hand, congenital hand deformities, resident education and Myers Park Clinic.
Carolinas Medical Center – Mercy:
- Fellows will gain experience in inpatient and outpatient surgical skills including arthroscopy, fractures and nerve and tendon repair. CMC Mercy houses an anatomy lab and arthroscopic simulator that are used by the fellows.
- Fellows will gain experience in inpatient and outpatient surgical skills including arthroscopy, fractures, and nerve and tendon repair.
Charlotte Surgery Center, Mallard Creek surgery center, matthews surgery center:
- Exclusively an outpatient ambulatory surgery center. The majority of cases are carpal tunnel, trigger finger, CMC arthroplasty and other short duration common surgical hand procedures. Additionally, fellows will learn the pros and cons of the business side of hand surgery in terms of ownership.
Michal Gart, MD
Patrick Marinello, MD
Darren Thomas, MD
About Charlotte NC
Charlotte has it all, from a thriving arts and cultural scene to an equally energetic sporting calendar, meaning that residing in the “Queen City” allows a multitude of activities to fulfill the fellow’s time outside of work. A prosperous city that is home to numerous profitable companies, Charlotte and its residents haven’t lost their old Southern charm or forgotten how to make traditional Southern cuisine.
Whether it's attending a professional sporting event (Carolina Panthers, Charlotte Hornets, or minor league baseball and hockey) or a fun-filled activity for the kids, there's no shortage of things to do in the
How is this Fellowship Unique?
- We have nine full-time, devoted faculty with pure interest in high quality education with a 4 to 1 faculty to fellow ratio. We have high volume, diverse clinical practices which include: full breadth of upper extremity surgery including arthroscopy and arthroplasty, congenital hand, brachial plexus / tetraplegia and amputee clinics, microsurgical experience including replantation, care of elite athletes, and high volume / high complexity upper extremity trauma.
- We have a daily structured conference schedule.
- One half day per month is set aside for microsurgical training on animal models at the Carolinas Medical Center.
- The fellows are supported in large part by the OrthoCarolina Research Institute, a 501(c)(3) research organization with 16 full time staff. The staff is available to assist the fellows in understanding the research process, regulatory and compliance issues, and the complexities of managing and completing a scientific study. We also have a full-time dedicated hand research coordinator.
- Charlotte offers an incredible variety of things to do, from high-energy racing, pro sports games and outdoor recreation to cosmopolitan art, culture and history.
Applying to our Program
Welcome to the OrthoCarolina Hand Teaching File. Our faculty and fellows have assembled years of images and created this teaching file for educational purposes. A very special thanks goes to Dr Mark Tait who spent countless hours making this idea a reality. Feel free to use any of these images for educational purposes including lectures and manuscripts. We simply ask that you give credit as "with permission, OrthoCarolina Hand Teaching File".