Stuart Green, M.D.Post-Trauma Reconstruction/ Ilizarov Surgery

Clinical Interests

Dr. Green is an orthopaedic surgeon whose subspecialty interest deals with post-trauma limb reconstruction, including non-unions, malunions, shortening and post-trauma infections of bones and joints. He has written four books and has contributed chapters in 23 others. Dr. Green has authored or co-authored approximately 150 articles in medical journals.

During the past 25 years, Dr. Green has lectured around the world and published extensively on matters dealing with his area of expertise.He has been the Presidential Guest Speaker at National Orthopaedic Conferences across the globe. He was the first American to visit Dr. G.A. Ilizarov in Kurgan, Russia and was instrumental in introducing the Ilizarov Method of reconstructive surgery to the world's orthopaedic surgeons.

In the mid-1980s, Dr. Green on modified the Ilizarov Method by substituting threaded half pins for tensioned wires in the circular fixator configurations. This strategy, developed while Dr. Green was at Rancho Los Amigos Medical Center in Downey California, is called the Rancho Technique.  (See http://www.ncbi.nlm.nih.gov/pubmed/1611729) Nowadays, it is rare to sit in the auditorium of an orthopaedic surgeons meeting anywhere in the world and see projected on the screen images of circular external fixators that are not secured to a limb with the Rancho Technique. The methodology has been adapted to many other circular fixators, including the Taylor Spatial Frame and the Orthofix circular fixator.

At around the same time, Dr. Green and Dr. David Seligson of Louisville Kentucky devised the world's first intramedullary femoral nail designed to be inserted through the knee joint, rather than from the upper end of the femur. The implant, manufactured by Smith and Nephew of Memphis, was called, naturally enough, the GS Intramedullary Nail. The insertion jig was later modified by Dr. Steven Henry, also Louisville, and the implant’s name was changed to the GSH Nail (See http://www.ncbi.nlm.nih.gov/pubmed/8222426). At present, it is estimated that around 10% of the femur fractures throughout the world are treated with Green and Seligson’s retrograde approach.

Dr Green is an acknowledged authority on medical ethics as it relates to musculoskeletal care. He has published extensively on the subject of the ethics of surgery for questionable indications as well as ethical considerations related to new medical device development and the unfavorable effect exaggerated medical–legal reports have on patients. He has been invited to lecture about these and related topics as the Presidential Guest Speaker for the Annual Meetings of both the Limb Lengthening and Reconstruction Society (2006), and The American Orthopaedic Foot and Ankle Society (2006), as well as the Association of Bone and Joint Surgeons (2004). Likewise, he has given invited lectures on the topic of medical ethics as it relates to orthopaedic surgery and surgical research at Harvard University School of Medicine (2003, 2006), Stanford University School of Medicine (2001), USC School of Medicine (2009), UCSF School of Medicine (1999), University of Connecticut School of Medicine (2003), and many other distinguished institutions, national organizations and foreign orthopaedic associations.

As a result of these interests, publications and speakerships, Dr Green became a member of the Committee on Ethics of the American Academy of Orthopaedic Surgeons in 2007, and has served on the Ethics Committee of UCI Medical Center. He is a member of the Association for Medical Ethics.

In 2008, Dr. Green served on a panel dealing with the ethical considerations involving surgeon-industry relations. Other panel members included: Jack Mitchell, Chief Investigator for the U.S. Senate’s Special Committee on Aging; Peter Winn, Assistant United States Attorney, U.S. Department of Justice; Felicia Cohn, PhD, Director of Medical Ethics at UCI; and Dr. Charles Rosen, Founder of the Association for Medical Ethics.

The year 2008 was the 75th anniversary of the American Academy of Orthopaedic Surgeons. To celebrate the event, the AAOS published a book on the history of American orthopaedic surgery called “Moving Stories” and produced a companion DVD titled “Moving Pictures.” Dr. Green’s role in our nation’s orthopaedic history is featured in both the book and the movie. The chapter from the book containing Dr. Green’s involvement with Russian orthopaedist G. A. Ilizarov can be read at the following link: http://www.aaos75.org/stories/physician_story.htm?id=14

In January 2009, The Medscape Journal of Medicine asked Dr. Green to present a video editorial about teaching moral reasoning and professional ethics to medical students, interns and residents through review articles in the medical literature. The resulting editorial (“Let’s Teach Moral Reasoning to the Next Generation of Doctors”), available at: www.medscape.com/viewarticle/586030, elicited favorable comments from viewers around the world. (A login name and password may be required to view this video editorial, but they are easy for physicians to obtain by registering on the Medscape website.)
Dr. Green was the keynote speaker at the June 2009 Annual Meeting of the American Society of Mechanical Engineers (Biomechanics Section), talking about ethical consideration related to surgical implant development and clinical testing.

In 2009, Dr. Green became involved with the development of a new product: a fully implantable self lengthening intramedullary nail. The implant’s developer, Ellipse Technologies, had created an externally-controlled internal lengthening spinal rod designed to eliminate multiple surgeries in children with early onset scoliosis. The company wondered whether their technology could be applied to a limb lengthening product. Dr. Green worked with the company’s engineers and in consultation with other practitioners, created the Precice Internal Self-lengthening intramedullary Nail. Dr. Green is a co-inventor of the device, US patent number 8,852,187. (See http://www.google.com/patents/US8852187) He became the company’s medical director shortly thereafter. He performed all the animal research on the implant as well.

The Precice Nail received FDA approval within a couple of years and is now the only externally-controlled intramedullary lengthening nail available in the United States of America. (See http://ellipse-tech.com/precice-limb-lengthening-technology/) Thousands of Precice Nails have been used worldwide to lengthen stunted limbs, whether caused by birth defects, developmental diseases, dwarfism, short stature or trauma. (see, for instance: http://www.ncbi.nlm.nih.gov/pubmed/24682741)

As a result, Ellipse Technologies grew from 5 employees in 2010 to more than 200 employees in 2016, the fastest growing company in Orange County California during some of the intervening years. In March, 2016, NuVasive, a medical device company in San Diego California, purchased Ellipse Technologies for $380 million. (See http://www.sandiegouniontribune.com/news/2016/jan/05/nuvasive-acquires-ellipse-spine/)

Dr. Green remains as medical director of the Precice division of NuVasive. He lectures around the world on the implant’s usage.

Research Interests

Dr. Green has been actively engaged in research at two of UC Irvine's biomedical research labs. At the Orthopaedic Biomechanics Laboratory at the Long Beach Veteran's Hospital, Dr. Green works with Thay Q. Lee, Ph.D. on problems related to the biomechanics of external skeletal fixation and internal fixation devices. In conjunction with Vincent Caiozzo Ph.D., Dr. Green studied the effect limb lengthening has on muscle tissue with the goal of the reducing the complication associated with limb elongation.

Background

Dr. Green received his undergraduate degree from Lafayatte College and his MD degree from New York Medical College. He completed his surgical internship and residency in Orthopaedic Surgery at the Hospital for Joint Diseases in New York. Dr. Green completed fellowship training in Infectious Diseases at the University of California, San Diego. He currently serves as a Clinical Professor in the Department of Orthopaedic Surgery at the University of California, Irvine. He is the son, father, and first cousin of orthopaedic surgeons.

Dr. Green is the Deputy Editor for Clinical Orthopaedics and Related Research; he has served as the Associate Editor for the Journal of Orthopaedic Trauma, the Associate Editor for Advances in Orthopaedic Surgery, and the Associate Editor for Techniques in Orthopaedics.

His interest in the history of medicine in colonial America resulted in the book "Dear Dr. Franklin; Emails to a Founding Father about Science, Medicine and Technology" Further information is available at dearDoctorFranklin.com.

Dr. Green’s focus on Benjamin Franklin and his publication of “Dear Doctor Franklin” resulted in an invitation from the Saturday Evening Post (founded by Franklin in 1728) to Dr. Green to contribute to a weekly blog, “What Would Ben Franklin Say,” on their website. There, Dr. Green considers many aspects of modern life, such as the election of a president of African ancestry, and offers a guess at what Benjamin Franklin would have to say about the matter. His blogs are available at the Saturday Evening Post’s website without a password. Here’s a link to a typical blog: http://www.saturdayeveningpost.com/2009/04/17/humor/email-ben-franklin.html

Dr. Green also works as a photographer (see www.stuartgreenphotos.com) and has had two major gallery shows in the Los Angeles area, the first in Santa Monica at the ADC Building Bridges Gallery (see http://fabrik.la/stuart-alan-green-a-journey-of-discovery-at-adc-building-bridges/) and the second at the Los Angeles Municipal Gallery (see http://www.seniorartsfoundation.org/events.html) His photography work focuses using the color theories of early 20th century artists to create photographs, which he modifies with various Photoshop related techniques. (See these YouTube videos to understand what he does: http://www.youtube.com/watch?v=SGncEi-nfis  and  http://www.youtube.com/watch?v=3t-Dkr0AsTY  and  http://www.youtube.com/watch?v=Yt_TlVwteaQ)