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You Don’t Know What You’ve Got Till It’s Gone

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LEXINGTON For many people, the convenience and function of their hands is not something they truly appreciate until it is gone. Brandon Devers, MD, hand and upper-extremity surgeon at Lexington Clinic Orthopedics – Sports Medicine Center, highlights the constant contributions of the human hand to our activities of daily living. “People arrive at our office daily saying, ‘I had no idea how debilitating it would be to lose the full function of my hand,’” says Devers.

It would be impossible to remain conscious of all the things our hands do for us over the course of a day. It goes without saying that anything capable of such diverse actions has to be both structurally and functionally complex. It was this complexity and the rich variety of anatomic, pathologic, and therapeutic entities that drew Devers to choose hand surgery as his subspecialty. He arrived at Lexington Clinic with his armament of diagnostic and surgical skills and joined the hand surgery team of Stephen C. Umansky, MD, and Michelle Derbin, PA-C. With a patient age range from one to 90 years, a day of surgery may include a fracture repair of the elbow, an endoscopic carpal tunnel repair, an extensor tendon repair, an injection of collagenase for a Dupytron’s contracture, and shortening of a congenitally long ulna. With Devers, any given day is a busy one.

But, Devers has always been a busy man. He played college football for Princeton and graduated with honors in 2005. This is an achievement that takes disciplined time management, an admirable intellect, elite-level athleticism, and dedication to a team. All of these abilities are called upon daily in Devers’ practice. After his undergraduate degree at Princeton, Devers attended medical school at Baylor College of Medicine and again graduated with honors and was elected to Alpha Omega Alpha in 2009. A residency in orthopedic surgery at Vanderbilt in 2014, was followed by a hand fellowship at the University of Cincinnati in 2015. With this superb training, it is likely Devers could have gone into practice anywhere he wanted, but he chose the hand surgery team at Lexington Clinic, which has the added bonus of allowing him to be back home with an extended family.

Since Devers’ arrival, the hand surgery team has grown their practice at a better-than-expected rate and are seeing a wide variety of injuries. “There is no other area in our specialty where you get to do fracture work, joint replacement or reconstruction, micro-vascular surgery, nerve repair, and more. So, I know that every day I show up for work there is going to be a different set of problems than I saw the day before,” says Devers. You can find Devers in the operating room two to three days a week doing three to eight cases a day depending on complexity.

Devers singles out endoscopic carpal tunnel repair as the most common procedure he performs. He is very comfortable with the single incision endoscopic technique, which he offers to all patients. Understanding that all the various techniques have the same outcome at six to 12 weeks, Devers prefers the single incision endoscopic technique, as there is less pain and quicker return to work by two weeks as compared to the others. The benefit of faster recovery is common to several recent advances in surgical techniques. More aggressive rehabilitation is possible now, which decreases the likelihood of adhesion formation, one of the most unwanted complications in any hand surgery.

Rheumatoid Arthritis (RA) is a condition that well illustrates the principle of maximum medical therapy before making the decision to operate, which Devers always adheres to. In the past, there were hand surgeons whose practice was primarily devoted to treating RA. Now, with the development of much more successful medical treatment, Devers estimates he sees only one or two patients with RA per month. Conversely, osteoarthritis (OA) continues to be a common condition affecting the hands and wrist. While osteoarthritic conditions may show advanced progression on imaging, Devers offers his patients initial conservative management with splinting, injections, and medications, which may lengthen the time before they have to undergo surgery. “I don’t treat x-rays. I treat patients,” Devers often says.

One feature of Umansky, Devers, and Derbin’s practice that they want other physicians to know about is that there is always someone in the clinic to see emergent or urgent patients. When Devers is in the operating room, Umansky or Derbin are in the clinic and vice versa. Also, they save time in each clinic schedule for same-day referrals. These openings are usually filled with trauma and fracture patients who would otherwise spend many hours in the emergency room and then still get referred to a surgeon.

Although Devers has been too busy building his practice to start any new research, a look at his curriculum vitae will show that he has several research papers published in prestigious journals. Recently, Devers traveled to the Mid-America Orthopedics Association meeting to present some of his research findings from his fellowship. He looks forward to continuing his research efforts in the form of participation in multi-center clinical trials and beta-testing technological advancements as his practice matures. These endeavors would be integrated with a patient-centered hand surgery practice where the primary focus will always be on providing the best individualized care possible for every patient.

I don’t treat x-rays. I treat patients.– Dr. Brandon Devers