The Fellowship Programs at the Department of Orthopaedic Surgery at Penn Medicine were developed to encompass the breadth of technical knowledge required of subspecialists in orthopaedic surgery. It is now estimated that nine in ten current orthopaedic residents will complete at least one fellowship before practice.

Penn Orthopaedics offers Fellowship Programs in adult reconstruction, foot and ankle surgery, hand surgery, shoulder and elbow surgery, sports medicine, pediatric orthopaedics, and spine surgery. Most offer a combination of clinic, operative, and clinical and laboratory research experience.

Penn Orthopaedics also offers an Orthoplastics and Limb Salvage (OLS) Fellowship – a microvascular surgery program uniquely focused on traumatic reconstruction. Directed by Drs. L. Scott Levin, Stephen J. Kovach and Samir Mehta, the program allows fellows to design a more advanced clinical and research experience in managing extremity reconstruction and salvage. OLS fellows have shared clinical responsibilities with rotating orthopaedic and plastic surgery residents, have access to the McKay Orthopaedic Research Laboratory for anatomy, microsurgery and biomechanics projects, and become integral members of the Hand Transplantation Service.

Recently, the editors of the Penn Orthopaedics Newsletter caught up with Zvi Steinberger, MD, who completed the Penn OLS Fellowship in 2020, along with a microsurgical research fellowship in the Levin Laboratory at McKay in 2016. A graduate of the Ben-Gurion University of the Negev, Dr. Steinberger is an attending orthopedic surgeon in the hand and microsurgery department at Sheba Medical Center in Tel Hashomer, Israel. We spoke to him via Zoom at his home in that city.

Dr. Steinberger, how did you learn about the OLS Fellowship Program at Penn Orthopaedics?

Actually, the OLS Fellowship didn't exist when first I came to Penn — it came later. After completing my residency in orthopaedic surgery and a hand fellowship in Israel, I knew I wanted experience in research, and particularly in microsurgical research. Now, you don't find programs like this everywhere, so I brought this interest to my Director, who knows everybody in the field, and she told me I needed to meet Dr. Levin here at Penn. Shortly after this, I moved with my family to Philadelphia for a year. This was in 2015-2016.

What did your Penn Orthopaedics research fellowship involve?

I was doing vascularized composite allotransplantations in rats. We were looking at immunomodulation and stem cells in forelimb transplantation. I published this research with Dr. Levin, which was an amazing experience. And in 2016, I took part in a bilateral hand transplantation at Penn — and from that moment on, I knew that hand microsurgery and limb reconstruction were what I wanted to do.

You returned to Israel in 2016, but came back to do a second fellowship at Penn several years later. What drew you back?

In Israel, I finished my residency in orthopaedic surgery and a hand fellowship. But having done this, I felt that I needed more background in microsurgery. I'd done my research in transplantation, of course, but this didn't involve as much microsurgery as I'd have liked, and to do what I want to do here in Israel, I really needed experience in this area. I'd kept in touch with Dr. Levin, and he suggested that I apply for the new Orthoplastic Fellowship for the following year at Penn.

In addition to advanced training at the PGY-6 level or higher, the Penn Orthoplastics and Limb Salvage Surgery Fellowship provides training in extremity reconstructive surgery, including trauma. Fellows receive additional advanced training in hand transplantation, microsurgical reconstruction of upper and lower extremities in adults and children, and brachial plexus surgery.

The Fellowship focuses on both upper and lower limb extremity, allowing the fellow and the institution to design a more advanced clinical and research experience in managing extremity reconstruction and salvage. The fellow has shared clinical responsibilities with rotating orthopaedic and plastic surgery residents and fellows.

The Orthoplastics and Limb Salvage Surgery fellow also becomes an integral member of the Hand Transplantation Service and is expected to participate in research, resulting in at least one publication or formal presentation alongside our faculty members, who are heavily involved in clinical and basic research. The Fellowship offers an extensive orthopaedic research laboratory for anatomy, microsurgery and biomechanics projects.

What about the Penn Orthoplastics Fellowship appealed to you?

To begin with, the OLS Surgery Fellowship has an amazing combination of clinical elements — orthopaedic, plastic and microsurgery. Many microvascular fellowships focus on other things, breast reconstruction following cancer treatment, for example. But the Penn OLS Fellowship is focused on traumatic reconstruction?something that is not only uncommon, but for someone looking for this type of exposure, as I was, like a glove to my hand. I mean, I'd had some exposure to these things, but suddenly, I had access to one of the best orthopaedic labs in the country and was learning microsurgery and reconstruction from two of the great leaders in this field, Drs. Levin and Kovach.

 Was that sort of access surprising to you?

Well, certainly. Dr. Kovach is a very busy surgeon and Dr. Levin is running one of the busiest Orthopaedic Departments in the country and contributing to national organizations and doing surgery — but it wasn't just access. I mean, Dr. Levin was there to answer my questions, to guide me, to give me a helping hand. But he has a talent for making you see the difference between what you want in the short-term and what you need in the long-term, between what's important and what's not. You only have so much time as a fellow and it's easy to become distracted.

Did you have a path in mind for your Fellowship when you arrived?

I think so - it wasn't something that I planned per se, but in the end it was the most perfect path I could imagine. It started in my orthopaedic residency, with orthopaedic problems, fixations, bones, you know, which evolved into research and hand surgery and eventually here at Penn with orthoplastics and microsurgery. I'll tell you why this was the perfect path. First, my interest in hand and limb reconstruction has a personal component. I was a special forces soldier in Israel. So this is close to my heart. And today, I see injuries from IEDs and missiles, mangled extremities and amputations, and often hand injuries. And the ability to take a patient who's sure his life is devastated and provide him with feet he can walk on, or a hand he can use, I don't think there's anything more satisfying than that. And I can say without question that I think microsurgery is the highest calling for a surgeon. It's really the highest surgical skill you have today in any field. Suturing vessels less than a millimeter or half a millimeter in diameter.

What benefits did you take from the OLS Fellowship at Penn back to your hospital in Israel?

At Sheba Medical Center in Tel Hashomer, we're now able to do surgeries that we couldn't before my training in Philadelphia. My hospital was very supportive of me both during my absence and on my return. And since I've come back, I've been using what I learned at Penn to provide excellent care here in Israel.

A few months ago, for example, we performed surgery on a young man who survived a missile hit on his SUV. He had his left lower limb amputated, and both upper limbs were badly injured.

To address these issues, we began with multiple debridements. After ensuring that there was no infection, we addressed the right upper limb first and reconstructed his nerves using allografts. Later, we approached his left upper limb, and during this operation replaced his elbow, reconstructed his extension mechanism and covered his prosthetic elbow using a pedicled latissimus dorsi muscle.

This really encompasses all the abilities and all the things that I learned from Dr. Levin; the patience, for example, the step-by-step progress of treating complex patients. Understanding the limits, what I can do, what I can't do, and understanding that some limitations change with time. Perhaps most importantly, what I learned at Penn was to treat the patient as a whole, not just as an injured foot or hand. If you follow Dr. Levin in clinic you really begin to understand that he sees a patient as a whole and the way that he talks to patients the way that he approaches patients, it's different. This is something that I took home with me. Seeing the patients as a whole, and understanding that your goals as a surgeon must be the patient's goals.

I learned, too, the value of working as a team. And understanding that it's okay to ask for help if there's something that's not exactly in your field. What I picked up from Dr. Levin particularly, is that in the operating room, you're the one who makes the decisions, but never the one who takes the spotlight; unless something goes wrong. Then it's all on you, not your team. Humility.

Learn more about the Penn Orthopaedics Orthoplastics and Limb Salvage Fellowship