American Board of Surgery, Inc

AMERICAN BOARD OF SURGERY, INC.  1617 JOHN F. KENNEDY BLVD.  SUITE 860  PHILADELPHIA, PA 19103-1847

SURGERY OF THE HAND

LIST OF 125 HAND SURGERY CASESMANAGEDDURING A 15-MONTH PERIODWITHIN THE PAST TWO YEARS

NAME OF APPLICANT

Last NameFirst NameMiddle Name

INSTRUCTIONS FOR COMPLETION OF THE LIST OF CASES

The following information must be provided for each case:

1.Initials of patients

2.Name and address of hospital or surgical facility

3.Date(s) of care

4.Diagnosis

5.Operations (if any - only six (6) nonoperative cases may be included)

The attached list includesthe following cases, separatedby category:

A.Bone and Joint (20)A.

B.Nerve (20)B.

C.Tendon and Muscle (20)C.

D.Skin and Wound Problems (14)D.

E.Contracture and Joint Stiffness (10)E.

F.Tumor (10)F.

G.Congenital (3)G.

H.Microvascular (3)H.

I.Nonoperative (6)I.

Total (125)

The numbers in parentheses indicate the minimum numbers which must be fulfilled in at least five categories.PLEASE NOTE - the minimum numbers for each of the nine categories together DO NOT total 125. Some categories will need more than the minimum numbers to reach a total of 125 cases (except Nonoperative, where the maximum is also six cases).

Nonoperative cases are those which require significant evaluation, such as pain problems. If including Nonoperative as one of the categories to fulfill the minimum five required categories, the nonoperative cases must be documented with consultation reports. No more than six nonoperative cases will be accepted. (If five other categories are fulfilled with minimum numbers, consultation reports do not need to be included.)

Complex cases can satisfy up to three categories. For example, the management of a complex mutilating injury involving repair of muscle, tendon, nerve, vascular injury, and skin would count for muscle and tendon, nerve, and vascular repair, but not for the skin. This example clearly indicates a more complex operative experience than a simple, single-task surgery. Those cases in which the involvement of two categories is part of a single-focus surgery, such as the use of a tendon in ligament reconstruction and tendon interposition of the basal joint, would count as only one case.

Asample formatfollows for listing your cases. This format must be used. List your cases on copies of this form or on a similar form.

Applicants should keep a copy of all submitted information (application form, case list, and case list summary), as the ABS will not furnish copies. The ASSH requires the Case List Summary as part of their application process, so please keep a copy of this summary if you plan to apply for membership in the ASSH!

If you have any questions, please visit our website or contact .

SAMPLE FORMAT

SURGERY OF THE HAND

SUMMARY OF OPERATIVE EXPERIENCE BY CATEGORY

(MUST BE 15 CONSECUTIVE MONTHS DURING THE PRECEDING TWO YEARS EXCLUSIVE OF FELLOWSHIP)

APPLICANT’S NAME

LAST NAMEFIRST NAMEMIDDLE NAME