University of California (Irvine) Program

The University of California, Irvine (UCI) offers a comprehensive Hand and Upper Extremity Fellowship through its Department of Orthopaedic Surgery, which is a combined program with the Departments of Plastic Surgery. The fellowship provides extensive training in hand and upper extremity surgery, covering a wide range of conditions affecting both children and adults, including specialized areas such as microvascular surgery.

One of the significant advantages of this program is its association with the only Level 1 Trauma Center in Orange County, allowing fellows to gain substantial exposure to upper extremity trauma. The Hand Service directly manages fractures of the hand and wrist, including distal radius fractures, and offers exposure to more complex issues, such as forearm, elbow, humerus, and clavicle fractures. Moreover, the program collaborates closely with the Orthopaedic Trauma Service to provide care for soft tissue reconstruction of traumatic injuries in both the upper and lower extremities, including free tissue transfer and microsurgery. As a result, fellows develop expertise in bone and joint trauma, soft tissue coverage, and complex microsurgical techniques such as replantation 1.

Fellows also participate in the treatment and reconstruction of patients from UCI's Burn Unit and the Orthopaedic Oncology service. This allows for involvement in elective practices that encompass a variety of upper extremity surgeries, including arthroscopy and wide-awake surgery. In addition, there is significant exposure to pediatric hand and brachial plexus surgery at the Children's Hospital of Orange County (CHOC), alongside adult reconstruction experience at the Long Beach Veterans Hospital.

Curriculum and Rotations

The fellowship comprises two 3-month rotations on the Orthopaedic Hand Service and the Plastic Surgery Hand Service. During the Orthopaedic Hand Service rotation, fellows primarily work at the UCI Medical Center, where they focus on elective adult reconstruction, traumatic injuries, soft tissue reconstructions, osteomyelitis, sarcoma reconstruction, and various arthroscopic procedures, including evaluation of shoulder surgeries related to brachial plexus and nerve transfer surgery 2.

On the Plastic Surgery Hand Service rotation, fellows acquire skills in both elective procedures and traumatic reconstructions. Experienced faculty members, including those from CHOC, provide education and supervision throughout the rotation, particularly in the treatment of congenital and pediatric brachial plexus injuries. The fellowship is further enriched by hands-on participation in multidisciplinary clinics and surgical cases.

Hospital Affiliations

The UC Irvine Medical Center is the primary training site for the fellowship, serving as a busy hospital equipped with training and research laboratories and extensive outpatient clinics. As a Level 1 Trauma Center, the medical center also accommodates a Regional Burn Center and an active Orthopaedic Oncology practice, thereby providing a diverse clinical experience. Fellows share on-call responsibilities to cover the varying needs of these services throughout their training 3.

Another key training site is the Long Beach Veterans Affairs (LBVA) Healthcare System, one of the largest veterans' hospitals in the country. Here, fellows encounter a patient population reflective of the common hand conditions faced by U.S. veterans, including arthritis, Dupuytren’s disease, and various nerve compression issues. This provides valuable opportunities for both surgical and non-surgical management that are applicable in a real-world, high-stakes environment.

At CHOC, fellows are exposed to pediatric trauma care and the treatment of congenital hand anomalies. This institution offers comprehensive clinical supervision to ensure an optimal learning environment and adherence to ACGME milestone competencies.

Research Opportunities

The program emphasizes research involvement, offering fellows multiple avenues to engage in clinical and laboratory research geared toward advancing their knowledge and expertise. The UCI fellowship includes access to specialized facilities such as a fresh cadaver anatomy laboratory, a microsurgery laboratory, and labs dedicated to the molecular biology of nerve regeneration. These resources are guided primarily by faculty who lead cutting-edge research with significant funding support, providing fellows the opportunity to contribute to impactful projects during their fellowship year 4.

Each fellow is expected to complete a research project, which is often showcased at the annual UCI Orthopaedic Residents Day and aims toward presentation at national meetings and eventual publication. Collaborative efforts in clinical projects are encouraged, alongside opportunities for contributing to basic science endeavors related to biomechanics and peripheral nerve research.

Application Process and Competitiveness

Applicants are required to submit a completed Universal Hand Surgery Fellowship application, including three letters of recommendation, USMLE scores, medical school transcripts, and a personal statement. To qualify, candidates must have completed a residency in orthopaedic surgery, plastic and reconstructive surgery, or general surgery and must possess a California medical license by the fellowship’s start 5.

The program is competitive, attracting a range of candidates, including those from international medical backgrounds. Fellows can expect a supportive training environment with access to experienced faculty who promote both academic and surgical excellence.

Visa and Diversity Commitment

The program provides visa support for qualified international applicants, specifically for J-1 visas, allowing non-U.S. citizens to train at the institution. UCI actively strives to maintain diversity within its fellowship programs, ensuring that recruitment efforts reflect the rich diversity of the community it serves, fostering an inclusive training environment that enhances the overall educational experience for all fellows.

The UCI Hand and Upper Extremity Fellowship thereby stands out not only for its clinical and surgical training but also for its strong emphasis on research, inclusivity, and comprehensive education within a multidisciplinary framework.