Physician-Owned & Operated · Serving Six South Central Texas Communities

Orthopedic Care for South Central Texas.

Quality orthopedic care for South Central Texas. We treat joint pain, sports injuries, fractures, and arthritis — most managed without surgery, with same-week appointments when an injury needs attention fast. You'll see the same doctor from the first visit through recovery, with straight answers when an operation is on the table. Most insurance accepted, including Medicare and Tricare.

Our Providers.

The pairings you’ll actually see in the OR — surgeon and PA who have scrubbed the same cases together for years, not just the same clinic. Every one of our PAs has stood across the operative field, not just in the exam room.

Where We See Patients.

Hover a clinic to see a photo and open it on the map. Click for address, hours, and directions.

Map data © OpenStreetMap contributors © CARTO

  1. New BraunfelsFlagship

    Main office · physician-owned

    960 Gruene Rd., Suite 101 · New Braunfels, TX 78130

  2. Seguin

    Guadalupe Regional Medical Center

    1339 E. Court St., Suite 220 · Seguin, TX 78155

  3. Cuero

    Cuero Regional Hospital

    2550 N. Esplanade St. · Cuero, TX 77954

  4. Kenedy

    Otto Kaiser Memorial Hospital

    3349 US-181 · Kenedy, TX 78119

  5. Hallettsville

    Lavaca Medical Center

    1400 N. Texana St. · Hallettsville, TX 77964

    Dr. Michael Vrana Outpatient specialty clinic · 3rd & 4th Wed each month

  6. Yoakum

    Yoakum Community Hospital

    1200 Carl Ramert Dr. · Yoakum, TX 77995

    Dr. Michael Vrana Outpatient specialty clinic · 2nd Wed each month

Most orthopedic problems don't need surgery. The first visit is usually about figuring out what's actually wrong and what the least invasive path to getting better looks like. Physical therapy does most of the work; injections, bracing, and orthobiologics are used when they fit the problem, not by default. If surgery eventually makes sense, you'll know why — and if it doesn't, we'll tell you that too.

  • PT-firstTherapy is the backbone of most treatment plans, not an afterthought.
  • Same buildingImaging, injections, and follow-up handled in-house without a referral chain.
  • No upsellWe won't push procedures, injections, or supplements that won't help you.

Fellowship-trained orthopedic sports medicine is a meaningful distinction, and it's one we have at OSI. Dr. Vrana is fellowship-trained in sports medicine; Dr. Twitero brings additional fellowship training in joint reconstruction; Dr. Templin brings decades of sports medicine surgical experience. Together they cover the full range of sports injuries — ACL reconstructions, meniscus surgery, rotator cuff repairs, biceps and triceps tendon repairs, and the general care that gets athletes and active patients back to what they do. When an operation is the right call, we favor arthroscopic techniques with smaller incisions, and structured physical therapy carries the recovery the rest of the way.

Hip, knee, and shoulder replacement, tailored to the patient. For the knee, that includes partial knee replacement — a durable option many patients don't realize exists, and one that isn't limited to people over 65. When only part of the joint is worn, replacing only that part preserves healthy tissue. For the hip, the approach (anterior or posterior) is chosen for the individual. Most primary replacements go home the same day or the next morning, and we continue to see our patients back at ten, fifteen, and twenty years — still doing well on their replacements.

Most broken bones heal well when they're set right the first time. Acute fractures are seen quickly across our six clinic locations — you shouldn't sit in an ER waiting room for a wrist that obviously needs to be set. We handle both adult and pediatric fractures, including the complex fixation cases other clinics refer out. Casting when that's enough, surgery when it isn't.

Every Condition We Treat.

General orthopedics, joint replacement, and sports medicine — covering the hip, knee, shoulder, elbow, hand & wrist, spine, foot & ankle, and acute fracture care.

Every page opens with how we make the diagnosis, the non-operative care we try first, and the point at which surgery becomes the right call.

Browse all surgical procedures →

Start here · Education first

Common Problems, Explained Honestly.

These are the first pages we wrote — long-form, patient-focused, and free of marketing puffery. No drama, no scare tactics, no surgical upsell. Just what the problem is, what the evidence says, and every non-operative option before surgery is ever considered.

AP X-ray of a right knee with medial joint-space narrowing from osteoarthritis

Knee

Knee Osteoarthritis

What “bone on bone” actually means, why the knee hurts the way it does, and what the non-operative and operative options really are.

Read the guide
AP pelvis X-ray showing hip arthritis with superolateral joint-space narrowing

Hip

Hip Arthritis

Groin pain, stiffness after sitting, trouble putting on shoes — the classic hip-arthritis story, and every treatment option from injections to replacement.

Read the guide
Shoulder MRI showing a full-thickness tear of the supraspinatus tendon

Shoulder

Rotator Cuff Tear

Not every tear needs surgery. Which ones do, which ones don’t, and why shoulder MRIs find tears in people who have zero symptoms.

Read the guide

Knee

Meniscus Tear

Why a twisting injury at 25 is a different beast than a degenerative tear at 55, and why the treatment that’s right depends on which one you have.

Read the guide

Hand & wrist

Carpal Tunnel Syndrome

Numb fingers that wake you up at night, shaking out the hand to get feeling back — that’s the classic picture. Here’s what to do about it.

Read the guide
Sagittal T1 hip MRI showing a labral tear at the acetabular rim

Hip

Hip Labral Tear

A ring of cartilage around the hip socket that tears in people with a specific hip shape. Confused with a groin strain more often than you’d think.

Read the guide
Anatomical line illustration of a full human skeleton on a deep navy background — the OSI NB full patient-education library

Full library

Every Condition We Treat

The full patient-education library — organized by body region, searchable, and written for people, not insurance codes.

Browse the library

When Surgery Is the Right Step, It’s a Craft.

Most orthopedic problems never reach an operating room. When one does, the surgeon making that call has trained specifically for it. OSI has fellowship-trained orthopedic surgeons on staff — each with their own area of concentration, so a case that reaches the OR is handled by someone with subspecialty experience in that problem rather than a generalist picking it up. The decision is slow, the work is precise, and technique sits in the surgeon’s hands. A glimpse of the work itself:

Placeholder imagery: the photos above are open-access orthopedic surgical teams (not OSINB physicians) shown while documentary photography of our own surgeons and PAs in the OR is commissioned. The marked slots are where those real-team photographs will replace the placeholders.

Reference · Only if surgery becomes the right step

Procedures, Explained.

Most orthopedic problems never need an operation. If surgery does come up in your visit, these are the procedures our surgeons are trained to perform — written as plain-language education, not advertising. No urgency, no outcome promises, no “book today.”

Postoperative AP X-ray of a left total knee replacement with femoral and tibial components

Knee · Considered after non-op fails

Total Knee Replacement

A last-resort option for knees that have worn through the cartilage and stopped responding to injections, bracing, and therapy. Recovery is a months-long commitment.

Read the full guide
Postoperative AP pelvis X-ray of a left total hip replacement

Hip · Considered after non-op fails

Posterior Total Hip Replacement

The posterior approach is one of several valid techniques for replacing a worn hip joint. Considered after activity modification, therapy, and injections no longer control the pain.

How it works
Postoperative AP X-ray of a right reverse total shoulder arthroplasty

Shoulder · Specific indications

Reverse Shoulder Replacement

Designed for shoulders where the rotator cuff can no longer power the joint. Reversing the ball-and-socket geometry lets the deltoid do the lifting work the cuff used to do.

Who it's for
Postoperative PA X-ray of a thumb CMC arthroplasty

Hand · After splinting + injection

Thumb CMC Arthroplasty

For basal-joint thumb arthritis that no longer responds to splinting or injection. The worn trapezium is removed and the thumb is stabilized with a soft-tissue reconstruction.

Read the full guide
Postoperative lateral X-ray of a right distal radius ORIF with a volar plate

Wrist · Displaced fractures

Distal Radius ORIF

Open reduction and volar-plate fixation for distal radius fractures that can't be held in good position with a cast alone. Restores length, alignment, and joint congruity.

When it's indicated

Full list

Every Procedure We Perform

Fractures, arthroscopy, ligament reconstruction, joint replacement, hand and wrist, sports medicine — the complete index.

Browse procedures

A Little Preparation Saves Time at Check-In.

Bring

Photo ID and insurance card(s); a current medication list with doses; any recent X-rays, MRI, or CT on disc or USB; a referral from your primary care physician if your plan requires one.

Accepted plans

Medicare, Tricare, Blue Cross Blue Shield, Aetna, Cigna, UnitedHealthcare, Humana. Most commercial plans are accepted; call to confirm in-network status before your visit.

Patient portal

For refills, visit summaries, and messages between appointments, call the front desk for portal access.

Request an appointment or call (830) 625-0009, Mon–Fri 8 AM–5 PM