This past year has been an active one for us at Children's Hospital. Fegan 2 continues to be our focus of ambulatory activity with more patients, staff, parents, and pediatric problems than at any time in the past. Our overall volume is up another 10%, seeing over 38,000 outpatients last year and performing just shy of 3,000 surgeries. While our clinical and research staff has continued to increase, we seem unable to keep pace with the demands placed upon us. Therefore, I believe continued expansion with an effort at increased efficiency is in order.

          Reports of John Hall's retirement over the past 2 years have been greatly exaggerated. He initially took off Mondays and worked four days a week until January of 1999. He now takes off Mondays and Fridays, enjoying four-day weekends. Hopefully, he will continue this level of activity with an abbreviated operating room schedule on Wednesday after this summer.

          Our staff remains stable with active senior orthopaedic surgeons comprising the bulk of the attending staff. While I believe that each staff member should be able to see and evaluate all pediatric orthopaedic problems, concentrated areas of expertise have been developed by each of the faculty members. This leads to improved patient care and better research potential in "high tech" or high-risk procedures. The staff has self-selected their areas of expertise in a manner that seems to keep all the bases covered. (Table 1) It certainly is a privilege to work with this dedicated group who continue to thrive here at Children's Hospital.

          We are undergoing practice reorganization with centralization of administrative functions. This is done in hopes of improving patient care and service as well as improving our financial performance. Given the present arena in which we function, attention to the bottom line is mandatory in order to stay afloat, as I am sure you are aware. In undergoing this change with consolidation of records and improved computer capability, we hope to provide a clinical research capability that will enhance our present level of productivity. You might be interested to know that in a recent hospital survey of all departments, the orthopaedic service was at the top of patient satisfaction in 4 of 7 areas questioned. This level of clinical responsiveness is in no small measure due to the hard work of the residents and fellows at our institution.

          Despite the level of clinical activity, our number of orthopaedic beds has shrunk to 18. When I first arrived at Children's Hospital in 1982 we occupied Divisions 26 and 36 on the sixth floor of the old Children's Hospital building. The total number of beds that we had on these two floors was somewhat over 40. We have had a steady fall to the present level of beds required with a commensurate decrease in length of stay and increase in ambulatory procedures. In the laboratory arena we maintain a presence in the (continued)

          Orthopaedic Biomechanics Laboratory at Beth Israel Deaconess Medical Center under the direction of Dr. Brian Snyder as well as an active Laboratory for Skeletal Disorders on Enders 11 on the Children's campus. With the departure of Dr. Toby Hayes from the Biomechanics Laboratory at Beth Israel, Dr. Snyder assumed the acting directorship of that lab. He is in his fourth year of practice at Children's and was recently promoted to Assistant Professor. Along with a busy clinical service, he has maintained an active research presence, gaining industrial, NIH, and Whitaker grants.

          In the Skeletal Disorders Laboratory on Enders 11, Dr. Glimcher continues to be the Director. Along with the senior researchers, Peter Hauschka and Samy Ashkar, they have maintained the level of investigational excellence and grant support for which our lab is renowned. The focus of the lab remains mineralization and matrix biology. The active research programs within the lab are studying the mechanisms of bone metastasis, mechanisms of the normal healing process, and mineralization, particularly with respect to growth factors, cellular signaling, and crystal structure. Despite the loss of two senior investigators, Dr. Lou Gerstenfeld to Boston University and Dr. William Landis to Ohio, the lab is continuing to excel. Two new researchers have been added this year. Dr. Kevin McCue comes to us at an instructor level from Washington University in St. Louis and Dr. Keith Solomon comes from Brandeis University via the Department of Immunology at Beth Israel Hospital.

          Both basic and applied research comprises the focus of our department. We received two OREF grants this year. One to continue to study acetabular cartilage by MRI following osteotomy and the other focusing on bone metastasis with a resident, Dr. Andrew Hecht, as principal investigator.

          A major focus of our department has always been resident education. Our lecture format continues with basic science, fracture, and clinical pediatric orthopaedic talks every morning from 6:30 to 7:30, except Wednesdays when Grand Rounds occur. My efforts at having the residents "write their own book in pediatric orthopaedics" with a Thursday morning case based conference continue with good reviews. The teaching program here has certainly not been static but evolving and, based on resident input, constant evolution continues. We still have a visiting resident from Lenox Hill at a junior level; five junior residents, one senior resident, and a chief resident from the Harvard Combined Orthopaedic Residency; and two fellows. In addition, we occasionally have a visiting resident or orthopaedic fellow.

          The two fellows from last year were Mohammad Diab who came to us from the University of Washington program in Seattle and William Albers who did his residency in orthopaedic surgery at Southern Illinois University. Mohammad chose to return to Seattle and join the staff at the Children's Hospital, accepting a position as Assistant Professor at the University of Washington. Bill selected a position with an academic affiliation at the Children's Hospital in Dayton, Ohio. This year's Fellows are Joel Lerman from the University of Arizona and Tom San Giovanni from the University of Miami. The fellowship has received accreditation from the ACGME and continues to attract outstanding young orthopaedic surgeons.

          In the areas of continuing medical education, we have sponsored a number of courses at Children's over the years. Two years ago we had the Hall Symposium and prior to that we had the Osteotomy Course every other year or so. Each fall we have the David Grice Lecturer who comes and spends two to three days with us. In November of 1998, Dr. Merv Letts from Ottawa, Canada was the thirteenth David Grice lecturer. He spoke on the Mangled Foot in Childhood, as well as some aspects of bracing and fracture care, which were of great interest to our staff. This November, Dr. Hamlet Peterson will be our fourteenth David Grice lecturer. We continue to have a host of national and international visitors remaining with us somewhere between one day and nine months. At the present time we have two French orthopaedic surgeons, Dr. Anne Soulie and Dr. Frederic Pfliger, visiting for about eight months. During their time here they are observing clinical work and Ann is working on a project on vascular malformations during her stay.

          At a recent meeting of the Pediatric Orthopaedic Society of North America, I had the opportunity to meet with a group of Harvard orthopaedic alumni who practice as pediatric orthopaedic surgeons. The number of individuals specializing in this area from our institution astounds me but is a source of great pride and satisfaction. From all current indications, this production of pediatric orthopaedic talent will continue.

James R. Kasser, M.D.
John E. Hall Professor,
Harvard Medical School

Orthopaedic Surgeon-in-Chief,
ChildrenÕs Hospital

Board of Directors Pediatric
Orthopaedic Society of North America

Council on Education, AAOS

Task Force on Educational
Effectiveness, AAOS

Subcommittee of Professors,
Harvard Medical School

Vice President of Physicians
Organization, ChildrenÕs Hospital

Clinical Faculty
John B. Emans, M.D.
Associate Professor, Harvard Medical School

Board of Directors Scoliosis Research Society

Board of Directors GICD
(International Spine Society)

Mark C. Gebhardt, M.D.
Ilfeld Associate Professor of Orthopaedic Surgery,
Harvard Medical School

American Board of Orthopaedic Surgeons

Peter Gerbino, M.D.
Instructor in Orthopaedic Surgery,
Harvard Medical School

John E. Hall, M.D.
Professor of Orthopaedic Surgery,
Harvard Medical School

Collecting cars and working
3 days per week.

M. Timothy Hresko, M.D.
Assistant Professor of Orthopaedic Surgery,
Harvard Medical School

Orthopaedic Medical Student Education Director,
Harvard Medical School

Trauma Committee, ChildrenÕs Hospital

Lawrence I. Karlin, M.D.
Lecturer in Orthopaedic Surgery,
Harvard Medical School

Lyle J. Micheli, M.D.
Associate Clinical Professor of Orthopaedic Surgery,
Harvard Medical School

Director, Division of Sports Medicine,
ChildrenÕs Hospital

Michael B. Millis, M.D.
Associate Professor of Orthopaedic Surgery,
Harvard Medical School
Chairman Research Committee,
Pediatric Orthopaedic Society of North America
Editor, ÒJE HallÓ Issue
Clinical Orthopaedics and Related Research
Editorial Board, Journal of Pediatric Orthopaedics

Leela Rangaswamy, M.D.
Lecturer in Orthopaedic Surgery,
Harvard Medical School

Robert K. Rosenthal, M.D.
Assistant Clinical Professor of Orthopaedic Surgery,
Harvard Medical School

Past President of American Academy
of Cerebral Palsy

Frederic Shapiro, M.D.
Associate Professor,
Harvard Medical School

Peter M. Waters, M.D.
Associate Professor of Orthopaedic
Surgery, Harvard Medical School

Director Hand Surgery Program,
ChildrenÕs Hospital

Seymour Zimbler, M.D.
Lecturer in Orthopaedic Surgery,
Harvard Medical School

Clinical Professor of Orthopaedic Surgery, Tufts Medical School

Basic Science Faculty
Melvin J. Glimcher, M.D.
Harriet Peabody Professor of Orthopaedic Surgery,
Harvard Medical School

Director of the Laboratory for Skeletal Disorders

Research: Mineral & Mineralization of Bone;
Phosphoproteins in Bone & Cartilage

Peter Hauschka, Ph.D.
Associate Professor, Harvard Medical School
& Harvard Dental School

Research: NO in Bone Resorption
Cytokines in Growth and Bone Repair

Breast Tumor Metastasis to Bone,
Osteoclast Cell Biology

Frederic Shapiro, M.D.
Associate Professor,
Harvard Medical School

Research: Bone Healing and
Cell Interactions

Erdjan Salih, Ph.D.
Assistant Professor,
Harvard Medical School

Research: Phosphokinase and
Phophorylation Sites in Phosphoproteins

Samy Ashkar, Ph.D.
Instructor, Harvard Medical School

Research: Immunological Factors
in Bone Healing

Lisa Kuhn-Spearing, Ph.D.
Instructor, Harvard Medical School

Research: Crystal Interaction with
Proteins & Drug Delivery;
Characterization of Biominerals

ASTM Task Force Chair for Tissue
Engineered Biomaterials

Keith Solomon, Ph.D.
Instructor, Harvard Medical School

Research: Mechanism of PTH Activity
in Bone & Cell Signaling

Kevin McHugh, Ph.D.
Instructor, Harvard Medical School

Research: Integrins and Bone Resorption

Yaotang Wu, Ph.D.
Instructor, Harvard Medical School

Research: NMR Spectroscopy & Bone Imaging

Jinxi Wang, Ph.D.
Instructor, Harvard Medical School

Research: Bone Healing & Fracture Repair