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Children's Hospital has been doing exceedingly well in
providing medical care for children locally, regionally, nationally
and even internationally. In doing so, the hospital has
finally replaced the red ink with black and is succeeding in its
program of growth. A new research building, as well as a new
clinical building, is rising skyward. The research building will
house a number of labs, including orthopaedics. However, we
felt that it would be better not to be across the street out of
the Enders building and decided to settle for remodeling rather
than a move. The clinical building will house eight new operating
rooms, three new ICU's, and a new medical and surgical
floor. In addition to patient rooms, there actually is a new on
call room for surgical staff including orthopaedics. The good
news is we have an attending "on call" room; the bad news is
we need it.
 Fueling the success of our institution, orthopaedics has
been identified as one of the strategic growth areas, with plans
to increase our patient volume by about 4% per year. In keeping
with this plan, we will be recruiting new staff to satisfy patient
demand and embark upon expanded and innovative programs.
Dr. Martha Murray joined our staff last January in the Division
of Sports Medicine. She will be doing general pediatric orthopaedics
and sports medicine. Martha was a resident in the
Harvard Combined Orthopaedic program. In addition to her
clinical work she will be working half time in research in the
area of bioengineering. The focus of her work is the anterior
cruciate ligament and meniscal replacement. Although she is
presently on maternity leave (Marie Rose, born April 2003), she
will be returning to half time practice in June. We are excited to
add her to our staff both for the scientific and clinical strengths
she brings to the program.
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Clinical Programs
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As you may remember our department has two divisions,
one in spine surgery headed by Dr. John Emans, and
the second in sports medicine headed by Dr. Lyle Micheli. The
Division of Spine Surgery has five attendings and is continuing
growth through increased clinical work, as well as innovation.
The newest procedures, which are changing the face of spine
surgery in infants and young children, involve the use of titanium
ribs for chest expansion. John Emans has been working
with Dr. Robert Campbell (San Antonio, Texas) on clinical work
involving this device. A paper on this appeared in last year's
Journal and the clinical uses for this continue to expand. Drs.
Karlin, Hresko and Hedequist complement the spine surgery
group with Dr. Hall continuing to work two half days a week in
the ambulatory area, seeing spine patients. There are occasional
"Hall sightings" in the operating room, which he finds much
less stressful in his present non-combatant role.
The adolescent and young adult hip program in which
Mike Millis and Young-Jo Kim participate is growing very
nicely. The further development of periacetabular osteotomy
for redirection of dysplastic or deformed acetabula has been
exciting. Young-Jo's work using MRI to evaluate the effect of
osteotomies on articular cartilage has resulted in a number of
publications and is assisting in evaluating the scientific basis for
such procedures. Combined with the periacetabular osteotomy
is a new procedure for surgical dislocation of the hip allowing
treatment of femoral head and neck abnormalities in children.
Dr. Millis presented a group of 45 such cases at a meeting of the
European Pediatric Orthopaedic Society in London this spring.
The hand and upper extremity program has prospered
under the direction of Peter Waters. There are now over 100
patients entered in his study of brachial plexus repair and natural
history for Erb's palsy. Dr. Waters has received grants from
the Pediatric Orthopaedic Society of North America and from
the Hand Society for his work in this area. The next addition
to our staff will be in this area.
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Education
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Educational activities at Children's Hospital remain a
priority. We have continued having Harvard third year medical
students working in our ambulatory area, as well as fourth year
medical students attached to the program both in the surgical
and ambulatory arena. We are hoping to increase the exposure
of medical students in musculoskeletal conditions in keeping
with the national drive by the AAOS. Timothy Hresko is leading
the effort in medical student teaching both for the Harvard
Combined Orthopaedic Program and at Children's Hospital.
The residents have moved towards an eighty-hour workweek
here at Children's as they have at institutions throughout
the country. In adopting new work hours our major problem
has not been the eighty hours per week but the continuous
work hour rules. We have therefore instituted a "night float"
trauma resident, who works each night in the emergency room
from 7 pm to 7 am. This seems to be working reasonably well
but does give an unusual dose of pediatric trauma during the
rotation rather than a more continuous learning experience.
Both the residents and staff are trying to adapt to these new
work hour changes in a way that is not educationally detrimental
to the orthopaedic program. I think we are achieving this.
With respect to fellow education, we have been approved
for a third fellow by the ACGME in pediatric orthopaedics. The
applications for the fellowship have been high and the applicants
excellent. Nationally a problem of the lack of interested
residents has resulted in insufficient supply of pediatric orthopaedic
surgeons. Fortunately, here at Children's we have been
able to continue to attract excellent fellows who needless to say
have many job offers after completing the program. Last year's
fellows finishing the program July 31, 2002 included Maurice
Albright, MD, Kevin Klingle, MD, and Christopher Iobst, MD.
Dr. Albright joined the staff at Massachusetts General Hospital
and is working with Brian Grottkau in pediatric orthopaedics.
He is happy and doing a great job in our sister institution. Kevin
Klingle joined the staff at Columbus Children's Hospital and is
affiliated academically with Ohio State University. Kevin was
from that part of the country and he and his wife were excited
to return home. Kevin's practice focuses on lower extremity
pediatric orthopaedics and pediatric sports. Dr. Iobst finished
the program here at Children's with a newborn infant right
at the end of fellowship. He moved to Miami where he works
at the Children's Hospital affiliated with the university and is
progressing nicely in his pediatric orthopaedic practice. Having
just seen all three of these fellows at the POSNA meeting in
Amelia Island in May, I can attest to their success and satisfaction
in their first year in practice.
On a national level our staff remain very active in continuing
medical education courses sponsored by various organizations
as well as visiting professorships throughout the country.
One of the most prominent of these accomplishments was by
Dr. Brian Snyder who ran the one-day course focusing on cerebral
palsy prior to the POSNA Meeting in Salt Lake City, Utah.
Dr. Snyder organized the course and also gave lectures, which
were well received. Dr. Snyder has become widely recognized as
an expert in cerebral palsy and upper motor neuron problems
in children.
Locally we had two distinguished visiting professors
this year; one was Dr. Charles T. Price from Orlando, Florida. He spoke
extensively on osteotomies of the lower extremity. He ran a workshop in teaching
the residents and staff about the use of Orthofix external fixation devices
to achieve proper alignment in lower extremity osteotomies. He also participated
in an afternoon of case discussions and scientific presentation prior
to an outstanding evening lecture. A second visiting professor was Dr. Ignacio
Ponseti. He gave a morning grand rounds on the use of the Ponseti method of corrective
casting with percutaneous heelcord lengthening in clubfoot. Following
the lecture a demonstration of techniques of clubfoot casting and evaluation
of patients with clubfeet continued all morning at Children's Hospital. Dr.
Ponseti's method of management of clubfeet has increased the number of
such deformities that can be managed with conservative methods yielding improved
functional outcome at lower cost. The method involves sequential
casting of the foot in supination concentrating on midfoot
deformity and resolving hindfoot equinus with percutaneous
heelcord release. This is followed by extensive use of bracing
within the first year of life to maintain correction and ensure
satisfactory outcome.
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Orthopaedic Laboratory
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Our orthopaedic laboratory continues with senior investigators,
Dr. Melvin Glimcher and Dr. Peter Hauschka. While Mel
Glimcher continues his work in mineralization and MRI evaluation
of bone, Peter Hauschka had concentrated on cell signaling
and osteoclast osteoblast interactions. Their work continues to
be well funded and highly successful. Raymond Samuels, MD,
PhD, an investigator in our lab began a series of research seminars
in musculoskeletal science which were highly successful.
These seminars brought the entire Harvard ortho research
community together for the first time in my memory. This
was a great initiative and we hope to continue it.
We have just begun the search for a new Ormandy
Professor in basic science for the lab. We have sufficient space
within the new research environment at Children's in order to
accommodate this expansion of the laboratory. I look forward
to reporting to you next year on the successful search and new
developments within the laboratory area.
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Clinical Practice
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Our ambulatory volume continues to increase. Our department
is comprised now of 17 attending orthopaedic surgeons.
Our administrator is James Cote who has done an excellent job
of expanding our ambulatory practice, improving our business
processes, and most important of all improving employee satisfaction
and retention. Our employees are remaining with us
and are a critical part of our growth strategy. We have three
nurse practitioners, five nurses and a host of administrative
assistants and practice assistants providing care for orthopaedic
patients. Fortunately, our clinical expansion has met with
sufficient revenue enhancement to allow us to continue to hire
and expand the work force consistent with clinical volume. We
are most grateful to this group for their effort. Our goal is
improving customer service for the coming year. We have been
recognized by the hospital for our initiatives in this area. The
Boston Globe did a less than complimentary article on our out
patient department this year which you may have seen. It was
entitled "The Waiting Boom." While we took some hits for the
waits patients experience, it did relate our efforts in better and
more efficient care which are paying off both for us and the
patients.
Mark Gebhardt was promoted to professor this year. We
congratulate him on this achievement. He holds the Ilfeld
Chair in orthopaedic Surgery at Harvard Medical School, which
was named in honor of Fred and Jane Ilfeld. You may remember
Fred Ilfeld for the brace, which carries his name, used to
treat hip dysplasia in infants. Dr. Ilfeld was an orthopaedic
surgeon in Los Angeles.
Finally, I would like to thank all of the alumni of the program
who have supported the efforts of Children's Hospital over
the years and I look forward to continued visits with all of you
at the Academy meeting. I have completed my year as President
of POSNA and my time on the Council of Education of the
American Academy of Orthopaedic Surgeons. I am looking forward
to concentrating more of my time locally on improving
our educational program and ensuring the continued growth
of what is a vibrant and exciting department at this time. Our
efforts to expand the orthopaedic laboratory our most exciting
and I look forward to being able to tell you of our advances a
year from now.
Links of interest:
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