THE CHILDREN'S HOSPITAL
James R. Kasser, MD
JOHN E. HALL PROFESSOR OF ORTHOPAEDIC SURGERY
HARVARD MEDICAL SCHOOL

Introduction

The Orthopaedic Department at Children’s Hospital Boston has been a busy place over the past year, with continued emphasis on teaching of our residents, fellows, and medical students and we take great pride in this activity. We have attracted more medical students in the early part of their education (the first two years), working in the Clinical Effectiveness Unit as well as shadowing experiences in the clinic. There is an active Orthopaedic Interest Group under the guidance of Kanu Okike, a Harvard Medical student interested in going into orthopaedics. The Orthopaedic Interest Group allows contact between young medical students deciding career direction and the orthopaedic staff. A number of faculty from all of the Harvard hospitals are involved in this program and I believe that it is mutually beneficial.

In addition to this, we are working with the Medical School to improve the musculoskeletal curriculum. This is a major undertaking at many medical schools, as musculoskeletal education is notoriously deficient nationwide. It is our hope to improve musculoskeletal education through the Orthopaedic Interest Group, increasing activity at the Medical School in the first couple of years, and improvement of our rotations at Children’s Hospital.

In the clinical area, we have expanded with a major presence at the Waltham site. We will have new office space which will be nearly the same size as our Fegan 2 area, with which you are all familiar. We’ll have 7 pods for examination of patients by both Sports Medicine and Orthopaedic Surgery. In addition to the orthopaedic area, we have great hopes of building an athletic training center for both clinical and research activity directed toward athletes and individuals with medical problems such as cardiopulmonary difficulties. It is hoped that the positive influence of exercise in such conditions ranging from congenital heart disease to obesity can be documented and enhanced, based on proper exercise routines. We hope to have this project underway over the next year or two and Drs. Micheli and Kocher are heading up this venture for Orthopaedics.

Jim Cote, our department administrator has moved on to a position in hospital administration; his great success in Orthopaedics lead him to this new position in which the accomplishments in our Orthopaedic Program can be replicated in many departments. Sue Ellard, who was our practice administrator, has been named the new department administrator. Our clinic staff, nurse practitioners, and nurses continue to increase in number and activity.

The most significant new clinical activity that we’ve added for orthopaedic surgery is what we call the Orthopaedic Surgeon of the Week. We take turns being on-call for one week at a time from 7AM to 7PM; this activity makes orthopaedic care readily available to patients with urgent needs, pediatricians in need of consultation, and orthopaedic surgeons looking for a place to refer patients with acute problems. We have evaluated this in terms of numbers of patients seen and overall impact on the orthopaedic program. It has been greeted with much enthusiasm by referring doctors and pediatricians. Most of the time, it’s been greeted with enthusiasm by our own doctors.

The Orthopaedic Department at Children’s Hospital, Boston has experienced significant growth in the past year. With the opening of Children’s Hospital Boston at Waltham last June, and the upcoming opening of an Orthopaedic Surgery/Sports Medicine ambulatory unit there this summer, we have expanded our staff with the addition of Susan T. Mahan, MD, who completed her pediatric orthopaedic fellowship with us in July 2005. Susan is pursuing a Master’s in Public Health from the Harvard School of Public Health. She sees patients in Boston and also at two of the Children’s satellite offices, Peabody and Waltham. Gregory J. Melkonian, MD joined us in February 2006 as a non-operative orthopaedist after a 27- year career in orthopaedic surgery in Concord, New Hampshire. He also has his Doctorate of Veterinary Medicine from Cornell University. He sees patients in Boston as well as at satellite offices in Lexington, Waltham and Exeter, New Hampshire. Dr. Melkonian continues to provide care to children with neuromotor conditions at several New Hampshire state clinics. We eagerly anticipate the addition of Drs. Travis Matheney and Samantha Spencer, who are completing their pediatric orthopaedic fellowships at Children’s and will join the staff in August, 2006; they are well known to the community, as they did their orthopaedic training in the Harvard Combined Orthopaedic Residency Program. Dr. John Frino, our third fellow, has accepted at position in the Department of Orthopaedic Surgery at Wake Forest University.


Matthew L. Warman, MD has been recruited as Director of Orthopaedic Research; he will occupy the Ormandy Chair at Harvard Medical School and have a joint appointment as Professor in the Departments of Genetics and Orthopaedic Surgery. We eagerly await the arrival of Dr Warman for the start of AY07.

On the academic front, the department has been busy as well. Peter Waters was promoted to Professor of Orthopaedic Surgery at Harvard Medical School and Associate Chairman of the Department of Orthopaedic Surgery at Children’s Hospital Boston. He received additional funding from POSNA to continue the Multi-center Brachial Plexus study. Dan Hedequist was promoted to Assistant Professor of Orthopaedic Surgery at Harvard Medical School. He has expanded his clinical practice to include off-site sessions at Children’s South Shore facility. He also participated in a VEPTR webcast which had a significant number of viewers and was extremely well received. Martha Murray was promoted to Assistant Professor in Orthopaedic Surgery and has continued her work in tissue engineering strategies to repair tissues within joints. Funding from NIH, OREF, CIMIT and the NFL Medical Charities program has resulted in multiple peer-reviewed publications this year, as well as expansion of the laboratory personnel and research scope. In addition, she co-hosted the first free ACL Injury Prevention Seminar in January which was attended by over 80 local coaches and athletic trainers; the second seminar is scheduled for June 2006. Mininder Kocher was named Associate Director of the Division of Sports Medicine. The textbook The Pediatric and Adolescent Knee by Micheli and Kocher was published this spring. Min was elected to the POSNA Board of Directors and received an AOSSM research grant for a multicenter prospective study of the management of ACL injuries in skeletally immature patients.

Brian Snyder has been appointed the chairman of the Research Committee of POSNA and chair of the SRS Research Committee. He was a participant in the Chest Wall Deformity Group Study (rabbit study research) and was awarded a research grant from the Scoliosis Research Society. The study is entitled How Does VEPTR Affect Pulmonary Function: An in-vivo Assessment Using the Rabbit Scoliosis Model. He is also reviewing grants for the NIH/MIAMS study section. Lawrence Karlin has several combined projects on spinal deformity underway with Dr Oheneba Boachie-Adjei from the Hospital for Special Surgery. Mike Millis has developed a relationship with the University of Bochum in Germany which will send resident-level physicians to Children’s Hospital Boston to work on various research projects in the Department of Orthopaedic Surgery for a 6-month period. He also notes that the Hip Fellowship has been ACGME- accredited. Seymour Zimbler continues his patient care efforts, expanding his practice to the new Waltham site, in addition to his clinics at Newton Wellesley, Peabody, Lexington and Brockton. Tim Hresko, as well as other members of the Spine Team (Drs. Emans, Karlin, Hedequist, Kim), remains active in the Spinal Deformity Study Group, an ambitious multi-center international collaboration on outcome studies for spinal deformity in children. He is involved in minimally invasive spine surgery with the evolution of video-assisted thoracoscopic surgery. John Hall is thoroughly enjoying his retirement. He graces us with his presence every once in a while but insists that he doesn’t miss surgery a bit. My responsibilities here at Children’s Hospital, Boston will be reduced by one, when I step down as the president of the Physicians’ Organization at the end of June. I remain active on the Board of Directors of the American Board of Orthopaedic Surgery, where my latest assignment is to be in charge of the recertification examination.

The 19th Annual Grice Day Lecture was held on November 9, 2005, with James H. Beaty, MD as the guest lecturer; his Grand Rounds talk was on Pediatric Hip and Femur Fractures. Dr. Beaty is Professor of Orthopaedic Surgery at the University of Tennessee/Campbell Clinic. He has served as Director of the Residency Program at the Campbell Clinic, as well as Chairman of the Department of Orthopaedic Surgery and President of the Campbell Clinic Foundation. From an academic perspective, Dr. Beaty has published numerous articles, concentrating on trauma and congenital lower extremity deformities. He is co-editor of Campbell’s Operative Orthopaedics and Rockwood and Green’s Fractures in Children. He is a frequent speaker throughout the world on issues of trauma and congenital lower extremity abnormalities in children. The morning session of the Grice Day program was devoted to talks by the orthopaedic staff on the research in which they are involved and the afternoon program consisted of case presentations by the residents and fellows and discussion with Dr. Beaty.

We welcomed Patricia Connell, MPH to head the Clinical Effectiveness Research Center. Patty comes to us after 16 years at the New England Research Institutes where she worked on a variety of federally-funded projects, most recently directing two multi-center randomized controlled trails that were part of the NIH-funded Pediatric Heart Network. She has extensive experience in protocol and form development, data management system design, and design and implementation of quality assurance procedures. Patty and her team of 6 research coordinators are currently working on the projects outlined elsewhere in this journal.

The Sports Medicine Research Laboratory, under the direction of Martha Murray, focuses on tissue repair and regeneration in the knee. Work funded by the NIH, CIMIT, NFL Medical Charities and OREF continues on tissue engineering strategies to develop new treatment methods for anterior cruciate ligament (ACL) and meniscal injuries. Results presented at the Orthopedic Research Society (ORS) and the AAOS meeting this spring in Chicago demonstrated an efficient means to improve the strength of healing of a partial tear of the ACL using collagen-platelet hydrogels. Additional work showing the efficacy of using collagen-platelet hydrogels to enhance suture repair of a complete transection of the ACL was presented at the ACL Study Group meeting in Hawaii. The laboratory had multiple articles published in the Journal of Orthopaedic Research this spring on various topics related to this work.

Work in the area of joint repair continues in collaboration with multiple investigators in the Children’s Hospital environs. Research to define protocols to allow prediction of ACL healing strength using non-invasive MRI imaging techniques has started with Dr. Susan Connolly and Maria Valenza in the Department of Radiology. The improvement of our animal models has been continuing as well, with the collaboration of Dr. Kurt Spindler at Vanderbilt University and Dr. Arthur Nedder and Mark Kelly at Children’s. Biomechanical evaluation of healing ligament and meniscus has been the subject of a collaboration with Dr. Brian Snyder and John Muller in the Orthopaedic Biomechanics Laboratory at BIDMC. In addition, collaborations with Dr Chris Evans and his group in the Center for Molecular Orthopaedics at BWH has worked to define the presence of pluripotential cells in the human ACL.

Dr. Jennifer Marler has joined the laboratory and is focusing her studies on tissue engineering approaches to enhance vascularization of musculoskeletal tissues. Dr. Eduardo Abreu continues his work on collagen characterization. Duretti Fufa, in collaboration with Drs. Sherwin Kevy and May Jacobson at the Center for Blood Research, has been working to define the release kinetics of growth factors from collagen-activated platelets. Blake Shealy has continued with his work in defining the changes in cellular metabolism as a function of the extracellular matrix environment. It has been an exciting year with progress on multiple fronts.

The Laboratory and the Division of Sports Medicine have also continued work in dissemination of injury prevention information to the community. The first free seminar for coaches and trainers of middle and high school athletes was held in January and was thought by all to be a resounding success, with over 80 attendees. The second seminar is scheduled for June 2006.

The management team for the Children’s Orthopaedic Surgery Foundation includes Susanne Ellard, Department Administrator; Toby Grooms, Practice Administrator; Dean Bauer, Financial Manager; Paula Donahue, Nursing Manager, and my assistant, Kathryn MacDonald.

The department is experiencing a major baby boom. Min Kocher and Michelle Dupre welcomed their third daughter, Ava Dupre Kocher, born on February 19, 2005.

Dan Hedequist and his wife, Celeste Demarco, welcomed the arrival of a son, Jesse, born in March 2005. Donald Bae and his wife, Jeannie Chung, are expecting their first child in May 2006. Sue and Matt Ellard anticipate the arrival of a baby girl in June. Martha and Mike Murray look forward to the birth of their third child in June, joining Joe and Marie. Young-Jo Kim and his wife, Lois Lee, who is an attending physician in the department of emergency medicine, are expecting their 2nd child in July; they have a 3-year-old son, Alexander. Susan Mahan and her husband, Steve Kirincich, are expecting their first child in August 2006.

The residents continue an active rotation at Children’s Hospital, Boston, increasing the number of third year residents here at one time from five to six residents each 6-month rotation. In addition to the Harvard residents, one resident comes from Lenox Hill Hospital in New York and starting in July 2006, we will have a resident from the Dartmouth program.

We have revamped the resident rotations to try to enhance the education for our residents. While we have enhanced their education, we also hope that we have provided better working conditions for the residents by respecting the 80-hour workweek, having a night float resident to prevent resident fatigue, and ensuring improved balance in surgical experience. Our program continues to evolve and change as one would hope. We remain committed to resident education, patient care and research in musculoskeletal conditions.





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