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Exploring Innovations in Imaging

TSRHC is only the fourth hospital in Texas to employ an advanced imaging technology called EOS®, to be used in specific patient cases. The system produces long length images of the spine and lower extremities with significantly less radiation than is normally required using other imaging tools. There is also the additional capability of creating 3-D images of the bony skeleton that can provide our surgeons a more complete review of a patient’s anatomy for treatment planning.

Medical Update_EOSEOS has the unique ability to simultaneously generate two views of the entire spine or lower extremities in approximately 10 to 15 seconds. Today, the most common alternative method of digital X-ray requires at least 30 minutes. This added efficiency provides a better experience to patients and their families.

The system captures weight-bearing 3-D images in the upright or squatting positions that are 1:1, meaning there are no areas of the scan that are distorted or magnified. By using these images, Scottish Rite Hospital surgeons can more accurately understand the unique aspects of a patient’s skeletal deformity and better prepare for surgery.

In addition, unique EOS software created specifically for pediatric patients, called MicroDose, exposes the patient to six to eight times less radiation than traditional X-ray equipment.

EOS imaging is based in Paris, with a U.S. subsidiary in Cambridge, Mass. The hospital’s radiology team is working closely with medical physicists to examine and maximize the potential capabilities and efficiencies of this groundbreaking technology.

Scottish Rite Hospital Physicians Leaders at Orthopaedic Society Annual Meeting

Physicians and other medical staff from Texas Scottish Rite Hospital for Children are major participants in this week’s 32nd annual meeting of the Pediatric Orthopaedic Society of North America, including 19 podium presentations.

The meeting in Indianapolis, Ind., is being presided over by Dr. Lori Karol, assistant chief of staff at Scottish Rite Hospital and president of the Orthopaedic Society. Dr. Karol is the first female president of the organization.

Dr. John Birch, assistant chief of staff emeritus, delivered the opening keynote speech Wednesday, a historical review of lower extremity deformity correction. On Thursday, the hospital’s Dr. Lawson A. Copley delivered the results of research made possible by his 2014 Arthur Huene Memorial Research Award.

The meeting gathers orthopedic surgeons and other medical personnel for four days of advanced training. The scientific program includes 171 paper presentations, 20 posters and 110 e-posters.

On Friday, six subspecialty sessions will cover medical issues in the areas of spine, sports, hip, neuromuscular/lower extremity, trauma and hand/upper extremity.

Other Scottish Rite Hospital orthopedic surgeons giving talks at the meeting include Dr. Karol, who is also medical director of the hospital’s Movement Science Laboratory and Performance Improvement; Chief of Staff Dr. Daniel J. Sucato; Chief Medical Officer Dr. B. Stephens Richards; Assistant Chief of Staff Emeritus Dr. Charles E. Johnston; Assistant Chief of Staff Dr. Karl E. Rathjen; Assistant Chief of Staff Dr. Philip L. Wilson, a sports medicine specialist; Director of Research Dr. Harry Kim; Medical Director of Ambulatory Care Dr. Brandon Ramo; and staff orthopedic surgeons Dr. Anthony I. Riccio and Dr. Lane Wimberly.

The presentations cover topics such as angular deformity corrections in athletes; treatment of early onset scoliosis; compartment syndrome; and electronic medical record applications in pediatric orthopedics.

Several former Scottish Rite Hospital fellows also are making presentations at the meeting.

Children are Not Small Adults – Scottish Rite Hospital Fracture Clinic

A phrase we use often in pediatric orthopedics is, “Children are not small adults.” And it is especially true when it comes to broken bones, which we refer to as fractures. Unlike adults, children are still growing. This means they have sensitive areas in their bones called growth plates. Another name for this is the “physis.” The physis is an area of cartilage near the ends of bones. Most long bones in the body have at least two growth plates, including one at each end. Growth plates are the area of the bone where the growing occurs. Since they are the weakest portion of growing bones, they are at risk of being broken, or fractured.

DSC_0362Growth plate fractures account for about 25% of all childhood fractures. When not treated properly, the injury could result in a shortened or deformed arm or leg. Because of this, injuries to the growth plate require prompt attention by an expert in pediatric orthopedics. Serious problems are rare, and most growth plate fractures heal without complication.

Though there are growth plates in most bones, these fractures typically occur in the arms and legs. They are often caused by a single event, such as a fall or collision. All growing bones are at risk, but there are certain factors that may make some children more at-risk than others.

Here are some things we know about growth plate fractures:

  • Boys are twice as likely to get these injuries because they continue to grow later in life than girls.
  • About 30% occur during competitive sports such as basketball, football or gymnastics.
  • About 20% occur during recreational activities such as skating or extreme sports.

We certainly encourage boys and girls to stay active in recreational and competitive sports, but we want you to know we are here when you need us. We only take care of children in our Fracture Clinic, so we have a lot of experience managing fractures in growth plates.

To learn more about our Fracture Clinic at our North Campus in Plano, please visit scottishritehospital.org/fracture.

No Mountain Too High – TSRHC’s Amputee Ski Trip

Celebrating 35 years of building confidence, camaraderie and courage on the Amputee Ski Trip

One crisp, clear Colorado morning in 1985, young Daniel Massey was enjoying a ski run on the freshly powdered slopes of Winter Park, Colo. Conquering moguls on only his second day of learning to ski, he was not your average skier. Performing this feat as a quad-amputee, born with no arms or legs, Daniel was clearly not average at all.

Cover story_DanielIn the early ’80s, Herring attended an orthopedic conference where he became inspired after seeing a presentation about the benefits of skiing for the physically challenged. J. C. Montgomery, Jr., the hospital’s president at that time and now executive chairman of the TSRHC Foundation, rallied donors, the community and corporate sponsors to help make the trip a reality. This year, the weeklong event marked a milestone 35th anniversary, and there has been much cause for celebration.

“I’m really celebrating what this trip has meant to the kids,” Herring says. “The kids come back and tell me, even as 40-year-olds, that it was a turning point in their life.”

These amputee patients are faced with peaks and valleys every day, but finding the courage to take on the Rocky Mountains can be transformative. “A child may be the only one in their school with a disability,” Herring explains. “Some have never come out in the open with their prosthesis, flown on a plane or spent a night away from home. So it’s a huge step for them.”

But it’s not a step they take alone. They are accompanied by nurses, orthopedists and prosthetists, who act as chaperones, coordinators and a support unit for the young skiers. The travel coordination, meal planning and activity arrangements are a team effort.

Cover story_groupThe highly recognized staff at the National Sports Center for the Disabled (NSCD) is also a key part of that team. They carefully evaluate each skier and fit them with adaptive gear best suited to their level of physical ability and interest, from snowboards to ski bikes. Each patient is then paired with an instructor who shows them the best techniques to experience the thrill and freedom of speeding down the mountain.

“They have the same attitude we do,” Herring says of the NSCD staff. “We want to enable these kids to do anything they could possibly do and make it fun for them.”

“It’s not an easy event to pull off, but it’s certainly worth the effort,” explains TSRHC’s Director of Prosthetics Don Cummings, who has double, below-the-knee-amputations and has been on the trip 25 times.

Some might consider such a mission truly impossible, but clearly this one has been a success.

“It’s amazing how many lives have been touched through this incredible experience — including mine,” says Cummings, who skied for the first time on his inaugural trip in 1988. “These kids have taught me to accept my disability and myself.”

Herring points out that another benefit of the trip is learning the challenges these patients face in daily life.

“Watching them navigate ice, climb up snowy stairs and carry their luggage, you see what they are dealing with outside of a clinic setting,” he explains. “We can take that knowledge and find ways to help them function better out in the world. This trip really represents our philosophy of treating the whole child.”

The many benefits this trip provides are made possible by organizations like American Airlines, which provides air transportation through its “Kids in Need” program, the Stephen M. Seay Foundation and Dallas retailer Saint Bernard. The trip also relies on help from individuals like longtime TSRHC friend and volunteer Bob Ayers, who has served as a ski trip chaperone for many years and is now a hospital trustee.

Herring believes the biggest benefit of the trip is the unique and life-changing camaraderie created between kids who share the same challenges. Teens find a safe place to shed their inhibitions, their worries and sometimes even their legs.

“Some of these kids have never hopped around in front of other people without their prosthetic leg on and all of a sudden, they feel free to do that because this is just who they are,” Herring explains. “This trip is much more than skiing. It’s an avenue for that self-acceptance to happen.”

It’s been 31 years since Daniel Massey, with his quad-amputation, first strapped on his ski boots and helped the two-armed person beside him do the same. He says that the ski trip put him with amputee teenagers who were not just coping but excelling.

“On my first trip, I was having a lot of concerns about what high school would be like. I didn’t know if I could drive a car, if girls would find me attractive or if my friends would leave me behind,” Massey reflects. “I left the mountain knowing that I could do anything I wanted in life.”

Since then, Massey has graduated from college, is enjoying a successful marketing career with one of the largest computer companies in the country and is a happily married father of twin boys.

It appears that from the top of that mountain he could see — his loftiest goals were within reach.

 

**This article was featured as the cover story in our Rite Up Magazine. View more of the magazine in our e-mag version. 

Taking Care of Your Throwing Athlete – TSRHC Sports Medicine

PR14_03_MarchWe know that younger throwers have less problems, and that trouble for pitchers typically begins around the age of 12. At this time, young baseball players are becoming involved in more than one team, they are growing rapidly, and they are trying to throw faster and harder. Chuck Wyatt, R.N., C.P.N.P., says to support your young athlete in these ways:

  • Follow pitch count and rest guidelines.
    • Include fast or “hot” throws from other positions including middle infielders.
  • Consider working with a pitching coach. Some evidence shows that poor form may cause problems.
  • Learn proper shoulder strengthening and flexibility exercises.
  • Encourage him to speak up about symptoms.
  • Teach him not to throw when he is in pain.

For information about elbow injury prevention and elbow problems in the throwing athlete, please visit our website at scottishritehospital.org/sports.

Tips for Keeping Your Toddler on the Go – TSRHC Fracture Clinic

TSRHC patient Kye was seen for a Toddler's Fracture he sustained in a fall from a chair.

Scottish Rite Hospital patient Kye was seen for a Toddler’s Fracture he sustained in a fall from a chair.

According to Gerad Montgomery M.S., F.N.P.-C. from our Fracture Clinic, toddlers are naturally at an increased risk for certain fractures and other injuries. This is because they are in a phase of rapid growth, very active and very unsteady when walking. Toddler’s bones are soft and will often break or buckle with seemingly harmless injuries. He tells us that many injuries that cause a sprain or strain in an adult will cause a fracture in a toddler. The good news, for patients like 22 month old Kye, is that these injuries generally are stable and do not require casts or splints for very long, if at all.

Here are some common toddler injuries we see in our Fracture Clinic:

Toddler’s fracture is a small break in the bone of the lower leg usually caused by a simple fall or a twisting injury. A common way these injuries occur is when a child’s foot is caught on a playground slide while going down the slide with a parent.

Nursemaid’s elbow occurs with a sudden forceful pull on an outstretched arm. This may happen when someone picks up the child or swings him or her by the arms. With this problem, the child often refuses to use the arm and holds it in a flexed position.

Finger-tip injuries occur in thousands of young children each year, and they typically wind up in an outpatient clinic or emergency room. These injuries often result from accidents with common items such as home and car doors, drawers or scissors.

Broken bones from falls and collisions occur when playing with larger, stronger and faster kids or on equipment that is not age-appropriate.

Lessons to Learn:

  • Do not pick up or tug on your child while holding only his or her hands or wrists, this can put stress on the elbow.
  • Do not swing your child around when holding only their hands or wrists.
  • Toddlers should use age-appropriate playground equipment and slides
  • Toddlers should ride down a playground slide
  • Watch your toddler closely when climbing or playing with bigger kids.
  • Doors, drawers and sharp objects are not toys and young children should not play with them.

As experts in managing fractures and other injuries in growing bones, we are here for you when you need us. To learn more about our Fracture Clinic on our North Campus in Plano, please visit scottishritehospital.org/fracture.

We’re Hosting a Career Fair on Thursday, April 28

Working with a world leader in pediatric orthopedics is like no other job. You’ll be part of an organization consistently ranked among the top 10 pediatric orthopedic hospitals by U.S. News & World Report. You’ll join a team of caring, energetic people dedicated to providing the best possible care. Better yet, your role will contribute to our mission of giving children back their childhood. No wonder our employees stay with us so long. Want to be one of them?

Come to our Career Fair

Date: Thursday, April 28, 4 – 7p.m.
Location: Texas Scottish Rite Hospital for Children (2222 Welborn Street, Dallas, TX 75219)

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Explore PRN and FT positions for:

  • Pediatric R.N.
  • Physical Therapist
  • Occupational Therapist
  • Radiology Tech
  • Med Tech
  • Respiratory Therapist
  • Pharmacist
  • Pharmacy Tech

Not a Nurse or Allied Health Professional?

There a many other opportunities to join our team. We invite you to see all of our current openings on our website.

For questions, please contact our Human Resources department at 214-559-7590.

Have you heard about our Fracture Clinic?

We’ve been taking care of fractures at Texas Scottish Rite Hospital for Children for a long time. As our hospital has grown, we have been able to create dedicated areas for the different specialties within pediatric orthopedics. Most recently, we have opened the Fracture Clinic on the North Campus in Plano. As a complement to our services, including Sports Medicine, the Fracture Clinic is here to help manage recent injuries.

Some injuries that have previously been treated in our other orthopedics clinics may be referred for expedited care in our Fracture Clinic. We are even offering walk-in hours for confirmed fractures. Those are fractures that have been diagnosed and treated initially in an urgent care or emergency setting, or in another provider’s office. For a visit during our walk-in hours, we require patients to have their x-ray disc in hand so that we can provide faster service, and more importantly, to avoid repeating these images.

We hope that you and your loved ones do not need these services, but we knew you would want to know that we can help, if you do. Please share this news with your friends and family.

To learn more about our Fracture Clinic, please visit scottishritehospital.org/fracture.

Getting back to sports after an ACL Reconstruction – TSRHC Sports Medicine

After an anterior cruciate ligament (ACL) tear, many young athletes choose to have surgery to replace the ACL. In very active kids, the knee is often unstable and at risk of injury without this important ligament. Returning to sports after this procedure takes time and a lot of work.

The post-surgery / “new” ACL, called a graft, needs time to be ready for certain activities. The length of time depends on several things including:

TYPE OF GRAFT ♦ AGE ♦ GENDER ♦ SPORT ♦ POSITION ♦ LEVEL OF COMPETITION

Because very young patients need a different surgery, they need more healing time. Read more about ACL reconstruction for athletes with open growth plates.

Early exercises focus on preventing swelling and stiffness. The graft can tolerate more and more stress over time. Throughout recovery an athlete is allowed to progress from simple exercises for the leg to complex movements that challenge the whole body. We refer to the later stage of rehabilitation as functional training.

The goals of this stage are often shaped by the patient’s sport-specific needs. Research has shown there are also some principles that apply to many athletes. The athlete’s ability to perform certain movements has been shown to help identify patients at risk of an ACL injury or re-injury. We use several different tests to help determine when a patient is ready to return to sports after an ACL reconstruction.

Philip Wilson, M.D., tells us that “as a practice, we are passionate about functional retraining as a means to avoid a second injury. Mounting research has shown that athletes in our pediatric and adolescent age groups are at an extremely high risk for injury to the surgical or opposite leg. Additional research has shown that increasing the time prior to return to sports, and demonstrating documented muscle strength and control are the best ways to avoid these new injuries.”

Because many sports require stability on a single leg in activities like running, pivoting, stopping, kicking, and throwing, the tests challenge athlete’s ability to stand on one leg. Additionally, these functional movements challenge the strength and flexibility throughout the body. A comprehensive rehabilitation program incorporates these concepts from the beginning:

FLEXIBILITY ♦ STRENGTH ♦ STABILITY ♦ MUSCLE ACTIVATION ♦ BALANCE ♦ CONTROL ♦ BODY AWARENESS

For this, and many other injuries, surgery is only the first step on the road back to sports. An athlete must also be committed to the rehabilitation and functional training required to return to sports. We encourage athletes to use these concepts in their training programs before they sustain game-changing injuries.

For information about injury prevention and pediatric sports medicine, please visit our website at scottishritehospital.org/sports.