The Limb Lengthening and Reconstruction Society (LLRS), an association for the study and application of the methods of Ilizarov-North America, is holding its 25th Annual Scientific Meeting in Charleston, South Carolina on July 22 and 23. The LLRS is an organization dedicated to researching new treatment for limb reconstruction, limb lengthening, extremity deformity correction, and complex fracture treatment. Texas Scottish Rite Hospital for Children is represented at the meeting by Karl E. Rathjen, M.D., David A. Podeszwa, M.D., John Birch, M.D., Alexander Cherkashin, M.D., Mikhail Samchukov, M.D., and current fellow, Connor Green.
Assistant Chief of Staff, Dr. Karl E. Rathjen, has served as the Vice President of LLRS for the past calendar year and was recently appointed President of the organization for the year 2016-2017. At the 2016 annual meeting, Rathjen will be co-leading the two-day meeting, while several of the hospital’s doctors and fellows will be presenting their work.
Drs. David Podeszwa, Alexander Cherkashin, and fellow, Connor Green, have the opportunity to discuss several topics to the LLRS group, which encompass some of the cutting edge research happening within the hospital’s Center for Excellence in Limb Lengthening and Reconstruction (CELLR). CELLR focuses on improving the lives of patients with different leg length discrepancies and limb deformities. Co-directed by Dr. David A. Podeszwa and Dr. Mikhail Samchukov, the center has more than 20 United States and International patents and continues to be recognized as one of the top centers in this field. The Limb Lengthening and Reconstruction Society Annual Scientific Meeting is another opportunity for our doctors and researchers to showcase the work of Scottish Rite Hospital to other institutions from across the country.
The hospital co-hosted the center’s International Scientific and Practical Conference in June, the first time that the center has collaborated with an outside institution to organize the annual meeting. It was attended by 500 medical professionals from 31 countries and marked the 45th anniversary of the center, the 65th anniversary of the development of the Ilizarov technique and the 95th birthday of the late Professor Ilizarov.
L to R: Drs. Birch, Gubin and Podeszwa in Kurgan
Gubin’s vision is to open up the center to the world, starting with this ongoing exchange with Scottish Rite Hospital. Since the 1990s, the hospital has developed a number of patented modifications to the original Ilizarov technique resulting in a series of devices known as the TRUE/LOKTM External Fixation System. Gubin is interested in integrating these advances into the treatment of limb differences at the center, located in Kurgan, Russia.
Elizabeth Gubin, who practices at Kurgan Children’s Hospital, will be studying Scottish Rite Hospital’s treatment of patients with cerebral palsy. She is setting up a cerebral palsy center in Kurgan and will meet with hospital neurologists and observe clinical visits and procedures.
Alexander Gubin visited Scottish Rite Hospital and other Western institutions that employ the Ilizarov technique before deciding to collaborate with the Dallas hospital. Hospital researchers Mikhail Samchukov,Alex Cherkashin and Marina Makarov are former leaders of the Ilizarov center and worked directly with Ilizarov himself. Though the relationship goes back many years, a formal exchange of physicians was established in 2014. Two Russian orthopedic surgeons from the center have already visited Scottish Rite Hospital. Dr. David Podeszwa, the newly appointed co-director of the hospital’s Center for Excellence in Limb Lengthening and Reconstruction, went to Russia in 2015.
The collaboration also includes two limb lengthening/reconstruction studies, with plans to expand cooperative research. The center will continue to send its physicians to Scottish Rite Hospital for training, and hospital orthopedists, researchers and fellows will have the opportunity to visit the center in Russia.
Drs. Samchukov, Cherkashin, Podeszwa, Makarov and John Birch lectured and moderated panels at the Russian conference, and Samchukov, Birch and Cherkashin (pictured left) were awarded honorary professorships for their contributions to the Ilizarov technique, the only three North Americans to receive the prestigious distinction at the meeting.
While in Kurgan, Cherkashin and Samchukov also met with an international group of surgeons at the annual TRUE/LOKTM Hex Summit to get their feedback on the Hex device developed at Scottish Rite Hospital. Dr. Podeszwa participated in a press conference on state television.
On the morning of Tuesday, July 26, Dr. Gubin will talk about the Ilizarov center in the 21st century in the Scottish Rite Hospital auditorium. Also on the program are presentations by Dr. Birch on the evolution of the Ilizarov technique at the hospital, and Dr. Podeszwa on the development of collaborations between the Ilizarov center and Scottish Rite Hospital.
From a child’s hands, imagination becomes creation. Through their hands, children explore the world around them. For thousands of children with hand and upper limb disorders, Texas Scottish Rite Hospital for Children has been a source of hope and healing. Learn how the Charles E. Seay Jr. Hand Center positions Scottish Rite Hospital as a leader in treating pediatric hand disorders.
Focus on Clinical Patient Treatment and Research
The Hand Center delivers a setting for both clinical patient treatment and clinical research focused on the treatment and care for pediatric patients with hand and upper limb disorders, says Dr. Scott Oishi, the Center’s director.
“Our clinical practice [treats] a variety of children who are either born with congenital hand differences or upper extremity differences, or patients who have had trauma or something happen to them after they’re born,” he says. “There are a lot of patients who come through here and get no surgery at all because all they really need is a lot of encouragement and ability to grow and expand their horizons.”
Dr. Oishi and Staff Hand Surgeon Dr. Christopher M. Stutz have the privilege of seeing many of their pediatric patients from the time they’re a few days old until the time they become 18 years old. “We’re able to keep a database of our patients as far as what type of diagnosis they have, what type of surgeries they underwent, and what their outcomes were, based on very good outcome measures,” Dr. Oishi says.
“I think one of the benefits of being a patient here [at Scottish Rite Hospital] is that in our clinic, if we feel you need to have therapy, we have a therapist who is literally steps away from us,” Dr. Oishi adds.
Building Confidence Through Hand Camp
Scottish Rite Hospital patient Mason was born unable to move his left hand. Mason’s father, Randy, says initially no one was able to name the source of the problem. “In the first seven days of his life, we ended up visiting six doctors, a lot of specialists, and we got referred to [Scottish Rite Hospital],” he says. “As soon as we walked in, they were able to identify the issue.”
Dr. Oishi notes that Mason underwent a free functional gracilis muscle transfer, transferring muscle from his leg to his arm.
“He has roughly 40 to 45 percent usage of his left hand already at the age of 7. We could tell that he’s growing and getting more use all the time,” Randy says. “[Scottish Rite Hospital], with the usage of Hand Camp, has given him the confidence to be able to talk about his arm. He’s not embarrassed by his arm; he doesn’t hide his arm from his friends.”
Amy Lake, therapist and co-director of the Scottish Rite Hospital Hand Camp, says the program started in 1995 to bring families together. “A child with a hand difference can go to school, be involved in activities, and never come in contact with another kid with a hand difference,” she says.
Andrea Brown, Hand Camp co-director, says the Hand Camp instills invaluable confidence in the children who attend. Moreover, parents also benefit from interacting with one another, as they receive valuable information to help their children as well.
Trained Fellows Who Deliver Hand Treatment Excellence
Dr. Oishi emphasizes that one of the most important aspects of the Hand Center is the training this team devotes to their clinicians. “We train fellows and trainees that then go out and practice pediatric hand surgery,” he says. “Our Center’s message is really one that Peter Carter, one of our retired hand surgeons here, taught us all — the to-for rule.”
“Either do something to them or you can do something for them,” explains Scottish Rite Hospital Staff Hand Surgeon Dr. Marybeth Ezaki. “We practice that rule every single day.”
Support Those Who Support TSRHC Patients
As a world leader in treating pediatric orthopedic conditions, Scottish Rite Hospital provides the highest level of care for children from birth to age 18, regardless of a family’s ability to pay. To learn more about Scottish Rite Hospital, its mission, and ways you can support continuing research for treatment of pediatric hand disorders, call 214-559-5000 or visit scottishritehospital.org.
The International Meeting on Advanced Spine Techniques (IMAST), an annual conference sponsored by the Scoliosis Research Society, includes spine surgeons, allied health professionals and researchers from across the globe to discuss new and innovative spine techniques. Texas Scottish Rite Hospital for Children is being represented at IMAST 2016 by orthopedists Dr. Dan Sucato and Dr. Steve Richards, researcher Dr. Hong Zhang, and research coordinator Dong Tran. Among hundreds of submissions from institutions across the country, the work of our doctors and researchers has been selected for two podium presentations.
“IMAST is a slightly different meeting than some of the other spine meetings we participate in because innovative and newer techniques are the focus of the meeting with ‘outside the box’ presentations and discussions”, says Sucato. Scottish Rite Hospital continues to be seen on the national stage. The opportunity to showcase our work is tremendously fulfilling, however, knowing that it can directly affect the care of a child makes it that much more rewarding.
The first presentation was authored by Eray Kilinc M.D., Dong-Phuong Tran, M.S., and Charles Johnston, M.D., analyzes 120 AIS (Adolescent Idiopathic Scoliosis) patients with specific types of curve patterns of the spine. The objective of the study is to understand whether there is a significant difference between using more vs. using less implants to correct the curve. By using less implants, the research has shown that although the results show that fewer screws achieve slightly less overall curve correction, overall satisfaction scores for both patients with more screws and less screws were similar.
Charles Johnston, M.D., Kelly Jeans, M.S., Dong-Phuong Tran, M.S., and Anna McClung, R.N.,B.S.N., authored the second selected presentation. This study evaluated EOS (Early Onset Scoliosis) patients who have undergone growing rod treatment. The objective was to assess whether children with EOS were able to keep up with their peers based on a graded exercise test. The study builds on earlier research, which has shown that children who have undergone extensive treatment are thought to have limited capacity regarding physical activity. The study included 12 patients who were tested while walking at a self-selected speed over-ground and then during a graded exercise test. In conclusion, our researchers discovered that patients with EOS are not only able to keep up with their peers while walking around their communities, but they also have the capacity to exercise.
Spinal conditions, such as scoliosis, can take many forms and vary in severity. Since the 1970s, our hospital has been an advocate for and leader in research and treatment of spinal disorders in pediatric patients. Discover why the Sarah M. and Charles E. Seay/Martha and Pat Beard Center for Excellence in Spine Research at TSRHC remains the nation’s premier center for spinal deformity research.
Center for a Team of Talent Collaborations
The purpose is to bring a number of different talented people in various disciplines to the table to try to answer the unanswerable questions we have in spine deformity today.
“There are a lot of treatment strategies — I call it tools in your toolbox — and we pick the right tool for each individual patient and case,” adds staff orthopedist Dr. Amy McIntosh. “But the beautiful thing about [TSRHC] and the Center for Excellence in Spine Research is all of the tools are available.”
Along with talent and tools, there’s another important T in the equation: the team approach that lies at the heart of the center’s mission and vision. Whether they’re being treated by physicians, nurses, or in-clinic orthotists, TSRHC patients receive only the best from the professionals working in these disciplines to provide treatment for scoliosis.
Putting Orthopedic Experts on the Research Front
The addition of Dr. Carol Wise as director of basic research has further advanced TSRHC’s research aims. Indeed, Wise was one of the first researchers to identify a gene for adolescent idiopathic scoliosis. “The end result we’re hoping for,” Dr. Wise says, “is to cure this disorder — to treat it non-invasively so that we’re not taking children into surgery to correct a deformity of their spine.”
Treatments as Personal as Patients Themselves
Because each patient who comes to TSRHC is a distinct individual, no two treatment options are the same. However, what does remain the same is the unparalleled level of care that the TSRHC team dedicates to each patient.
Overall, Dr. Sucato says, the TSRHC team aims to prevent scoliosis from intensifying, thus preventing intensive treatments. But when surgeries are required, the team dedicates itself to making them as safe as possible: “The most important thing we do is we ask, ‘What are the important clinical questions we have for our patients? What are the answers that we don’t have today that we can research today so we have a better answer for tomorrow?'”‘
Watch this video below to learn more about our Center for Excellence in Spine Research:
At Texas Scottish Rite Hospital for Children, our mission is to discover new and innovative ways to best care for children affected with orthopedic and certain related neurological conditions. We opened our doors in 1921, and since then, our doctors and researchers have been seeking ways to provide the best quality care for our patients.
Our Sarah M. and Charles E. Seay Center for Musculoskeletal Research consists of six Centers for Excellence. You may be wondering….What exactly is a Center for Excellence? The main objective of these centers is to support our holistic approach to treatment by bringing clinicians, researchers and other health care professionals together to collaborate on relevant research for challenging pediatric disorders.
While the internationally recognized research conducted at TSRHC benefits children around the world, many people may not realize how our research makes the leap from a local platform to a global stage. Whether publishing journal articles, educating fellows or hosting visiting physicians, our hospital is constantly engaged in sharing discoveries that improve treatment outcomes for children everywhere.
To that end, our hospital also actively participates in medical conferences and symposiums nationally and internationally, many of which influence the direction of orthopedic care.
Recently, our Center for Excellence in Limb Lengthening and Reconstruction had a prominent presence at an international conference that brought together three notable limb-lengthening societies for the first time.
In addition to our team’s conference presentations, physicians from other institutions repeatedly featured TSRHC’s external fixations systems, the TRUE/LOK™ and the TL-HEX, in their lectures. This reflects our team’s positive influence in the international practice of limb lengthening and reconstruction.
This April, TSRHC’s medical team will have a highly visible role at the prestigious Pediatric Orthopaedic Society of North America’s annual meeting. Presentations submitted for this meeting are rigorously judged. This year, we have been invited to give 24 presentations. It will be one of the strongest representations of any pediatric orthopedic program in the country.
To have the work of our expert team of researchers and physicians recognized on a global scale is tremendously gratifying, but to know that the information and resources we share benefit children throughout the world is by far the greatest reward.
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.
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.
Dallas researcher, Virginia Pascual, MD, publishes new findings in prestigious Cell journal
DALLAS (March 31, 2016) – New research that may dramatically improve drug development for systemic lupus erythematosus patients will be published April 21 in Cell, the most prestigious scientific journal among biologists. The paper, “Personalized Immunomonitoring Uncovers Molecular Networks That Stratify Lupus Patients,” is authored by Dr. Virginia Pascual, principal investigator of the study and researcher at Baylor Institute for Immunology Research, part of Baylor Scott & White Research Institute.
“This achievement reflects Dr. Pascual’s commitment to excellence and to continuous improvement of quality care for patients with lupus,” said Donald Wesson, senior vice president of medical education and research for Baylor Scott & White Research Institute. “For many investigators, simply getting a publication in Cell is the highlight of their career, but for Dr. Pascual it’s another great honor in a career that has brought prestige to her work and to Baylor Scott & White Health.”
Lupus is a chronic disease that causes the body’s immune system to attack its own tissues, causing inflammation, pain and organ damage. It’s a complicated condition that’s difficult to diagnose – no single test can definitively detect it – and complex to treat since no two cases are alike. Clinical trials for effective drug treatments have had limited success. In this study, Dr. Pascual and her team aimed to understand the molecular diversity of the disease in an effort to make future drug development easier and more effective.
“The results included in this paper provide an explanation for why clinical trials fail in lupus, and opens the door for true personalized approaches to drug discovery and treatment in this disease,” Dr. Pascual said.
Researchers studied the transcription of genes in 924 blood samples from 158 pediatric lupus patients from Texas Scottish Rite Hospital for Children clinics and other children’s hospitals for up to four years. This personalized immunomonitoring approach, which measures gene expression activity of different cell types, allowed researchers to classify patients into seven groups with similar molecular disease structure at the time of both disease flares and remissions.
Dr. Marilynn Punaro, medical director of rheumatology at Scottish Rite Hospital, and members of her team are co-authors of the study, which may improve clinical trial design and implementation of tailored therapies in lupus and other genetically and clinically complex autoimmune diseases.
“This is a landmark study that has the potential to dramatically improve treatment and quality of life for the hundreds of thousands of people suffering with lupus,” Dr. Pascual said.
About Baylor Scott & White Health
Formed from the 2013 merger between Baylor Health Care System and Scott & White Healthcare, the system referred to as Baylor Scott & White Health is the largest not-for-profit health care system in the state of Texas. With total assets of $9 billion* and serving a population larger than the state of Georgia, Baylor Scott & White Health has the vision and resources to provide its patients continued quality care while creating a model system for a dramatically changing health care environment. The system now includes 48 hospitals, more than 900 access points, 6,000 active physicians, and 40,000 employees, plus the Scott & White Health Plan, Baylor Scott & White Research Institute and Baylor Scott & White Quality Alliance — a network of clinical providers and facilities focused on improving quality, managing the health of patient populations, and reducing the overall cost of care. For more information visit: BaylorScottandWhite.com
Also known as Legg-Calvé-Perthes disease, Perthes disease is a childhood disorder of the hip. The disease affects the ball portion of the hip joint, known as the femoral head. Perthes is uncommon— approximately 5 to 10 children per 100,000 will be diagnosed — and it more commonly affects boys -1 in 760 boys. Here are some interesting facts about this pediatric hip disorder.
What Happens to the Hips in Perthes Disease
In a normal hip joint, the round head of your femur fits into the round socket in the pelvis. Perthes disease interrupts the blood flow to the femoral head, causing all or part of it to die due to lack of blood. The bone death is medically referred to as osteonecrosis.
Once the bone dies, the femoral head is more prone to breakage and heals poorly. As a result, the pressure and weight on the bone from normal rigorous activities can cause the round portion to become flat over few months to a year after the diagnosis. For one to two years after bone death occurs, new bone gradually begins to fill in the areas where the body has removed away the dead bone.
The Cause of Perthes Is Still Unknown
While we know what happens to the hip to alter the shape of the femoral head, we still don’t know what causes the precipitating interruption of blood flow. We also know that Perthes is not heritable, since less than five percent of its patients have a family history of the disease. However, some other heritable hip conditions or blood disorder can mimic Perthes, such as multiple epiphyseal dysplasia and sickle cell disease. History of taking corticosteroid for treatment of asthma, inflammatory conditions, or cancer can also produce bone necrosis that mimics Perthes.
Diagnosing Perthes Disease
Because so many other diseases can mimic the symptoms of Perthes, it is known as a disease of exclusion. Doctors will rule out other conditions by taking a careful look at medical history and performing a physical exam. The physician will typically ask about the following diseases to rule them out:
Family history of hip disorders or early joint replacement
Steroid use, such as for asthma
Prior hip surgeries
History of sickle cell disease
History of hip infection
History of endocrine or clotting disorders
To confirm a potential Perthes diagnosis, doctors will perform an X-ray of the hips. If the X-ray is taken too soon after symptoms have begun, it may appear normal. In that case, physicians can order a very sensitive diagnostic test called perfusion MRI if they still suspect Perthes.
Treatments and Complications
The body will naturally remove and replace the dead bone of the femoral head with new bone, so, to some extent, Perthes heals itself. However, the healing process may be slow and even after healing has taken place, the femoral head may not return to its original round shape. When that fails to happen, patients may experience long-term complications, such as pain, stiffness and a greater risk of arthritis later in life.
Until the healing phase is complete, non-surgical treatments might include crutches, wheelchairs, casting and/or bracing, and reduced physical activity. Surgical treatments might include pelvic or femoral osteotomy, a process that reshapes the pelvis or femur.
While Perthes is in some ways self-healing, femoral heads sometimes don’t heal properly. With the interventions we have today and new treatment knowledge about the condition, those with Perthes can usually return to daily activities and sports activities without problems.
For more information about Perthes Disease and becoming a patient at TSRHC, visit the hip disorders section on our website.