This week, members from our Center for Excellence in Limb Lengthening are attending the 26th Annual Limb Lengthening and Reconstruction Society (LLRS) Scientific Meeting in Park City, Utah. This organization brings together medical professionals from around the country to discuss the latest research and techniques for the treatment of limb reconstruction, limb lengthening, extremity deformity correction and complex fracture treatment.
Scottish Rite Hospital has several medical staff and researchers who are members of this group, including orthopedic medical staff John Birch, M.D., Lori Karol, M.D., Karl Rathjen, M.D., David Podeszwa, M.D., and Lane Wimberly, M.D. Additionally, researchers Marina Makarov, M.D.*, Alex Cherkashin, M.D.†, and Mikhail Samchukov, M.D.‡, contribute to the success of LLRS. Assistant Chief of Staff, Karl Rathjen, M.D., has served as this year’s president of the organization. Rathjen is leading the two-day meeting while several of the hospitals’ doctors, researchers and past fellows are making presentations.
This year, our staff has been selected to present on the latest research conducted in the Center for Excellence in Limb Lengthening. “The LLRS annual meeting is a great opportunity to showcase our research to specialists in this field from around the world,” says Rathjen. “Scottish Rite Hospital has become well-known for our work with this patient population and we are honored to be able to share our knowledge.”
The Limb Lengthening and Reconstruction Society allows our staff to collaborate with fellow medical professionals to continue learning the latest techniques and treatments for these patients. Scottish Rite Hospital is dedicated to conducting ongoing research in this area not only to provide the best care possible to patients at our institution, but also to children everywhere.
* Medical Degree from Omsk Medical School, Russia
† Medical Degree from Novosibirsk State Medical School, Russia
‡ Medical Degree from Khabarovsk State Medical School, Russia
Doctors from Scottish Rite Hospital are in Cape Town, South Africa attending the 24th International Meeting on Advanced Spine Techniques (IMAST), an annual conference sponsored by the Scoliosis Research Society. This three-day international meeting brings together spine surgeons and other medical professionals from around the globe to discuss leading-edge spine research. IMAST allows attendees to discuss and debate the latest spine techniques to ultimately improve patient care.
This year, Scottish Rite Hospital’s Chief of Staff Dan Sucato, M.D., M.S., has been selected to present on the spine team’s most recent work in neuromonitoring for adolescent idiopathic scoliosis (AIS).This project, “Neuromonitoring for AIS: A 20-year Analysis of AIS Patient Incidence of Critical Changes and Predictive Factors to Define Patients at Risk,” reviews a single institution’s experience of neuromonitoring in spinal deformity surgery in a series of adolescent patients with idiopathic scoliosis in order to describe predictive factors for intraoperative neurologic injury. Authored by Dan Sucato, M.D., M.S., Kiley Poppino, B.S., Alex Thoveson, B.S., Ali Parsa, M.D., Steven Sparagana, M.D., and Patricia Rampy, M.S., C.N.I.M., the presentation is one of the top scoring abstracts at the conference.
The various conferences the hospital attends allow our doctors and researchers to not only share their knowledge, but also learn from fellow medical professionals across the world. “It is a privilege and an honor to be selected to present our research on an international stage,” says Sucato. “Although it brings light to the innovative work we conduct, it is more fulfilling to know that we are bringing better care and treatment to our patients and other children globally.”
Scottish Rite Hospital is known around the world for its expertise in treating children with orthopedic conditions. Our doctors and researchers travel the globe to educate and share their latest research with fellow medical professionals in order to bring better treatment to children everywhere.
This week, two members from the hospital are in Beijing at the 3rd China International Forum of Pediatric Development (CIFPD). This conference brings together pediatric specialists from across the world to advance international pediatric development and collaboration. The meeting includes keynote speakers and presentations on various topics in pediatric health.
Our Medical Director of Ambulatory Care, Brandon Ramo, M.D., and researcher Johnny Zhang, M.D.* were invited to give presentations regarding scoliosis. Ramo, Zhang and other spine experts from across the globe are discussing their latest innovations for the treatment of children with severe spinal deformities.
“This is a great opportunity to collaborate with other specialists and share our research”, says Ramo. “It is an honor to be invited to such a prestigious meeting with the sole purpose of bringing better care to children, both in the U.S. and all over the world.”
Presentations from Scottish Rite Hospital include:
- Halo Traction for the Treatment of Children with Severe Scoliosis
- Predicting Growth and Curve Progression in the Young Patient with Scoliosis
- Scottish Rite Hospital’s use of Mehta casting for Infantile Scoliosis
- Selection of levels in Adolescent Idiopathic Scoliosis
As an institution, it is a privilege to be known as leaders in pediatric orthopedics. We’re committed to traveling the globe in order to share research and innovation. This conference, along with others our staff attend throughout the year, not only allow the hospital to share their expertise, but also gives our staff the opportunity to learn in order to bring the best care possible to each of our patients.
*Medical Degree from Tianjin Medical University, China
Scottish Rite Hospital is hosting the 39th Annual Brandon Carrell Visiting Professorship, June 23-24. This two-day educational course is a culmination of our fellow training program and highlights the research projects of our fellows as well as our orthopedic residents. Our orthopedic trainees are required to complete at least one research project with our medical staff and research team during their rotation at Scottish Rite Hospital. This year’s program is highlighting clinical research studies in the areas of spine, hip, trauma, lower limb deformity, musculoskeletal infection (MSI), sports, and psychology.
Our visiting professor this year is Deborah Eastwood, M.B., Ch.B., F.R.C.S (London). Dr. Eastwood is a consultant orthopedic surgeon and the orthopedic director of the Motor Learning Laboratory at the Royal National Orthopaedic Hospital in Stanmore, and consultant orthopedic surgeon at Great Ormond Street Hospital in London. She has been a member of the Board of Directors for the European Paediatric Orthopaedic Society (EPOS) from 2009 through 2015 and President of EPOS 2013-2014.
This year, co-director of the Center for Excellence in Limb Lengthening, David A. Podeszwa, M.D., is the Brandon Carrell conference program director. He is excited for the fellows and residents to present their research. “I look forward to this course each year because it is a great opportunity for our fellows and other staff within the hospital to share their current research and learn from one another,” says Podeszwa. “It is an honor to have Dr. Eastwood at our institution so our staff may learn from her expertise.”
The Brandon Carrell Visiting Professorship is another component of the hospital’s mission of patient care, education and research. We continue to strive for excellence and be a leader in pediatric orthopedics by allowing staff to learn from medical professionals from around the world, as well as each other. The course advances our knowledge of pediatric orthopedics, which will improve the care of our patients.
Scottish Rite Hospital is world-renowned for its patient-centered care for children with orthopedic conditions. Our six centers for excellence provide a strong foundation to the hospitals mission of patient care, research and education. Through the centers, our experts are able to work with the hospital’s multidisciplinary team to better understand these complex conditions and to find answers through groundbreaking research.
Last year, an article published in the Journal of Bone and Joint Surgery (JBJS) by Assistant Chief of Staff, Lori A. Karol, M.D., determined the effectiveness of compliance counseling on brace use with patients who are diagnosed with adolescent idiopathic scoliosis (AIS). The study found that patients who were counseled with the use of compliance data reports wore their brace more hours per day compared to those who were not. From this initial research, Karol has conducted further studies to look at other aspects correlated to brace success.
An additional article published in JBJS last year by Karol, Donald Virostek, CPO, Kevin Felton, CPO, ChanHee Jo, Ph.D, and Lesley Butler, MPH, investigated the effect of skeletal maturity of a child who is braced for AIS on the likelihood of preventing surgery. This project compared Risser stages (which indicate what stage of growth the patient is in) and the number of hours the brace was worn on a daily basis with whether or not surgery was eventually required. Results indicated that patients with the most growth potential were more likely to have curve progression. Based on this study, young teens with scoliosis are now asked to wear their braces nearly full-time to hopefully prevent worsening of the curve and eventual surgery.
This month, a third article was published by Karol and her research team in JBJS, titled “Brace Success Is Related to Curve Type in Patients with Adolescent Idiopathic Scoliosis.” The research found that patients with lumbar curves are nearly always successful when treated with bracing.
The research conducted in our Center for Excellence in Spine allows our doctors to better understand these complex orthopedic conditions. From Karol’s initial brace compliance study, our medical staff and researchers have been able to ask more questions on this topic and look at other factors that may affect a child’s success while being in a brace. Our world-renown research is just another component to our patient-centered care to ultimately give children back their childhood.
Texas Scottish Rite Hospital is hosting the Charles F. Gregory Memorial Lecture to recognize the graduates of the University of Texas Southwestern Medical School (UTSW) Orthopedic Surgery residency program. This annual lecture was established in honor of Charles F. Gregory, M.D., who was the Chairman of Orthopaedic Surgery at UTSW from 1956-1976. Gregory was fiercely committed to excellence in post-graduate medical education and instituted numerous initiatives to create a superior educational experience for orthopedic surgeons in training at UTSW.
Orthopedic surgery residents at UTSW receive a substantial portion of their education during clinical rotations at affiliated hospitals including Scottish Rite Hospital, Children’s Health and Parkland Hospital. All UTSW orthopedic residents complete a six-month pediatric orthopedic surgery rotation at Scottish Rite Hospital where they receive clinical and surgical instruction from world-renowned pediatric orthopedic specialists. During their time at the hospital, residents also have the opportunity to work with our research staff and participate in a research study.
This year’s Charles F. Gregory Memorial Lecture program includes six resident research presentations, three of which were generated from clinical investigations performed at Scottish Rite Hospital. Staff Orthopedic Surgeon, Anthony Riccio, M.D., is the Director of Resident Education at Scottish Rite Hospital and is responsible for overseeing the UTSW orthopedic residents during their pediatric orthopedic rotation. “This is a wonderful opportunity for our graduating orthopedic residents to share their research with fellow medical professionals”, says Riccio. “All of the staff at the hospital are honored to play a role in the academic and professional development of these outstanding residents.”
Research projects from Scottish Rite Hospital include:
- Efficacy of Injections in Subtalar Coalition Patients to Prevent or Delay Operative Intervention
- Body Mass Index Affects Brace Wear Compliance in Children with Adolescent Idiopathic Scoliosis
- Is Anteromedial Drilling Safe in Transphyseal ACL Reconstruction in Adolescents with Growth Remaining
Scottish Rite Hospital is proud of the partnership and collaboration it has with UTSW through the orthopedic residency program. The Charles R. Gregory Memorial Lectureship gives the graduating residents the opportunity to present their work and provides our medical staff with the ability to share their expertise with the local orthopedic community and many future medical professionals.
Why are we in this clinic?
You are at the EOS clinic because your child has early onset scoliosis. There will be many challenges for you, your child and your doctor, but you have come to the right place. This clinic brings the necessary team members together to treat your child’s condition in the best way possible.
In this clinic we will watch the three main issues of early onset scoliosis: growth, lung function and the progression of the scoliosis.
You and your child will be invited to take part in several research projects which might lead to better care for children all over the world with this same medical problem. Whether you decide to take part in the various research projects, your child’s doctor will keep giving your child the best care available.
Who will my child see in the clinic?
- Orthopedic (bone) Doctor: The orthopedist will watch the scoliosis growth and general growth of your child. This doctor will decide on a treatment plan for the scoliosis and might order special tests to monitor your child’s overall health regarding the scoliosis.
- Pulmonary (lung) Doctor: The pulmonologist will watch lung growth and function. This doctor will order special tests to see how well your child’s lungs are working. They might order medicine or equipment to help your child’s lungs work better.
- Clinic Nurse: The clinic nurse will manage your child’s care. This nurse will explain your child’s medical condition and talk with you about any tests and treatment your c child might need. The clinic nurse will be the one to call with questions or concerns.
- Respiratory (breathing) Therapist: This therapist will do the breathing tests (Pulmonary Function Tests or PFTs) to see how well your child’s lungs work. They will also teach you and your child about any other tests or treatments needed.
- Scoliosis Research Nurse: The research nurse will explain our research projects to you. This nurse might also measure your child’s height and armspan and record clinical information that could be useful in research and also help the doctors in the treatment of your child.
- Orthotist (the “brace maker”): If your orthopedic doctor says your child needs a back brace, the orthotist will make one that is just right for your child.
Breathing Test: Pulmonary Function Test or PFT
What is a PFT?
A PFT (Pulmonary Function Test) is a painless breathing test that can help the doctor determine if your child’s lungs are working properly. A PFT can also help the doctor determine what kind of medicine(s) will be the most effective for your child. This breathing test will be done at every EOS clinic visit.
How is a PFT done?
The respiratory therapist will teach your child a few different ways of breathing. During the test, your child will blow into a tube with force, a lot like blowing out birthday candles.
How should I prepare my child?
- Tell your child that the test does not hurt. Explain how the test is done and answer as many questions as you can.
- If your child is already taking a bronchodilator (inhaler or nebulizer), try not to use it within four hours before the breathing test, if possible.
- If your child is wheezing, coughing or having any problems breathing, go ahead and give the medicine as prescribed.
- The respiratory therapist will take your child to a room to test your child’s lung function. A parent or guardian is allowed to be in the room with your child to cheer them on.
Practice Makes Perfect
- A PFT is hard work. Your child must do the best they can when being tested so your doctors will be able to determine the best treatment method.
- To help your child with the test you will find a pinwheel in this package. Please follow the directions for putting it together.
- Use this pinwheel to help make your child become more comfortable with taking a “really big breath and blowing it out all the way.”
- Practicing this for several days before your appointment will help make your child less anxious during the test.
Halo Traction is used to assist in the correction of scoliosis and kyphosis. It is usually used before other treatments for scoliosis or kyphosis, such as bracing, Risser/Mehta cast, growing rods or spinal fusion. The duration of halo traction treatment may be several weeks to several months.
The traction attached to the halo ring very gently pulls on the head, creating a pull (traction) into the back. This helps the doctors get a better correction before the next treatment is used. When the traction is removed, you will notice the curve’s return.
Your child will be completely asleep in the surgery room before the doctor applies the halo ring to the head. There will be between four and eight pins used to secure the halo ring. The pins are attached to the skull and do not go into the brain. Your child could have a headache for a few days, but this is easily controlled with medicine.
The day after the halo is applied, the doctor will attach the traction to the bracket on the halo ring. The traction weight (or pull) will be adjusted by the doctor. Traction weight should be maintained at all times while in traction in the wheelchair or walker.
A traction pulley device will be used:
- On a walker if your child can walk.
- On a wheelchair even if your child walks, as this will allow use of traction while sitting.
- On a bed.
Our goal is to have traction used most of the day.
Throughout the time in traction, the staff will be checking several functions (neuro checks) to make sure the traction isn’t excessive (pulling too much). The neuro checks are:
- Ability to move eyes side to side while keeping head still (lateral gaze)
- Sticking tongue out
- Showing teeth
- Hand grip strength
It is very important to follow the staff’s direction when asked to do these things, no matter how strange it may seem. You and your child will be taught how to do the neuro checks and will need to do these checks four times a day (at each meal and bedtime). Your child needs to report any strange or different feelings, such as numbness, tingling or difficulty swallowing. The doctor will order how often and how much the traction will be increased and change in traction should only come from your child’s doctor.
Your child will need to stay in traction all day except for time out to shower.
- Shower and wash hair as usual.
- The doctor will order pin care if more than a shower is needed to clean the pins.
- The pin sites need to be checked daily for redness and drainage.
- Hair does not need to be cut before the ring is applied. Assistance may be needed to check the pin sites.
- A button up shirt should be worn. A pullover shirt may not go over the halo ring.
- If your child already uses a wheelchair, it can usually be modified so the traction can be used.
- Use caution when getting out of traction, as your child may be a little off balance.
- Use caution with the walker and traction, as the walker can fall over on ramps and uneven ground.
When to call your nurse
- Any abnormal or neuro check changes.
- Red pin sites, drainage from pin sites or loose pins.
- Pain after the first few days.
- If your child cannot close the eyes or constantly has the facial expression of “surprise”.
Scottish Rite Hospital’s team in the Movement Science Lab is in Salt Lake City, Utah participating in the Gait and Clinical Movement Analysis Society (GCMAS) Annual Meeting. The conference brings together professionals from diverse medical backgrounds to improve the quality of life for individuals with any movement disorder through research and collaboration.
Team members from our Movement Science Lab are among other medical professionals from around the country that have the opportunity to present their most recent research. With four podium and two poster presentations accepted, the hospital is presenting on various topics within pediatric orthopedics. Director of the Movement Science Lab and an executive officer for GCMAS, Kirsten Tulchin-Francis, Ph.D., is proud of the representation the hospital has at this year’s meeting. “For our team, this is a great opportunity to showcase our expertise in how we study the movement and function of our patient population,” says Tulchin-Francis. “Our orthopedic staff supports the work we conduct and believe that the research can truly help determine better treatment plans for our patients.”
The team is presenting on the following topics:
- The Periacetabular Osteotomy Improves Radiographic And Gait Functional Outcomes Of Adolescents With Cerebral Palsy
- Plantar Pressures Following Surgical Intervention For Clubfoot: Intermediate Follow Up At 5 Years Of Age
- Outcomes Following Treatment For Idiopathic Clubfoot At Age 10yrs: Gross Motor Function, Strength & PODCI
- The Development And Treatment Of Adolescent Hip Pain In A Patient With Legg-Calve-Perthes Disease
- Differences In Squatting Biomechanics In Individuals With Unilateral And Bilateral Adolescent Hip Dysplasia
- Rectus Sparing Approach To Periacetabular Osteotomy In Adolescents Preserves Hip Flexion Strength At Short Term Follow-Up
Our state-of-the-art Movement Science Lab brings a unique view into how our patients function to better understand their condition and to determine the best treatment plan. This annual meeting allows our staff to further their knowledge and share their expertise with fellow medical professionals. It is a privilege to be a part of a specialized meeting in order to bring more discussion and groundbreaking innovation back to the hospital to ultimately give patients back their childhood.
Last week, our medical staff and researchers attended the 2017 EPOSNA conference in Barcelona, Spain. This inaugural meeting combined two established pediatric orthopedic societies, POSNA (Pediatric Orthopaedic Society of North America) and EPOS (European Pediatric Orthopaedic Society) to foster education and research on a global scale.
Scottish Rite Hospital had a tremendous showing with presentations throughout the four-day meeting. The hospital returned from Spain with two of the three major awards given at the meeting – Best Quality, Safety, Value Initiative (QSVI) presentation and Best Basic Science Research podium presentation. Staff Orthopedist, Amy McIntosh, M.D., and Director of Performance Improvement, Kerry Wilder, received the QSVI award on their work in quality improvement regarding reductions in surgical site infections (SSI) in patients undergoing spine surgery. This is a great accomplishment as this is the first quality improvement award the hospital has won at an international meeting.
Staff orthopedist, Lawson Copley, M.D., received the award for Best Basic Science Paper for his research work on acute hematogeonous osteomyelitis (AHO), which is a bone infection that is most commonly caused by bacteria called, Staphylococcus aureus. Copley and his team conducted a thorough analysis of bacterial virulence genes (genes responsible for causing infection) isolated from children with osteomyelitis to determine which ones were associated with a severe illness.
The 2017 EPOSNA combined meeting provided a great opportunity for our staff to learn and present their work to fellow medical professionals from around the world. Research and education continues to be at the forefront to help answer the challenging questions we face and is critical in carrying out the hospital’s mission to ultimately provide the very best care to our patients and children everywhere.