|
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.
|
