Clinical Services

This past year was one of continued growth and expansion of our department. We had nearly 100,000 patient visits in our ambulatory area and did 6,300 surgical cases in the main operating room and the satellite ORs combined. Cases more appropriate to satellite surgery such as foot, hand and sports procedures were moved to satellite facilities primarily in Waltham and Lexington. Given the traffic patterns around the Longwood campus, the packed clinic on Fegan 2 and the desire for patients to be seen closer to home, our orthopaedic diaspora to satellites throughout eastern Massachusetts and even into New Hampshire continues.

Department growth continues more so in trauma and sports than other areas, as one might expect. We have instituted an Urgent Program, both on the main campus and in the satellites, staffed daily by an orthopaedic surgeon as well as a nurse practitioner or physician’s assistant. There has been nearly 20% growth in our satellite urgent program, improving patient access with same day service. In addition to trauma growth, the demand for Sports Medicine services continues to increase. There are 6 surgeons and 10 primary care physicians working in the Sports Medicine program. With the recognition of sports-related head injury (concussion) as a major public health problem, our department has been exceedingly busy in the pre-participation evaluation, follow-up, and management of concussions. This is done in concert with Neurology and Neurosurgery in order to ensure a comprehensive program in concussion management. Recognizing the responsibility for prevention as well as treatment, the opening of the Micheli Center for Sports Injury Prevention (Figure 2) occurred this year. It is located in Waltham, adjacent to one of our satellite facilities. Named after Lyle Micheli, M.D., its focus is on injury prevention as well as exercise and training. Bill Meehan, M.D., (Figure 3) one of our primary care sports medicine physicians, serves as the Director of the Micheli Center program. It is intended to be a center of research and exercise teaching in the hopes of finding ways to prevent sports injury and improve performance. In addition to his clinical and administrative effort, Bill Meehan was instrumental in gaining a grant from National Football League Players’ Association through the Harvard Catalyst Program for the evaluation and prevention of injury in NFL football players.

Another of our programs which is showing steady growth is the Cerebral Palsy Program under the direction of Dr Brian Snyder. With the addition of Dr. Ben Shore to the program, an added focus on clinical research and predictive rules for problems in cerebral palsy is evolving. Ben Shore finished a fellowship with Kerr Graham in Melbourne, Australia, an international authority on the orthopaedic care cerebral palsy patients. Following a fellowship here at Children’s, he obtained a Master’s in Public Health from the Harvard School of Public Health and he is now actively involved in the Cerebral Palsy Program. A Spasticity Program with neurosurgeon, Dodi Robinson, and a full complement of physicians caring for children with CP, is developing nicely, facilitating a comprehensive evaluation of patients with cerebral palsy. In this way, we are able to provide excellent state-of- the-art care for musculoskeletal problems related to spasticity and the effects of cerebral palsy in children.

With the consolidated care of patients with myelodysplasia, we are actually seeing an increase in the number of patients with this problem in our program, despite decreased incidence with recognition of prevention using folic acid in pregnancy. Dr. Lawrence Karlin continues to do the heavy lifting in this program, providing comprehensive orthopaedic care to patients with myelodysplasia.

As casts have replaced much of the surgery in the management of clubfeet and vertical talus, we are seeing a similar move towards casting in spinal care of patients with early onset scoliosis. Dr.s Emans, Karlin and Glotzbecker are actively involved in developing this program as well as surgery for early onset scoliosis as needed. Dr. Snyder has provided the basic science in bone development, curve generation, and pulmonary development as an underpinning of this clinical work. As the conservative approach to early onset scoliosis is evolving, Recognition of the value of brace treatment nationally complements our emphasis on the “Boston” brace at Children’s Hospital as a method for the management of adolescent idiopathic scoliosis.