Price Transparency

#SRHaccess Facebook LIVE Recap: Limb Lengthening – Intramedullary Lengthening

by | Aug 17, 2018 | Limb Lengthening

On this week’s Facebook live, Co-director of the Center for Excellence in Limb Lengthening David A. Podeszwa, M.D. joined us to discuss intramedullary lengthening – a form of treatment for our limb lengthening and reconstruction patients.

 the Facebook live.

Watch –What is intramedullary lengthening and how does it work?

  • It is a technique of lengthening the bone that uses a rod that is surgically planted inside the bone, lengthening it over time using a magnet or an electrical current.

When is intramedullary lengthening used as a treatment plan?

  • Ideal for patients who have a leg-length discrepancy over 4 or 5 centimeters at the time that they’re done growing.
  • Intramedullary technique works better in patients who have straight bones

What’s the difference between the external fixators and intramedullary rods?

  • Usually, an intramedullary rod is preferred over an external fixator.
    • Quality of life is better for patients with intramedullary rods.
    • Less pain for the patient, and less care required with intramedullary rods.

Different types of intramedullary rods:

  • Magnetic rod – a magnet slowly lengthens the rod inside the bone
  • Electrical current – a small transducer sends an electrical current that slowly lengthens the rod.

How long do patients stay in the hospital after one of these rods is implanted?

  • A majority of the time the rod goes in and the patient will go home the next day.
    • We wait anywhere from 5-14 days after the rod goes in before we start lengthening process in clinic.

How long does the lengthening process take?

  • It’s going to be at least between six and nine months.
    • The bone will lengthen about a millimeter a day, and every centimeter of lengthening requires about a month of healing.

Multidisciplinary approach:

  • A child whose limb length difference is over two inches requires a team of experts to guide the patient and their family through the six- to nine-month process.
  • Working as a team: before a surgery date is set, the patient and their family meet with multiple departments within the hospital.
    • Physicians meet with fellow physicians to discuss the treatment plan.
    • Patient meets with the nursing team to discuss education regarding the procedure and what to expect.
    • Our psychology team meets with the patient and family to help them understand the treatment and how to cope with the before and after stages.

At what age our patients a candidate for an intramedullary rod?

  • Patients become candidates when they are 8, 9 or 10 years old, depending on the deformity.
    • In most cases, it is best to wait until the patient is done growing.

What’s the activity level allowed during this process?

  • Once the lengthening process begins, the patient will be on crutches until the lengthening process is complete and the bone has healed enough to walk on it again.
    • Between the daily physical therapy and the extended time on crutches, the patient is the most important part of the lengthening process.

Final thoughts about limb lengthening:

  • As the technology improves, it will open a lot of doors for patients.
  • In the end, treating the difference is to improve the patient’s life, but not define their childhood.

Our experts are here for the patient and their family every step of the way.  Have more questions about limb lengthening?  Email askadoc@tsrh.org.

Learn more about limb lengthening and the research our hospital is conducting.

A Collaborative Research Program Advances Care for Children Diagnosed with Cerebral Palsy

A Collaborative Research Program Advances Care for Children Diagnosed with Cerebral Palsy

by | Jul 19, 2018 | Research & Innovation

At Scottish Rite Hospital, our team is dedicated to providing individualized, expert care to each child. The hospital’s Neurology department is focused on providing treatment to orthopedic patients who have related neuromuscular diseases and neurological disorders. Over the years, the hospital has established specialized clinics for children with these complex conditions. Through the collaboration between our trained neurologists and orthopedic team, the patients are able to receive multidisciplinary care to address their specific needs. 

To continue advancing the care and treatment of our neurology patients, the department is committed to ongoing research. Each year, the hospital hosts a two-week research program for children diagnosed with hemiplegic (one side of the body) cerebral palsy. To participate in this research, children meet study inclusion criteria and go through an evaluation one week prior to being enrolled in the program. Constraint induced movement therapy (CIMT) is a form of treatment where the child’s stronger arm is put into a splint forcing them to use the affected arm for all daily activities. The two-week therapy program includes gross and fine motor activities that encourage independence with identified goals. Activities include crafts, making snacks and games. The program also includes the use of the Armeo®Spring Pediatric (an upper limb video game based robotic exoskeleton). As part of the research, our team evaluates the child before and immediately after completing the program as well as six months later. By analyzing the progress of these children, the data has shown an impact from the therapy including improvement in range of motion, function and use of the affected arm. 

Like many of the research projects that take place at the hospital, this program involves staff from multiple departments. Our Neurology team works closely with the hospital’s research occupational therapists, Angela Shierk, Ph.D., O.T.R. and Heather Roberts, Ph.D., O.T.R., to make this a success. Pediatric clinical nurse specialist Nancy Clegg, Ph.D., R.N., has been involved with this program over the years and can see the impact it has made. “The children we see in our clinics and those who participate in this program are in need of specialized care,” says Clegg. “Our neurologists, orthopedic surgeons and therapists are able to conduct robust research to bring more knowledge and better care back to the patients affected by cerebral palsy. The CIMT program is just one of the many research programs that allow us to collaborate and discover innovative treatment options to enhance overall care.” 

Scottish Rite Hospital Provides Multidisciplinary Care Through New NSP Clinic

Scottish Rite Hospital Provides Multidisciplinary Care Through New NSP Clinic

by | Jun 28, 2018 | Research & Innovation

At Scottish Rite Hospital, providing premier patient-centered care is at the forefront of our mission. Through the hospital’s six centers for excellence, our doctors and researchers collaborate to study the common to the complex of orthopedic conditions to find new and innovative ways to care for our patients. For 15 years, the Center for Excellence in Spine has evolved to be an essential component to the effectiveness of treating the hospital’s spine patients. 

Scoliosis presents in many shapes and forms. Our experts in the spine center collaborate to determine the best and most effective techniques to treating spinal disorders. Recently, the hospital created a clinic specifically for neuromuscular-syndromic scoliosis patients (NSP). This patient population consists of children diagnosed with neuromuscular (affects the muscles and nerves and can lead to scoliosis) and syndromic scoliosis (spine curve develops as part of a syndrome). Because of the complexity of this disorder, these children need to be cared for by multiple specialists. The patients and families come to the hospital for one, comprehensive appointment that includes specialists from multiple disciplines. Depending on the child’s needs, assessments available from various experts include:

Anesthesiology
Child Life
Dental
Developmental Behavioral Pediatrician
Dietary
Labs/Hematology
Medical Consult
Coordinators (for external appointments)
Neurology
Nursing staff
Occupational Therapy
Physical Therapy
Psychology
Pulmonology
Research
Social Services
Surgical planning
Urology
Staff orthopedic surgeon Amy L. McIntosh, M.D., has been the leader of this initiative and believes in the positive impact it can have on the patient and their families. “The clinic is patient and family centered,” says McIntosh. “It coordinates multiple services into one appointment with the hope of decreasing the burden on families. The clinic also emphasizes open communication between providers and the families with a goal of reducing post-operative complications and costs.”

As a component of the clinic, research is heavily involved to collect certain information on this patient population to evaluate the effectiveness of this approach to care. The study titled, “Rate in Infection in Non-Congenital and Non-Idiopathic Scoliosis: A Prospective Observational Cohort Study Following Implementation of Multimodal Prevention Protocol,” analyzes all patients diagnosed with neuromuscular and syndromic scoliosis who are undergoing surgery. The hospital’s team of clinical research coordinators collect clinical and radiographic data on patients who are willing to enroll with a goal of creating a standardized model to decrease infection rates.

Scottish Rite Hospital’s Center for Excellence in Spine continues to grow and be innovative to provide world-renowned care to scoliosis patients. It is initiatives like the NSP clinic that showcase the hospital’s commitment to collaboration and approach to multidisciplinary care to advance how the hospital treats this patient population.

Learn more about our Center for Excellence in Spine.

Integrated Team Approach to Patient Care Shows Positive Results

Integrated Team Approach to Patient Care Shows Positive Results

by | Apr 23, 2018 | Research & Innovation

At Scottish Rite Hospital, our experts are dedicated to caring for the whole child—mind, body, and spirit. The hospital includes six Centers for Excellence that each cultivate the mission of patient care, research, and education. Within those centers lies integrated services that allow our specialists to provide world-renowned care to every patient. 

The hospital’s psychology department is an essential component of the overall success of our patients before, during, and after treatment. As integrated members of the hospital’s health care team, our licensed psychologists work closely with our orthopedic staff to promote a healthy lifestyle for the child through clinical care, education, and ongoing research. 

Recently, an article from the hospital was published in the Journal of Pediatric Orthopaedics titled, “Perioperative Interdisciplinary Intervention Contributes to Improved Outcomes of Adolescents Treated with Hip Preservation Surgery.” It is a collaborative project including pediatric psychologists, researchers, and orthopedic surgeons. This study evaluated adolescent candidates for hip preservation surgery and the impact of perioperative interdisciplinary care on pre-operative and post-operative outcomes. Patients who undergo hip preservation surgery typically present with chronic pain lasting longer than six months, which has the potential to develop negative psychological effects on the adolescent. 

The team evaluated a total of 67 patients before and after undergoing hip preservation surgery. Our psychologists worked closely with this group of patients before surgery to provide education, counseling, and self-reported outcomes. In comparison to patients who did not receive psychological intervention prior to having surgery, those who did recorded:

  • Higher self-esteem and self-reliance
  • Less anxiety and depression
  • Decrease in school problems and social stress

In conclusion, the project revealed that pre-operative education and counseling for patients undergoing hip preservation surgery improved their overall physical and psychological function after surgery. Pediatric psychologist Heather Richard, Psy.D. is excited about the results of this research and what it means for the future of care. “This collaborative study shows the true impact education and counseling can have on a patient undergoing surgery,” says Richard. “Our psychology team is proud to be a part of an institution that understands the importance of this service and how it can positively influence the patient. We look forward to continuing our research to improve our care of the whole child.” 

Read more about the published article.

Genetics Team Attends International Meeting in China

Genetics Team Attends International Meeting in China

by | Apr 10, 2018 | Research & Innovation

Staff from Scottish Rite Hospital travel near and far to participate in medical conferences to share their most recent research and learn from other experts in the field. Last week, members from our genetics research team were in Shenzhen and Guangzhou, China to attend the International Consortium for Spinal Genetics, Development and Disease (ICSGDD) conference. The ICSGDD includes two groups who combined after last year’s inaugural international conference, “Genomic Approaches to Understanding and Treating Scoliosis.” The hospital led and largely organized this three-day, two-part meeting with the first half in Shenzhen hosted by the University of Hong Kong and the second half in Guangzhou hosted by Sun Yat Sen University Hospital.

The conference included faculty and presenters from across the world who have been selected to provide the latest innovations within scoliosis genetic research. Scottish Rite Hospital’s Director of Molecular Genetics Carol Wise, Ph.D. is one of three conference chairpersons. As a leader and co-founder of ICSGDD, she understands its significance and the impact it could have for patients diagnosed with scoliosis. “This group has made great strides over the past year to bring better treatment for complex forms of scoliosis,” says Wise. “The ICSGDD conference is unique because it brings together experts in scoliosis genetic research from different areas of the world. The diversity of the group cultivates collaboration and in-depth discussions to better understand these conditions.”

This international conference is one of many that the hospital is actively involved with each year. As a research and teaching institution, it is important for staff to learn from fellow medical professionals and share their expertise, both locally and internationally, to ultimately provide the best care possible to our patients.

Learn more about the hospital’s Sarah M. & Charles E. Seay Center for Musculoskeletal Research.