Ortho times - Children's Hospital Boston

inside this issue
New Ortho/Sports
Clinic
Meet the Staff
New Director of
Orthopaedic Research
Research Notes
Welcome
New Physicians
Botox and Spasticity
Surgical Corner
Ask Chris: Ortho
FAQS
Throwing Out the
First Pitch
Kids Corner:
Word Search
Ortho times
“All the News,
No Bones About It!”
new Ortho/sports Clinic
By Virginia Brunelle
Volume Vii
december 2006
This October, the Department of Orthopaedic Surgery celebrated the opening of our newest clinic
at Children’s Hospital Boston at Waltham. The Department of Orthopaedic Surgery collaborated
with the Sports Medicine Division to create a dedicated Ortho/Sports clinic.
Located on the second floor of Children’s
Hospital at Waltham this new clinic space is a
welcome addition to our expanding practice.
Boasting over 14,000 feet of square footage, the
new clinic offers twenty-one exams rooms, a cast
room, and brace shop. Additional onsite services
include comprehensive radiology services, physical
and occupational therapy, and day surgery.
Our Boston clinic accommodates 21 orthopaedic
surgeons and over 57,000 patient visits per year.
This can often lead to extended wait times and congestion in our waiting room. With the addition
of our new Ortho/Sports Clinic in Waltham we strive to continue our goal of providing exceptional
care and service.
Featuring plenty of seating, bright colors and interesting artwork our clinic reception area
provides a relaxing space for families when they arrive for their appointment. Utilizing a
pod system, each physician’s work area includes three exams rooms connected to a work
area, along with access to private consultation rooms. This arrangement allows us to
provide care for our patients with greater efficiency and privacy.
Children’s Hospital at Waltham is located off of Interstate 95. This convenient location
allows us to offer free and ample parking. For more info on scheduling your next
appointment in Waltham please call 617-355-6021.
Meet the staff –
Melissa Boyd
By Renee taylor
If your child should need surgery, you will speak with
one of the seven orthopaedic surgical coordinators.
The coordinators will help in scheduling the surgery
for you child, as well as any pre/post operative
appointments and tests.
Melissa Boyd recently joined the group of surgical coordinators in July. Melissa
schedules operations and procedures for Drs. Travis Matheney, Brian Snyder
and Gregory Melkonian. If your child is in need of surgery with any of these
physicians, you will most certainly get to know Melissa.
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The large and open Cast Room provides casting, splinting
and bracing, as well as crutch fitting and instruction.

new director of
Orthopaedic Research
By Virginia Brunelle
We are pleased to announce the addition of
Dr. Matthew Warman as the new Director
of the Orthopaedic Research Laboratories,
at Children’s Hospital Boston. Dr. Warman,
a Howard Hughes Investigator, joins us as
Professor of Genetics and Orthopaedic
Surgery from Case Western Reserve
University.
Having received his Sc.B. degree from
Brown University and his M.D. degree from Cornell University, Dr.
Warman subsequently completed an internship and residency in Pediatric
Medicine at Children’s Hospital National Medical Center in Washington,
D.C. Dr. Warman’s association with Harvard and Children’s began in
1986 when he became a Fellow in Clinical Genetics here at Children’s.
He was also a Research Fellow in Genetics working with Dr. S.A. Latt
in the Howard Hughes Medical Institute. Before leaving Boston for
Case Western Reserve University he was a Research Associate in the
Departments of Anatomy and Cell Biology working with Dr. Bjorn Olsen
at Harvard Medical School.
Research notes
By Jason Andersen
While many patients may be familiar with the
clinical aspects of the Department of Orthopaedic
Surgery, there are also numerous research
projects going on behind the scenes. In
addition to providing clinical care to patients,
many of our physicians conduct a variety of research
studies aimed at improving patient care
and enhancing medical treatment.
A recently completed research study led by
Drs. Peter Waters and Donald Bae reviewed
the incidence of sports related injuries in patients
diagnosed with brachial plexus birth
palsy (BPBP). The brachial plexus is a network
of nerves that originates at the spinal cord and
conducts neuromuscular signals to the shoulder,
arm, and hand. BPBP refers to an injury of
varying severity to this network of nerves that
is sustained during childbirth.
Children’s Hospital Boston is recognized as an
international referral center for patients with
BPBP. Drs. Waters and Bae see children with
this condition on a regular basis. Parents of
patients diagnosed with BPBP frequently ask
questions regarding the safety of their child’s
participation in athletic activities. There is
currently a lack of research investigating the
incidence of sports-induced injuries sustained
by athletes with disabilities such as
BPBP. With the assistance of Dr. Avallone
and Robert Yu (a member of The Clinical
Effectiveness Research Center), Drs. Waters
and Bae sought to investigate the frequency and
type of injuries sustained by children with BPBP
while participating in
athletics.
The goal of this
study was to determine
whether
patients with BPBP
are at any greater
risk than the general
pediatric population
of incurring
He is certified in pediatrics as well as clinical, biochemical, and molecular
genetics. Dr. Warman is a recipient of the Clinical Scientist Award in
Translational Research from the Burroughs Wellcome Fund.
Dr. Warman’s research aims to understand how the human skeleton
develops and then maintains itself over a lifetime of use. By caring for
and working with patients who often have, heritable forms of skeletal
disease.
Dr. Warman hopes to learn about genes and biologic pathways that
will also be important to individuals with common skeletal diseases.
Ultimately, Dr. Warman and his research team hope their research will
lead to improvements in diagnosing, treating, and preventing diseases
that affect bones and joints. In addition to running his own research
laboratory, Dr. Warman looks forward to mentoring young investigators,
who are starting their own research programs, and to enhancing
collaborations among all the Orthopaedic Research Laboratories, and
between these labs and other research teams within and beyond the
Children’s Hospital community.
Dr. James Kasser, Chief of Orthopaedic Surgery, adds “The addition
of Dr. Warman to our staff will complement our clinical services with
enhanced investigative capacity, enabling us to enter into a new era of
orthopaedic care in the next two decades.”
For more information on orthopaedic research at Children’s please visit
www.childrenshospital.org/research
“The goal of this study was to
determine whether patients
with BPBP are at any greater
risk than the general pediatric
population of incurring
injuries during participation in
athletics”.
injuries during participation in athletics. Over
a span of two years, two questionnaires were
administered to 85 pediatric BPBP patients and
their parents pertaining to this topic of prevalence
and type of sports-induced injuries.
After analyzing patients’ responses, the researchers
found encouraging results. The data
demonstrated that nearly all injuries sustained
by BPBP patients were relatively minor, such
as bruises, sprains, or strains. Additionally, the
type, severity, and frequency of injury were not
statistically significantly different from national
statistics of the pediatric athletic population.
In other words, the data supports the theory
that most children with BPBP participate in
and enjoy a variety of sports, without a significant
increased risk of incurring injury in any
particular sport. Additionally, the children participated
in a variety of sports involving upper
extremity usage, and the level of achievement
they reached was similar to children
without BPBP.
The research team believes that results
from this study will give BPBP
patients and their parents more evidence-based
information to consider
when making decisions about
choosing to participate in sports.
Research efforts like this would
not be possible without the invaluable
voluntary contribution of patients. As always,
the researchers thank all of those who
have previously contributed to the research
efforts of the department and encourage potential
study candidates to participate in future
studies whenever possible.
For more information on clinical studies within the
Department of Orthopaedic Surgery please visit
www.childrenshospital.org/research/cerc
Welcome new Physicians
The Department of Orthopaedic Surgery is pleased to announce that
Dr. Samantha Spencer and Dr. Travis Matheney have joined our team.
Dr. Spencer attended the University of Michigan Medical School. She
completed her surgical internship in
the Massachusetts General Hospital’s
Department of General Surgery and her
orthopaedic residency in the Harvard
Combined Residency Program in
Orthopaedic Surgery. She also completed
a fellowship in pediatric orthopaedic
surgery at Children’s Hospital Boston.
Dr. Spencer is an Instructor in
Orthopaedic Surgery at Harvard Medical
School and a staff surgeon in the Orthopaedic Surgery Department at
Children’s Hospital Boston.
Dr. Spencer is now seeing orthopaedic and trauma patients at our
BOtOX and spasticity
By dr. Gregory Melkonian
The following article was written by one of our orthopaedic physicians, Dr. Gregory
Melkonian, who works primarily in our Cerebral Palsy Program. Dr. Melkonian
provides us with information on Botox and its use at Children’s.
Botulinum toxin, Botox © , is a therapeutic muscle relaxing agent that reduces
the rigidity of muscles or unwanted spasms in a specific muscle. Initially
used for cosmetic and ophthalmological procedures, its use has expanded
to neurologic conditions, which result in spastic dystonia, involuntary
muscle movement, and dynamic muscular deformities. In the Department
of Orthopaedic Surgery the principle use of Botox is for cerebral palsy and
similar conditions.
Botulinum toxin is the same toxin that can cause botulism, a form of food
poisoning. It is however, given in extremely small amounts and is placed directly
into the muscle effecting only the area it has contact with. The amount injected
into the muscles depends on the patient’s weight and will vary from patient
to patient. In older children and those with larger muscles the injection
can be done with anesthetic cream applied to the skin in advance, and with
the patient awake. In small children and for muscles that are challenging to
locate, sedation and/or anesthesia is required with the use of EMG needle
localization.
By injecting directly into the muscles Botox © helps to decrease tone or
unwanted spasms in specific muscles. It does this by stopping the impulses
between the nerve endings and the muscle which would otherwise produce a
muscle contraction. Botox © is completely reversible and can prevent or delay
the need for surgery.
Side effects are usually minimal but can include localized pain, weakness and
lethargy. Post treatment requires proper physical and/or occupational therapy.
Frequently, splinting and casting are necessary to improve and maintain the
effects of Botox © . The clinical effects on average last from between 2 to 6
months. It is often necessary to repeat the injections within 6 months to
maintain optimal effects.
Page 2 Page
Boston, Waltham, and Weymouth locations. She also performs surgical
procedures at Children’s Hospital Boston.
Dr. Matheney attended Dartmouth
Medical School. He completed his
surgical internship at Massachusetts
General Hospital’s Department of
General Surgery and his orthopaedic
residency in the Harvard Combined
Residency Program in Orthopaedic
Surgery. He also completed a fellowship
in pediatric orthopaedic surgery at
Children’s Hospital Boston.
Dr. Matheney is an Instructor in
Orthopaedic Surgery at Harvard Medical School and a staff surgeon in
the Orthopaedic Surgery Department at Children’s Hospital Boston.
Dr. Matheney is now seeing orthopaedic and trauma patients at our
Boston, Waltham, and Peabody locations. He also performs surgical
procedures at Children’s Hospital Boston.
surgical Corner
We know that there is a lot that goes into getting you and
your child ready for surgery. We hope that this series of
questions and answers will help ease the process for you.
Q. Can my child have surgery in Waltham?
A. Your child can have surgery in Waltham if it’s a day
surgery procedure.
Q. What type of procedures can be scheduled in
Waltham?
A. Any procedure that does not require an overnight stay.
Q. What type of after surgery care will my child
receive?
A. Following surgery your child will be taken to a recovery
area where their blood pressure and pulse will be closely
monitored. Once alert he or she will go to the adjacent
step down area to relax before going home.
Q. Who do I contact if I have questions about
my child’s surgical procedure that is scheduled
in Waltham?
A. You would contact the surgical scheduler in Boston that
handles scheduling for that specific surgeon.
Q. Does Waltham have all the necessary equipment
that will be needed for my child’s surgery?
A. The operating rooms are equipped with all the equipment
that will be needed for your child’s upcoming procedure.
Q. Can I bring someone with me the day
of surgery?
A. Two adults may accompany your child in the Preoperative
area and Recovery Room.

Ortho FAQ’s
By Chris deParolesa
Since accepting responsibility
for pre-authorizing MRI and
CT procedures, it has become
customary to receive notification
from parents, co-workers, and counterparts in
radiology requesting assistance. What is a preauthorization
and how can one be obtained?
First, we stress the importance of understanding
your insurance plan. If your child is scheduled
to undergo an MRI or CT scan, the procedure
must be authorized promptly (Please note: not all
insurances require pre-authorization). In effect, a
patient must receive clearance from their insurance
company in order to receive an authorization.
Once contact is made with an authorization
representative, a considerable amount of criteria
must be provided or the claim will be rejected. Most
importantly, the diagnosis and symptoms must be
pertinent. A strong case for imaging must be made.
If the resource medical staff remains skeptical, clinical
notes are submitted for further review. It may take up
to two business days to produce an approval. These
procedures are very expensive, so failure to adhere
to these instructions and obtain an authorization may
result in a high medical bill.
Please contact our scheduling office 617-355-6021,
option #3, with any questions.
Children’s Hospital Boston
300 Longwood Avenue
Boston, MA 02115
Phone: 617-355-6021
Option 2: Speak with a nurse
Option 3: Schedule/ Cancel/ Confirm
appointments
Option 4: Speak with a surgical scheduler
Fax: 617-730-0456
www.childrenshospital.org/ortho
Orthopaedic Surgical Foundation
Fegan Building, 2nd Floor
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authorizations bones botox
cerebralpalsy doctor fenwaypark
throwing out the First Pitch
By dr. Laurie Glader
On September 26th, 7-year old Chuckie Higgins, a Children’s Hospital
Boston patient, threw out the first pitch at a Red Sox game. Chuckie, a second
grader at the Lyndon-Patrick Pilot School in West Roxbury, is a longtime Red Sox fan and
can easily tell you about any player on the team. His mother, Johanna, says his room is all
baseball, and that baseball is his biggest love. Chuckie began playing baseball at the age of 3
for the Jason Roberts Challenger League where he is the star second baseman.
Chuckie’s presence on the mound was in conjunction with a generous gift from CVS
Pharmacy. That evening at the ballpark, CVS
presented the Cerebral Palsy Program at Children’s
with a check for $26,500 for its work in functional
mobility. The Cerebral Palsy Program acts as a hub
for children with mobility issues, referring them
to the brace shop and equipment clinic, as well as
to specialists in physical therapy and gait training
analysis. Often, children with mobility issues also
require surgery or neuromuscular injections, and
these services are also provided.
Chuckie has been a patient at the CP Program for
several years. For Chuckie and his family, who are
all avid Red Sox fans, the opportunity to participate
in the announcement by throwing out the first
pitch was the dream of a lifetime. His mother says
the experience was “out of this world.”
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