Ortho Times Vol 24 - Children's Hospital Boston

Boston Children’s Hospital Ranks #1 on U.S. News & World Report
Best Children’s Hospitals Honor Roll
Ranked in the Top 4 in all 10 Specialty Areas
Boston Children’s Hospital ranks first in the
U.S. News and World Report’s 2012-13 Best
Children’s Hospitals Rankings Honor Roll.
Boston Children’s is first in Cardiology &
Heart Surgery, Nephrology, Neurology &
Neurosurgery; second in Cancer, Diabetes &
Endocrinology, Gastroenterology and Urology;
third in Neonatology and Orthopedics; and
fourth in Pulmonology. Boston Children’s
partners with Dana-Farber Cancer Institute to
operate the Dana-Farber/Children’s Hospital
Cancer Center – an integrated pediatric oncology
program.
“We’re honored by this recognition and view
it as a challenge to continue to work tirelessly
to improve the quality of care given to each
and every family that comes through our
doors,” says James Mandell, MD, CEO of Boston
Children’s Hospital.
The rankings feature 50 hospitals in each
of 10 pediatric specialties: cancer, cardiology
How clinical research directly impacts patient care
[Adam Nasreddine and Anni Lierhaus]
For nearly a decade, one option for treating femur (thigh bone) fractures in children and adolescents
with surgery has included the use of a metal plate secured across the broken bone to hold the two
ends in place while healing takes place. Research studies from this and other institutions showed
that plate fixation was safe and resulted in similar or better outcomes than other treatment techniques
available for some types of fractures. While practice patterns varied somewhat, the consensus
among most orthopedic surgeons was that it was not necessary to remove the plate after successful
fracture healing, unless it was causing the patient problems.
Recently, physicians in the Orthopedic Center
noticed that a couple of patients returned to
clinic many months after their fracture had
healed, complaining of knee pain. X-rays
revealed that the patients were developing
a valgus deformity, in which the thigh bone
becomes bowed. This observation caused physicians
to wonder if the deformity was occurring
in other patients but going undetected.
With the approval of Boston Children’s Hospital’s
Institutional Review Board, researchers
in the Orthopedic Center reviewed the medical
records for all patients whose femur fractures
were treated, over the last five years, with a
plate. They discovered that progression of a
valgus deformity could be detected in approximately
10% of patients.
For most of these patients, the deformity
progression was minimal and didn’t cause any
other symptoms. This was reassuring. However,
for two patients (these were the patients
that inspired this study,) the bowing of the leg
had become so severe that surgical correction
was required.
and heart surgery, diabetes and endocrinology,
gastroenterology, neonatology, nephrology,
neurology and neurosurgery, orthopedics, pulmonology,
and urology. Eighty hospitals across
the country ranked in one or more specialties.
Boston Children’s was the only hospital in New
England named to the U.S. News Honor Roll,
and was ranked in the top 25
“The rankings reflect the dedication of our
caregivers, researchers, staff, volunteers and
referring doctors across Boston Children’s
community of care,” adds Sandra Fenwick,
President and COO of Boston Children’s. “Our
staff represents the finest in their fields, and
it’s only through working together that we can
provide such exceptional care.”
This year, U.S. News surveyed 178 pediatric
centers to obtain hard data such as availability
of key resources and ability to prevent complications
and infections. The hospital survey
made up 75 percent of the evaluation to determine
rankings. A separate reputational survey
Results of this investigation were presented at
a physician staff meeting and it was decided
that patients who were believed to be at high
risk of developing a valgus deformity should be
contacted and asked to return for clinical and
X-ray evaluation of their fractured leg. Patients
considered to be at high risk were those whose
plate was placed close to the knee joint and
who were very young immature at the time
of the fracture. Several patients returned for
follow-up and were found not to have any problems.
One patient, who initially didn’t respond
to phone calls from the research team, later
presented to the clinic a couple of months later
with knee pain and a valgus deformity severe
enough that surgical treatment was necessary.
Based on the results of this study, physicians
now believe it is important to follow patients
and continue to take X-rays as necessary,
not just until the fracture is healed, but until
the patient reaches skeletal maturity. This
study is a good example of how our clinical research
can improve our knowledge and result
in better patient care and outcomes.
in which 1,500 pediatric specialists—150 in
each specialty—were asked where they would
send the sickest children in their specialty
made up the remaining 25 percent of data used
for evaluation.
This patient’s fracture was healed at 6
months. The patient returned 3 years later
because of pain, and was found to have
a major valgus deformity (the left leg is
bowed in and closer to the right leg).
Orthopedic Center | 300 Longwood Avenue, Fegan 2 | Boston, MA 02115 | bostonchildrens.org/ortho | 617-355-6021