New Staff - Children's Hospital Boston

OrthoTimes Vol
All the News, No Bones About It
Working Together to Provide the Best Care
Justin Bosley
The Department of Orthopaedic Surgery and the Division of
Sports Medicine occupy different buildings. However, they are
both committed to the same goal: improving the health of patients
with musculoskeletal conditions or injuries. The teamwork
begins with the person who answers the phone when a patient
calls for an appointment. The staff member will work with patients
to help schedule an appointment with either an orthopaedic
or sports medicine physician. At the time of your appointment,
the physicians work closely together when necessary, so
that their shared expertise and experience can benefit all patients
that visit the Orthopaedics and Sports Medicine Clinics.
In addition to the facilities in the Longwood Medical Area, the
Department of Orthopaedic Surgery and Division of Sports Medicine
share clinic space at the new Children’s Hospital Boston location
in Waltham, just off I-95 / Route 128. The clinic in Waltham is
highly accessible and features free patient parking. All clinicians
in the department regularly hold sessions in Waltham. Patients
are encouraged to consider using the Waltham location for both
Improving Quality of Service
Julie Leighton
Improving the quality of service for our
patients and families is a top priority for
the Department of Orthopaedic Surgery.
In 2002, Orthopaedic Surgery developed
a customer service team comprised of
various members of the department. In
its fifth year, the Customer Service team,
who’s members rotate yearly, researches
and implements new ideas to help im-
Inside this issue
clinic visits and surgical appointments,
if the location is convenient.
In line with the hospital’s commitment
to furthering medical knowledge, the
Department of Orthopaedic Surgery
and Division of Sports Medicine share
a research center. Each research coordinator
works with a team of physicians
on particular research areas;
including upper extremities, lower
extremities, hips, spine, and sports
medicine.
prove communication and the overall experience
for our patients and families.
For several years, the Customer Service
Team has been conducting a Patient Satisfaction
Survey. This past August we collected
close to 600 surveys. Areas of feedback
included telephone experience, quality of
communication, reception and registration,
and overall clinic experience.
If in need of the best orthopaedic
and sports medicine care available,
the team of physicians at Children's Hospital Boston
will work together to provide it.
Providing the Best Care New Staff Strength of a Child
Improving Quality Service Research Notes FAQ’s
Shoulder Dislocations Meet the Staff Kid’s Corner
10 Jan 2008
Based on your suggestions we will be
working on improving the experience in
our waiting and exam rooms.
We appreciate our patients and families
taking the time to provide us with suggestions
and feedback. Your thoughts and
opinions are important to us; we make
changes based on what you think.

Shoulder Dislocations
Donald S. Bae, MD
Kickoff
The air has turned cooler, snow is starting to fall, and the New
England Patriots and Boston Celtics are back to their winning
ways…all sure signs that winter is here. With the change in seasons,
many children and adolescents are looking forward to the
return of winter sports. Sports participation continues to rise
both regionally and nationally. It is estimated that over 35 million
children and adolescents participate in organized sports, and the
majority of households will have at least one child participating
in athletic activities.
As sports participation continues to
rise, particularly in younger
children and adolescents at
higher levels of competition,
so too has our awareness
of sports related injuries,
including shoulder
dislocations.
More Than Just a Ball
and Socket
The shoulder is a complex
connection between the
arm and body, designed
to allow motion and
stability. One of the
main components
of the shoulder is
figure 1
the glenohumeral
joint, which links
the upper portion
of the humerus bone (humeral head) to the bony socket of the
scapula (the glenoid) (figure 1). While the glenohumeral joint has
often been described as a “ball and socket” joint, in truth, the connection
is more complex.
The glenoid is more shallow than the humeral head is round, and
thus the humeral head can shift out of the center of the glenoid
(subluxation) or completely move out of the glenoid (dislocation).
To prevent this, the joint is dependent upon the surrounding soft
tissue for stability. The glenoid is surrounded by a “bumper” or
rim of cartilage, called the labrum, which adds to glenohumeral
figure 2
joint stability (figures
2 and 3). This
labrum acts similar
to the chock
blocks that are
placed around
the wheels of
airplanes and figure 3
used to keep
the wheels from
moving (figure
4). In addition,
the labrum is
connected to
the shoulder joint
ligaments and capsule,
which provide additional stability.
In a shoulder dislocation from a fall or sports-related injury, there
may also be injury to the labrum, ligaments, and joint capsule
(figure 5). Though the humeral head may be placed back into the
glenoid, the injured labrum, ligaments, and/or capsule may not
heal in their original position, thus increasing the likelihood of repeated
shoulder dislocations.
Initial Care
Following a shoulder dislocation, treatment initially consists of
manipulating the humeral head back into the center of the glenoid.
While this can happen spontaneously, occasionally manipulation
needs to be done with a physician’s guidance with
sedation or anesthesia. After reduction of a shoulder dislocation,
patients are typically treated with sling immobilization, followed
by physical therapy to restore shoulder motion and strengthen
the muscles around the shoulder. Despite appropriate care of a
first-time shoulder dislocation, the likelihood of recurrent shoulder
instability episodes may be as high as 60 to 95 percent in adolescents
and young adults.
In patients involved in contact sports (e.g. football), specialized
braces have been designed to restrict the shoulder from being
placed in vulnerable positions and thus reduce the likelihood of
repeated instability events. continued on page 3
Welcome New Staff
Virginia Brunelle
The Department of Orthopaedic Surgery is
pleased to announce that Kimberly Bayliss, RN
and Erin Dawicki PA-C, have joined our clinical
support team.
The Orthopaedic clinical support team includes,
nurses, nurse practitioners, and physician assistants.
Each member of the clinical support
team contributes a fundamental role in providing
care to our patients and families with integrity,
compassion, and expertise.
Kimberly Bayliss, RN
Kimberly attended Northeastern University,
where she received a Bachelor of Science in
Shoulder Dislocations,
continued from page 2
These braces may be used to allow athletes
to return to sports participation for
the remainder of their season or indefinitely.
Surgical Treatment
In patients with recurrent shoulder dislocations
that do not improve with physical
therapy and activity modification, surgical
treatment is an option. Ultimately the
decision to pursue surgery is made by
the patient/parents and treating orthopaedic
surgeon after careful evaluation
and discussion.
Surgery for shoulder instability is designed
to repair and/or tighten the
labrum, ligaments, and joint capsule
around the shoulder. In most situations,
this may be performed using arthroscopy.
Small incisions are made around the
shoulder and an arthroscope (or pencilsized
camera) is used to look inside the
glenohumeral joint.
-2- -3-
Nursing. Prior to joining the Orthopedic Clinic,
Kimberly worked at Children’s on 10 Northwest,
an inpatient unit. She has also worked at
New England Medical Center, in the Pediatric
Intensive Care Unit, and Franciscan Hospital for
Children.
Erin Dawicki, PA-C
Erin attended the Medical University of South
Carolina where she received a Master of Science
in Physician Assistant Studies. Erin most recently
worked as an EMT on the Disaster Medical Assistance
Team at Rhode Island Hospital.
Specialized instruments are then used to
repair the injured labrum, ligaments, and
capsule.
There are some situations in which arthroscopic
techniques are not used.
figure 4
figure 5
Instead, the shoulder surgery is
performed using a longer incision
over the front of the shoulder joint.
This is often referred to as “open” surgery.
Your Home Team
The Department of Orthopaedic Surgery
at Children’s Hospital Boston has a number
of healthcare providers who are available
to help young athletes with shoulder
instability. Our team of orthopaedic surgeons,
physical therapists, nurses, and orthotists
is well trained and ready to assist
young athletes pursue successful, enjoyable,
and safe sports seasons. In this
game, we want everyone to be a winner.
1. Candy cane
2. Hockey
3. Superbowl
6. Patriots
Across Down
Kid’s Corner Answers
4. Penguin
5. Gingerbread
6. Plow
7. Salt
8. Ski
9. Snowflake

Hand and Upper Extremity Research
Emily Reiff
Drs. Peter Waters and Donald Bae lead
the research efforts for the hand and
upper extremity team in orthopedics.
With a particular interest and experience
in brachial plexus birth palsy (BPBP),
they coordinate an ongoing multicenter
research study to define the
optimal treatment for this condition.
Collaborating with doctors in North
America and Australia that treat similar
patients, the physicians are gathering
information at each clinic visit, surgery
and radiographic exam to ultimately
perform a comprehensive analysis on a
large patient population to determine
the optimal timing for microsurgical
intervention in affected infants.
Drs. Waters and Bae continue to publish
extensively on BPBP injuries including;
quality of life assessments, economic
analysis on the timing of microsurgery,
and the effects of BPBP on the growing
shoulder joint. Recently Dr. Waters
presented a study on muscle volume
measurements in patients with BPBP
injuries at the annual Grice Day
research symposium.
Meet the Staff
Dennis Burke
Billy Maxwell is our newest cast
technician in orthopaedics. Born and
raised in Tampa Bay, Florida - Billy
began his career as an athletic trainer
for the Tampa Bay Buccaneers and
later the Cincinnati Reds. He later
joined Tampa General Hospital and
Children’s Hospital, in St. Petersburg
Florida, as a cast technician. Billy will be working in our Boston
and Waltham locations. He will also be assisting surgeons, in
the operating room,with cast applications. Please welcome
Billy to Orthopeadics.
In addition to the research on brachial
plexus, the hand and upper extremity
team conducts clinical research on
traumatic, congenital, and other
neuromuscular conditions. The
American Society for Surgery of the
Hand recently awarded research funding
to Drs. Water and Bae to study the
outcomes of children who sustained
supracondylar humerus fractures with
associated blood vessel or nerve injury.
Supracondylar humerus fractures are
common injuries, in which the long
bone of the arm is broken just above the
elbow joint. By measuring vascular and
neurologic function, through physical
examinations, ultrasounds, and patient
questionnaires, the doctors hope to gain
a better understanding of the long term
results of these injuries; to guide future
standards of care.
The research team, with Emily Reiff’s
assistance and coordination, also
explores many other conditions of the
upper extremity, including research
on chronic Monteggia elbow fractures,
clavicle (or collarbone) fractures,
Did You Know?
On the Children’s website you can:
A request an appointment
A research conditions & treatments
A view our winter survival guide
A view maps, directions and virtual tours
A view a complete list of available
support services
Learn more at www.childrenshospital.org
cartilage and ligament injuries of
the wrist, and congenital differences of
the thumb. The entire hand and upper
extremity team is dedicated to clinical
research in hopes of advancing our
orthopaedic knowledge and providing
the highest quality care to our patients
and families. The Team thanks all of
the patients and families that have
participated in and contributed to these
research efforts.
For more information please visit
www.childrenshospital.org/hand
Children’s
now en Español
Children’s launched a Spanish Website in September
to reach out to Spanish-speaking patients,
families, visitors and staff. The site includes general
information about the hospital, an overview of
clinical services, suggestions on how to prepare for
hospitalization, career opportunities and articles
on Latino patients.
www.childrenshospital.org/espanol
Strength of a Child
Iliamar Torres
A mother of one of Dr. Mark Gebhart’s patients wanted to share their story about traveling from Puerto Rico to Children’s to seek care for her
daughter. The story below was originally written in Spanish, the family’s primary language. It has been translated into English and summarized.
In December of 2006, my daughter, Ilián
Marie Jaca Torres, complained of pain in
her right knee accompanied by a mild
fever. We saw several doctors in Puerto
Rico who all indicated that she was simply
experiencing growing pains. This diagnosis
did not alleviate my worries. In
March we decided to seek another opinion.
X-rays of her hips and legs showed a
tumor on her right tibia. The following
biopsy confirmed that Ilián had Ewing’s
Sarcoma. She immediately started chemotherapy.
We hoped that after finishing
six cycles we would then be able to
travel to Children’s Hospital Boston to
seek care from Dr. Mark Gebhardt. We
were hopeful that Dr. Gebhardt would
be able to perform a bone resection and
reconstruction (bone implant) on her leg.
Once her chemotherapy was complete,
we traveled to Boston to meet with Dr.
Gebhardt. After evaluating Ilián Marie
he explained to us that because she was
8 year old and still growing she was not
a candidate for a bone implant. All of our
joy and hope was undid in minutes. Dr.
Gebhardt discussed three alternatives:
amputation of her leg, an expandable
prosthesis , or radiation.
FAQ’s Jeff Hall
My child needs x-rays at their next visit. Where
should I check-in first, Orthopaedics or Radiology?
If you are told your child needs x-rays prior to
being seen in Orthopaedics, you can now
check-in at Radiology first! You no longer have
to pick up x-ray orders at the front desk in
Orthopaedics prior to going to Radiology.
As of October, 22nd 2007, Orthopaedics imple
mented a paperless ordering system for ancillary
tests; such as x-rays, MRI, CT scans,
ultrasound, etc.
This is all done to make your child’s visit run
The expandable prosthesis is a fairly new
type of surgery in the United States. It
consists of removing the tumor and
placing a titanium device in the leg to
function as bone. The prosthesis expands
with the growth of the child
through magnetic fields. The benefits
include not having to have additional
surgery in order to adjust the prosthesis.
We learned that the expandable prosthesis
could save Ilian’s leg from amputation.
After a meeting with Dr. Gebhardt
and a team oncologists and radiologists,
to further discuss the alternatives, we
decided to proceed with the expandable
prosthesis.
Surgery was scheduled for September
28, 2007. The surgery took about seven
hours to complete and it was a success.
Dr. Gebhardt looked so happy when
he told us the good news. Her tumor
was removed easily, and the prosthesis
fit perfectly. I remember when Ilián
reached the recovery room she was able
to move her toes on her right foot, even
Dr. Gebhardt seemed surprised. One
week after the surgery we received great
news about her pathology results. We
learned that Dr. Gehardt resected 99.99%
of the tumor.
-4- -5-
Q.
A.
Q.
A.
Ilián Marie’s recovery has been extraordinary.
She began physical therapy one
week after her surgery. A month later
she was able to play a game of “Twister”
at our church. Dr. Gebhardt had not
cleared Ilian to participate in activities
such as “Twister”. When Dr. Gebhardt
saw the photos he prohibited her to do it
again - but I saw him smile with satisfaction.
Throughout her illness, Ilián has demonstrated
a maturity, strength and braveness
one might not even expect to see
in an adult. On several different occasions,
people have asked me if it is true
that Ilián is only eight years old. Ilián has
taught me a great lesson in life. She always
looks for the positive in every challenge
that she has faced. Ilián and I are
very happy; and we first of all thank God,
who has allowed everything that I just
shared with you become a reality and for
giving me such an extraordinary daughter.
Secondly we thank Dr.. Gebhardt
and his team for their excellent work and
support during a very difficult time in
both our lives.
For more information on Ewing’s Sarcoma
please visit www.childrenshospital.org/ortho
more efficiently and to save you from waiting in
multiple lines.
I have another appointment today in a different
department but I am unsure of how to get there
from Orthopaedics, what should I do?
Approach the Concierge desk (on the side of the
front waiting room) and speak with our Concierge
representative. They will happily walk
you to your appointment or give you directions
on where you need to go.

KIDS
CORNER
Crossword
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7
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617-355-6021
Opt. 2: Speak with a nurse
Opt. 3: Schedule/ cancel/ confirm appts.
Opt. 4: Speak with a surgical scheduler
The Division of Sports Medicine is excited to announce a Sports
Medicine Urgent walk-in-clinic. This service is available to all new
and existing patients. Any athlete or patient who has an urgent injury
can now be seen on Wednesdays from 2 to 4:00p.m. by calling
the Sports Medicine Appointment Line at 617-355-3501.
Patients will be immediately triaged into an urgent slot by
one of our clinicians. They will be instructed to register at the
check-in counter on the 6th Floor of the Sports Medicine Clinic
at 319 Longwood Avenue. They will then be evaluated by
a clinician and referred appropriately to one of our attending
physicians as needed for further evaluation and treatment.
For more information visit www.childrenshospital.org/sportsmed
3
Sports Medicine Walk-In Clinic
2
Across
4. Tap dancing animal that loves cold weather
5. Wintertime cookie that wears buttons
6. Machine used to remove snow
7. Helps ice on the road melt
8. Fun downhill winter sport
9. No two are ever alike
Down
1. Striped holiday candy
2. Winter sport played on ice
3. Big game played in January
6. New England Champions
Answers on page 3.
Children’s Orthopaedic
Surgical Foundation
300 Longwood Avenue/ Fegan 2
Boston , MA 02115
Online Chats
Upcoming
Scoliosis & Bracing Chats
February 6th
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April 2nd
May 7th
Chats are held on the first
Wednesday of the month,
from 7 to 8:00p.m. est
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