Gillette Children’s Pediatric Orthopedics Offering a Full Spectrum of Care for Children and Adolescents

Pediatric orthopedic surgery is a rapidly evolving and relatively uncommon subspecialty focused on one of the most clinically challenging patient populations: children who have complex neurological and orthopedic disorders.

These patients face medical conditions that begin during childhood and often have lifelong consequences. Few specialty health centers in the world are able to offer the focused pediatric orthopedic expertise, depth of research resources and extensive interdisciplinary teams needed to guide these children and their families from diagnosis through optimal outcomes.

Gillette Children’s Specialty Healthcare in St. Paul is among the handful of hospitals recognized for expertise in caring for children who have these rare and disabling medical conditions. The fellowship-trained pediatric orthopedic surgery team at Gillette is distinguished for both its size and the breadth of focused expertise offered by its surgeons and nurse practitioners. Gillette’s reputation attracts patients from around the globe. Last year, Gillette served patients from 48 states and 14 foreign countries, as well as every county in Minnesota.

An international referral center, Gillette treats more than 25,000 patients annually at clinics in St. Paul, Minnetonka, Maple Grove, Burnsville, Duluth, Brainerd Lakes and Willmar. U.S. News & World Report ranks Gillette’s pediatric orthopedic program one of the top programs in the nation and the highest ranked in the Midwest. The hospital has gathered the largest group of fellowship-trained pediatric orthopedic surgeons in the region, annually serving more than 10,000 patients who need orthopedic care.

The subspecialty training of Gillette’s pediatric orthopedic surgeons is a key factor in the hospital’s high quality of care. This depth of expertise enables Gillette orthopedic staff to develop areas of subspecialty focus, facilitate the exchange of treatment concepts and ideas among members of the group, and engage in research to improve treatment techniques and outcomes. This group teams with specially trained nurse practitioners and physician assistants to form the Center for Pediatric Orthopedics at Gillette.

“Seventy-five percent of our patients have complex neuromuscular disorders,” explains Stephen Sundberg, MD, pediatric orthopedic surgeon and Program Medical Director for the Center for Pediatric Orthopedics at Gillette. “The depth of our subspecialty care has established us as one of the premier institutions in the world, but we also have an Acute Orthopedic Clinic to treat children who have more common conditions, such as broken bones. Whether a condition is complex or acute, all children receive the highest level of pediatric orthopedic care.”

Multidisciplinary Diagnostics

Gillette Childrens Pediatric

Gillette’s distinction as a world-class facility for care is also evidenced by its diagnostic approach. Gillette has ushered real change into the management of disabilities and complex conditions by moving to a model that brings numerous specialists together to develop treatment plans tailored to individual patient needs.

“Asking our families to travel, sometimes long distances, three or four times to consult with individual subspecialists and to wait weeks or months between those appointments is not in the best interests of the child or the family,” Dr. Sundberg explains. “We have developed specific consultative and diagnostic clinics to tailor care for specific pediatric disorders. When I meet with the family of a child who has spina bifida, I can be joined by a urologist, a rehabilitation medicine physician and a neurosurgeon in a single visit. Together, we can meet with the patient and discuss the care we feel is most appropriate. When needed, our approach gives families and patients more convenience and accelerates the time within which children are diagnosed and treated.

“Another example of this approach is our Spasticity Evaluation Clinic, where pediatric orthopedic surgeons, pediatric neurosurgeons and pediatric rehabilitation medicine physicians evaluate a child who has cerebral palsy and collaborate on developing the best approach to manage that child’s spasticity and orthopedic issues.”

Customized Assistive Technology

Additional resources developed at Gillette provide unique support to patients who have complex conditions. Within the hospital, Gillette’s Assistive Technology Department makes upper- and lower-limb orthoses and spinal orthoses. The group also customizes seating systems, powered mobility systems, and augmentative and alternative communication devices for each patient’s needs.

“When I see a patient, I can have an orthotist join me in the exam room,” Dr. Sundberg explains. “There is huge value to having orthotists actually see the patient with us and adjust or design a brace within our facility. With an outside organization, brace construction and delivery may take significantly longer. Here, if I say the patient needs it tomorrow, we’ll have it tomorrow. It is an incredible resource.”

Therapy for the Long Haul

Another area of strength for Gillette lies in its rehabilitation medicine and therapy services. For many patients requiring orthopedic care, therapy is critical to their recovery and long-term functional outcomes. Gillette’s orthopedic team often consults with the organization’s pediatric rehabilitation medicine specialists to assess children and determine the best therapeutic interventions and care plans. The physicians help direct pediatric rehabilitation services encompassing physical and occupational therapy, as well as speech and language pathology services.

“We’d like to think we orthopedic surgeons are the most important part of our program,” Dr. Sundberg says with a smile, “but we know that our pediatric rehabilitation medicine specialists and therapists are the kings and queens of short- and long-term rehabilitation for our patients. Their expertise in working with children who have disabilities and complex needs makes a huge difference in patient outcomes.”

Mining Data for Best Practices

Stephen Sundberg, MD
Stephen Sundberg, MD, notes that taking time to help patients and their families understand the underlying orthopedic issues and treatment options is critical to the long-term success of orthopedic interventions.

Drawing on the resources of Gillette’s James R. Gage Center for Gait and Motion Analysis — one of the first gait centers in the country, and the first to be accredited — Gillette pioneers clinical care and research that sets international gold standards for patients who have cerebral palsy, gait abnormalities and movement problems.

Gait and motion analysis collects data related to movement, muscle activity, energy consumption and forces affecting motion, providing clinicians with an invaluable tool in determining the best treatment and intervention plan for each patient.

Years ago, children who had neuromuscular conditions were often scheduled for a succession of annual operations: a heel cord lengthening was one year, a tibia rotation the next and surgery to correct a hip migrating out of socket the year after that. As a result, these children spent the better part of their growing years undergoing and recovering from multiple orthopedic operations.

Today, guided by data gathered in gait and motion analysis, comprehensive surgical plans are developed. Instead of spacing out individual surgical procedures over many years, orthopedic surgeons at Gillette are able to plan for and perform single-event multilevel surgery (SEMLS). A SEMLS takes care of multiple procedures, as two orthopedic surgeons work together in one surgical setting. It has become the gold standard across the country and around the world.

Dr. Sundberg explains that performing several procedures in a single surgical event offers multiple advantages.

“Often,” he says, “this surgery is the child’s only major orthopedic intervention during the growth years, enabling these patients to go through their adolescent and high school years without additional disruption to their education, their lives and their families’ lives. The social benefit alone is substantial. From a financial standpoint, the expense of three or four separate surgeries compared with a single event is significant. Medically, every surgery involves risk; reducing the number of surgeries reduces that risk for these children. Also, our research has shown that the cumulative results of multiple isolated procedures are not nearly as good as the results of some combined single event surgeries.”

Gait analysis also plays a significant role in documenting and tracking clinical outcomes for patients undergoing orthopedic or neurosurgical procedures at Gillette.

“Research and publications produced by Gillette clinicians and staff members have substantially changed the medical community’s approach toward managing children who have cerebral palsy and neuromuscular conditions,” notes Tom Novacheck, MD, pediatric orthopedic surgeon and Director of the Center for Gait and Motion Analysis.

He adds that the evolution of surgical treatment for children who have crouch gait exemplifies the value of the Center’s data in improving outcomes.

Motion Analysis
Gait and motion analysis plays a critical role in helping clinicians understand the underlying pathology that affects movement. The data gathered helps clinicians develop treatment plans tailored to the patient’s needs.

“Some gait centers focus only on presurgical motion analysis, whereas Gillette patients also have a second gait analysis performed after recovering from surgery,” Dr. Novacheck explains. “This provides an invaluable before-and-after comparison of the child’s movement patterns, oxygen consumption and energy expenditure. Historically, crouch gait was treated with hamstring lengthening, but we discovered from gait analysis that this often did not work. However, by borrowing a femur osteotomy technique used for other conditions and developing a new technique to improve the muscle’s ability to extend the knee, we were able to begin applying new treatments, and gait analysis confirmed improved outcomes. This new treatment has now become the standard at many centers around the world, and Gillette was a leader in its development. This new surgical protocol has improved outcomes and given children much better results.

“There are perhaps 10 to 15 hospitals in the country that routinely obtain before-and-after gait studies,” Dr. Novacheck says. “We have more outcome information at our gait center than anyone else in the world. This rich body of data, accumulated over 25 years, has been critical to our successful care of children who have complex disorders.”

Transformational Medicine

Focusing on the needs of children and their families is critical to developing clinical excellence and improving outcomes. Steven Koop, MD, pediatric orthopedic surgeon and Gillette Medical Director, explains, “Our experience has taught us an important lesson: Medicine is measured by how lives are changed and improved. At its best, the business of medicine is transformational, not transactional.”

Gillette’s dedication to serving children extends to supporting primary care and referring physicians in the community.

“We handle a broad scope of children’s orthopedic issues,” Dr. Sundberg says. “When physicians are caring for children who have injuries, infections, gait abnormalities, or other developmental or genetic issues, we are happy to consult.”

Gillette established a One-Call Access number to support primary care physicians and provide information to address concerns.

“Any primary care doctor can call, and one of our pediatric orthopedic physicians will be happy to talk with him or her,” Dr. Sundberg explains. “We believe in the adage of accessibility, ability and affability. As a physician, it’s part of my responsibility to be accessible to my colleagues.”

Gillette’s One-Call Access number is 651-325-2200. The toll-free number is 855-325-2200.

Source: MD News December 2013, Twin Cities Edition