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Center for Pediatric Orthopaedicsat Gillette Children’s Specialty Healthcare

AGillette Centerof Excellence

Pediatric OrthopaedicsCE 04 11/12/04 12:24 AM

Centers of Excellence at Gillette Children’s Specialty Healthcare

Treating people who have disabilities and complex medical conditions requires a team

approach. At Gillette, our doctors, surgeons, nurses, therapists, orthotists, psychologists,

social workers and other specialists work together to care for patients. Throughout our

centers of excellence, we offer leading-edge medical treatments tailored to the unique needs

of each patient.

Gillette’s centers of excellence:

■ Center for Cerebral Palsy

■ Center for Craniofacial Services

■ Center for Gait and Motion Analysis

■ Center for Pediatric Neurosciences

■ Center for Pediatric Orthopaedics

■ Center for Pediatric Rehabilitation

■ Center for Pediatric Rheumatology

■ Center for Spina Bifida

Pediatric OrthopaedicsCE 04 11/8/04 9:17 PM

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Center for Pediatric Orthopaedics

Gillette’s Center for Pediatric Orthopaedics is one of our busiest centers of care. In 2003,

orthopaedic patients made up half of Gillette’s new patients. This brochure highlights many

of the orthopaedic services offered through Gillette’s Center for Pediatric Orthopaedics.

Since the late 1800s, Gillette has specialized in diagnosing and treating the complex ortho-

paedic problems of children and teens who have physical disabilities. Although treatment

approaches and medical equipment have changed, our pediatric orthopaedists continue to

provide high-quality specialized health care. Annually, we treat thousands of children from

throughout the world at our outpatient clinics and 60-bed hospital in St. Paul, Minn.

Depending on their conditions, orthopaedic patients might also receive treatment in our

specialty clinics, which focus on:

Our orthopaedists also treat orthopaedic complications that result from traumatic brain

injuries, neuromuscular conditions and stroke, as well as trauma-related fractures.

■ Brachial plexus injuries■ Cerebral palsy■ Spasticity

■ Spina bifida ■ Spine disorders■ Upper- and lower-extremity issues

A Gillette Centerof Excellence


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Our Team Approach

Caring for young people with orthopaedic complications is often different from caring foradults. At Gillette, we adapt treatments and services to meet the changing needs of ourpatients as they grow and develop. Our orthopaedic staff includes a number of specialists.

Surgeons

Our pediatric orthopaedic surgeons specialize in treating complex and rare orthopaedicconditions, such as orthopaedic complications of cerebral palsy, spine conditions and complexfractures. In addition to providing clinical and surgical services, our orthopaedic surgeonsserve on university faculties and are active in research, publishing and lecturing.

Anesthesiologists

Our pediatric anesthesiologists and nurse anesthetists are specially trained to administeranesthesia to infants and children. Our anesthesia staff evaluates patients before surgeryand monitors their reactions to anesthesia during surgery. The staff works closely with ourorthopaedic and nursing staff to help patients manage postsurgical pain.

Pediatric Nurse Practitioners

Pediatric nurse practitioners are registered nurses who have advanced education and training in treating children’s medical needs. In collaboration with our physicians, ournurse practitioners evaluate patients, create treatment plans and monitor outcomes.Additionally, they provide follow-up consultations and education to patients and families.

Nurses

Our orthopaedic nursing staff collabo-rates with our surgeons to managepatient care before, during and afterprocedures. Our nurses also coordinatepatient care throughout inpatient staysand during follow-up outpatient clinicappointments.

As part of Gillette’s orthopaedic team, Sarah Gutknecht, nurse practitioner,

examines a patient who has clubfoot.Among other treatments, Gillette uses

the Ponsetti method (a nonsurgicaltechnique) to treat clubfoot.


Casting Technicians

Our casting technicians provide casts for patients with acute orthopaedic and postsurgicalneeds. Our technicians are trained in cast applications for the Ponsetti method (a nonsurgicalcasting technique), which is used to treat clubfoot. We also replace casts and apply sequentialcasts. Our technicians put children at ease by encouraging them to handle casts and askquestions about the procedure before casting begins. Lighter materials are used to createcasts for our smallest patients.

Assistive-Technology Specialists

Our assistive-technology staff includes certified orthotists, prosthetists, and adaptive-technology specialists. This group designs and customizes specialty orthoses, prosthesesand seating systems. Our assistive-technology staff works with our doctors and rehabilita-tion therapists to create equipment that helps people manage daily tasks. Such devicesinclude powered-wheelchair controls, communication devices and protective headgear.

Occupational Therapists

Gillette’s occupational therapists help children develop independent-living skills, improvearm and hand movement, and increase their functional skills. We also evaluate adaptiveequipment needs, provide splints, and evaluate and treat children who have feeding difficulties.

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Laster Logan, technician, builds rapport with a young

patient before removing her cast.Our casting technicians replace

casts and apply sequential castsfor pediatric and adult patients.


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Physical Therapists

Gillette’s physical therapists evaluate eachpatient’s abilities. They recommend treat-ments to improve gross-motor skills andhelp prevent problems such as muscle contractures and loss of strength. By monitoring range of motion, strength andabilities, physical therapists help patientsimprove function, independence andmobility.

Child Life Specialists

Through therapeutic play, educational programs and hospital tours, our child lifespecialists help children and families copewith — and better understand — medicalprocedures, surgery, hospital stays and pain.

Social Workers

Our social workers interview patients and families to determine their needs. They helpfamilies find community resources for needed services, and they provide educational andemotional support to patients and families.

Psychologists

Gillette’s psychologists regularly screen patients to evaluate their cognitive, academic andpsychosocial strengths and challenges. They provide individual and family counseling,often focusing on helping patients and families cope with disabilities, pain and stress. Ifneeded, our psychologists contact patients’ schools to discuss special academic services orbehavior-management strategies.

Residents and Fellows

As a teaching hospital, Gillette provides orthopaedic residents and fellows with advancedmedical training in treatments for children who have disabilities. Our orthopaedic residentsand fellows come from the University of Minnesota and Henry Ford Hospital in Detroit, Mich.

Patty Malone, physical therapist, helps a patient regain her sense of

balance. Our physical therapists helppatients improve their gross-motor

skills, strength and coordination.


Primary Services

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Hip Treatments

Our orthopaedic surgeons treat a wide range of hip abnormalities. We see patients withdevelopmental dysplasia of the hip, slipped capital femoral epiphysis, and Legg-Calve-Perthes disease. We also see patients who have joint disease, joint overuse symptoms, andother acute and degenerative hip conditions.Our orthopaedic surgeons approach eachpatient’s condition with the growth, develop-ment and lifelong use of the hip in mind. Wethen suggest the treatments we believe willresult in optimal outcomes. Options for children who have hip problems might includemonitoring, bed rest, traction, orthoses, castsand surgery.

Upper- and Lower-Extremity Treatments

Gillette’s pediatric orthopaedists specialize intreating upper- and lower-extremity conditions,which include: ■ Permanent joint contractures

■ Extra or missing fingers or toes

■ Brittle-bone disease (osteogenesis imperfecta)

■ Sprengel’s deformity (elevation of the scapula)

■ Clubfoot

Some patients who have cerebral palsy requireupper- and lower-extremity services. For them,we focus on maximizing lower-limb functionand addressing hand and arm problems at an early age. By properly evaluating and splint-ing hands and arms when children are young, we can prevent or minimize skin breakdownand muscle contractures.

Gillette’s assistive-technology specialists and occupational therapists work with our ortho-paedic surgeons to provide splints so children can maintain maximum function. Candidatesfor hand and arm splinting include patients with thumb-in-palm deformities and patientswhose contractures keep them from extending their wrists.

Deborah Quanbeck, M.D., an orthopaedic surgeon,adjusts the Pavlik harness of a patient who has hip

dysplasia. The harness holds the hip in a positionthat helps correct the abnormality.

´


Spine Treatments

Our orthopaedic surgeons are known internationally for their expertise in treating spineconditions. In addition, our physicians have revolutionized many treatments for spine dis-orders over the years. They’ve developed effective spinal orthoses and surgical techniquesthat reduce patients’ hospitalization and recovery time.

Today, treating spine conditions begins with regular evaluations by our orthopaedic specialists. For patients who have scoliosis, Gillette offers comprehensive services, includingorthoses and surgery. Our assistive-technology specialists can customize orthoses on-sitefor patients.

Because teens are the age group most likely to be affected by scoliosis — and the groupmost reluctant to wear braces — we’ve devoted one section of our Web site to teens whohave scoliosis. Gillette also has published two booklets — Zoey and Her Brace and My BackHas a Squiggle in It — that explain scoliosis to children under age 6. To access the informa-tion, log on to www.gillettechildrens.org. Go to the Family Resource Center link, then clickon For Teens for scoliosis information or on CDs and Videos for the booklets.

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John Lonstein, M.D.,one of our ortho-paedic surgeons,

helps a patient who has scoliosis under-

stand how the spine is formed. Scoliosis isone of the conditionsGillette’s orthopaedic

surgeons treat.


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Limb-Length Treatments

Gillette’s orthopaedists treat patients with complex leg- and arm-length discrepancies. Usingadvanced surgical and distraction techniques, we treat both congenital discrepancies anddeformities related to trauma or growth-plate injuries.

Our techniques include conventional orthopaedic surgery and the Ilizarov method (a mini-mally invasive limb-lengthening procedure). The Ilizarov method relies on the body’s abilityto heal itself through “distraction osteogenesis.” During this procedure, surgeons make asmall incision in the leg and fracture the bone. An external fixator (a system of pins, rodsand clamps) keeps the bone segments in place and gradually increases the distance betweenbone segments. As the segments separate, the body grows new bone tissue. Surgeons usea spatial fixator — an orthopaedic device that encompasses an external fixator frame — toalign bone fragments.

Brachial Plexus Treatments

Our pediatric orthopaedists, neurosurgeons, pediatric rehabilitation medicine specialists,and physical and occupational therapists evaluate and recommend treatment for patientswho have brachial plexus injuries. The brachial plexus is a network of nerves that conductssignals from the spine to the shoulder, arm and hand. When those nerves are damaged,brachial plexus injuries occur. Although brachial plexus injuries can happen anytime, manytake place during birth. Symptoms include a limp or paralyzed arm, lack of sensation in thearm or hand, and muscle-control weakness in the arm, hand or wrist. At Gillette, we treatbrachial plexus injuries with physical and occupational therapy. Our therapy plan is successful in the majority of such cases, reducing the need for patients to have surgery.

Ann Van Heest, M.D.,orthopaedic surgeon, evaluates a patient’s

range of motion during a brachial plexus clinic.


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Motion Analysis

Gillette’s Center for Gait and Motion Analysis is a vital part of our orthopaedic services.Motion analysis is an advanced computer technology that analyzes how muscles, joints andnerves work together to allow movement. Although some people have similar walkingpatterns, the way their muscles and joints work together can be very different.

Motion analysis helps doctors accurately identify problems specific to each patient. Oncethe cause of the problem is known, doctors can prescribe the most effective treatments.Orthopaedists, technicians, engineers and physical therapists are part of the Center for Gaitand Motion Analysis team.

When our center opened in 1987, it was the only one of its kind in the Upper Midwest. Our doctors were among the first in the world to use motion analysis to treat children withwalking and movement problems.Today we operate the busiest clini-cal motion analysis center in thenation, performing more than 600exams each year. Ours is the onlylab in the country to routinely measure metabolic oxygen consump-tion, which shows how much energychildren use when walking (with orwithout orthoses).

Typically, our patients include people who have:■ Amputations■ Arthritis■ Brain injuries■ Cerebral palsy■ Conditions that cause toe-walking■ Legs of different lengths■ Misaligned bones and foot

deformities■ Movement problems of the arms

and hands■ Spina bifida■ Other neurological or orthopaedic

conditions Sue Sohrweide, a physical therapist and member of our motion analysis staff, places reflectors on a patient’s legs

to record walking patterns. Several cameras track the movement of the reflectors.


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Fractures and Sport-Related Injuries

Gillette’s orthopaedic specialists care for patients with chronic disabilities who participate in sports and recreational activities and for children who sustain complicated fractures orsports-related injuries. Our orthopaedists evaluate, monitor and customize treatment plans,which might include orthopaedic surgery. Our therapists offer ongoing physical and occu-pational therapy to help alleviate the symptoms caused by fractures, sprains, overuse anddegenerative conditions.

Stephen England,M.D., an orthopaedic surgeon, evaluates a

patient’s ability to move his fingers

while in a cast. Ourorthopaedists treat

acute fractures and sports-related

injuries.


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Treatments for Pain

At Gillette, we place a high priority on managing pain. With patients and their families, we discuss:■ How children communicate pain

■ Patients’ previous experiences with pain and pain-management strategies

■ How to manage pain after a child leaves the hospital

Our anesthesiologists work closely with our orthopaedic surgeons and nurses to aggressivelymanage postoperative pain with epidural anesthesia and patient-controlled analgesics. Wefrequently evaluate patients’ postoperative pain and adjust pain medicine accordingly.

Patrick Rivard, a registered nurse,and other Gillettenurses play a key

role in helpingpatients managetheir pain. They

use distraction play,such as toys and

other tools, to helppatients handle

difficult procedures.

0No Hurt

2Hurts

Little Bit

4Hurts

Little More

6Hurts

Even More

8Hurts

Whole Lot

10Hurts Worst

We use the Wong Baker pain scale to help our younger patients communicate their level of pain.


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Treating orthopaedic conditions sometimes requires other medical services, such as radiology and assistive technology.

Pediatric Radiology

Most of our orthopaedicpatients need X-rays. Gillettehas long-spine X-ray equipmentthat produces high-quality filmsfor diagnosing scoliosis andother spinal deformities. Ourtechnicians also take films ofchildren in seating systems andthose wearing metal fixatorsfollowing limb-length surgery.

In addition to traditional X-rays, we offer computerizedradiography. This innovativetechnology benefits patients byexposing them to less radiationthan traditional radiography. Computerized radiography also permits electronic storageand sharing of patient X-rays, increasing efficiency.

Prosthetics

Some patients present special medical challenges when it comes to designing prostheses.Lower-limb designs, for example, must take into account that young children spend a greatdeal of time crawling. As a child becomes more active and begins to walk, our specialistsredesign the prosthesis accordingly. Our team of orthopaedic surgeons, prosthetists, pediatricrehabilitation medicine physicians, nurses, social workers, and physical and occupationaltherapists works with patients to design a prosthetic device that best meets their needs.

Supplementary Services

Susan Schneider, a radiology technologist, takes an X-ray using our computerized radiography equipment.


Assistive Technology

Gillette’s certified orthotists, prosthetistsand other assistive-technology specialistswork directly with our orthopaedists andtherapists to determine children’s assistive-technology needs. Gillette offers a fullline of orthotics, including dynamic ankle-foot orthoses. The thin, flexible supra-malleolar orthosis has a custom-contouredfootplate, which stabilizes and supportsthe dynamic arches of the foot. Our on-site department lets us coordinate children’s clinic visits with fittings fororthoses, prostheses, seating systems and other assistive devices.

Mobile Outreach Clinic

Gillette’s Mobile Outreach Clinic plays an important part in treating orthopaedic patients.The service brings assistive-technology and some physician services to patients who live ingreater Minnesota. The clinics lessen the need for families to travel long distances whenpatients need new or adjusted orthoses, seating and adaptive equipment. Gillette conductsmore than 150 outreach clinics each year.

Gillette has three Mobile OutreachClinic trucks, which transport theequipment needed to create and

adjust adaptive equipment.

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George Gent, a certified orthotist, adjusts a child’s ankle-foot orthosis. Our assistive-technology

specialists design and create customized orthoses, seating, artificial limbs and other devices that

help patients accomplish daily tasks.

John Fawcett, a certified orthotist, adjusts a patient’s orthosis during an outreach clinic.


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Case Study 1 — Hip Dysplasia

A.J., an otherwise healthy child with developmental hip dysplasia, started walking at 12months but presented with an asymmetrical gait and “out-toeing” on the right. A physicalexamination revealed a leg-length discrepancy (left side shorter), asymmetric skin folds andlimited abduction on the left. Ortolani and Barlow maneuvers were negative.

An X-ray showed dislocation of the hip, delayed ossification of the femoral head, and dys-plastic changes in the acetabulum (Figure 1). Prereduction traction allowed for sufficientrelaxation, avoiding the need for femoral shortening. An attempted closed reduction, how-ever, was unsuccessful. Hip-spica casting followed an open reduction. Because acetabulardevelopment was inadequate, reconstruction was necessary 14 months later (Figure 2). Thepatient’s prognosis is good.

Case Studies

Figure 1: Before Figure 2: After


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Case Study 2 — Limb-Length Discrepancy

Two years after a motor vehicle accident, K.K., 14, was referred with a nonunion of the distaltibia. In addition, he had a substantial deformity (with a length discrepancy of 5 centimeters)and severe angular and rotational deformity of the extremity (Figure 3).

The second X-ray (Figure 4) shows the unhealedlower tibia bone. Figure 5 shows how a spatial fixator corrected the length deformity at the upperend of the tibia and the nonunion deformitythrough the lower end of the tibia. Finally, Figure 6shows normal alignment, equal leg length, andabundant bone formation at each of the treatmentsites. K.K. now enjoys full participation in allactivities.

Figure 4 Figure 5

Figure 3

Figure 6


Case Study 3 — Absent Ulna and Radius

J.J.’s ulna and radius are absent; her right hand didn’t develop properly in utero. When shewas 5 months old, Gillette’s prosthetists fitted the child with a new type of prosthesis madeentirely of silicon.

Traditional prostheses are hard and heavy. They sometimescause one limb to be longer than the other. The new prosthesis exposes more of the natural arm, allowing the child to retain more sensation. In addition, the silicon material allows the prosthesis to be the same length as the child’s other limb. After J.J.received the prosthesis, her sitting balanceimproved. She also could push herself up,reach for toys and clap.

Dick Stricker, a certified prosthetist, evaluates J.J.’s prosthetic arm.

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Although J.J. could sit without a prosthesis, her parents say her balance improved dramaticallyonce she began wearing an artificial arm.


Gillette is renowned as a regional pediatric and teaching hospital specializing in care forpeople who have disabilities and complex orthopaedic conditions. Many of our doctorshave national and international reputations for their expertise in:■ Cerebral palsy

■ Foot deformities

■ Hand and arm deformities

■ Hip deformities

■ Limb-length discrepancies

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Information & Referrals

For more information about Gillette’s Center for Pediatric Orthopaedics, call 651-229-1758 or800-719-4040 (toll-free). To refer a patient, call 651-229-3944.

Gillette’s main campus is located at the intersection of Jackson Street and UniversityAvenue in St. Paul, Minn. For a detailed map and directions, visit our Web site at www.gillettechildrens.org.

International Reputation

■ Motion analysis

■ Muscular dystrophy

■ Prostheses

■ Spina bifida

■ Scoliosis and spinal deformities

LEARN MORE!

For more information about pediatric orthopaedics, visit our Web

site at www.gillettechildrens.org.


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Our Mission

Gillette meets the special health-care needs of people — primarily children and teens —

who have disabilities. Our mission is to help those we serve realize greater well-being,

independence and enjoyment in life.

We combine medical, nursing, therapeutic, technical, psychosocial and other expertise in

family-centered programs. We provide services at our clinics, in our hospital and through-

out the region, in response to community needs and often in collaboration with other

organizations. We seek to build community partnerships that help continue our mission

and enhance care for people who have disabilities.


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New Brighton Clinic550 County Road DNew Brighton, MN 55112651-636-9443800-578-4266 (toll-free)

St. Paul (Main) Campus200 University Avenue EastSt. Paul, MN 55101651-291-2848800-719-4040 (toll-free)

Burnsville Clinic305 East Nicollet BoulevardBurnsville, MN 55337952-223-3400866-881-7386 (toll-free)

Duluth ClinicLakewalk Center1420 London RoadDuluth, MN 55805218-728-6160800-903-7111 (toll-free)

Minnetonka Clinic6060 Clearwater DriveMinnetonka, MN 55343952-936-0977800-277-1250 (toll-free)

www.gillettechildrens.org

©Copyright 2004, Gillette Children’s Specialty Healthcare. All rights reserved.


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