About Us
Orthopaedic Surgery Team | Education | Research
At Cincinnati Children's Hospital Medical Center, the Orthopaedic Surgery Division provides diagnosis and treatment for the full spectrum of orthopaedic disease and conditions in children, including:
- Congenital and acquired spinal deformities
- Neuromuscular spinal disorders
- Instability problems associated with dwarfism and dysplasia
Other areas of expertise include:
- Scoliosis
- Sports medicine
- Brachial plexus injuries
- Neurofibromatosis
- Cerebral palsy
- Myelomeningocele
- Limb deficiency
Cincinnati Children's was one of the first centers in the country to perform the internationally known DeBastiani limb-lengthening procedure. Cincinnati Children's was also one of the first pediatric orthopaedic centers to utilize spinal and pelvic endoscopy to treat congenital and acquired deformities. Our faculty has now established an international reputation in this area.
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The current Division of Pediatric Orthopaedic Surgery was established in December 1977. The division has grown from one full-time member and two part-time to seven full-time members and several volunteer attending physicians with specified clinical involvement.
Our faculty includes seven full-time orthopaedic physicians:
- Eric J. Wall , MD, Director
- Alvin H. Crawford, MD, Director Spine Center
- Charles T. Mehlman, DO, MPH, director of Musculoskeletal Outcomes Research and Co-director Limb Reconstruction Center
- Twee T. Do, MD , director Neuromuscular Services
- Junichi Tamai, MD
- Donita Bylski-Austrow, PhD, director Biomechanics Research Laboratory
- A. Atiq Durrani, MD
- Shital N. Parikh, MD
Five volunteer physicians serve as nuclear faculty, seeing patients in specialty clinics and assisting with the training of Orthopaedic residents. Attending physicians include:
- David Greenfield, MD, foot disorders clinic and myelomeningocele clinic
- Thomas Kiefhaber, MD, hand clinic
- Andrew Markiewitz, MD, hand clinic
- James Willis, MD, hand clinic
- Craig Willis, MD
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The Orthopaedic Surgery Division sponsors seven internationally respected pediatric orthopaedic surgeons as visiting professors each year, as well as an annual pediatric hand lecturer and pediatric hip lecturer. The graduates of Cincinnati Children's Pediatric Orthopaedic Fellowship hold their alumni meeting every other year during the Pediatric Hip Day Symposium.
The Orthopaedic Surgery Division has trained 37 fellows, including one World Health Organization award recipient. The department has residents from the University of Cincinnati, as well as our external rotating residents, two post-graduate orthopaedic fellows, as well as pediatric and family care residents who matriculate on the service annually.
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The Orthopaedic Surgery Division's efforts continue in the realm of clinical studies. However, our basic science research initiative has strengthened and expanded considerably int he past few years. The spine research program has focused on understanding anatomy, biomechanics and biology of the spine and how this may be used to improve the clinical practice of spine surgery by:
- The development of innovative treatment methods
- Study of mechanobiology of growth, which relates new treatment modalities with changes in pressure and tissue structure
- The biomechanical function of spine ligaments
These studies, in addition to extending basic science, have been designed to relate directly to the diagnosis and management of patients with deformities of bone, ligament, and growth plate cartilage. The ultimate goal is to significantly advance the treatment of these disfiguring and often disabling musculoskeletal disorders.
The Orthopaedic Surgery Division has become the leader in endoscopic spinal surgery in children. The research program in the area of endoscopic spinal hemiepiphysiodesis in particular, has benefited from a multidisciplinary team approach involving surgical, biomechanical and biological expertise. Current efforts are concentrated on improving the understanding of the interaction between pressure and growth, in order to optimize treatment of idiopathic scoliosis. In addition, the team is addressing the cellular mechanisms of controlled growth inhibition with a goal of devising new strategies for early and minimally invasive spinal deformity treatment. This research won the top award at the 2003 Scoliosis Research Society and is currently being published in the premier refereed Spinal Journal. Development of teh patented implant technology toward clinical trial is continuing with the help of local industrial partners.
The benefits of thoracoscopy over thoracotomy to patients with severe deformity, including decreased pain, shoulder disability, hospital stay and cost containment are significant. In cooperation with Ethicon Endosurgery and Cincinnati Children's more than 100 national and international spine surgeons were taught by interactive teleconferencing the technique of minimally incisional spinal fusion by videoassisted thoracoscopy.
Open pelvic osteotomy is required for children with abnormal development and disease of the hip joint. Pelvic osteotomies are highly basic procedure and usually involve high blood loss, long incisions, and prolonged recovery.
In July 1995, our group began development of an endoscopic technique of pelvic osteotomy in which the three supporting bones of the hip socket are cut under endoscopic visualization through small incisions and the socket is rotated into a better weight supporting position.
Results of studies on this procedure were presented at the International Pediatric Orthopaedic Think Tank and Pediatric Orthopaedic Society of North America Meeting. Our group continues to refine our technique and expand on its clinical use.
Over the past nine years our major efforts have concentrated on the development of a safe, secure, and cost-effective semi-rigid segmental fixation for surgical correction of idiopathic scoliosis and other spinal deformities in children. Preliminary results were presented to the Scoliosis Research Society and the American Academy of Orthopaedic Surgeons. The mechanical construct was well accepted in orthopaedic circles and is being used throughout North America as well as in some European and South American countries.
In collaboration with San Diego Children's and Philadelphia Shriner's Hospitals, an endoscopic implant for minimally invasive correction of thoracic scoliosis was developed and is now distributed by DePuy Spine.
Another major thrust is in the area of limb length inequality. We have been among the primary investigators on the use of the orthofix device for limb lengthening by Callostasis (corticotomy followed by regenerative bone from callous formation). This procedure was developed by Professor Giovanni DeBastiani.
After visiting Dr. DeBastiani's facility in Verona, Italy in 1988, we initiated leg-lengthening procedures. Our results were presented to the American Academy of Orthopaedic Surgeons and the orthofix study group in Verona, Italy, in December 1991. Since 1993, we have also utilized the Ilizarov (Russian) lengthening device.
In cooperation with Dr. Charles Glueck from Cincinnati Jewish Hospital and Ralph Gruppo, MD, from Cincinnati Children's Hematology Oncology Division, we are currently investigating the association of hypofibrinolysis and thrombosis as the etiology of Legg-Calve Perthes Disease.
Our findings of abnormal levels of Protein S and Protein C have been reinforced by recent findings of a resistance to activated Protein C and the mutant Factor IV Leiden Gene in our patients. These works have been published in the Journal of Bone and Joint Surgery, as well as Clinical Orthopaedics and Related Research.
Other areas of investigation currently underway include:
- A multidisciplinary study of the use of selective posterior rhizotomies in children with cerebral spastic disorders
- Improved techniques for obtaining spinal fusions in children with spondylolisthetic defects of the lower spine
- Tumors of the foot and ankle in children
- Limb salvage procedures for malignant tumors of the upper and lower extremities using allografts, autografts, and custom designed prostheses
- Excision of bony bridges to correct angular deformities and leg length discrepancies that have developed following growth plate injuries to major long bones
- Combined bone pegging and metallic fixation for the treatment of acutely unstable slipped capital femoral epiphysis, a group of patients which encounters the highest risk for avascular necrosis
- The use of percutaneous epiphysiodesis to manage acquired leg length inequalities
- The incidence of central nervous system tumors in children presenting with spastic torticollis
- The association of familial thrombophilia, hypofibrinolysis and high lipoprotein pathophysiologic etiologies of Legg-Calve-Perthes Disease
- Regional Center for Epidemiology of Sports Injuries in Children and Adolescents
- The use of continuous epidural for postoperative pain relief in patients with cerebral palsy
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For more information, please contact the Orthopaedic Surgery Division at Cincinnati Children's Hospital Medical Center, 513-636-4454.
