Research
The research of the Orthopaedics Division is aimed at improving treatment, diagnosis, and prevention of pediatric musculoskeletal disorders. Particular emphasis is given to the most severely affected surgical patients including those with skeletal deformities of the spine and extremities and those with the most common injuries due to trauma and sports.
Spine Deformities
Neonatal Kyphectomy: Its role in myelomeningocele management
It is estimated that 10 to 15% of children born with myelomeningocele will have a significant kyphotic deformity. The typical lesion is in the thoracolumbar area with the apex of the kyphosis being at lumbar two or three. This deformity makes it difficult to obtain initial skin closure and allows early breakdown of the subsequently closed skin because of a bony prominence. Both problems may lead to meningitis with its attendant complications of deterioration of neurologic function and mental retardation.
If the kyphosis is left uncorrected there is a steady increase in the angle of deformity which increases after the first year when a child starts to sit frequently, leading to an operative procedure by age three. The uncorrected deformity makes it difficult to fit appliances for standing or to be supine.
The procedure, introduced in 1968, did not become popular because of complications, particularly blood loss and a high rate of failure of fusion. We have performed this procedure sixteen times with a neurosurgical-orthopaedic team. The follow-up is six months to 9.5 years (average 4.4 years) with no deaths or significant complications.
Pediatric Fractures
A database is being compiled on fractures treated in Orthopaedic Clinic for a prospective on-going study of outcomes following non-operative management. The series includes:
- 387 phalanges
- 385 metacarpals
- 256 hands
- 1210 forearms
- 98 clavicles
- 494 humerus
- 795 tibias/fibulas
- 233 feet
Endoscopic Scoliosis Surgery
Costoplasty
The division is currently completing work on endoscopic internal costoplasty to reduce rib deformity associated with scoliosis. We are currently developing and testing endoscopic implants to correct adolescent idiopathic scoliosis using an entirely endoscopic technique.
Spinal Hemiepiphysiodesis
The goal of this work is to create innovative treatment protocols for young patients with idiopathic scoliosis: early, less expensive, and much less invasive, both during and after surgery. The purpose of the first phase of the study was to determine if the growth of the spine can be altered using a relatively simple implant and surgically relevant methods. This was shown to be true in a preclinical model. This work received the prestigious Russell Hibb's Award from the 2003 Scoliosis Research Society.
Closely related studies are aimed at defining normal and pathological structure and function of the vertebral growth plates in scoliosis patients and defining the mechanism of action of the implant on the growth plate.
The method is in the preclinical stage. We are pursing peer review and regulatory (FDA) processes. No clinical trials are scheduled at this time. For further guidance with respect to current options for your child, please consult a scoliosis surgeon.
Sports Research
The Cincinnati Children's Hospital Medical Center Division of Sports Medicine is now performing clinical research on growth plate overuse injuries in child and adolescent athletes. We are investigating a new growth plate overuse syndrome of the distal tibia and fibula bones, which may prove to be one of the leading cause of chronic ankle pain in skeletally immature athletes.
Support for this grant was provided by a $161,000 development grant for the Cincinnati Children's Sports Medicine Center. This grant covered the creation of a database to track and research all sports injuries treated at Cincinnati Children's.
As part of this study, 80 youth soccer teams in Cincinnati were prospectively followed to determine the epidemiology of youth soccer injury. Additionally, we completed a roller blade project with the Emergency Medicine Division. We found that 46 percent of all roller blade injuries are wrist fractures, and that wrist guards are extremely effective (90%) in preventing this common injury.
Endoscopic Pelvic Osteotomies
We have developed an endoscopic technique of bone cutting and fixation, which is in clinical use for hip dysplasia treatment.
Pediatric Forearm Fracture Project
Approximately 500 pediatric forearm fractures are cared for in the division of pediatric orthopaedics each year. This project is aimed at optimizing pediatric forearm management and also providing more cost effective care. Predictors of fracture instability and other pediatric forearm outcome variables will also be identified.
Currently, a pilot study involving a retrospective review of over 700 "buckle-type" fractures has been completed and appropriate predictors of fracture instability identified. This project is ongoing and will continue to expand.
Pediatric Femur Fracture Project -- Surgical versus Non-Surgical Treatment
Pediatric femur fractures are the most common problems requiring inpatient management at our institution. Our institution also has a long tradition of successful treatment of these fractures with 90-90 skeletal traction (three weeks), followed by spica casting (six weeks).
Other pediatric centers have reported encouraging results using flexible intramedullary nails as well as external fixation for these same pediatric femur fracture patients.
Currently, very little data exists concerning the psychosocial implications on the patients and their families of these various treament options and very little cost data exists other than from the isolated view of the hospital inpatient stay.
This project is aimed at qualifying and quantifying psychosocial issues that are judged to be important to patients and families and to also perform a cost analysis of these various treatment approaches. A pilot project is presently underway concerning development of a psychosocial questionnaire that will be administered to families. A full-time research nurse is presently being sought to facilitate both data acquisition and entry for this project.
For more information, please contact the Orthopaedic Surgery Division at Cincinnati Children's Hospital Medical Center, 513-636-4454.
