Tag Archive for: Oetgen

Matthew Oetgen, MD, and the hip pinning robot

Transforming pediatric hip surgery with robotics and 3D imaging

Matthew Oetgen, MD, and the hip pinning robot

“This project is exciting as it targets more precise surgery with improved safety in terms of decreased radiation,” says Matthew Oetgen, MD, division chief of Orthopaedic Surgery and Sports Medicine at Children’s National.

What if surgeons could fix a child’s hip with pinpoint accuracy – using fewer X-rays and cutting-edge robotics? That’s the promise of a new National Institutes of Health funded project combining 3D imaging and robotic technology to improve the treatment of slipped capital femoral epiphysis (SCFE), a condition that affects the hip joint in growing children.

What’s been the hold-up in the field?

Right now, orthopedic surgeons place screws by hand using 2D X-ray images to guide them. To see the screw from different angles, they have to move the X-ray machine around. “The screw must be placed near the center of the femoral head, but not penetrate it,” says Kevin Cleary, PhD, associate director of engineering at the Sheikh Zayed Institute for Pediatric Surgical Innovation (SZI). This process takes time and can increase the amount of radiation the patient receives.

Even though better tools like 3D imaging and surgical robots exist, they aren’t used together in current surgical practice. “Individual procedures have nuances that require their own validated workflows,” says Tyler Salvador, a research engineer at Children’s National Hospital. In other words, each type of surgery is different, and doctors need proven steps before using new technology in the operating room.

How does this work move the field forward?

This project brings together low-dose 3D X-rays from nView with a small surgical robot called Micromate™ to help place screws more precisely during SCFE surgeries. “Our research group has been developing robotics, imaging, and related technologies to improve surgical procedures,” says Dr. Cleary. While these tools exist separately, putting them together in one system focused on bone surgery is new. Tyler Salvador adds, “This will provide a complete solution for precision SCFE implant placement and verification.”

“This project is exciting as it targets more precise surgery with improved safety in terms of decreased radiation,” says Matthew Oetgen, MD, division chief of Orthopaedic Surgery and Sports Medicine at Children’s National. “This is a paradigm-shifting effort that will improve outcomes while improving safety which is the holy grail of translational clinical research. It embodies the goal of the SZI — combining technical expertise with surgical leadership to improve outcomes in pediatric surgery.”

Children’s National leads the way

Children’s National is unique because the Sheikh Zayed Institute combines research and clinical care in one place. “Having the labs right inside the hospital helps us work closely with doctors,” says Salvador.

Together, this work is paving the way for safer, faster and more precise surgeries for children with hip problems. By combining advanced imaging and robotics, the team at Children’s National is helping shape the future of pediatric orthopedic care. In addition to this robotic hip pinning project, the Children’s National team is also behind two additional groundbreaking projects including robotic gallbladder removal and a kidney surgery initiative.

This project has been funded in whole with federal funds from the National Institutes of Health under Contract No. R01EB035559.

Dr. Matthew Oetgen in the operating room

Life-changing care: How Children’s National tackles pediatric cervical spine injuries

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The Cervical Spine program at Children’s National Hospital is responsible for treating a range of conditions, including trauma, congenital abnormalities and tumors. These conditions can lead to instability or misalignment of the cervical spine. Some of the common symptoms of cervical spine injuries are motor and sensory deficits, incontinence and headaches. These symptoms can indicate underlying issues that need to be addressed promptly.

“There are unique challenges in pediatric cases due to anatomical differences. The cervical spines of children are more at risk for injury because of their developmental stage and structural characteristics,” says Matthew Oetgen, MD, MBA, chief of Orthopaedic Surgery and Sports Medicine at Children’s National.

The patient benefits

Children’s National offers a range of treatment options for cervical spine injuries, ranging from nonoperative care to surgical interventions. Nonoperative care options include immobilization with cervical collars or halos. These methods help stabilize the spine without surgery. Surgical interventions such as fixation and fusion are used to maintain alignment and decrease instability and are necessary for more severe cases.

Dr. Matthew Oetgen in the operating room

“There are unique challenges in pediatric cases due to anatomical differences. The cervical spines of children are more at risk for injury because of their developmental stage and structural characteristics,” says Dr. Oetgen.

Case 1

In a recent case, a patient was referred to the orthopaedic clinic for a small scoliosis. Benjamin Martin, MD, associate chief of Clinical Operations and Affairs, reviewed the patient’s X-rays and found the spinal deformity minor and not concerning. However, he identified neurological signs during the patient’s physical exam, including mild weakness, unsteady gait, hyperreflexia and positive Babinski and clonus tests. An MRI revealed unstable os odontoideum with upper cervical stenosis and spinal cord compression causing myelomalacia. The patient was referred to Dr. Oetgen and John Myseros, MD, associate chief of Neurosurgery, who confirmed the diagnosis. The patient underwent a C1 decompression and C1-2 fusion using computer-aided navigation. The patient recovered well, achieving C1-2 fusion, improved neurological function and made a full recovery.

Case 2

In another case, a patient with progressive cervical kyphosis was referred to Dr. Oetgen. Diagnosed with medulloblastoma in 2015, the patient had undergone multiple cervical spinal surgeries elsewhere, resulting in post-laminectomy kyphosis causing pain, fatigue and restricted activity. This complex case was managed collaboratively by Drs. Myseros and Oetgen. The patient first underwent halo gravity traction to address the contracted deformity, followed by a combination surgery: anterior discectomy and fusion at C3-4 and C4-5, and posterior cervical fusion from C2-C6. The patient recovered well, showing significant improvement in alignment, comfort and activity levels.

Case 3

In the final case, a patient with Lowe Syndrome was referred after four months of neck pain, stiffness and a rotational deformity of the head, limiting motion and causing discomfort. An MRI and CT scan revealed chronic atlanto-axial rotatory instability, a rare deformity in children. Due to the severity and duration of the patient’s symptoms, Dr. Oetgen and the neurosurgical team recommended an occiput-to-C2 posterior decompression, realignment and fusion. The procedure was successful, and the patient has since returned to full activity with normal alignment and no symptoms.

Key takeaway

The importance of early intervention in cervical spine injuries is key to preventing long-term neurological deficits. It’s important to stay current on screenings and seek timely treatment to maintain neurological function.

Read more about our advances in Orthopaedic Surgery and Sports Medicine.

x-ray highlighting hip bones

Children’s National hosts inaugural orthopaedic hip symposium

x-ray highlighting hip bonesOn September 25, 2024, members of the Orthopaedic Surgery and Sports Medicine division at Children’s National Hospital hosted the inaugural DC Orthopaedic Hip Symposium. This educational event brought together hip preservation and hip arthroplasty specialists from the surrounding area to discuss comprehensive hip care – from care of the symptomatic young adult hip up to replacement of the native hip.

Jeffrey Peck, M.D., a hip preservation orthopaedic surgeon at Children’s National, gave his perspective on the meeting.

Q: What are the current challenges in the field of hip preservation and hip arthroplasty? 

A: Hip conditions that cause pain, such as dysplasia or impingement, can be undiagnosed or misdiagnosed by non-specialist providers. We have several very effective treatments in the fields of hip preservation and hip arthroplasty. By bringing together the hip specialists in the DC area, we aimed to deepen our own understanding of how to best treat hip pain and to share with other care providers how patients can get the right care at the right time.

Q: How did this gathering address those challenges? What were some of your key takeaways from the event?

A: By bringing people together who treat the hip at multiple different times and in different ways, we were able to broaden our perspective of looking at hip care. This will help us look more sensibly at those areas of uncertainty and will help each of us optimize how we assist patients with hip pain. The event highlighted how there are remaining areas within hip care in which a single, superior approach is not definitively settled.

Q: Who presented, and on what topics?

A:

  • Andrew Wolff, M.D., discussed borderline hip dysplasia and when arthroscopy can be considered.
  • Jeffrey Peck, M.D., discussed borderline hip dysplasia, looking at how a periacetabular osteotomy is indicated to preserve the hip and improve pain.
  • John Christoforetti, M.D., discussed challenging and complex cases of hip pain in soccer athletes.
  • Christopher Cannova, M.D., discussed how to best perform a total hip arthroplasty when dysplasia has progressed to end stage hip arthritis.

Q: How do you think Children’s National is leading the way in the care of these patients?

A: Children’s National is leading the way in caring for hip preservation patients by providing an integrated care model for patients with hip pain, including a Hip Preservation Fellowship Trained orthopaedic surgeon, physical therapists, psychologists, athletic trainers and physiatry physicians who work in tandem with the surgeons and therapists to optimize non-operative care for patients. By hosting and participating in events like this, we keep our team up to date on the latest approaches to hip treatment as we provide high-quality care to our patients.

“Medicine in general has become increasingly complex and adolescent hip issues are not excluded,” said Matthew Oetgen, M.D., M.B.A., chief of Orthopaedic Surgery and Sports Medicine at Children’s National. “Adolescents are participating in more intensive sports at an early age and we are seeing more and more hip pathology in these kids. We feel it is vital to not only provide comprehensive care for these patients, but also work with our community colleagues to exchange care ideas so we all continue to educate and improve the care for these patients. We hope to continue this forum and expand the outreach so we foster excellence in care throughout the region.”

2024-25 US News Badges

Children’s National again ranked among the best in the nation by U.S. News & World Report

2024-25 US News BadgesChildren’s National Hospital in Washington, D.C., was ranked as a top hospital in the nation by the U.S. News & World Report 2024-25 Best Children’s Hospitals annual rankings. This marks the eighth straight year Children’s National has made the Honor Roll list. The Honor Roll is a distinction awarded to only 10 children’s hospitals nationwide.

This year, U.S. News ended ordinal rankings on its Honor Roll. Instead of assigning a numerical rank from 1 to 10, all hospitals on the Honor Roll will be recognized as having attained the highest standards of care in the nation.

In addition, Children’s National tied for #1 pediatric hospital in the Mid-Atlantic region, which includes New York, New Jersey, Delaware, Pennsylvania, the District of Columbia, West Virginia and Virginia. It’s also best in the Mid-Atlantic in Neonatology.

For the fourteenth straight year, Children’s National ranked in 10 specialty services. New this year, U.S. News included behavioral health as a service line in the rankings. Since it’s the first year, there are no ordinal rankings for behavioral health, but the Children’s National program was named one of the top 50 programs in the country.

“In my first year here, I witnessed what makes Children’s National so special — our commitment to collaboration, empowering one another, and charting a bold path forward for pediatric care,” said Michelle Riley-Brown, MHA, FACHE, president and chief executive officer of Children’s National. “I’m proud U.S. News again recognized Children’s National as one of the top in the nation and the highest-ranked pediatric hospital in D.C., Maryland and Virginia. Together, we’ll continue to push the boundaries of care, research and innovation to make a difference for those who matter most — the kids.”

The annual rankings are the most comprehensive source of quality-related information on U.S. pediatric hospitals and recognizes the nation’s top 50 pediatric hospitals based on a scoring system developed by U.S. News.

“For nearly two decades, U.S. News has published Best Children’s Hospitals to empower the parents and caregivers of children with complex medical needs,” said Ben Harder, chief of health analysis and managing editor at U.S. News. “Children’s hospitals appearing on the U.S. News Honor Roll have a track record of delivering unparalleled specialized care.”

The bulk of the score for each specialty service is based on quality and outcomes data. The process includes a survey of relevant specialists across the country, who are asked to list hospitals they believe provide the best care for patients with the most complex conditions.

The Children’s National specialty services that U.S. News ranked in the top 10 nationally are:

The other four specialties ranked among the top 50 are Behavioral Health, Cardiology and Heart Surgery, Pulmonology and Lung Surgery, and Urology.

EPOSNA Logo

Global gathering of orthopaedic leaders at EPOSNA Conference

EPOSNA LogoThe 2024 European Pediatric Orthopaedic Society of North America (EPOSNA) Conference took place over four days at the National Harbor in Maryland. The event focused on improving the clinical care of children, as well as advancing the education of surgeons and scientific research in pediatric orthopaedics.

“This meeting allows the scientific exchange of ideas that advances our field and allows our treatments and outcomes to improve,” says Matthew Oetgen, M.D., chief of Orthopaedic Surgery and Sports Medicine at Children’s National Hospital.

Children’s National at EPOSNA

  • Laura Tosi, M.D., was inducted into the POSNA Hall of Fame.
  • Oetgen and Megan Young, M.D., served as local co-hosts of the conference.
  • Sean A. Tabaie, M.D., joined a newly formed POSNA advocacy group for gun safety measures to combat the alarming increase in pediatric gun violence, often resulting in musculoskeletal injuries.
  • Oetgen moderated a series of sessions that focused on traumatic pediatric injuries.
  • Tabaie presented during the Neuromuscular session, sharing insights on a novel scoring system validated for quantifying foot deformities in children with cerebral palsy.

“By attending and participating in this meeting we keep up with the science, continue learning and improve the care we provide to our patients,” says Dr. Oetgen.

Highlights from the sessions our team attended

  • A study published on a cohort of asymptomatic teenagers in the Netherlands reported an incidence of 6.4% of hip dysplasia.
  • A paper was published looking at differences in femoral version (rotational profile of the femur bone) in periacetabular osteotomy (PAO) patients. It found that patients with painful hip dysplasia had significantly improved hip pain after a PAO in all three femoral version groups.

 

Matthew Evan Oetgen, M.D., and Timothy Dennis Kane, M.D.

Children’s National announces two new professorships

Matthew Evan Oetgen, M.D., and Timothy Dennis Kane, M.D.

Drs. Oetgen and Kane join a distinguished group of Children’s National physicians and scientists who hold an endowed chair.

Children’s National Hospital named Matthew Evan Oetgen, M.D., as the Joseph E. Robert, Jr. Professor of Orthopaedic Surgery and Sports Medicine. Dr. Oetgen serves as chief of Orthopaedic Surgery and Sports Medicine.

Children’s National Hospital named Timothy Dennis Kane, M.D., as the Joseph E. Robert, Jr. Professor of General and Thoracic Surgery. Dr. Kane serves as chief of General and Thoracic Surgery.

About the award

Drs. Oetgen and Kane join a distinguished group of Children’s National physicians and scientists who hold an endowed chair. Children’s National is grateful for its generous donors, who have funded 48 professorships to-date.

Professorships support groundbreaking work on behalf of children and their families. They foster new discoveries in pediatric medicine. These appointments carry prestige and honor that reflect the recipient’s achievements and donor’s forethought to advance and sustain knowledge.

Dr. Oetgen is a longstanding leader in orthopaedic surgery and sports medicine. Under his leadership, Children’s National opened the Fight For Children Sports Medicine Center in 2021. It provides a wide range of orthopaedic services to help young athletes function at their peak performance. Additionally, his team launched the nation’s first pediatric Spinal Fusion Surgical Home. This program led to significant decreases in average length of stay and patient pain scores for children with idiopathic scoliosis.

“We provide state-of-the-art care to young athletes across the region,” says Dr. Oetgen. “This professorship will help us continue the development of innovative clinical and research programs that streamline care for children with complex orthopaedic needs.”

Dr. Oetgen has authored more than 60 book chapters and publications. He has presented at many major national and international conferences in his field. Dr. Oetgen is also a key member of the multidisciplinary clinical trial team that was the first to apply magnetic resonance guided high-intensity focused ultrasound to non-invasively relieve osteoid osteoma tumors in children.

Dr. Kane works to develop the Joseph E. Robert, Jr. Center for Surgical Care’s minimally invasive surgery program through clinical practice, instruction and research, while improving minimally invasive surgical techniques and speed into standard clinical care for pediatrics. He serves as principal investigator in the Minimally Invasive Therapy Program in the Bioengineering Initiative of the Sheikh Zayed Institute for Pediatric Surgical Innovation. He has specific interest and expertise in minimally invasive thoracic, gastrointestinal and neonatal surgery. Under his direction, the Division of General & Thoracic Surgery developed peroral endoscopic myotomy (POEM), a newer technique to treat esophageal achalasia in children.

“Children’s National performs more POEM procedures than any other children’s hospital in the country,” says Dr. Kane. “I’m grateful for this professorship and look forward to making even more surgical advances in pediatric care.”

The Joseph E. Robert Jr. Trust, through their vision and generosity, are ensuring that Drs. Oetgen, Kane and future holders of these professorships will launch bold, new initiatives. These innovations will help rapidly elevate our leadership in the field of pediatric orthopaedic and general surgery and improve lifetimes for children.

About the donors

The Joseph E. Robert, Jr. Charitable Trust is a long-time champion of Children’s National. It honors the memory of the late Joseph “Joe” E. Robert, Jr. A native of Washington D.C., Joe was an entrepreneur and visionary who believed in the importance of investing in children through education and healthcare. His first gift to Children’s National created and endowed our Joseph E. Robert, Jr. Center for Surgical Care. He was also instrumental in shaping the vision and building support for the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National, created in 2009 with a $150 million gift from the Government of Abu Dhabi.

These professorships embody Joe’s legacy of inspiring others to think bigger and differently to advance pediatric healthcare for children of the Washington, D.C. community and beyond.

“Joe’s legacy is represented through the incredible work being done at Children’s National,” says David Fensterheim, board chair of Fight For Children. “Drs. Oetgen and Kane are trailblazers in pediatric healthcare. We are proud to honor them and their cutting-edge work with this prestigious professorship.”

Dr. Sean Tabaie talks to a patient with a cast

CME: Bracing and casting in the pediatric orthopaedic surgery clinic

Dr. Sean Tabaie talks to a patient with a castJoin Children’s National Hospital for a pre-recorded Continuing Medical Education (CME) presentation on Bracing and Casting in the Pediatric Orthopaedic Surgery Clinic: Improving Patient Care through Understanding and Troubleshooting. This 90-minute presentation will focus on bracing and casting in pediatric spinal deformity, trauma, cerebral palsy and sports medicine. The session offers one (1) CME credit and features Matthew Oetgen, M.D., M.B.A., Jeffrey Peck, M.D., Sean Tabaie, M.D., M.S., M.B.A., and Keyur Desai, M.D.

Learning Objectives:

  • Learn the common types of braces and casts used to treat patients in pediatric orthopedic out-patient clinics.
  • Understand indications for use, appropriate fitting, and patient questions to assess commonly used braces and casts.
  • Recognize complications associated with braces and casts in children and learn how to trouble-shoot these issues to improve patient care and safety.

Click here to view the presentation.

To claim credit for this presentation, please follow these steps:

  1. Log into your INOVA CME account, or create an account: cme.inova.org
  2. Credit for this session can be claimed in one of two ways:
    1. Text session code “QUXSEV” to 703-260-9391
    2. Enter the session code “QUXSEV” at cme.inova.org/code​​​​​

You have 30 days from March 1, 2024, to claim credit.

Gabi cheerleading

Transformative surgery: A catalyst for a girl’s future career aspirations

Gabi cheerleading

“I knew something was wrong because Gabi couldn’t walk in a straight line or ride a bike,” said Gabi’s mom, Petrice Young. “Since the surgery, she’s a different person. Dr. Oetgen literally changed her life.”

When Gabi, 17, went for her 12-year checkup, her pediatrician noticed a deformity in her spine. He quickly recommended Gabi make an appointment at Children’s National Hospital with Matthew Oetgen, M.D., chief of Orthopaedic Surgery and Sports Medicine. The X-rays indicated Gabi had a very large, 73 degree thoracic and 77 degree lumbar, double-S curvature in her spine and it was likely that as she continued to grow, the curve would get bigger.

Surgery was the best next step. The news came as a surprise to Gabi and her family, especially since she wasn’t experiencing any pain at the time.

“I knew something was wrong because Gabi couldn’t walk in a straight line or ride a bike,” said Gabi’s mom, Petrice Young. “Since the surgery, she’s a different person. Dr. Oetgen literally changed her life.”

Gabi was discharged just four days after her spinal surgery.

As a junior in her high school’s biomedical magnet program, Gabi actively participates as a cheerleader and is currently in her third year as a member of the softball team – something she’d never done before. She maintains a 4.0 GPA and participates in community service regularly.

Her dream career? Becoming an orthopaedic surgeon one day, expressing that her personal experience with the surgery will contribute to fostering a unique and meaningful patient-doctor relationship. She is extremely grateful to Dr. Oetgen for performing the surgery and influencing her career goals.

A program developed to treat the wide range of pediatric spine patients

Since 2015, patients undergoing spinal fusion at Children’s National have been part of the first-of-its-kind pediatric Spinal Fusion Surgical Home care model. This model was developed by a multidisciplinary team with the goal to streamline care for adolescent idiopathic scoliosis (AIS) patients with an emphasis on increasing quality outcomes.

The team’s coordinated approach means they can deliver care more efficiently, resulting in shorter hospital stays and allowing children to come home as soon as it is medically safe. As a leader in this care concept, Children’s National has standardized the infection-control process, pain-management pathway and physical-therapy program for AIS patients who require spinal fusion.

What is AIS?

Gabi playing softball

Gabi actively participates as a cheerleader and is currently in her third year as a member of the softball team – something she’d never done before.

AIS is a condition of the spine, which typically affects children between the ages of 10 and 14 years old, marked by an abnormal side-to-side shaped curve that measures 10 degrees or greater. There are two types of curves associated with idiopathic scoliosis – C-shaped (one curve) and S-shaped (two curves). Along with the curve, the spine also rotates or twists, pulling the ribs along with it. Children with idiopathic scoliosis may experience uneven hips and shoulders and the head may not be centered with the rest of the body.

The period of rapid growth poses the greatest risk for the progression of a child’s spinal curve. Even after reaching skeletal maturity, a child with a curve exceeding 50 degrees may continue to progress at a rate of one to two degrees per year throughout their lifetime.

Treatment of early onset scoliosis

Early onset scoliosis (EOS) is a curve in the spine present before the age of 10. Diagnosing and addressing spinal deformities in children before the age of 10 can significantly impact the long-term outcomes. Close monitoring allows healthcare professionals to intervene promptly if necessary, preventing the progression of the spinal curve.

Minimally invasive techniques are particularly advantageous in pediatric cases, as they often result in shorter recovery times, reduced pain and minimized disruption to a child’s normal activities. This approach aligns with the goal of returning the child to a normal, active life as quickly and seamlessly as possible. Some minimally invasive techniques for EOS include:

  • Casting – young children may be placed in what is called Mehta casting. In this advanced casting technique, the child’s chest and abdomen are casted. Every two to four months the cast is replaced as the child grows.
  • MAGEC™ (MAGnetic Expansion Control) spinal growing rods – these rods are surgically attached to the spine and doctors use an external remote control outside of the body to lengthen the magnetically controlled rod as the child grows. Traditional growing rods require multiple surgeries.

As part of the Growing Spine Study Group, Children’s National collaborates with other hospitals around the world to enhance care for EOS and related deformities.

The right facility

Children’s National is equipped to treat the most severe and high-risk cases of scoliosis. In rare cases, severe spinal curves can require month-long inpatient spinal halo-gravity traction prior to surgery. This can impede a child’s quality of life just as severely as the condition itself, often making eating, breathing and moving difficult.

Spinal halo-gravity traction can reduce the degree of surgical intervention necessary by accomplishing some gradual straightening of the spine prior to spinal fusion procedures. For severe spinal deformities, this has been shown to improve the safety and effectiveness of the final surgical procedure.

Recognizing the challenges posed by both the condition and its treatment, the surgery team at Children’s National endeavors to coordinate cases, providing patients with mutual support throughout the traction process.

Read more about our advances in Orthopaedic Surgery and Sports Medicine.

ICEOS logo

Global summit to address complex pediatric scoliosis

ICEOS logoThe 2023 International Congress on Early Onset Scoliosis and the Growing Spine (ICEOS) was a three-day conference for surgeons and health professionals from around the world. The sessions focused on solutions for pediatric spine deformities. Matthew Oetgen, M.D., chief of Orthopaedic Surgery and Sports Medicine at Children’s National Hospital, was a member of the faculty.

Session highlights included:

  • Pre-Course: Pediatric Spine Study Group (PSSG) Mini-Research Symposium – Considerations for your biosketch, regulatory and IRB
  • How Do You Propel Your Research Team

“Overall this was a great meeting with valuable content,” says Dr. Oetgen. “Learning and teaching alongside fellow orthopaedic leaders is a fantastic opportunity for everyone involved.”

Dr. Oetgen participated in the following sessions:

  • Timing of Hemivertebra Excision
  • Let’s Debate! nView Workshop – 3D imaging and guidance, available technologies for pediatric spine and when to use them
  • Case-Based Learning – Congenital Scoliosis

The 2024 ICEOS Meeting will be November 13-15 in Phoenix, AZ.

IPOS logo

Global gathering of orthopaedic leaders at IPOS

IPOS logoThe 2023 International Pediatric Orthopaedic Symposium (IPOS) was a comprehensive four-day conference that addressed a wide range of pediatric and adolescent orthopaedic conditions. The meeting focused on hands-on teaching and state-of-the-art surgical approaches to pediatric orthopaedic surgery.

“IPOS is unique in that, unlike many scientific meetings, there is less emphasis on original scientific content,” says Matthew Oetgen, M.D., chief of Orthopaedic Surgery and Sports Medicine at Children’s National Hospital and one of the faculty members of the symposium. “Instead, the focus is on providing instruction, hands-on learning and the introduction of new technology.”

Some session highlights include:

  • Essentials of Pediatric Orthopaedics – lectures on upper extremity and lower extremity trauma.
  • The Course for Mid-Career Surgeons – a talk full of valuable insights on mentorship and paying it forward.
  • The Author’s Preferred Techniques – surgical technique lectures on cavus foot reconstruction and repairing pediatric thumb fractures.

“Each of these sessions offer unique takeaways for a variety of learning levels from residents and fellows to course faculty members like myself,” says Dr. Oetgen. “Overall, this year’s IPOS was very educational and I was proud to have had a number of Children’s National faculty attend and experience the course.”

Dr. Oetgen participated in several sessions:

  • Essentials of Pediatric Orthopaedics II and III – Session Moderator
  • Essentials of Pediatric Orthopaedics: Back Pain, Kyphosis and Disc Disease – Lecture
  • Top Gun Surgical Simulation Competition – Faculty Leader
  • Hands-On Workshop – Pinning an Elbow – Faculty
  • Reconsidering How You Should Code for Fractures
  • EMR Hacks to Improve Wellness and Patient Experience – Lecture
  • Industry Spotlight Session nView Medical – Next Generation Pediatric 3D Imaging and Navigation – Simplifying Your Current Surgical Workflow – Lecture
    • Children’s National is was the first pediatric hospital in the country to use the 3D imaging technology by nView Medical in the operating room. Researchers studied its impact in the area of pediatric spine surgery, navigation and imaging. The team continues to be a major investigator and knowledge leader with this technology. Moving forward, researchers plan to study the technology’s impact in pediatric orthopaedic surgery.

 

Matthew Oetgen

Advancing care: Innovations and learning in Spinal Fusion Surgical Home

Matthew Oetgen

“We are committed to discovering methods that eliminate variability in the care process and enhance the quality of care for pediatric orthopaedic patients,” says Matthew Oetgen, M.D., M.B.A., chief of Orthopaedic Surgery and Sports Medicine at Children’s National Hospital.

“We are committed to discovering methods that eliminate variability in the care process and enhance the quality of care for pediatric orthopaedic patients,” says Matthew Oetgen, M.D., M.B.A., chief of Orthopaedic Surgery and Sports Medicine at Children’s National Hospital. “The Spinal Fusion Surgical Home model is specifically designed for young patients with adolescent idiopathic scoliosis (AIS), laying the foundation for numerous other children undergoing various surgical procedures.”

The first-of-its-kind for pediatric patients, the Children’s National Spinal Fusion Surgical Home continues to streamline care with an emphasis on increasing quality outcomes for patients. At its inception, the program implemented a newly developed model of care to optimize the spinal fusion process for AIS patients. As a leader in this care concept, Children’s National has standardized the infection-control process, pain-management pathway and physical-therapy program for patients undergoing spinal fusion.

The patient benefit

A patient with a right thoracic deformity of approximately 33 degrees and a left thoracolumbar deformity of 54 degrees was treated with an instrumented posterior spinal fusion from T4-L3 and was admitted for 5 days post-operatively.

Children’s National has implemented standardized protocols and ongoing enhancements, including the establishment of a specialized surgical team and the integration of a Lean process analysis. This has led to a notable decrease in the average length of stay for spinal fusion patients from about five days to three days. The surgical home has also reduced the transfusion rate from 30% to 12% and patient pain scores have decreased. Additionally, the number of patients who have returned to the emergency department due to complications has also decreased.

In a case prior to the surgical home model being established, a patient with a right thoracic deformity of approximately 33 degrees and a left thoracolumbar deformity of 54 degrees was treated with an instrumented posterior spinal fusion from T4-L3 and was admitted for 5 days post-operatively. Per standard protocol at the time, this patient stayed in the intensive care unit (ICU) immediately after surgery for a day and a half.

In another case, a patient with a right thoracic deformity of 58 degrees and left thoracolumbar deformity of 67 degrees was treated with a similar instrumented posterior spinal fusion from T4-L3 and admitted for 2.5 days post-operatively. With the new model in place, this patient did not need any time in the ICU, required less length of stay and had less loss of blood.

“By working together with all our care givers, we have been able to standardize our care and decrease care variability. This has proven effective at improving outcomes allowing our patients to recover faster and avoid complications. These cases are an example of our system being primed to treat children with ever increasing complexity with better and better outcomes,” says Dr. Oetgen.

x-ray of a patient with a right thoracic deformity

A patient with a right thoracic deformity of 58 degrees and left thoracolumbar deformity of 67 degrees was treated with a similar instrumented posterior spinal fusion from T4-L3 and admitted for 2.5 days post-operatively.

Children’s National leads the way

Over the years, the Spinal Fusion Surgical Home has continuously fine-tuned its approach, resulting in greater success outcomes and better patient care. Children’s National orthopaedic experts have published many articles highlighting this evolution:

  • Lean process mapping: Implementation of a standardized care pathway developed with the use of the Lean process mapping technique to create an evidence-based protocol for preoperative, operative, postoperative and post-discharge care. Since 2015 our program has demonstrated effective and sustained improvements to the care of patients and decreased postoperative length of stay.
  • Significant decrease in perioperative blood transfusions: A study published in Pediatric Anesthesia details team findings that implementation of blood-conservation strategies as part of a perioperative surgical home for patients with AIS undergoing posterior spine fusion resulted in significant decrease in perioperative blood transfusions.
  • Reduced patient length of stay: An in-depth Lean process mapping technique improved outcomes and decreased length of stay of patients, as outlined in an article in Spine Deformity, through use of a standardized care pathway. Work to improve surgical efficiency, intraoperative fluid and blood management, and postoperative pain management continues to further improve effectiveness.
  • Standardization of intraoperative pain control: A study published in the Journal of Anesthesia on the implementation of the medical home model for AIS-improved pain control and decreased opioid consumption and hospital stay. Through pathway standardization, consistent multi-modal analgesia and early mobilization, the medical home model improved outcomes and is our standard of care.
  • Reduction in perioperative outcome disparities: Acknowledging the well-documented racial and ethnic disparities in treatment and perioperative outcomes for patients across healthcare, the team documented and published findings that this model was able to reduce racial and ethnic disparities in length of stay and pain scores.
  • Dedicated surgical team: Having dedicated spine personnel in the operating room decreases surgical time and improves clinical outcomes, as detailed in a study on Spine Deformity.

Read more about our advances in Orthopaedic Surgery and Sports Medicine.

U.S. News Badges

Children’s National Hospital ranked #5 in the nation on U.S. News & World Report’s Best Children’s Hospitals Honor Roll

U.S. News BadgesChildren’s National Hospital in Washington, D.C., was ranked #5 in the nation on the U.S. News & World Report 2023-24 Best Children’s Hospitals annual rankings. This marks the seventh straight year Children’s National has made the Honor Roll list. The Honor Roll is a distinction awarded to only 10 children’s hospitals nationwide.

For the thirteenth straight year, Children’s National also ranked in all 10 specialty services, with eight specialties ranked in the top 10 nationally. In addition, the hospital was ranked best in the Mid-Atlantic for neonatology, cancer, neurology and neurosurgery.

“Even from a team that is now a fixture on the list of the very best children’s hospitals in the nation, these results are phenomenal,” said Kurt Newman, M.D., president and chief executive officer of Children’s National. “It takes a ton of dedication and sacrifice to provide the best care anywhere and I could not be prouder of the team. Their commitment to excellence is in their DNA and will continue long after I retire as CEO later this month.”

“Congratulations to the entire Children’s National team on these truly incredible results. They leave me further humbled by the opportunity to lead this exceptional organization and contribute to its continued success,” said Michelle Riley-Brown, MHA, FACHE, who becomes the new president and CEO of Children’s National on July 1. “I am deeply committed to fostering a culture of collaboration, empowering our talented teams and charting a bold path forward to provide best in class pediatric care. Our focus will always remain on the kids.”

“I am incredibly proud of Kurt and the entire team. These rankings help families know that when they come to Children’s National, they’re receiving the best care available in the country,” said Horacio Rozanski, chair of the board of directors of Children’s National. “I’m confident that the organization’s next leader, Michelle Riley-Brown, will continue to ensure Children’s National is always a destination for excellent care.”

The annual rankings are the most comprehensive source of quality-related information on U.S. pediatric hospitals and recognizes the nation’s top 50 pediatric hospitals based on a scoring system developed by U.S. News.

“For 17 years, U.S. News has provided information to help parents of sick children and their doctors find the best children’s hospital to treat their illness or condition,” said Ben Harder, chief of health analysis and managing editor at U.S. News. “Children’s hospitals that are on the Honor Roll transcend in providing exceptional specialized care.”

The bulk of the score for each specialty service is based on quality and outcomes data. The process includes a survey of relevant specialists across the country, who are asked to list hospitals they believe provide the best care for patients with the most complex conditions.

The eight Children’s National specialty services that U.S. News ranked in the top 10 nationally are:

The other two specialties ranked among the top 50 were cardiology and heart surgery, and urology.

Osteopath examining boy's spine

Early-onset scoliosis etiology has greatest impact on long-term patient-reported outcomes

Osteopath examining boy's spine

A new study found underlying etiology of early-onset scoliosis has a significant impact on long-term patient reported outcomes.

Health-related quality of life is an important parameter to assess in the treatment of early-onset scoliosis (EOS). Understanding the impact of surgical intervention on a patient’s quality of life will help set patient expectations and can be useful in shared decision making around treatment options. A study published in Spine Deformity found underlying etiology of EOS has a significant impact on long-term patient reported outcomes.

What’s been the hold-up in the field?

“There is limited understanding of how our surgical interventions affect patient reported quality of life because a validated patient outcome tool has been lacking,” says Matthew Oetgen, M.D., M.B.A., chief of Orthopaedics at Children’s National Hospital and one of the study’s authors. “The recent development and use of the Early Onset Scoliosis Questionnaire (EOSQ) allows us to assess patient reported outcomes.”

How does this work move the field forward?

Underlying etiology has a significant impact in the long-term patient reported outcome. This information will allow surgeons and families to understand the impact of surgical intervention, set expectations, give a baseline for expected patient benefit from treatments and indicate when other assessments should be undertaken to improve patient outcomes.

How will this work benefit patients?

Many patients report good outcomes with surgical intervention for EOS. This will allow us to reassure patients and families we can make a positive impact in their lives when treating EOS, which is a very stressful diagnosis.

You can read the full study, Impact of surgical treatment on parent-reported health related quality of life measures in early-onset scoliosis: stable but no improvement at 2 years, in Spine Deformity.

x-ray of cervical spine

Experts reach consensus in study using modified Delphi technique

x-ray of cervical spine

The understanding of many aspects of care for children with cervical spine injuries is limited due to the low number of these injuries and the limited experts in the field.

A new study, published in the Journal of Neurosurgery: Pediatrics, brought together an international, multidisciplinary group of pediatric cervical spine experts to generate 45 consensus statements regarding the management of pediatric cervical spine disorders and stabilization using a modified Delphi technique.

What this means

Cervical spine injuries are rare in the pediatric population. The understanding of many aspects of care for children with cervical spine injuries is limited due to the low number of these injuries and the limited experts in the field. Despite this, cervical spine injuries can have devastating outcomes if improperly treated. Consensus around optimal treatment of these injuries from experts is necessary.

“Giving evidence and practical treatment guidelines to these injuries for less experienced centers to follow is important,” says Matthew Oetgen, M.D., chief of the Division of Orthopaedic Surgery and Sports Medicine at Children’s National Hospital and one of the study’s authors. “The goal is to better elucidate the treatment of these injuries to improve care internationally.”

How will this work benefit patients?

Improved guidelines and recommendations for the treatment of patients with cervical spine injuries will lead to more optimal outcomes and decreased complications for pediatric patients with these rare but potentially devastating injuries.

What did you find that excites you?

“We were able to practically define what constitutes abnormalities in pediatric cervical spines — what constitutes injuries and what does not — to improve the assessment of children,” says Dr. Oetgen. “We have improved the understanding of optimal preoperative, intraoperative, postoperative and nonoperative care for these patients to improve outcomes for these injuries.”

How is Children’s National leading in this space?

Although rare, pediatric cervical spine injuries are serious. Limited centers, like Children’s National, have expertise in this area of surgery. This study is the initial legwork towards improving the treatment options of these injuries internationally. Children’s National, along with other institutions, will continue to develop approaches for the management of pediatric cervical spine disorders and stabilization.

You can read the full study, Developing consensus for the management of pediatric cervical spine disorders and stabilization: a modified Delphi study, in the Journal of Neurosurgery: Pediatrics.

growth of the Children's National Spina Bifida Program

A look at the Children’s National Spina Bifida Program

The Spina Bifida Program at Children’s National Hospital, led by co-directors, Christina Ho, M.D., and Briony Varda, M.D., has seen impressive growth and there are plans to continue expanding the program. Drs. Ho and Varda share insights on the multidisciplinary care being provided, along with their plans for the future of the program.

Q: How would you describe the growth of the program?

A: The growth of the Spina Bifida Program has been remarkable! The graph below really shows it all (more than a 25% increase in patient visits in the past year). We currently hold multidisciplinary programs including providers from neurosurgery (Robert Keating, M.D.), orthopaedic surgery (Matthew Oetgen, M.D.), physical medicine and rehabilitation (Mi Ran Shin, M.D.), urology (Briony Varda, M.D. and Christina Ho, M.D.), and expanded to include bowel management (Celicia Little, N.P.), gynecology (Allison Mayhew, M.D.) for our adolescent patients, as well as a dedicated nurse, Nicole Allentuck, R.N., and program associate, Christine Scott.

We are extremely proud of how the program has grown, particularly through the past two years, with the advent of our adolescent clinic and having a dedicated supportive team that ensures we have significant re-engagement of patients who had previously been lost to care. We are also working with the Prenatal Pediatrics Institute at Children’s National to enhance our prenatal care for patients diagnosed with spina bifida.

growth of the Children's National Spina Bifida Program

Q: What advancements is the spina bifida program making that benefit patients?

A: We have developed a transition clinic for our adolescent spina bifida patients to help address goals of care, independence with care and readiness for transition to adult providers. Our program coordinator, Celicia Little, N.P., also oversees our bowel management program to provide specialized bowel management care for our patients. We have been working on educational information specific to different areas within spina bifida, including how to catheterize, common medications, bowel management and anticipatory guidance. This helps to provide longevity for our patients as well.  We are evaluating ways to decrease visits to the emergency department and ensure appropriate antibiotic usage with proper diagnoses of urinary infections in patients who perform CIC.  To further our goal of providing longitudinal care within our program, we have engaged gynecology colleagues to see patients within our adolescent clinic and begin promoting independence through perpetuated discussions (e.g., are they able to schedule their own physician appointments or grocery shop for themselves?) in preparation for adult transitional care. Additionally, we readily offer telehealth visits for convenience and in hopes of easing access to care.

Q: Looking ahead, what’s next for the Spina Bifida Program? How will we continue to measure success?

A: We are excited to continue expanding our Spina Bifida Program. We currently care for more than 500 patients within the Washington, D.C., Maryland and Virginia areas. We want to continue to include patient narratives through our research initiatives to inform quality of care, including decreasing E.D. utilization and needless antibiotic use. We also want to expand our adolescent program to include sexual healthcare as they transition to adult care with our adult collaborators within MedStar and GWU. We would like to provide more comprehensive care, improve access to care, and ensure patients and families have utilization of the armamentaria of medical resources available at Children’s National.

US News Badges

Children’s National named to U.S. News & World Report’s Best Children’s Hospitals Honor Roll

US News BadgesChildren’s National Hospital in Washington, D.C., was ranked No. 5 nationally in the U.S. News & World Report 2022-23 Best Children’s Hospitals annual rankings. This marks the sixth straight year Children’s National has made the list, which ranks the top 10 children’s hospitals nationwide. In addition, its neonatology program, which provides newborn intensive care, ranked No.1 among all children’s hospitals for the sixth year in a row.

For the twelfth straight year, Children’s National also ranked in all 10 specialty services, with seven specialties ranked in the top 10.

“In any year, it would take an incredible team to earn a number 5 in the nation ranking. This year, our team performed at the very highest levels, all while facing incredible challenges, including the ongoing pandemic, national workforce shortages and enormous stress,” said Kurt Newman, M.D., president and chief executive officer of Children’s National. “I could not be prouder of every member of our organization who maintained a commitment to our mission. Through their resilience, Children’s National continued to provide outstanding care families.”

“Choosing the right hospital for a sick child is a critical decision for many parents,” said Ben Harder, chief of health analysis and managing editor at U.S. News. “The Best Children’s Hospitals rankings spotlight hospitals that excel in specialized care.”

The annual rankings are the most comprehensive source of quality-related information on U.S. pediatric hospitals and recognizes the nation’s top 50 pediatric hospitals based on a scoring system developed by U.S. News.

The bulk of the score for each specialty service is based on quality and outcomes data. The process includes a survey of relevant specialists across the country, who are asked to list hospitals they believe provide the best care for patients with the most complex conditions.

The seven Children’s National specialty services that U.S. News ranked in the top 10 nationally are:

The other three specialties ranked among the top 50 were cardiology and heart surgery, gastroenterology and gastro-intestinal surgery, and urology.

inside the sports medicine center

Children’s National launches premier pediatric sports medicine center

inside the sports medicine center

The center houses orthopaedic surgeons, sports medicine physicians, physical therapists and imaging specialists and includes sports performance and injury prevention programs, a state-of-the-art rehabilitation and training gym and a motion capture lab for traditional 3D gait analysis and sports performance improvement.

The Fight For Children Sports Medicine Center at Children’s National is the first facility of its kind dedicated solely to young athletes in the Washington, D.C., region and serves as a one-stop shop for children’s athletic endeavors. The center houses orthopaedic surgeons, sports medicine physicians, physical therapists and imaging specialists and includes sports performance and injury prevention programs, a state-of-the-art rehabilitation and training gym and a motion capture lab for traditional 3D gait analysis and sports performance improvement.

“Children are not just small adults. They are their own entity and have concerns that are specific to them. We’ve developed the center in a way that focuses on young and adolescent athletes,” says Matthew Oetgen, M.D., M.B.A., division chief of Orthopaedic Surgery and Sports Medicine at Children’s National Hospital. “It’s not just about treating the injury — it’s about getting them rehabbed and instilling the confidence that they can get back and play sports again and that there’s not going to be another issue that we can’t solve together.”

Taking care of an athlete and improving their performance includes many steps and providers. The Fight For Children Sports Medicine Center offers integrated care that allows children to recover from injuries, improve their performance and prevent future injuries all under one roof. This makes the treatment plan more cohesive for the care team and more convenient for patients and families.

The Fight For Children’s Sports Medicine Center is now accepting patients in Silver Spring, MD. Visit our website to learn more.

Matthew Oetgen

Matthew Oetgen, M.D., M.B.A, lauded for paper on treating Compartment Syndrome

Matthew Oetgen

For his work in advancing the care for children with complex orthopaedic needs, Matthew Oetgen, M.D., M.B.A., chief of Orthopaedics at Children’s National Hospital, recently accepted the award for Best Basic Science Paper at the 2021 Pediatric Orthopaedic Society of North America (POSNA) annual meeting. Dr. Oetgen co-authored the paper titled “Activation of A Central Immunosuppressive Cascade Prevents Ischemia Reperfusion Injury after Acute Compartment Syndrome in a Murine Model.”

Compartment Syndrome is rare and often difficult to diagnose. It occurs when interstitial pressure exceeds perfusion pressure and results in warm ischemia and cell death due to impaired aerobic metabolism. Following surgical decompression and reperfusion of the extremity, a robust innate inflammatory response results in further tissue injury due to the production of reactive oxygen species and local capillary dysfunction.

The authors described using varenicline, an FDA-approved medication for smoking cessation, to mitigate inflammation after ischemia reperfusion injury in murine models. Twenty-four hours after reperfusion, the treatment reduced acute leukocyte infiltrate, 7 days following reperfusion, the expression of pro-fibrotic genes was reduced and 14 days following treatment, histologic evidence of collagen deposition was also significantly reduced.

“The promising results of this study show that this medication may have the potential to blunt the immune response resulting in better outcomes for children with compartment syndrome,” says Dr. Oetgen.

Watch Dr. Oetgen’s presentation here.

US News badges

For fifth year in a row, Children’s National Hospital nationally ranked a top 10 children’s hospital

US News badges

Children’s National Hospital in Washington, D.C., was ranked in the top 10 nationally in the U.S. News & World Report 2021-22 Best Children’s Hospitals annual rankings. This marks the fifth straight year Children’s National has made the Honor Roll list, which ranks the top 10 children’s hospitals nationwide. In addition, its neonatology program, which provides newborn intensive care, ranked No.1 among all children’s hospitals for the fifth year in a row.

For the eleventh straight year, Children’s National also ranked in all 10 specialty services, with seven specialties ranked in the top 10.

“It is always spectacular to be named one of the nation’s best children’s hospitals, but this year more than ever,” says Kurt Newman, M.D., president and CEO of Children’s National. “Every member of our organization helped us achieve this level of excellence, and they did it while sacrificing so much in order to help our country respond to and recover from the COVID-19 pandemic.”

“When choosing a hospital for a sick child, many parents want specialized expertise, convenience and caring medical professionals,” said Ben Harder, chief of health analysis and managing editor at U.S. News. “The Best Children’s Hospitals rankings have always highlighted hospitals that excel in specialized care. As the pandemic continues to affect travel, finding high-quality care close to home has never been more important.”

The annual rankings are the most comprehensive source of quality-related information on U.S. pediatric hospitals. The rankings recognize the nation’s top 50 pediatric hospitals based on a scoring system developed by U.S. News. The top 10 scorers are awarded a distinction called the Honor Roll.

The bulk of the score for each specialty service is based on quality and outcomes data. The process includes a survey of relevant specialists across the country, who are asked to list hospitals they believe provide the best care for patients with the most complex conditions.

Below are links to the seven Children’s National specialty services that U.S. News ranked in the top 10 nationally:

The other three specialties ranked among the top 50 were cardiology and heart surgery, gastroenterology and gastro-intestinal surgery, and urology.

Boy with scoliosis during rehabilitation

Children’s National first-use of anterior vertebral body tethering system for idiopathic scoliosis

Boy with scoliosis during rehabilitation

On Monday, Feb. 1, 2021, Children’s National Hospital performed the first anterior vertebral body tethering procedure for a child in the Washington, D.C., area. The device is a recently approved option for treating children with idiopathic scoliosis, the most common type of scoliosis. It allows for gradual correction of a spinal deformity through the natural growth of the spine, leading to improvements in spinal alignment while maintaining spinal flexibility.

In August 2019, the U.S. Food and Drug Administration (FDA) approved the first spinal tether system for pediatric patients called The Tether – Vertebral Body Tethering System. This device is attached to the spine during a minimally invasive thorascopic procedure performed by a multidisciplinary medical team, which includes orthopaedic surgery, thoracic surgery and anesthesia.

“This promising technology may help maintain the flexibility of the spine as it grows straighter over time,” says Matthew Oetgen, M.D., chief of Orthopaedics at Children’s National. “Novel devices like The Tether offer additional treatment options for idiopathic scoliosis, which have the potential to improve pediatric surgical outcomes and quality of life for children and adolescents with significant spinal deformities.”

The procedure at Children’s National brought together some the region’s best pediatric orthopaedic and thoracic surgeons, including Dr. Oetgen, Shannon Kelly, M.D., associate chief of Orthopaedic Surgery, and Timothy Kane, M.D., chief of General and Thoracic Surgery.

“Children’s National can offer these types of procedures because the hospital is home to many talented pediatric surgeons across specialties, many of whom are experts in minimally invasive techniques for children,” says Dr. Kane. “We collaborate together, often, because we know that’s the best way to continually improve the care we provide to children and their families.”

Idiopathic scoliosis is the most common type of scoliosis and can occur in children between age 10 and 18 or until they are fully grown. Spinal fusion surgery is the most common treatment for children with the most severe spine curvatures and continues to be the “gold standard” for surgical treatment of this condition. It takes about 3 months for a child or adolescent to fully recover from the procedure. While spinal fusion produces excellent and reproducible outcomes, in certain patients with less severe deformities and significant skeletal growth remaining, vertebral body tethering may offer some benefits over spinal fusion. In clinical trials, the spinal tether was shown to shorten recovery time and increase range of motion. Early diagnosis is vital to dictate which treatment will be most beneficial.