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Benjamin Martin and Anjna Melwani

Children’s National orthopaedic surgery experts prepare for the 2018 POSNA annual meeting

The Pediatric Orthopaedic Society of North America (POSNA) will hold its 2018 annual meeting May 9-12, 2018 in Austin, TX. POSNA is dedicated to improving the care of children with musculoskeletal disorders through education, research and advocacy. Along with 1,400 othopeadic surgeons, physicians and other health care professionals, experts from Children’s National will attend and participate in the following activities:

  • Matthew Oetgen, M.D., M.B.A., Division Chief of Orthopaedic Surgery and Sports Medicine, along with hospitalists Rita Fleming, M.D., and Anjna Melwani, M.D., will give a presentation on quality, safety and value titled, “Hospitalist co-management of pediatric orthopedic patients improves outcomes and quality processes.”
  • Danielle Putur, M.D., Miguel Pelton, M.D., Niharika Patel, M.P.H., and Emily Niu, M.D., will present a poster titled, “ACL growth with age in the skeletally immature: an MRI study.”
  • Benjamin Martin, M.D., will present a poster titled, “The effectiveness of intrathecal morphine compared to oral methadone for postoperative pain control after posterior spinal fusion for adolescent idiopathic scoliosis.”
Benjamin Martin, M.D., and Anjna Melwani, M.D., are among the experts from Children’s National who will be presenting at the POSNA annual meeting.

Benjamin Martin, M.D., and Anjna Melwani, M.D., are among the experts from Children’s National who will be presenting at the POSNA annual meeting.

As a newly elected POSNA board member, Dr. Oetgen will also preside over the clinical award session, as well as chair the Spine Subspecialty Day, which is designed to update surgeons on current, cutting-edge topics and provide tips and tricks on a range of issues related to adolescent idiopathic scoliosis and moderate a discussion at this year’s meeting.

Additionally, Benjamin Martin, M.D., recently won the 2017 POSNA Clinical Trials Planning Grant – “The Treatment of Pediatric Diaphyseal Femur Fractures: A Clinical Trials Planning Grant.”

Visit the POSNA website to find out more information on this year’s conference.

Matthew Oetgen

3D printed implant used to repair knee cartilage

Matthew Oetgen

“Our preliminary study shows this novel 3D printed material is able to allow ingrowth from the bone, so the body started to grow into the material to help fix it in place,” says Matthew Oetgen, M.D., M.B.A. “These are the first step requirements for an implant like this to be acceptable for treating lesions.”

Every year, an estimated 1 million children tear the articulate cartilage that lines their knees. Unfortunately, these types of injuries are extremely hard to repair because of the cartilage’s poor healing qualities and unique physiochemical properties.

Now, a new study by Children’s National Health System researchers has found that a three dimensional (3D) printed synthetic implant can be successfully used as a scaffold to encourage the healing and repair of articulate cartilage lesions.

Three bones meet in the knee joint: the femur, the tibia and the patella. The surface of these bones is covered with articulate cartilage, which can be damaged by injury or by normal wear and tear. Because articulate cartilage has poor healing qualities, these injuries will rarely heal or regenerate on their own, especially in younger and more active patients.

“These are active 12 to 19 year olds, so it can really affect relatively normal kids,” says Matthew Oetgen, M.D., M.B.A., Division Chief of Orthopaedic Surgery and Sports Medicine at Children’s National. “While there are many ways to repair these lesions — from implanting autogenous cells to using grafts to fill the defect — none of these options are perfect, and they all have some down sides.”

To facilitate repair of these injuries, a team of researchers led by Dr. Oetgen received a grant from the Pediatric Orthopaedic Society of North America (POSNA) to design a 3D printed implant that promotes bone and cartilage growth.

To make the implant, the team used nanoporous thermoplastic polyurethane (TPU), a biodegradable material that is highly elastic and yet strong, very much like the native cartilage in the osteochondral region. TPU is also porous, which allows blood and nutrient flow through the implant.

“The implant is designed to allow native cells to repair the lesions with normal articular cartilage and not scar tissues like some repairs,” says Dr. Oetgen.

The implant itself has a stratified structure: an upper region that contains micro channels to allow for increased perfusion; a middle zone with a nanoporous structure that mimics porous cartilage and encourages stem cell recruitment, growth and differentiation; and a lower region, or articular surface, that allows for smooth transition from the articulating surface to the implant surface and minimizes adverse interactions between the articulate cartilage and the meniscus.

When tested in vitro, the implant was able to support the growth of stem cells and vascular cells, and structurally mature vascularized bone was formed around the implant after 10 days. In animal models with full thickness osteochondral lesions the implant did just as well: The scaffold was able to promote bone, soft tissue and vascular growth without eliciting an immune response.

“Our preliminary study shows this novel 3D printed material is able to allow ingrowth from the bone, so the body started to grow into the material to help fix it in place,” says Dr. Oetgen. “These are the first step requirements for an implant like this to be acceptable for treating lesions.”

Because of the ease with which 3D printing can be scaled up, Dr. Oetgen is hopeful that the implant will one day become a viable option for repairing articulate cartilage injuries. He plans on trying the implants in a larger animal model and on larger lesions, and is also looking at custom printing for the implants to match natural lesion shapes and sizes.

Femoral fracture

POSNA grant addresses variations in femoral fracture treatment

Femoral fracture

While there are plenty of options for treating pediatric femoral diaphyseal fractures, doctors don’t have a lot of specific guidance on the optimal regimen for each patient age, fracture location and fracture pattern.

Pediatric femoral diaphyseal fractures are some of the most common types of long bone fractures. There are many effective ways to treat these injuries, but unfortunately this assortment of options also leads to variations in cost and clinical outcome for patients and makes it difficult to develop clinical trials exploring the treatment of pediatric femur fractures.

To address this issue, a Children’s National research team led by Matthew Oetgen, M.D., M.B.A., Division Chief of Orthopaedic Surgery and Sports Medicine, received a $30,000 grant from the Pediatric Orthopaedic Society of North America (POSNA) to design a multi-centered, randomized, controlled clinical trial for the treatment of pediatric diaphyseal femur fractures. The team’s ultimate goal is to submit the resulting trial design to an extramural agency for study funding.

While there are plenty of options for treating pediatric femoral diaphyseal fractures, doctors don’t have a lot of specific guidance on the optimal regimen for each patient age, fracture location and fracture pattern. As a result, many treatment decisions are based on surgeon preference, regional variation in care and previous training or experience.

Another issue that arises in the treatment of diaphyseal femur fractures is the impact on the patient’s family. In general, femur fractures are caused by significant trauma that affects both the patient and the family members. On top of this, families are faced with issues such as extended hospitalization, the need for wheelchairs and walkers, pain control, missed school and secondary surgeries for removal of implants. Often, families are left to their own devices to resolve these issues, many of which are more impactful than the injury itself.

Dr. Oetgen believes that a well-planned and well-structured randomized clinical trial guided by patient and family concerns as well as expert surgical opinion has the potential to improve both treatment and care of femoral diaphyseal fracture patients.

“It is no longer good enough to design studies that only look at healing time for femur fractures,” explains Dr. Oetgen. “These injuries have such significant secondary impacts for the families of these patients, we need to determine which treatment is optimal for both fracture healing and is easiest for the families to tolerate. This grant will allow us to consider all of these outcomes in designing a study to find the best treatment for these injuries.”

To aid in the design of their clinical trial, Dr. Oetgen and his team will:

  1. Conduct an extensive literature review on the impact and treatment of pediatric femur fractures.
  2. Survey a diverse group of pediatric orthopaedic surgeons to establish areas of agreement, opposition and equipoise on the surgical treatment of pediatric femur fractures, and use that information to form a consensus opinion on the optimal design of the clinical trial.
  3. Solicit input from non-physician stakeholders (families, parents, payers, state Medicaid representatives, patient advocacy groups, professional organizations) on the important aspects of care in pediatric femur fracture treatment.

The team expects to have the study design competed by February 2019.

POSNA awards clinical trials planning grant to Children’s National

Children’s National Health System has received a prestigious grant from the Pediatric Orthopaedic Society of North America (POSNA) to investigate pediatric femur fractures. The Clinical Trials Planning Grant in the amount of $30,000 will propel work to develop a clinical trial focused on femur fractures, with the ultimate goal of designing a multicenter trial for surgical treatment of pediatric femur fractures.