Tag Archive for: Tabaie

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.

post-op x-ray of internal brace augmentation surgery

Innovative internal brace augmentation improves long-term foot stability

The use of internal brace (IB) augmentation leads to significantly improved long-term foot stability in flatfoot reconstructive surgery for children with cerebral palsy (CP) and pes planovalgus (flat foot) deformities, according to data presented by researchers at the American Academy for Cerebral Palsy and Developmental Medicine annual meeting.

Moving the field forward

The study looked at 58 patients − 31 without IB augmentation and 27 with IB augmentation. Both cohorts maintained improved radiographic indices at the final 24-month timepoint. However, weightbearing radiographs for the IB augmentation group had less midfoot collapse, maintaining a statistically significant difference in all radiographic parameters two years following the index procedure.

“Internal brace augmentation is an innovative surgical technique that provides additional stability to the medial column soft tissues following lateral collateral ligament (LCL) surgery,” says lead author Sean Tabaie, M.S., M.D., F.A.A.O.S., pediatric orthopaedic surgeon at Children’s National Hospital and  developer of this surgical technique.

The patient benefit

“Pes planovalgus deformities are common in children with CP and with painful progression, surgery is often indicated,” says Dr. Tabaie. “This procedure will help prevent mid-foot collapse and better maintain long-term foot shape when weightbearing.”

This novel surgical technique helps to maintain proper biomechanical orientation of the foot following LCL for correction of a pes planovagus foot deformity in the ambulatory pediatric CP population. Patients who received IB augmentation demonstrated consistently better radiographic parameters, including talar-first metatarsal angles and talonavicular coverage angles compared to those who underwent surgery without IB augmentation.

Children’s National Hospital leads the way

Children’s National demonstrates leadership in this area through its involvement in innovative clinical research including the surgical approach outlined in this study. This work is unique for two reasons:

  • Patient population: The study focuses on a specific and complex patient population—children with CP and pes planovalgus foot deformities. This highlights Children’s National Hospital’s commitment to addressing the individual healthcare needs of pediatric patients with special conditions.
  • Surgical innovation: The use of IB augmentation as a surgical technique is innovative. Children’s National is at the forefront of exploring new approaches to improve outcomes and quality of life for children with CP.

girl hugging boy in wheelchair

Comparison of immobilization techniques following hip reconstruction surgery in children with cerebral palsy

girl hugging boy in wheelchair

Currently, there is no standardized protocol or consensus regarding post-operative immobilization following hip reconstruction in children with cerebral palsy or with other neuromuscular conditions.

A new study, led by Sean Tabaie, M.D., and published in Cureus, evaluated the effects of several methods of postoperative immobilization to determine which technique has the fewest complications.

Why it matters

Currently, there is no standardized protocol or consensus regarding post-operative immobilization following hip reconstruction in children with cerebral palsy or with other neuromuscular conditions.

What we learned

Findings provide evidence that there are no significant clinical ramifications of using less restrictive immobilization types such as abduction pillows in patients undergoing hip reconstruction surgery. There was no significant difference in length of stay, pain control duration or complication rates among the three methods of immobilization tested in the study.

What’s next

Further analysis is warranted to gather sufficient data of patients immobilized with an abduction pillow after skeletal osteotomies in conjunction with an anterior hip open reduction to definitively recommend its use versus a more restrictive option in the setting of an open reduction.

You can read the full study “Evaluating Postoperative Immobilization Following Hip Reconstruction in Children with Cerebral Palsy” in Cureus.

3d illustration of a lumbar spine injection

Epidural analgesia best option for kids after neuromuscular hip reconstruction?

3d illustration of a lumbar spine injection

A study showed that post-operative use of epidural analgesia in patients with neuromuscular conditions provided similar outcomes to traditional pain management regimens.

Sean Tabaie, M.D., pediatric orthopaedic surgeon and medical director of the motion capture lab at Children’s National Hospital, led a retrospective study to determine whether post-operative use of epidural analgesia in patients with neuromuscular conditions, such as cerebral palsy, provided similar outcomes with regard to pain scores, length of stay, duration of foley placement, duration of pain control and complications as compared to traditional pain management regimens.

The study showed that the use of epidural analgesia was associated with comparable pain scores, despite the increased length of stay and duration of Foley placement.

Why it matters

Neuromuscular conditions, such as cerebral palsy, are the most common motor disabilities in the pediatric population. Children with these conditions frequently have accompanying hip deformities that require pelvic and femur osteotomy to correct the spastic hip dislocations.

Studies suggest that children with cerebral palsy already experience twice as many complications and have high reoperation rates following hip surgery compared to their non-cerebral palsy counterparts. Therefore, to optimize outcomes in an already at-risk patient population – likely to undergo multiple procedures to correct musculoskeletal abnormalities – it is crucial to minimize opioid usage given its addictive nature and side effects such as constipation, sedation and tolerance.

Sean Tabaie

Dr. Sean Tabaie

What’s next

“We believe the present study can serve as a foundation for future prospective and multi-center studies, which should aim to investigate dose and timing of epidural analgesia in children with neuromuscular conditions with a particular focus on surgical approach, side effects and time to return to activity,” says Dr. Tabaie.

Given the scarcity of data surrounding the use of epidural anesthesia in children with neuromuscular conditions, future research should seek to further investigate the efficacy of epidural analgesia for post-operative pain management in children with neuromuscular conditions.

You can read the full study “Use of Epidural Analgesia in Children With Neuromuscular Conditions Following Hip Reconstruction” in Cureus.

Authors on the study from Children’s National include Sean Tabaie, M.D.

images of baby's legs and casts

Innovation in clubfoot management using 3D anatomical mapping

Idiopathic clubfoot is one the most common congenital deformities of the lower extremity. Its incidence is reported to be 1-2 cases per 1000 live births.

While clubfoot is relatively common and the treatment is highly successful, the weekly visits required for Ponseti casting can be a significant burden on families. Researchers at Children’s National Hospital are looking for a way to relieve that burden with a new study that could eliminate the weekly visits with a series of 3D-printed casts that families can switch out at home. The study, presented at the SPIE Medical Imaging Conference 2022, uses a novel photogrammetry method to gather 3D surface images of infant clubfoot anatomy and assess the foot position and correction.

Even better, this approach captures the images without additional radiation exposure.

“We’re not changing the gold standard of Ponseti casting, we’re adding to it,” says Sean Tabaie, M.D., orthopaedic surgeon at Children’s National and one of the study’s authors. “The more families we have in this study the greater the potential to move this field forward.”

Read more about the study, Development of a novel photogrammetry method for acquiring 3D surface models of infant clubfoot anatomy.

boy with cerebral palsy

Race and salvage hip procedures in cerebral palsy

boy with cerebral palsy

The authors discovered that Black patients had an increased risk compared to white patients of undergoing a salvage procedure for hip dysplasia.

A new study by Children’s National Hospital orthopedic surgeon Sean Tabaie, M.D., FAAOS, examined whether or not race is an independent risk factor for patients with cerebral palsy to undergo a salvage hip procedure or experience postoperative complications for hip dysplasia treatment.

Due to tone issues, patients with cerebral palsy are specifically prone to hip dislocation. Treatment modalities for these patients include preventive soft tissue release, reconstruction and salvage procedures. Reconstructive surgery of the hip joint is considered the gold standard with the goal of producing a mobile and painless hip. Salvage procedures are defined as operations that are used after there has been permanent changes to anatomy of the femur and/or pelvis. In the case of patients with cerebral palsy, when hip reconstruction is no longer an option, salvage procedures are considered a last resort, if not a radical solution, to improve quality of life and pain relief.

Using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric database, Dr. Tabaie and colleagues examined data from 3,906 patients with cerebral palsy between the ages of 2 and 18 years undergoing a procedure for hip dysplasia. They discovered that Black patients had an increased risk compared to white patients of undergoing a salvage procedure for hip dysplasia. Additionally, Black patients were found to have an increased risk of any postoperative complication compared to white patients. Fortunately, there were no significant findings between the race and risk of surgical site complications, unplanned readmissions or reoperations.

The authors conclude that, “After controlling for variability in baseline characteristics, the present results suggest that patient race is independently associated with the risk of pediatric patients with cerebral palsy to both undergo a salvage hip procedure and to experience postoperative medical complications, with Black patients having increased odds for these unfavorable outcomes compared to white patients.”

Dr. Tabaie is the medical director of the Motion Capture and Gait Lab at The Fight for Children Sports Medicine Center at Children’s National Hospital as well as assistant professor of Orthopaedic Surgery and pediatrics co-chair of Diversity, Equity and Inclusion for the Joseph E. Robert Jr., Center for Surgical Care.

Read the full article, Race Is Associated With Risk of Salvage Procedures and Postoperative Complications After Hip Procedures in Children With Cerebral Palsy, in the Journal of Pediatric Orthopaedics.

Sean Tabaie

Sean Tabaie, M.D., discusses the diagnosis and treatment of Osgood-Schlatter disease

Osgood-Schlatter disease (OSD) occurs when there’s an inflammation of the area just below the knee where the patellar tendon attaches to the tibia. It commonly occurs in adolescents during growth spurts, causing knee pain. Children who participate in sports or activities that involve a lot of running or jumping are at an increased risk of developing OSD.

Sean Tabaie, M.D., pediatric orthopaedic surgeon at Children’s National Hospital, spoke to KinectMD about OSD symptoms, diagnosis and treatment. Watch the interview below.

Hand using laptop and press screen to search

An assessment of orthopedic surgery residency program websites

Hand using laptop and press screen to search

The competitiveness of the orthopedic surgery specialty combined with the unclear impact of the COVID-19 pandemic on residency recruitment has presented significant challenges to applicants and residency program directors during the pandemic. With limited in-person opportunities in the 2020-2021 application cycle, applicants have had to gauge chances and best fit by browsing program websites.

In an observational study published in the Journal of Medical Internet Research Medical Education, Sean Tabaie, M.D., orthopaedic surgeon at Children’s National Hospital, and co-authors assessed the accessibility and content of accredited orthopedic surgery residency program websites during the COVID-19 pandemic.

The authors looked at a total of 189 accredited orthopedic surgery residency programs that were identified using the online database of the Electronic Residency Application Service (ERAs). They found that most residency program websites offered program details and an overview of educational and research opportunities, however, few addressed the virtual transition of interviews and sub-internships during the COVID-19 pandemic.

Read the full article in the Journal of Medical Internet Research Medical Education.

x-ray of child with dislocated hip

Hip surveillance helps identify dislocations in children with cerebral palsy

x-ray of child with dislocated hip

Hip surveillance is a process used to monitor the hips closely and frequently, identifying the problems earlier.

Children with cerebral palsy (CP) have an increased risk for hip displacement. Hip displacement in children with CP can happen slowly over time and can be painful, but a hip surveillance program can prevent this. Hip surveillance is a process used to monitor the hips closely and frequently, identifying the problems earlier. It is an ongoing process that continues for every child until skeletal maturity.

“Every child with cerebral palsy should be referred for hip surveillance regardless of determination by the Gross Motor Function Classification System,” said Sean Tabaie, M.D., orthopaedic surgeon at Children’s National Hospital.

Dr. Tabaie created a hip surveillance manual for primary care providers who care for this patient population. In most cases, these patients are monitored and followed closely by their primary care team. Education material regarding hip surveillance, including the background knowledge, is often not available to those practitioners in a concise format. To successfully initiate a hip surveillance program, it is important to promote education and provide the appropriate materials to that group of practitioners.

“Our goal is to improve the care of children with cerebral palsy by decreasing the overall presentation of dislocated hips in our clinic settings and promote the appropriate timing of referrals for evaluation of hip subluxation secondary to cerebral palsy or neuromuscular conditions,” said Tabaie.

Download the Surveillance Guidelines for Children with Cerebral Palsy here.

little girl in wheelchair

A holistic and proactive approach to the management of the patients with cerebral palsy

little girl in wheelchair

The cerebral palsy program at Children’s National Hospital takes a comprehensive approach to meet children’s needs from infancy through young adulthood.

Though children with cerebral palsy (CP) often require significant rehabilitative and surgical support, most often each service is provided in the individual specialty itself. Patients and their families frequently experience a great deal of stress coordinating care, getting to appointments, keeping track of medications and managing treatments on their own.

However, the CP program at Children’s National Hospital, co-led by an orthopaedic surgeon, Sean Tabaie, M.D., and a pediatric rehabilitation specialist, Olga Morozova, M.D., working together and in collaboration with Shannon Kelly, M.D., (Orthopaedics) and Jeff Rabin, D.O., (Physical Medicine and Rehabilitation) has evolved into a truly comprehensive approach. The program is designed to meet the needs of these children from infancy through young adulthood with the goal of improving function and preventing musculoskeletal deformities and complications.

Providing children and their families with a single point of care coordination allows the care team to track and anticipate a multitude of potential challenges for each child as early as possible and intervene in smaller ways before they bring pain and long-term complications or require major surgical interventions. Key highlights of this collaborative program include:

  • Hip surveillance: Patients with CP are followed closely to identify hip pathology prior to serious subluxation or dislocation. Early identification allows for the use of medical or surgical interventions to prevent a minor issue from becoming a major one.
  • Serial casting for children with early signs of muscle contractures: Dr. Morozova uses agents to relax the muscles and Dr. Tabaie applies the cast in the operating room followed by continued weekly serial casting in the clinic. “Proper medical management and bracing at regular intervals can improve muscle function and prevent the need for larger surgeries and more intense rehabilitation later,” says Dr. Morozova.
  • Advanced coordination between physical therapy in the hospital and outpatient services in the region, building on the hospital’s partner agreement with the HSC Health Care System.
  • Single event multi-level surgeries (SEMLS): Ensuring that surgical procedures capture all surgical needs at one time by assessing the entire anatomy and scheduling multiple surgical or pharmaceutical interventions to occur in a single session.

The doctors point out that offering these services in one cohesive location and combining treatments into the same appointment or procedure date is something that many patients with CP and their families truly appreciate.

“I think families of children with CP will travel great distances if the care they receive is comprehensive and eliminates some of the back and forth travel they do now,” says Dr. Tabaie.

Today, the team sees close to 100 patients with CP per month and hopes to expand to reach as many families in the region and beyond who need them.

Dr. Tabaie says, “Our goal is to identify patients early and start managing them to help their quality of life today, prepare them to grow as healthily and in as little pain as possible and set them up to be as healthy as they can possibly be as adults, too.”

Dr. Sean Tabaie at the Limb Deformity Course

Orthopaedic surgeon shares expertise at Baltimore Limb Deformity Course

Dr. Sean Tabaie at the Limb Deformity Course

Dr. Tabaie oversees a hands-on lab session focused on teaching orthopaedic surgeons and other allied health professionals proper assessment and placement of corrective hardware for limb deformities.

Sean Tabaie served as a lab instructor to guide hands-on applications of the latest devices for treatment of limb deformities.

Earlier this year, Children’s National orthopaedic surgeon Sean Tabaie, M.D., served as a faculty member for one of the most highly regarded courses focused on limb deformities, the 29th Annual Baltimore Limb Deformity Course. The course is presented each year by the International Center for Limb Lengthening.

The event brings together nearly 400 orthopaedic physicians, podiatrists and allied health professionals from 36 countries and 33 states to learn from pre-eminent surgical experts in these conditions. The three-day meeting provides lecture content as well as hands-on opportunities to practice care and treatment of limb deformities in both adults and children.

Dr. Tabaie served as a lab instructor, sharing expertise and in-depth knowledge from the pediatric perspective about how to assess limb alignment and plan corrections for specific deformities. The faculty teams also outlined current best practices for correction of several specific deformities, including Blount’s deformity, using internal and external devices.

“It was an honor to be asked to serve as faculty alongside these pre-eminent leaders in the field of limb deformity,” he says. “It is workshops like these that give us the opportunity to share what we know and also learn from the experience of others. And ultimately, lending expertise to these courses helps everyone more effectively assess and treat limb deformities in children and adults around the world.”

Read more about the course’s esteemed history and its 2020 schedule.