July 9, 2019

This month’s installment of Medically Speaking features Texas Children’s orthopedic surgeon, Dr. John Heydemann, discussing the rising prevalence of obesity in American adolescents and the increased level of difficulty it creates in the treatment of pediatric orthopedic injuries or deformities.

To clearly relate the two, he highlights four specific treatment areas or conditions that are often exacerbated by, or that can contribute to, obesity. These are:

  • Trauma, including increased fracture rates, higher risk of loss of reduction and increased risk of complications
  • Blount’s disease, a growth disorder of the shin bone that causes the lower leg to be angled inward
  • Slipped capital femoral epiphysis, a hip condition that occurs in adolescents and teens
  • Back pain, potentially due to children leading more sedentary lifestyles

Learn more about the services provided and conditions treated by Texas Children’s Division of Orthopedics.

Fighting obesity at Texas Children’s

In addition to contributing to or complicating the treatment of orthopedic injuries, obesity drives significant health outcomes in Texas Children’s patients. Obesity is one of the biggest drivers of preventable chronic diseases and in childhood can lead to high blood pressure and cholesterol, increased risk of type 2 diabetes, asthma and sleep apnea, and joint problems, not to mention the associated psychological ramifications, such as anxiety and depression.

But obesity it a health problem Texas Children’s Hospital is attacking head on.

This year, Texas Children’s included a system-wide BMI goal as part of our Fiscal Year 2019 care quality objectives. The target was to record BMI for 85 percent of the patient population, ages 2 to 19. In addition to recording BMI, an additional target was set to refer or implement counseling and/or education for more than 40 percent of patients with BMI greater than the 85th percentile.

So far this year, Texas Children’s is exceeding those goals. Through March 2019, we’d recorded BMI for more than 87 percent of our patients, and more than 73 percent of those with BMI in the 85th percentile or higher have been referred to or received the resources they need to combat obesity.

About Medically Speaking

Medically Speaking, a video series from Texas Children’s Service Line Marketing, features some of the brightest minds from several Texas Children’s specialty and subspecialty areas. The series is meant to be a helpful educational resource for parents and a convenient way for physicians and other caregivers to stay up-to-date on the latest in pediatric medicine. Viewers can watch talks on a variety of interesting topics, including advancements in surgery, breakthroughs in research, new clinical trials, and novel and back-practice treatments for specific conditions.

Don’t miss future Medically Speaking episodes featured here on Connect, or view additional episodes now.

This presentation is not intended to present medical advice or individual treatment recommendations, and does not supplant the practitioner’s independent clinical judgment. Practitioners are advised to consider the management of each patient in view of the clinical information. All content is shared for informational purposes only, and reflects the thoughts and opinions of the original author. No physician-patient relationship is being created by the use of this presentation. The presentation sets out recommendations based upon similar circumstances and is provided as an educational tool. The presenters are not attorneys, and to the extent this presentation provides commentary on current laws and regulations affecting health care activities, it is not intended as legal advice.

May 13, 2019

The world-class orthopedic care Texas Children’s is known for is now even more accessible for patients who need it.

Texas Children’s and the Division of Orthopedics are proud to offer specialized orthopedic care on Saturday mornings at Texas Children’s Specialty Care Upper Kirby, from 8 a.m. to noon.

“This new offering is really about improving access for our patients and families,” said Chief of Orthopedic Surgery Dr. Brian Smith. “This care expansion functions as a musculo-skeletal urgent care center with expert orthopedic care, providing families quick, direct access to treatment without waiting hours in an emergency room (ER). I’m proud of all the work Janai’ Buxton and the team have done to make this service available and predict this model will be a success – and perhaps lead to similar expansions across the Texas Children’s system.”

Expanding orthopedic care became a goal after a team of experts at Texas Children’s noticed a trend in families in need of early-morning and late-evening appointments. Many parents also inquired about weekend availability. Additionally, the growth of the Division of Orthopedic Surgery over the past three to four years has equipped Texas Children’s to meet more patients where they are, when they need us. The team began putting the pieces into place to improve access.

“Making orthopedic care available on Saturday mornings provides a huge benefit for parents who work during the week, for children with busy schedules, and for families with urgent needs,” said Buxton, physician assistant and clinical lead for Orthopedic Surgery advanced practice providers (APPs). “Parents will appreciate that convenience and can rest easy knowing they’re getting care from experts who specialize in pediatric orthopedics. Additionally, this initiative may help alleviate high volume of non-emergent orthopedic injuries at Texas Children’s Urgent Care locations and reduce overall weight times for our emergency centers across the Houston area.”

When a child is sick or injured, parents have to change their schedules to ensure their child gets the care they need. This can mean missing work, often without pay, to take the child to an appointment. Additionally, if a child is injured at a Friday sporting event, families sometimes have to wait hours in the ER or even wait until the beginning of the week for specialty pediatric orthopedic care.

Now, at Texas Children’s Specialty Care Upper Kirby, patients and families can be seen on Saturday mornings by an APP specially trained in orthopedic injuries and conditions. Services provided include:

  • Fracture evaluations, including X-ray
  • Injury evaluations for knees, ankles, arms, wrists, etc.
  • Routine injury or surgical follow-up appointments, at the discretion of the patient’s surgeon or physician

Appointments and walk-ins are welcome. Parents should note that not all conditions will be seen during this clinic.

More information about Orthopedics at Texas Children’s, and about making orthopedic appointments at Upper Kirby and other Texas Children’s locations, is available online.

February 4, 2019

On February 1, Texas Children’s officially welcomed Dr. Brian Smith as the new chief of the Division of Orthopedic Surgery.

“I am delighted that Dr. Smith has joined the Texas Children’s family,” said Surgeon-in-Chief Dr. Larry Hollier. “We believe he will provide seasoned leadership and mentorship for our Orthopedic Surgery faculty and staff.”

As chief of the Division of Orthopedic Surgery, Smith now helms one of the premier pediatric orthopedic surgery programs in the nation, with extensive expertise in the treatment of a variety of conditions, from minor fractures and sports-related injuries, to complex trauma and congenital and developmental disorders.

“I am honored and humbled to join the faculty at one of the very best children’s hospitals and pediatric orthopedic surgery programs in the country,” said Smith. “This division is poised to rise to an even higher level, and I couldn’t be more excited to help it get there.”

Smith joins Texas Children’s from Yale New Haven Children’s Hospital, where he served as Director of Pediatric Orthopedics for the past 11 years and also as Interim Surgeon-in-Chief from 2011 to 2012. Additionally, he served as Yale School of Medicine’s Orthopedic Surgery Residency Director from 2012 to 2018, with 25 residents and rotations at five area institutions.

Smith earned his medical degree and completed his orthopedic residency at Georgetown University School of Medicine before serving four years in the U.S. Air Force as an orthopedic surgeon, where he held the rank of major. He then completed a fellowship in pediatric orthopedic surgery at Boston Children’s Hospital.

Clinically, Smith’s primary interests are spinal deformities and spine surgery. Research interests include spinal deformity in children, maturity indicators in children to assess risk of scoliosis progression, and neuromuscular disorders and fractures.

An active member of the orthopedic professional community, Smith has served on the Board of Directors for the American Academy of Orthopaedics and the orthopedic section of the American Academy of Pediatrics. He has also been health council chair for the Pediatric Orthopaedic Society of North America and chairman of the ethics committee for the Scoliosis Research Society.

In addition to his clinical and research expertise, Smith brings a bright vision of the future for the Division of Orthopedic Surgery.

“My goal is to help us achieve even greater recognition as one of the preeminent destinations nationally and internationally for pediatric orthopedic care,” Smith said. “The opportunity to help this team reach new heights in terms of improving patient care and outcomes, facilitating research, and educating the next generation of pediatric orthopedists is incredible, and I’m looking forward to meeting the challenge.”

Learn more about the Division of Orthopedics and the services we offer.

June 26, 2018
Texas Children’s Hospital has once again been named as a national leader among pediatric institutions by U.S. News & World Report in their recently published 2018-19 edition of Best Children’s Hospitals.

Ranked fourth among all children’s hospitals nationally and one of only 10 hospitals to achieve the Honor Roll designation for the tenth straight year, Texas Children’s is the only hospital in Texas – and the entire Southern region of the U.S. – awarded this coveted distinction.

“Each year, our Texas Children’s team exhibits incredible strength and kindness, as well as passion, caring for the inspirational children and families we serve,” said Texas Children’s President and CEO Mark Wallace. “I believe this is one reason why we continue to maintain the respect and reputation as one of the best hospitals in the nation, and the destination for pediatric care in Texas.”

In addition to ranking children’s hospitals overall, U.S. News & World Report also ranks the top 50 pediatric hospitals in 10 major sub-specialty areas. To be considered for the honor roll distinction, a hospital must have high rankings in at least three sub-specialties. For the second straight year, Texas Children’s Heart Center ranks No. 1 in the nation for pediatric cardiology and heart surgery. Texas Children’s Pulmonology ranks as the best program in the country for children with lung diseases.

Texas Children’s has 8 subspecialties ranked in the top 10, and the hospital improved outcomes across all sub-specialties. There are approximately 190 children’s hospitals in the U.S. and this year, 86 of the 189 surveyed hospitals were ranked among the top 50 in at least one sub-specialty. The 2018-19 Best Children’s Hospitals Honor Roll recognizes the 10 hospitals with the highest rankings across all sub-specialties. Here are a few highlights of this year’s rankings for Texas Children’s:

  • Cardiology and Congenital Heart Surgery is again no. 1 in the nation and received the top score in externally reported risk-adjusted operative mortality for congenital heart surgery.
  • Pulmonology, which first debuted in the top spot in the 2016 rankings, is now again ranked no. 1 in the nation. We received the top score in several asthma outcomes and structure metrics, such as mean LOS for asthma patients.
  • Neurology and Neurosurgery moved from no. 4 to no. 3, receiving the top score in several outcomes metrics, such as 30-day readmissions for craniotomy and Chiari decompression and complication rate for epilepsy surgical procedures.
  • Nephrology also moved from no. 4 to no. 3, with the top score in one-year kidney transplant graft survival and hemodialysis catheter-associated bloodstream infections.
  • Urology moved from no. 6 to no. 4, propelled by the top score in unplanned hospital admission for urologic issues within 30 days of surgery, as well as significant improvements in hypospadias and revision surgeries.

Texas Children’s, working closely with our academic partner Baylor College of Medicine, continues to pioneer advancements in pediatric health care and earns the U.S. News honor roll distinction by being ranked among America’s best in:

  • #1 Cardiology and Congenital Heart Surgery
  • #1 Pulmonology
  • #3 Neurology and Neurosurgery
  • #3 Nephrology
  • #4 Gastroenterology and GI surgery
  • #4 Urology
  • #6 Cancer
  • #6 Diabetes and Endocrinology
  • #15 Orthopedics
  • #21 Neonatology

This year’s rankings are the results of a methodology that weighs a combination of outcome and care-related measures such as nursing care, advanced technology, credentialing, outcomes, best practices, infection prevention and reputation, among others.

“From a measurement perspective, our survey results demonstrate how hard we’re working as an organization to deliver high quality care to our patients,” Wallace said. “The more consistently we deliver high quality care and the safer we deliver that care to our patients, the better their outcomes are, and the better our overall numbers are.”

Our results continue to reflect the diligent efforts of a solid structure focused on the U.S. News survey. The process of compiling and refining our data is an ongoing challenge, which will continue to improve under the excellent leadership of Trudy Leidich, Elizabeth Pham and the entire USNWR team.

The 2018-19 edition of Best Children’s Hospitals is available online at www.usnews.com/childrenshospitals.

August 15, 2017
Orthopedic Surgeon Dr. Scott McKay was recently named a recipient of the 2017 Pediatric Orthopaedic Society of North America (POSNA) /Sociedad LatinoAmericana de Orthopedia Y Traumatologia Infantil (SLAOTI) Traveling Fellowship Award to South America.

McKay, alongside two other pediatric orthopedic surgeons, will spend the first two weeks of October in Argentina and Chile visiting and learning new techniques and exchanging ideas with their South American counterparts. The surgeons will end their trip in Brazil at the POSNA/SLAOTI meeting.

McKay, who specializes in injuries to the pediatric/adolescent athlete, was awarded the travel grant in March.

POSNA is a non-profit professional organization of over 1,200 surgeons, physicians and allied health members who are passionately dedicated to advancing musculoskeletal care for children and adolescents through education, research, quality, safety and value initiatives, advocacy, and global outreach to children in underserved areas.

The POSNA/SLAOTI annual traveling fellowship to South America allows three POSNA members a year to travel abroad and three members of an alliance society to tour in North America annually.

March 14, 2017

Texas Children’s Hospital recently launched a pediatric orthopedic surgery physician assistant fellowship program that provides advanced pediatric orthopedic subspecialty training to physician assistants. The program is the first of its kind in the country to offer a 12-month didactic and clinical pediatric-specific training program.

“Our fellowship ensures a unique opportunity to gain experience in pediatric orthopedic surgical subspecialties and to participate in leading edge work, both through didactic and clinical opportunities,” said Chief of Orthopedic Surgery Dr. John Dormans. “The fellowship also demonstrates the commitment Texas Children’s has to advancing the field of pediatric orthopedic surgery and the passion it has for surgical education and research.”

The year-long program includes 10 months of core clinical rotations through the pediatric orthopedic surgical subspecialties at Texas Children’s Hospital. Fellows also will be given two elective months to repeat rotations through a subspecialty of their choosing. All training is provided within the Texas Children’s system, both in the Medical Center and surrounding locations, by department supervising physicians.

Megan Lomax, from Arkansas, and Darius Dranginis, from San Antonio by way of Lithuania, are the programs first fellows. With just two months of the program under their belts, both said they already have learned so much.

“I’ve already learned more than I expected,” Dranginis said. “I am surrounded by top professionals in their field who are always willing to help and that makes a big difference.”

Lomax said the fellowship has been the opportunity of a lifetime and is giving her a chance to give back to patients the way medical staff gave to her when she came to Texas Children’s in college to receive surgery for an eye condition called strabismus.

“I feel like I have come full circle in my experiences as a patient and now fellow provider at Texas Children’s,” she said. “I love being surrounded by healthcare providers who share the same passion for kids as I do, and I look forward to learning all that I can about orthopedics during this fellowship year.”

The launch of the pediatric orthopedic surgery physician assistant fellowship follows the start of the Texas Children’s Hospital surgical physicians assistant fellowship program in 2015. The program touted by the Association of Postgraduate Physician Assistant Programs as an “innovative fellowship program” graduated four fellows during its first year and six fellows in 2016. Another six fellows began the program in January.

“The program is drawing people from across the world, which speaks to the visibility and the quality of the program as a whole,” said Fellowship Program Medical Director and Chief of Plastic Surgery Dr. Larry Hollier. “Having an opportunity in a subspecialty such as orthopedics will just add to that allure and will most likely open doors to programs in other subspecialties.”

January 17, 2017
11817POSNA640The Texas Children’s Hospital Division of Orthopedic Surgery recently hosted the second annual meeting of the Children’s Orthopedics Trauma and Infection Consortium for Evidence Based Study (CORTICES).

Organized by local hosts Dr. Scott Rosenfeld and Dr. Jaclyn Hill, the January 8-9 meeting was attended by about 20 physicians and investigators from peer hospitals across the country. Supported in part by a Texas Children’s Hospital Auxiliary Research Grant for the study of regional variations in pediatric musculoskeletal infections, the group met to discuss preliminary data that has been collected from nearly 15,000 pediatric patients around the country. Additionally, the group began plans for future research projects in the field of pediatric musculoskeletal trauma and infection.

The Texas Children’s Hospital Orthopedic Surgery and Sports Medicine Programs focus on the study and treatment of musculoskeletal conditions in order to advance knowledge, prevent disease, improve health and ensure the highest level of individualized care for patients from newborns to young adults. With more than 30 Pediatric Orthopedic Surgeons and Advanced Practice Providers, Texas Children’s Orthopedics is recognized as a leader in research, teaching, and the clinical care of children not only across Houston, Texas but around the world.