#SRHaccess Facebook LIVE Recap: Limb Lengthening – Intramedullary Lengthening

by | Aug 17, 2018 | Limb Lengthening

On this week’s Facebook live, Co-director of the Center for Excellence in Limb Lengthening David A. Podeszwa, M.D. joined us to discuss intramedullary lengthening – a form of treatment for our limb lengthening and reconstruction patients.

 the Facebook live.

Watch –What is intramedullary lengthening and how does it work?

  • It is a technique of lengthening the bone that uses a rod that is surgically planted inside the bone, lengthening it over time using a magnet or an electrical current.

When is intramedullary lengthening used as a treatment plan?

  • Ideal for patients who have a leg-length discrepancy over 4 or 5 centimeters at the time that they’re done growing.
  • Intramedullary technique works better in patients who have straight bones

What’s the difference between the external fixators and intramedullary rods?

  • Usually, an intramedullary rod is preferred over an external fixator.
    • Quality of life is better for patients with intramedullary rods.
    • Less pain for the patient, and less care required with intramedullary rods.

Different types of intramedullary rods:

  • Magnetic rod – a magnet slowly lengthens the rod inside the bone
  • Electrical current – a small transducer sends an electrical current that slowly lengthens the rod.

How long do patients stay in the hospital after one of these rods is implanted?

  • A majority of the time the rod goes in and the patient will go home the next day.
    • We wait anywhere from 5-14 days after the rod goes in before we start lengthening process in clinic.

How long does the lengthening process take?

  • It’s going to be at least between six and nine months.
    • The bone will lengthen about a millimeter a day, and every centimeter of lengthening requires about a month of healing.

Multidisciplinary approach:

  • A child whose limb length difference is over two inches requires a team of experts to guide the patient and their family through the six- to nine-month process.
  • Working as a team: before a surgery date is set, the patient and their family meet with multiple departments within the hospital.
    • Physicians meet with fellow physicians to discuss the treatment plan.
    • Patient meets with the nursing team to discuss education regarding the procedure and what to expect.
    • Our psychology team meets with the patient and family to help them understand the treatment and how to cope with the before and after stages.

At what age our patients a candidate for an intramedullary rod?

  • Patients become candidates when they are 8, 9 or 10 years old, depending on the deformity.
    • In most cases, it is best to wait until the patient is done growing.

What’s the activity level allowed during this process?

  • Once the lengthening process begins, the patient will be on crutches until the lengthening process is complete and the bone has healed enough to walk on it again.
    • Between the daily physical therapy and the extended time on crutches, the patient is the most important part of the lengthening process.

Final thoughts about limb lengthening:

  • As the technology improves, it will open a lot of doors for patients.
  • In the end, treating the difference is to improve the patient’s life, but not define their childhood.

Our experts are here for the patient and their family every step of the way.  Have more questions about limb lengthening?  Email [email protected].

Learn more about limb lengthening and the research our hospital is conducting.

Meet Malachi – The 13-year-old Motivational Speaker

Meet Malachi – The 13-year-old Motivational Speaker

by | Aug 15, 2018 | General News, Press Coverage

Watch full video.

DALLAS – Some people’s first thought when they hear about a 13-year-old motivational speaker is probably, “What could I possibly learn from a 13-year-old?”

If that’s what crosses your mind, it’s time to think twice. Malachi Walker was born in 2005, but he has the kind of wisdom some people born in 1975 could use. “My goal with the book is helping other people accomplish their goals and get out of their bad situations,” he explained.

Malachi wrote The Boomerang Effect, which he explains is “the strategy to help you shatter your glass ceiling.” “What you sow you will reap and what you throw you will keep,” he said. “That’s what the boomerang effect is. Your choices come back to you.”

He’s not only an author, but he’s also a budding motivational speaker. At Scottish Rite Hospital’s recent annual book sale, Malachi read and signed The Boomerang Effect for a captive audience of patients and families.

The book features an appropriate title for the speaking appearance, as he was back at the place it all began.

Scottish Rite doctors diagnosed Malachi with a knee problem that kept him out of soccer, his greatest passion, for 13 months. But during those 13 months, he wrote his book. His mother Christina and father Charlie were supportive, but surprised. “When he first told us that he wanted to be a motivational speaker, I remember looking at Charlie, you know – when [Malachi] wasn’t looking at us – and my eyes got really big, and I thought, ‘OK we’re going to help you do that!’

The book is also about being kind, because Malachi has realized how you treat people has an impact on how they treat you in return. That is a lesson the Walkers have worked hard to teach their children. “You never know if they’re going to pick up what you teach them,” Christina said. “It’s neat to see him grab something and do something with it.”

Malachi is practicing his motivational speaking skills by regularly posting videos on his YouTube channel.

A Collaborative Research Program Advances Care for Children Diagnosed with Cerebral Palsy

A Collaborative Research Program Advances Care for Children Diagnosed with Cerebral Palsy

by | Jul 19, 2018 | Research & Innovation

At Scottish Rite Hospital, our team is dedicated to providing individualized, expert care to each child. The hospital’s Neurology department is focused on providing treatment to orthopedic patients who have related neuromuscular diseases and neurological disorders. Over the years, the hospital has established specialized clinics for children with these complex conditions. Through the collaboration between our trained neurologists and orthopedic team, the patients are able to receive multidisciplinary care to address their specific needs. 

To continue advancing the care and treatment of our neurology patients, the department is committed to ongoing research. Each year, the hospital hosts a two-week research program for children diagnosed with hemiplegic (one side of the body) cerebral palsy. To participate in this research, children meet study inclusion criteria and go through an evaluation one week prior to being enrolled in the program. Constraint induced movement therapy (CIMT) is a form of treatment where the child’s stronger arm is put into a splint forcing them to use the affected arm for all daily activities. The two-week therapy program includes gross and fine motor activities that encourage independence with identified goals. Activities include crafts, making snacks and games. The program also includes the use of the Armeo®Spring Pediatric (an upper limb video game based robotic exoskeleton). As part of the research, our team evaluates the child before and immediately after completing the program as well as six months later. By analyzing the progress of these children, the data has shown an impact from the therapy including improvement in range of motion, function and use of the affected arm. 

Like many of the research projects that take place at the hospital, this program involves staff from multiple departments. Our Neurology team works closely with the hospital’s research occupational therapists, Angela Shierk, Ph.D., O.T.R. and Heather Roberts, Ph.D., O.T.R., to make this a success. Pediatric clinical nurse specialist Nancy Clegg, Ph.D., R.N., has been involved with this program over the years and can see the impact it has made. “The children we see in our clinics and those who participate in this program are in need of specialized care,” says Clegg. “Our neurologists, orthopedic surgeons and therapists are able to conduct robust research to bring more knowledge and better care back to the patients affected by cerebral palsy. The CIMT program is just one of the many research programs that allow us to collaborate and discover innovative treatment options to enhance overall care.” 

Oklahoma girl with rare bone disease designs super hero casts

Oklahoma girl with rare bone disease designs super hero casts

by | Jul 6, 2018 | General News, Press Coverage

Watch full video.

CLEVELAND, Oklahoma –

An 8-year-old girl, who’s had more than 40 broken bones in her young life, got something special during her most  recent surgery.

Doctors diagnosed Courtney White with a rare bone disease when she was just a baby after she broke her femur twice in a matter of months.

The condition cause her bones to break easily, which means she spends a lot of time wearing casts.

Her most recent casts – one on each leg – feature Courtney as a super hero.

Courtney now has rod in every major bone in both legs. And doctors recently had to replace a rod in one shin and put a rod in the other.

Before the surgery, doctors at the Texas Scottish Rite Hospital in Dallas challenged Courtney to design her own cast. She drew up Wonder Woman boots because she’s a little warrior.

Her family will tell you, Courtney is a super hero in their eyes every day.

She has Osteogenesis Imperfecta, Type 6. Experts say only 6 to 7 people out of every 100,000 have OI and of those, only 1-percent lives with Type 6.

“We have found that each day is a new experience. We never know day to day what her mobility will look like or what her pain level will be or if we will have another injury,” her dad Justin White said. “That has been life for Courtney, it’s her normal and she has learned to embrace it.”

Courtney has broken 40 bones and has gone through 12 surgeries.

But despite all that, she still lives for adventure. She likes to hunt and fish and spend time with her mom, dad and big sister.

“She knows there are some things that she just won’t be able to do, but she also knows that there are many things that she can do, she’s just going to have to work harder for them than most people,” Justin said. “We’ve tried to teach her not to feel sorry for herself, but instead, accept things as they come and work through them.”

And that’s how she lives her life. He says Courtney is always positive, cheerful and faces every challenge head on – with unflinching faith.

A few days before Courtney’s most recent surgery her grandpa overheard her saying this prayer, “Father, thank you for this wonderful world that I live in, and thank you for my wonderful life. I love you so much, because everything you do is wonderful.”

Her dad says that’s Courtney, the bravest, toughest person he’s ever known.

“Her bones make break often, but her spirit and her faith never do,” her dad said.

Scottish Rite Hospital Provides Multidisciplinary Care Through New NSP Clinic

Scottish Rite Hospital Provides Multidisciplinary Care Through New NSP Clinic

by | Jun 28, 2018 | Research & Innovation

At Scottish Rite Hospital, providing premier patient-centered care is at the forefront of our mission. Through the hospital’s six centers for excellence, our doctors and researchers collaborate to study the common to the complex of orthopedic conditions to find new and innovative ways to care for our patients. For 15 years, the Center for Excellence in Spine has evolved to be an essential component to the effectiveness of treating the hospital’s spine patients. 

Scoliosis presents in many shapes and forms. Our experts in the spine center collaborate to determine the best and most effective techniques to treating spinal disorders. Recently, the hospital created a clinic specifically for neuromuscular-syndromic scoliosis patients (NSP). This patient population consists of children diagnosed with neuromuscular (affects the muscles and nerves and can lead to scoliosis) and syndromic scoliosis (spine curve develops as part of a syndrome). Because of the complexity of this disorder, these children need to be cared for by multiple specialists. The patients and families come to the hospital for one, comprehensive appointment that includes specialists from multiple disciplines. Depending on the child’s needs, assessments available from various experts include:

Anesthesiology
Child Life
Dental
Developmental Behavioral Pediatrician
Dietary
Labs/Hematology
Medical Consult
Coordinators (for external appointments)
Neurology
Nursing staff
Occupational Therapy
Physical Therapy
Psychology
Pulmonology
Research
Social Services
Surgical planning
Urology
Staff orthopedic surgeon Amy L. McIntosh, M.D., has been the leader of this initiative and believes in the positive impact it can have on the patient and their families. “The clinic is patient and family centered,” says McIntosh. “It coordinates multiple services into one appointment with the hope of decreasing the burden on families. The clinic also emphasizes open communication between providers and the families with a goal of reducing post-operative complications and costs.”

As a component of the clinic, research is heavily involved to collect certain information on this patient population to evaluate the effectiveness of this approach to care. The study titled, “Rate in Infection in Non-Congenital and Non-Idiopathic Scoliosis: A Prospective Observational Cohort Study Following Implementation of Multimodal Prevention Protocol,” analyzes all patients diagnosed with neuromuscular and syndromic scoliosis who are undergoing surgery. The hospital’s team of clinical research coordinators collect clinical and radiographic data on patients who are willing to enroll with a goal of creating a standardized model to decrease infection rates.

Scottish Rite Hospital’s Center for Excellence in Spine continues to grow and be innovative to provide world-renowned care to scoliosis patients. It is initiatives like the NSP clinic that showcase the hospital’s commitment to collaboration and approach to multidisciplinary care to advance how the hospital treats this patient population.

Learn more about our Center for Excellence in Spine.