A Day in the Life of Pediatric Orthopaedics

Glimpse a day in the life of orthopaedic surgeons and patients as they overcome everything from broken bones and sports injuries to complex spine conditions. This day in the life video follows CHOP's expert team of pediatric orthopaedic surgeons and researchers — including Jack Flynn, Wudbhav Sankar, Kristy Weber, Lawrence Wells, Robert Campbell, Ted Ganley, Maurizio Pacifici, Naomi Brown, David Horn and Benjamin Chang. The orthopaedics team offers patients and families a host of nonsurgical treatments like casting and fitting for prosthetic limbs as well as complex surgical options, including pelvic osteotomy, open hip reduction, periacetabular osteotomy, posterior spinal fusion, bilateral adductor lengthening, vertical expandable titanium rib (VEPTR), growing rods, ACL reconstruction, surgical arthroscopy, bone tumor removal, limb sparing surgery, syndactyly repair, surgical dislocation of the hip, and more.

Transcript

A Day in the Life of Pediatric Orthopaedics

Jack Flynn, MD: It’s really about the mission. Fixing a limb that the child will use without problems for the rest of their life, correcting a spine problem, which literally can save their life, whether it’s opening up their chest to allow their lungs to develop, or correcting a severe spine deformity, taking out a tumor, it’s really about having a positive impact on a young child which is going to last a lifetime.

Jack Flynn, MD: For a CHOP orthopaedic surgeon, the days start very early. Many of my colleagues are here by 6 o’clock in the morning preparing for surgery.

Dr. Robert Campbell: All right, Matt how are you doing?

Matthew, patient: Good.

Matthew’s father: For us, it’s been quite an experience, but you know, this place is the best. It’s amazing because we just happen to be 10 miles away from CHOP.

Matthew’s mother: Many families travel around the world to get here, so we’re very thankful that we don’t have to travel.

Matthew’s father: Every time we sit in that waiting room and hear all the different languages being spoken.

Dr. Robert Campbell: Matthew Howder, neuromuscular syndromic scoliosis. The plan is bilateral partial thoracotomies with expansions of the VEPTRs and correction of truncal shift. Any questions anybody?

Matthew’s father: Matt’s had about 27 surgical procedures in his life.

Matthew’s mother: He couldn’t walk. He could barely sit up. He couldn’t breathe. It’s been transformative for Matthew.

Tori, patient: Well, I feel more confident. I had like low self-esteem. And then after the surgery I just felt so much better. And I just look better. I had to get used to the way the rods were in my back. I went into it thinking I wasn’t going to be able to do anything. Now that I know that I can, I’m really happy about it.

Zachary’s mother: With his disease there’s muscle tightness. We met with Dr. Baldwin for the tendon release surgery to kind of lengthening them and let them stretch out. And now his body’s not actually fighting itself to walk.

Zachary’s father: That’s that long-term goal of one day he will walk. Whether it’s with assistance or not, he’ll walk.

Zachary’s mother: He’ll be upright, yeah.

Zachary’s father: He will do it.

Dr. Ted Ganley: Hi guys, ready for a little tune up today? So go ahead and point to that bum knee for me. I make an extra incision because I use your hamstrings as your new ACL.

Benjamin Ruth, patient: OK

Dr. Ted Ganley: OK, so this is Benjamin Ruth. He has a right ACL rupture. We are going to surgical orthoscopy the right knee. ACL reconstruction using his own tissues. We’re going to take down a little bit of that base of the ruptured anterior cruciate ligament. We took two ligaments and tendons and quadrupled them for an eight strand graft, which is stronger than the native ACL.

Dr. David Horn: What happens is cleft feet are very unlike other feet because there’s less other tissues that are scarred up behind the ankle. So you never get like over correction by doing it. I mean if you do it in somebody who doesn’t have it, sure you could really cause problems.

Patient’s mother: OK

Joshua’s father: Uh oh, there he is.

Jack Flynn, MD: Hi, how are you guys doing? How’s everything going?

Joshua’s father: Good, good, good

Jack Flynn, MD: How’s your boy doing? How you doing?

Joshua: Good

Jack Flynn, MD: He had a big, big operation not too long ago, how’s he responded to all of this?

Joshua’s father: Really good, you know, no pain, nothing. Look there’s a project, he’s great.

Jack Flynn, MD: Is he taller than he was before?

Joshua’s father: Yes he has to lower his head to get into the van.

Jack Flynn, MD: That’s terrific, excellent. You’re doing great. You’re an all-star. You’re an all-star. I’m so proud of you.

They moved down to Florida and his scoliosis progressed 85 degrees in the course of about a year or so. And they moved back up here because they were concerned that they couldn’t get the same kind of care that they were getting when they lived up here.

Joshua’s father: Joshua was close to losing his lung, but today we can say a success story. You know, Josh is totally straight.

Dr. Kristy Weber: This is the reconstruction after the tumor surgery. This replaces the bone that was destroyed by the cancer.

Dr. Kristy Weber: We have no cancer at all. And we’re going to watch her carefully either here or in Saudi Arabia for a long time.

Stephanie, patient: I was diagnosed with hip dysplasia. So it pretty much meant that my hip bone was out of alignment. By the time I finished my freshman year, I couldn’t really run anymore. I was having trouble sleeping and standing because I was in pain so much of the time. I was told, “Like you’re gonna have to wait until you have a hip replacement at 35. And then you’re going to have another hip replacement. And then another one, and maybe another one.”

So Dr. Sankar cut my bone and then repositioned it and pinned it so my bones could regrow around the pins and then be removed. Since I had my surgery, not only did I relearn how to walk, but I also relearned how to run. And in the fall I ran my first marathon, which is 26.2 miles. CHOP changed my life.

Anthony, patient: I tore my patella tendon and that’s the kneecap tendon that holds your kneecap to the rest of your leg. And I snapped that. I think sports kind of define me. I played basketball. I played soccer. And I’m running track this season. They really took good care of me, and I see why they’re one of the top hospitals in the country.

Maurizio Pacifici, MD: So half of our time is actually spent trying to understand really the basic fundamental mechanisms by which the skeleton forms and grows. And then the other half of our time is spent trying to find treatment.

Ben Chang, MD: What I would do is when you go home, is write down, you know, a series of tasks that you would like to be able to perform with a prosthesis.

Patient’s mother: What she really wants to do is play the violin.

Patient: Stop … that tickles.

Dr. Lawrence Wells: He should not play catcher right now until the shoulder is completely better.

Patient: Playing against a team or like playing by yourself?

Dr. Ben Chang: Any kind of playing. I don’t want you to get hit because that finger will break again. And then you’ll be sorry.

So I’m going to make you a new thumb today. What do you think Logan? Yes?

Dr. Ben Chang: OK this is Logan [unclear] for right hand syndactyly repair with full thickness skin graft, yes?

Medical team: Yes

Dr. Woody Sankar: So we’ve got this egg-shape ball and it’s almost like it’s slopped off to the side. Really it’s kind of like the balancing the ball on a seal’s nose. You want to get the socket that he has, which admittedly is not the same size as the ball, but you can't shrink the ball down. You want to balance what socket you have over the top of the ball. You have any questions for me or anything? OK, you’re a trooper. See you guys tomorrow morning.

Brooke’s father: He told us that her left hip had been dislocated, probably since birth. And it was about six hours of surgery. Brooke came out and we had told her she was going to get a turtle shell, cause she’s really into turtles. And so she had a body cast. You know we would have traveled anywhere in the country to get her the best surgeon, and I think we wound up with that. And they told us if we hadn’t done the surgery, she probably wouldn’t be able to run by the time she was 15.

Brooke, patient: I like to play my piano. I like to jump. I like to run. I like to play soccer. I like to ride on my scooter.

Zoe, patient: I used to get surgeries constantly when I was a baby. I’ve grown up with those doctors and nurses. And I love them all. I’m so grateful. My left lung is not as large as my right one. So I had some trouble breathing when I was younger. They didn’t know if I was even going to be able to talk when I was a baby. So I got sign language up until about age 6 or 7. So from going from like my parents not even knowing if I would be able to talk, like at all, to being at a place where I can sing in a choir is really cool.

I have so many hobbies and interests now. And I guess there’s no limit to what anyone can do if they set their mind to it really.

Jack Flynn, MD: One of the things that makes it so rewarding to work with this group of orthopaedic surgeons is how much they enjoy just coming to work. I mean you drive home at night and you just realize that you had an impact that’s going to affect a human for the rest of their life. It’s so rewarding that even the long days seem to go by very quickly.

Related Centers and Programs: Division of Orthopaedics, Hip Disorders Program, Young Adult Hip Preservation Program, Sports Medicine and Performance Center, Center for Thoracic Insufficiency Syndrome, Limb Deformity Program, Bone and Soft Tissue Tumor Program, Spine Program, Foot and Ankle Program, Hand and Arm Disorders Program, Neuromuscular Program