Gillette Orthopedics: Focused Expertise = Better Outcomes

By Josh Garcia
Thursday, August 30, 2018

The orthopedic team at Gillette Children’s Specialty Healthcare collaborates with specialists and primary care providers to ensure children have access to the latest treatments and technologies for orthopedic conditions stemming from injuries, neuromuscular disorders and more.

Gillette Children’s Specialty Healthcare is a leader in this field of orthopedics due to the size and longevity of its orthopedics program. It houses one of the largest concentrations of pediatric orthopedic surgeons and clinicians in the United States, which allows for a level of specialization that was formerly unheard of in the field.

“Decades ago, a single orthopedist would cover all aspects of orthopedic care,” says Andrew Georgiadis, MD, pediatric orthopedic surgeon at Gillette. “At institutions such as ours, a single orthopedist can specialize in a particular pathology or system and become a regional or national expert, which is a burgeoning phenomenon in pediatric orthopedics.”

This differentiates Gillette from other pediatric hospitals in the area and across the nation.

“Gillette was developed and continues to thrive as a hospital dedicated to pediatric care of individuals with disabilities and other complex medical needs, which has allowed us to develop expertise and devote resources to orthopedic care and other conditions,” says Alison Schiffern, MD, pediatric orthopedic surgeon and Fellowship Director at Gillette. “We have 15 full-time pediatric orthopedists and numerous additional orthopedic providers who specialize in areas such as pediatric spine, hand and deformity correction.”

Specializing in Specialization

Like many orthopedic surgeons at Gillette, Dr. Schiffern treats an almost equal mix of patients who present with traumatic injuries, developmental issues or neuromuscular abnormalities. However, Gillette’s expansive capabilities have allowed her to specialize in the diagnosis and treatment of one condition in particular: clubfoot.

Clubfoot is a congenital deformity that affects the development of a child’s foot, resulting in feet that are turned inward and down at birth. This condition, if not treated, can severely affect a child’s ability to walk and ultimately becomes painful.

“Clubfoot can sometimes be diagnosed prenatally during an ultrasound; otherwise it is identified immediately following birth,” Dr. Schiffern says. “As soon as a child presents with clubfoot, we can begin using the Ponseti method to address the deformity.”

The Ponseti method is the leading treatment for clubfoot in the United States and uses weekly sequential casting to gently stretch feet back into the proper position. This technique typically takes six to 12 weeks to complete and originated in Iowa, where Dr. Schiffern received focused training in addition to her fellowship training in the method. She now tends to almost a hundred patients with clubfoot annually.

“We have a dedicated clubfoot clinic in Minnetonka that I run with a nurse practitioner and physician assistant,” Dr. Schiffern says. “We will have an additional dedicated weekly clinic at our St. Paul campus in September.”

The work of Dr. Schiffern and other providers at Gillette has positioned the institution as a vital resource for clubfoot care.

“We’re working closely with those who developed the Ponseti method and are training a smaller group of individuals to become experts in clubfoot treatment,” Dr. Schiffern says. “We are establishing a strong continuity of care among multiple providers for the treatment of clubfoot in Minnesota.”

“Gillette has multiple providers from many different specialties who all focus on one goal: to have children reach their full potential, whatever it may be.”
— Trenton Cooper, DO, MS, pediatric orthopedic surgeon at Gillette Children’s Specialty Healthcare

Technology and Treatment

Clubfoot is often linked to other conditions, such as spina bifida and cerebral palsy, both of which are subspecialties at Gillette.

“We have the advantage of providing universal spine care for children,” says Dan Miller, MD, pediatric orthopedic surgeon at Gillette. “We’re uniquely suited in multiple avenues, especially in regard to our radiology and imaging resources.”

One of many pieces of advanced technology available to specialists at Gillette, the low-dose stereoradiography system allows Dr. Miller to perform spinal imaging using a fraction of the radiation required for conventional radiographs.

“We can take X-rays of the spine with anywhere from five to 45 times less radiation, thus minimizing radiation burden on children with spinal deformities who receive several X-rays over the course of their lives,” Dr. Miller says.

Children with gait disorders as a result of spinal conditions and other musculoskeletal or neuromuscular deformities may also benefit from the capabilities of the James R. Gage Center for Gait and Motion Analysis at Gillette, which is known worldwide for its ability to evaluate children’s bones and muscles as they walk. These evaluations help specialists better understand children’s pathologies and determine which interventions would be beneficial for patients, including those with cerebral palsy.

“Many will undergo physical rehabilitation and require bracing, walkers, gait trainers and other ambulation aids and medical equipment that are updated as they grow,” Dr. Georgiadis says. “Nonambulatory children with cerebral palsy are put on a surveillance schedule to track whether their hip subluxation is static or changing as they get older.”

Whereas other institutions may require children to receive physical rehabilitation off-site or obtain orthotic equipment elsewhere, Gillette offers both services in-house. Orthopedic surgeons also retain oversight on patients during rehabilitation to foster seamless care.

“A critical portion of success for any surgery is the rehabilitation that occurs after the child has healed,” Dr. Miller says. “It’s a privilege to have a world-class inpatient rehabilitation center on-site so that we can work collaboratively with the rehab team.”

Collaboration and Clinics

Despite being home to a large, multidisciplinary pediatric orthopedics program, the physical size of Gillette is relatively small when compared with a traditional children’s hospital. The close proximity and dense concentration of orthopedic and other specialists allows for close collaboration on patient cases and treatment plans.

“When I have questions, I can walk down the hall, find the appropriate specialist and have those questions answered,” Dr. Schiffern says. “We also have a handful of multidisciplinary clinics that bring our specialists together across fields to evaluate patients and develop comprehensive care plans.”

These clinics include a monthly gathering to discuss spina bifida cases. Urologists, physiatrists, neurosurgeons, orthopedists, physical therapists and orthotists evaluate and collaborate with patients in a single clinic appointment to ensure every aspect of patient care is covered.

In addition to spina bifida and clubfoot clinics, other specialty clinics include osteogenesis imperfecta, spasticity evaluation, early motor delay, hip dysplasia, limb length discrepancy, upper extremity (e.g., hand, brachioplexus) and muscular dystrophy. The spasticity evaluation clinics are developed to address spasticity issues caused by cerebral palsy, strokes , and brain and spinal cord injuries. Some clinics, such as those for spasticity, are performed in smaller groups directly with patients. That level of personalized care is rare, according to Dr. Georgiadis.

“Physiatrists, neurosurgeons and orthopedists spend 60 to 90 minutes with patients to determine the proper spasticity-reduction treatment,” he says. “That’s something I’ve never seen anywhere other than Gillette.”

This collaboration continues into the OR during single-event multilevel surgery (SEMLS), which is often performed by two surgical teams to maximize the safety and efficiency of these procedures. SEMLS is typically performed on lower extremities and involves the correction of multiple soft-tissue and bone issues during one surgical procedure, allowing for fewer surgeries over the course of a child’s life and less time spent in rehabilitation.

“These procedures decrease blood loss, operative time and the number of hospital stays during childhood so that children aren’t spending every summer in the hospital,” Dr. Miller says. “It’s a benefit that Gillette is able to offer because of our specialists’ expertise and willingness to help each other — we’re not isolated on our own islands.”

Coordination and Care

Gillette’s dedication to collaboration isn’t limited to internal staff. The orthopedic team keeps an open line of communication with patients’ primary care physicians to update them on treatment plans and the ways certain orthopedic conditions may affect other aspects of children’s health.

Advanced practice nurses and complex care pediatricians are vital in coordinating care between Gillette and referring physicians.

“Complex care pediatricians are not meant to replace children’s pediatricians,” Dr. Miller says. “They bridge care from children’s existing medical homes to our institution.”

No matter how complicated a patient’s condition may be, advanced practice nurses and complex care pediatricians work with providers to make the patient experience as comfortable as possible while ensuring seamless transitions from other facilities to Gillette and back. Complex care pediatricians discuss logistical and personal concerns with families and find ways to incorporate those preferences into treatment plans, especially in the case of families who live outside of the region and may need to travel long distances for care.

“There are numerous discussions between our complex care pediatricians and referring pediatricians to minimize the travel burden,” Dr. Georgiadis says. “Patients can come to Gillette every few months to take care of several items instead of coming in for separate appointments every week. This makes the process more efficient and less taxing for families.”

“While we pride ourselves as experts on spinal surgical care, we also take pride in treating spinal conditions with bracing, casting, physical therapy and other conservative options. The vast majority of our patients with spinal deformities do not require surgery.”
— Dan Miller, MD, pediatric orthopedic surgeon at Gillette Children’s Specialty Healthcare

Spreading the Word

In addition to collaborating with primary care physicians, Gillette offers educational opportunities for outside healthcare providers who are interested in learning more about orthopedics.

“We have a yearly conference in which we give lectures on pediatric orthopedic care to primary care providers, physical therapists and other professionals outside of Gillette,” says Trenton Cooper, DO, MS, pediatric orthopedic surgeon at Gillette.

An additional daylong conference is given to pediatric and primary care residents, some of whom will perform rotations at Gillette.

“We cover common orthopedic conditions such as clubfeet and hip dysplasia,” Dr. Schiffern says. “We want the residents to have an idea of what we do and extend that relationship into their practice.”

To learn more about the pediatric orthopedics program at Gillette Children’s Specialty Healthcare or to refer a patient, visit or call 651-325-2200.