Pediatric Orthopedics Over the Last 50 Years
This is the third in a series of blog posts celebrating the 150th anniversary of HSS. Throughout the year you’ll hear from varied departmental representatives on the evolution of their clinical service and the hospital overall. We hope you’ll enjoy this look back as we continue to lead musculoskeletal medicine into the future.
Dr. Leon Root joined Hospital for Special Surgery as a fellow in 1961 and returned as an attending in 1967. He is the Chief Emeritus of Pediatric Orthopedics and the namesake of the HSS Leon Root, M.D. Motion Analysis Laboratory. Over his 46 years here, he’s witnessed many improvements and the evolution of patient presentation and care. We sat down with Dr. Root to discuss the landscape of pediatric orthopedics at HSS. Read ahead and watch the video below to hear his comments.
What drew you to the field of pediatric orthopedics?
There’s something special in caring for children that makes you want to work harder and also brightens your day. In orthopedics, you can take someone who’s injured or in pain and take their pain away, help them walk and help them function again. It’s a very rewarding specialty.
What success story are you proudest of?
There was a little girl with osteogenesis imperfecta (“brittle bone disease”). I prescribed exercise because the stronger the muscles, the stronger the bones. She started swimming and did so well that she swam in college and went to the Paralympics in Sydney, Australia. She won a gold and two silver medals. She’s a very special person and dear to my heart. In fact, I went to her wedding!
What was pediatric orthopedic care at HSS like when you started practicing?
When I came to HSS, everyone did pediatric orthopedics. You had different teams of attending physicians who rotated on the adult and children’s services. In 1972, when Dr. Philip Wilson, Jr. became surgeon-in-chief, he decided that pediatric orthopedics should be a specific service. Since I was already in charge of the pediatric orthopedic clinic and the cerebral palsy clinic, he said, “Why don’t you become chief of pediatric orthopedics?” I said, “Of course.”
Initially it was just Dr. Walther Bohne and me. Dr. Bohne did mostly children’s foot problems. With the hospital’s support, we were able to bring in other pediatric orthopedic attendings. Now we have nine full-time pediatric orthopedic surgeons on staff. When I look at these younger doctors and see the work that they do, I feel tremendous pride. There’s no question in my mind that we have the best pediatric orthopedic service in New York City. I think you can compare it to any pediatric orthopedic service in the country.
What new injuries or conditions are you seeing?
In this modern age, we are seeing more sports injuries. Children are getting involved at a younger age in intense sport activities. They’re tearing ligaments that need to be repaired in a different way than adults because children are growing, so you must be careful not to injure their growth plates. I don’t think that children should be doing the same sport all year-round. They should participate in different activities in order to improve overall agility and skills. For instance, they should play soccer in the fall, basketball in the winter, baseball in the summer, whatever it might be. Sports should be done under supervision with the proper equipment, and in contact sports, try to have size and mass comparable when they play against each other.
How has the patient experience changed?
In the 1960s and 1970s, a child’s hospital stay would be for weeks not days. We had a public school in the hospital so that children could keep up in school. A child with scoliosis would stay in casts for six months or longer. Even when admitted with a heel cord lengthening, a child’s stay would be for several days. In those days the parents weren’t allowed to stay at night and had to leave at 8:00 p.m. That was hard for the parents and hard for the children. Today we encourage a parent to stay overnight with the child. In many cases, after an operation, the child will go home that night or, at the most, stay three or four days. The sooner the child gets out of the hospital, the sooner they recover.
What are some treatment advances you’ve seen?
Over the years, a problem that was difficult to solve was a significant leg length discrepancy. Operations had been designed to cut the bone and extend it to make the leg longer, but the techniques used were often complicated with uncertain results. At times the good leg was shortened in order to equalize length or the growth of the good leg was slowed down to let the short leg catch up.
About 50 years ago a Russian doctor named Ilizarov developed a technique for lengthening bones that used circular cages around the leg, which were attached to pins and wires that transfixed to the bone. The involved bone would then be cut between the pins and the bone would be very slowly pulled apart. The gap created would be filled in with bone, and, because the distraction was so slow, the nerve and blood vessels would be stretched without compromising them. The Ilizarov technique came to the U.S. in the late 1980s, and with it we can not only correct leg length but also correct significant deformities of bone. Dr. Roger Widmann [current chief of Pediatric Orthopedic Surgery] is especially expert with these procedures.
How has HSS contributed to today’s standard of care?
I am particularly proud of the expertise of our staff. Although each doctor is trained as a pediatric orthopedist, each of them has special areas of expertise. We’ve made great strides in the treatment of scoliosis, and patients leave the hospital after extensive spine surgery after just a few days. In the area of cerebral palsy we’ve popularized doing multi-level surgery under one anesthesia, thereby reducing the number of separate operations a child has and reducing overall time in the hospital and away from school and play. Fracture care in children has reached new levels of excellence. Our doctors no longer accept incomplete reductions of fractures, especially around joints, but can provide excellent alignment with various types of pinning and plating.
We have improved the treatment for children born with club feet with skilled cast manipulations, so that operations are rarely necessary. Additionally, we have a special clinic for brittle bone disease and other skeletal dysplasias, for which procedures can be performed on young children to avoid major deformities as adults.
Dr. Leon Root is an orthopedic surgeon and Chief Emeritus of Pediatric Orthopedics. His clinical specialties are cerebral palsy, low back pain, osteogenesis imperfecta and hip pain. He was president of the American Academy for Cerebral Palsy and Developmental Medicine in 1988. Dr. Root wrote the popular No More Aching Back in 1992.