Hip fracture

For more than a century, orthopedic surgeons and investigators at Children’s Hospital Boston have played a vital role in the field of musculoskeletal research. We’ve pioneered treatment approaches and major advances in the care and treatment of ailments such as hip dysplasias, scoliosis, polio, tuberculosis and traumas to the hand and upper extremities.

Our pioneering research helps answer the most pressing questions in pediatric orthopedics today—providing children with the most innovative care available.

In Children’s Orthopedic Center we take great pride in our basic science and clinical research leaders, who are recognized throughout the world for their respective achievements. Our orthopedic research team includes:

• full-time basic scientists
• 28 clinical investigators
• a team of research coordinators and statisticians
   

New trauma/ER database

Under the direction of Travis Matheney, MD, Children’s database of orthopedic ER trauma cases—implemented in July, 2010—has begun outcomes research, in which we track/compile orthopedic trauma data, such as:

• type and location of a fracture
• outcome (quality improvement)
• whether the injury required admission to the hospital
• how was the injury initially treated
   

The information gathered from this ongoing tracking study will further influence how specialists in Children’s Orthopedic Trauma Program care for children by providing accurate, comprehensive tracking and outcomes data.
 

Studies of developmental hip conditions

Developmental hip conditions such as hip dysplasia, slipped capital femoral epiphysis and Legg-Calve-Perthes disease can lead to premature arthritis in young adults with resulting pain and disability. Our research focuses on understanding the pathomechanics (mechanical forces that adversely change the body's structure and function) of these conditions. With better understanding, we can improve existing therapies and develop new therapies for these complex conditions.

Current and recent studies include:

• We’re conducting a large number of ongoing studies to follow patients who’ve had various treatments for hip problems. Our studies use outcomes measures, custom questionnaires and special methods for measuring results—both prospectively (before treatment) and retrospectively.

For example, femoral acetabular impingement (FAI) is a research topic that Children’s is working on extensively. FAI is a “bump” on the neck of the femur that permanently remains as a result of SCFE. The impingement can be small (causing no additional damage) or larger (creating cumulative damage to the cartilage inside the hip and resulting in arthritis). In a long-term study, our researchers are investigating the effectiveness of removing the bump at the time of surgery.

• We’re studying long-term outcomes after Bernese periacetabular osteotomy (Bernese PAO) for hip dysplasia: Since 1991, Children's has performed more than 1,400 Bernese periacetabular osteotomies to correct dysplastic hips in teens and adults, whose hip sockets have finished growing. This large volume makes Children’s the most experienced center in the United States for this procedure—and the second-most experienced in the world.
  
  PAO is our standard treatment for a hip socket that’s too shallow in a patient whose socket has finished growing—typically ages 13 or 14 through adult—and whose hip is still viable enough to be repaired rather than replaced. The procedure rotates the hip socket into a more stable position and is the most complex and powerful procedure for positioning the hip socket.
  
  We’re constantly obtaining and analyzing radiographic and clinical long-term follow-up data on sub-groups of our PAO patient population as it ages, to determine the effectiveness of the procedure for halting or preventing the development of osteoarthritis of the hip.
   
• We’re studying the use of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) to assess early osteoarthritis in dysplastic hips: In early osteoarthritis, the charge of the extracellular matrix is degraded and lost. The delayed gadolinium-enhanced MRI of cartilage technique is designed to indirectly measure the early loss of charge density in cartilage. Read more.
   
• We’re studying perfusion MRI as a predictor for developing avascular necrosis after closed reduction of dislocated hips: Our retrospective analysis is looking at predictive values of contrast-enhanced MRI after closed reduction for avascular necrosis (cellular death due to interrupted blood supply) in developmental dysplasia of the hip. Read more.
   
• Children’s is a founding member of the Academic Network of Conservational Hip Outcomes Research (ANCHOR), a collaboration of researchers dedicated to following patients with developmental hip disease. The group now comprises 10 centers in the United States and one in Europe, and enrolls more than 500 patients each year in various studies.
   

Clinical Effectiveness Research Center

Children’s Orthopedic Clinical Effectiveness Research Center (CERC) helps coordinate research and clinical trials to improve the quality of life for children with musculoskeletal disorders. This collaborative clinical research program is unique in the nation and plays an instrumental role in establishing—for the first time—evidence-based standards of care for pediatric orthopedic patients throughout the world.

Major areas of focus for the CERC include:

• brachial plexus birth palsy
• hip disorders
• spinal disorders
• trauma/fractures
• upper extremity disorders
   

Ongoing laboratory studies include:

• Basic science studies
• Biomechanical/instrumentation studies
   

Orthopedic basic science laboratories

Working in Children’s labs are some of the leading musculoskeletal researchers in the nation. Our labs include:

• Orthopedic basic science research
• Center for the study of genetic skeletal disorders
• Sports Medicine research laboratory
• Bone cell biology laboratory
• Matthew Harris Lab