Leading-Edge Pediatric Orthopedics Helps Children Thrive

By Thomas Crocker
Tuesday, February 26, 2019

In a city with a burgeoning pediatric population, the pediatric orthopedic surgery team at The Children’s Hospital of San Antonio helps children with a variety of musculoskeletal conditions reach their functional potential.

Top row, left to right: William Koeck, MD; Erica Zepeda, PNP; Shawn Funk, MD
Middle row: Jeffrey Warman, MD; Kelley Warren, PA; Elizabeth Magnabosco, MD
Lower row: Rhianna Little, MD; Amanda Stewart, NP

Featuring three full-time and two part-time pediatric orthopedic surgeons — all of whom are fellowship-trained in pediatric orthopedic surgery and/or scoliosis — as well as two physician assistants and three pediatric nurse practitioners, the pediatric orthopedic surgery team treats infants, toddlers, school-age children and teenagers for a wide range of congenital, developmental and traumatic conditions, including:

  • Cerebral palsy, spina bifida, muscular dystrophy and other neuromuscular disorders
  • Clubfoot and other deformities and conditions of the foot
  • Developmental dysplasia of the hip
  • Fractures
  • Infections of the musculoskeletal system
  • Limb-length deficiencies and deformities
  • Spinal deformities, such as scoliosis and kyphosis
  • Sports-related injuries, such as anterior cruciate ligament and meniscal tears

A multidisciplinary approach to diagnosis and treatment — see “Masters of Multispecialty Care” — and streamlined care that is convenient for busy families are hallmarks of pediatric orthopedics at The Children’s Hospital of San Antonio.

Preston Luke broke his leg while vacationing with his family in San Antonio. Shawn Funk, MD, was his orthopedic surgeon.

“Our team includes practice coordinators for each pediatric orthopedic surgeon who give parents a single contact person to turn to with questions or concerns,” says Elizabeth Magnabosco, MD, Section Chief of Pediatric Orthopedic Surgery at The Children’s Hospital of San Antonio. “We have a dedicated social worker who is available at any time for our patients’ needs. My colleagues and I work with programs in the hospital, such as Child Life, to prepare patients for surgical procedures.”

Three locations in San Antonio bring pediatric orthopedics close to where families live and send their children to school. The Children’s Hospital of San Antonio operates pediatric orthopedic clinics at:

  • The Children’s Hospital of San Antonio downtown campus at 333 N. Santa Rosa St.
  • The Children’s Hospital of San Antonio Specialty Care Center at 15900 La Cantera Parkway
  • The Children’s Hospital of San Antonio Health Pavilion – Stone Oak at 1434 E. Sonterra Blvd.

Each location features daily coverage by a midlevel or physician member of the pediatric orthopedic surgery team. The pediatric orthopedic surgeons hold clinic daily at the downtown location and one to two times per week at the Specialty Care Center and Health Pavilion.

“We have instituted direct care scheduling from The Children’s Hospital of San Antonio — Pediatric Primary Care clinics into our orthopedic clinics, which streamlines the process for patients,” Dr. Magnabosco says. “From the ER, we can arrange for follow up orthopedic outpatient care at any of our locations in La Cantera, Stone Oak and Goldsbury Center for Children and Families (downtown). Parents can leave the Emergency Department with an appointment to continue care for their child at their preferred location. Our clinics have emergency care capabilities. If a child needs to be seen for an injury, care is usually available the same day or the next day.”

“Pediatric orthopedic surgeons are the last general orthopedic surgeons. Adult orthopedic practitioners tend to be quite specialized, focusing on joint replacement or musculoskeletal areas, such as the shoulder, foot and ankle, or spine. On the pediatric side, we do it all.”
— Elizabeth Magnabosco, MD, Section Chief of Pediatric Orthopedic Surgery at The Children’s Hospital of San Antonio

Areas of Expertise

Pediatric orthopedic surgeons at The Children’s Hospital of San Antonio care for the full gamut of childhood orthopedic conditions, but they are especially skilled at treating:

  • Clubfoot — Pediatric orthopedic surgeons partner with maternal-fetal medicine specialists to hold consultations with expectant parents when prenatal ultrasound reveals clubfoot in utero. Those meetings provide invaluable education to parents and pave the way for treatment to begin soon after birth. The pediatric orthopedic team has enjoyed excellent results with the standard-of-care Ponseti method, a treatment that involves casting to reposition the deformed foot and bracing to prevent it from returning to its abnormal position.
  • Hip dysplasia — “Community pediatricians have become quite adept at identifying newborns with hip dysplasia,” Dr. Magnabosco says. “We see these babies immediately to start nonoperative treatment. If hip dysplasia isn’t identified until later, all of our pediatric orthopedic surgeons are skilled in the operative treatment of this condition. My colleague, Shawn Funk, MD, has additional expertise in treating adolescents with a shallow hip socket. He can perform the Ganz periacetabular osteotomy for redirecting the hip socket to completely cover the head, which may decrease or eliminate the risk of developing arthritis as an adult.”
  • Neuromuscular disorders — Pediatric orthopedic surgeons monitor a large population of children with cerebral palsy and other neuromuscular disorders for joint deformities. They also perform surgery, as necessary, to enhance patients’ function and help them avoid more extensive problems.
  • Scoliosis — The Children’s Hospital of San Antonio has been a pioneer in the treatment of scoliosis and thoracic insufficiency syndrome for three decades, since pediatric orthopedic surgeon Robert M. Campbell Jr., MD, designed and implanted the first titanium rib prosthesis, which became the widely used Vertical Expandable Prosthetic Titanium Rib (VEPTR), at the hospital. Established in 2008, the Spinal and Thoracic Treatment and Research (STTAR) Center at the hospital offers a variety of treatments for early-onset scoliosis and related conditions, including VEPTR, Shilla and other growing rod-based methods, Mehta casting, and spinal fusion. A dedicated operating room team, including anesthesiologists, is responsible for spine surgeries. The use of Stryker navigation technology allows surgeons to view 3D, real-time, intraoperative images of the spine, which improves the safety and speed of surgery, according to Dr. Magnabosco.

“We worked with pediatric intensivists to develop a postoperative protocol for spine surgery patients to help them recover as quickly as possible,” she says. “We also partnered with infectious disease physicians to create an evidence-based antibiotic prophylaxis protocol for spinal surgeries that addresses the most common complication of infection in these operations. Data are still being collected but seem to indicate our infection rate, which was already quite low, has continued to drop.”

Poised to Grow

From July 1, 2016, to July 1, 2017, San Antonio, the nation’s seventh-largest city, added more people — 24,208 — than any other city in the country with a population of at least 50,000, according to the U.S. Census Bureau. That influx of new residents pushed the city’s population above 1.5 million for the first time. As of July 1, 2018, people younger than 18 accounted for an estimated 25.4 percent of San Antonio’s population, the Census Bureau reported.

The Children’s Hospital of San Antonio plans to enhance its ability to meet the demand for pediatric orthopedics by adding two physicians who can provide more sports medicine services and offer treatment for complex lower limb deformities. Expanding pediatric orthopedic outreach programs to San Antonio’s growing, diverse population is a priority for hospital leaders. As the pediatric orthopedics program grows, burnishing its reputation for high-quality, compassionate care will be paramount.

“We are not just physicians — we’re also caregivers,” Dr. Magnabosco says. “We develop relationships with our patients and their families. Whether a child has a condition that requires ongoing care from an orthopedic surgeon or a broken arm from a fall on the playground, we’re always ready to provide the personalized treatment he or she needs.”

For more information about pediatric orthopedics at The Children’s Hospital of San Antonio, visit chofsa.org or call 210-704-4708.