ORTHOPEDICS
A Joint Effort continued
“ Our goal is to not do surgery on these kids . Our goal is to see them early enough that we can treat them with nonoperative methods .”
MARGARET SIOBHAN MURPHY-ZANE , MD
“ They want to know what their scar looked like and how it was going back to school ,” Dr . Selberg says . “ We do a lot of education before surgery , so we can make sure our patients are on board — that they have their work set up and their home environment set up . I find it really helps people be more successful with the outcome of their surgery and be happy about it .”
Dr . Selberg and her team have found this is helping patients feel more confident and prepared before surgery . The team is also analyzing the benefits of using a dedicated perioperative team protocol for the PAO procedure , including anesthesia providers specializing in hip procedures and an intraoperative neuromonitoring team . So far , they have found this approach minimizes blood loss , shortens operative time and lowers transfusion rates . Dr . Selberg presented these findings to the Pediatric Orthopaedic Society of North America in 2022 .
A FOCUS ON NON-NARCOTIC PAIN MANAGEMENT
The other main focus of Dr . Selberg ’ s research is looking at ways to implement a non-narcotic pain management routine . Right now , she is conducting a pilot study using the HeartMath device — a small machine that measures heart variability . Participants are trained in perioperative resiliency , providing them with a toolkit of options for coping with surgery and recovery , such as various breathing techniques .
“ When they are in the hospital , they can employ some of these techniques for taking control of their breathing , visualizing what options they have to ask for help and getting up to move around ,” Dr . Selberg explains . “ The first answer is not , ‘ They just need more pain medication .’ Setting up the expectation that we have lots of tools in our toolkit for dealing with pain really helps it become very manageable for patients .”
These education opportunities , paired with the research on the benefits of a perioperative team protocol , are setting patients up for success and allowing teenagers to use less pain medication post-operation .
“ Those things really distinguish our center for excellence in terms of doing surgery in a safe way and making sure we are minimizing narcotic use and minimizing hospital stay ,” Dr . Selberg says . “ That ’ s definitely one of our strengths .” •
1 . Murphy-Zane , Margaret S et al . “ Application of Accepted Use Criteria for the Treatment of Developmental Dysplasia of the Hip Decreases the Number of Infants Treated With a Pavlik Harness .” Journal of pediatric orthopedics vol . 43,2 ( 2023 ): e138-e143 . doi : 10.1097 / BPO . 0000000000002295 .
2 . Salton , Reba L et al . “ Twelve-week standard of care protocol longer than median time to normalization among IIc hips treated with Pavlik harness .” Journal of pediatric orthopedics . Part B vol . 31,4 ( 2022 ): 313-318 . doi : 10.1097 / BPB . 0000000000000946 .
3 . Salton , Reba L et al . “ Prediction of Late Dysplasia Based on Ultrasound and Plain X-Ray at 6 Months .” Journal of pediatric orthopedics vol . 43,2 ( 2023 ): 99-104 . doi : 10.1097 / BPO . 0000000000002301 .
COURTNEY SELBERG , MD
Orthopedic surgeon , Children ’ s Hospital Colorado
Assistant professor , Orthopedics , University of Colorado School of Medicine
GAIA GEORGOPOULOS , MD
Orthopedic surgeon , Children ’ s Hospital Colorado
Associate professor , Orthopedics , University of Colorado School of Medicine
MARGARET SIOBHAN MURPHY-ZANE , MD
Orthopedic surgeon , Children ’ s Hospital Colorado
Associate professor of clinical practice , Orthopedics , University of Colorado School of Medicine
NANCY HADLEY-MILLER , MD
Orthopedic surgeon , Children ’ s Hospital Colorado
Professor , Orthopedics , University of Colorado School of Medicine
10 | CHILDREN ’ S HOSPITAL COLORADO