Division of Orthopaedic and Scoliosis Surgery, Texas Children’s Hospital; Houston, TX, USA
 Baylor College of Medicine; Houston, TX, USA
John P. Dormans, MD, FACS
Division of Orthopaedic and Scoliosis Surgery
Texas Children's Hospital
6701 Fannin St, Suite 660
Houston, TX 77030, USA
Since opening its doors in 1954, Texas Children's Hospital has served the ever growing needs of the regional Texas community. As Houston and the surrounding communities within Texas have expanded immensely over the years, so too have the subspecialties of pediatric orthopaedics and orthopaedic surgery. The authors offer a look back at the history and accomplishments of Orthopaedic and Scoliosis Surgery at Texas Children’s Hospital from the perspectives of the orthopaedic surgeons who have served throughout Houston and the institution, and propose a vision for what’s to come in the future.
Level of Evidence: V; Descriptive review/Expert opinions.
Keywords: Texas Children’s Hospital; Pediatric Orthopaedic Surgery; Houston; History.
Texas Children’s Hospital first opened its doors in 1954 and was soon established as the primary pediatric teaching hospital associated with Baylor College of Medicine (Figure 1A, B). The collaborative academic partnership that formed between Texas Children’s Hospital and Baylor College of Medicine persists to this day. From humble beginnings as a three-story building with 106 beds, the hospital treated a total of 4,558 patients in its first year of operation . Although the field of pediatric orthopaedic surgery was still being pioneered at that time, the emerging need for highly specialized pediatric surgical care would eventually be realized at Texas Children’s with the exponential growth of Houston and the surrounding regions.
Figure 1. Groundbreaking ceremony at the future site of Texas Children’s Hospital on May 23, 1951 (A). Texas Children’s Hospital in 1954 (B).
Meeting the needs for musculoskeletal care in a rapidly expanding pediatric community remains a challenge to this day, but is one readily accepted by the leadership of Texas Children’s and a responsibility increasingly embraced by generations of orthopaedic providers. Today, as the healthcare providers in Orthopaedic and Scoliosis Surgery at Texas Children’s strive to continue advancing patient care, we offer a look back at the history of orthopaedic leadership in Houston and at Texas Children’s Hospital.
In the late 1940s, shortly before Texas Children’s opened, the polio epidemic was sweeping the nation. It was during this time in 1946 that renowned orthopaedic surgeon and innovator Dr. Paul R. Harrington (Figure 2) arrived in Texas from Kansas . A graduate of the University of Kansas, Dr. Harrington was an accomplished athlete and star basketball player for the Kansas Jayhawks (Figure 3). A true pioneer for his groundbreaking work in spine instrumentation that includes the Harrington Rod, Dr. Harrington persevered through trial and error with his invention and countless rejections from manufacturers . Ultimately, his monumental achievements helped solidify Texas’ place in orthopaedic history. In addition to his significant and enduring technical contributions to the field, Dr. Harrington was also a founding member of the Houston Orthopaedic Society and a Professor of Orthopaedic Surgery at Baylor College of Medicine with surgical privileges at Texas Children’s until he retired from practice in 1972 (Figure 4).
The year 1946 also marked the arrival of Dr. Joseph “Joe” Foster who joined Baylor College of Medicine as the first Professor and Chairman in the Department of Orthopaedics . In this role, Dr. Foster paved the way for future generations of surgeons and established the first training program in orthopaedic surgery that incorporated Baylor College of Medicine, Hermann Hospital, St. Joseph’s Infirmary, and Arabia Temple Crippled Children's Clinic and Hospital (today known as Shriners Hospital for Children) [2,4]; the collaborative training program would eventually grow to incorporate Texas Children’s Hospital. Dr. George Lane, a decorated Air Force veteran of World War II, was the first to graduate from Baylor’s orthopaedic surgery training program. Dr. Lane entered into private practice in 1955 and served as the Chief of Polio and Spina Bifida clinics at The Institute for Rehabilitation and Research (TIRR) in Houston from 1958 to 1975. He continued to practice in Houston until 1998.
Texas Children’s Hospital Opens
Figure 2. Book cover for Dogged Persistence: Harrington, Post-polio Scoliosis, and the Origin of Spine Instrumentation, published in 2015. Written by Marc Asher, MD. Used with permission from the Harrington Archives, University of Kansas Medical Center, Kansas City, KS.
Upon the opening of Texas Children's, Dr. Edmund Cowart was named the first Chief of Orthopaedic Service. Figure 5 describes the timeline of orthopaedic leadership at the hospital. After completing his medical degree at the University of Pennsylvania and subsequent surgical training in New York and the University of Iowa, Dr. Cowart began his orthopaedic practice in Houston in 1931 . Prior to Texas Children's, Dr. Cowart was a veteran of the European Theater during World War II and completed his service as a Lieutenant Colonel .
Following Dr. Cowart’s leadership, Dr. Arthur Glassman (Figure 5) entered the role as Chief of the Orthopaedic Service in 1959. After completing his medical education and surgical training at the University of Iowa, Dr. Glassman served in the U.S. Armed Forces in the European Theater during World War II from 1942 to 1945 . Soon after his service, Dr. Glassman came to Houston in 1946 to start an orthopaedic surgery practice. As Chief of the Orthopaedic Service at Texas Children’s for more than 20 years, Dr. Glassman was an influential force in bolstering the presence of the subspecialty at the institution (Figure 4).
Before the Division of Orthopaedic and Scoliosis Surgery was fully formed in the early 1990s, Texas Children’s relied on external consultants to provide orthopaedic care for patients. Over the course of his career, Dr. Jesse Dickson operated at TIRR, Methodist Hospital, St. Luke’s Episcopal Hospital, Shriners Hospital for Children―Houston, Hermann Hospital, and Texas Children’s. Dr. Dickson served as Chief of TIRR from the late 1960s until the new millennium. A Houston native and a member of the first class to graduate from St. John’s School, Dr. Dickson began his residency in orthopaedic surgery at Baylor College of Medicine in 1961 and metDr. Harrington during his first year there in the spring of 1962. Following his residency, Dr. Dickson spent several years in the armed forces and returned to begin practice in Texas following a hip fellowship at the Hospital for Special Surgery in New York City. During his time in Houston, Dr. Dickson worked closely with Dr. Harrington in the later years of his career. Dr. Dickson commented on his experiences working with the late surgeon. “He was the nicest individual. When he started doing his instrumentation, there was loads of criticism,” Dr. Dickson said, “People told him he was crazy.” Despite this, Dr. Harrington stayed the course and continued to improve his spinal instrumentation and surgical techniques. According to Dr. Dickson, Dr. Harrington never said anything negative regarding those who had doubted or ridiculed his procedure. Ultimately, Dr. Harrington became highly regarded for his technique and became known for his speed when operating and his ability to minimize blood loss during surgery. Dr. Harrington suffered a heart attack in 1968 and Dr. Dickson soon took over his practice. Due to his worsening health, Dr. Harrington’s ability to perform at his best was diminished. Dr. Dickson said, “When he could no longer do his best, he wouldn’t do it.” Dr. Dickson continued performing the Harrington procedure until the mid-1980s. Before his retirement in 2002, Dr. Dickson served as President of the Scoliosis Research Society (SRS) in 1990.
Figure 3. Honorary team captain for the University of Kansas, Paul Harrington, MD (shown center, second row). Used with permission from the Harrington Archives, University of Kansas Medical Center, Kansas City, KS.
Dr. Warren Malcolm Granberry, a San Antonio, Texas native, served at Texas Children’s as a consulting physician from his arrival to Houston in 1965 until the late 1970s. Though trained as a hand specialist, Dr. Granberry’s experience made him well-equipped to care for a variety of general pediatric orthopaedic conditions. He enjoyed the challenge of correcting deformities and relieving pain, and took true pride in the care of his patients. For Dr. Granberry, orthopaedic surgery is very much a family business. In a recent interview, he reminisced about a particular case at Texas Children’s that involved operating with his sons Michael (now a joint specialist in Mobile, Alabama, who was the upper-level resident at the time) and Bill (a foot and ankle specialist at Baylor College of Medicine in Houston, who was then a junior resident). As he recalled with a chuckle, “In reviewing the OR nurse report following the surgery, it read, ‘Attending Granberry, Assistant Granberry and Granberry’.”
After completing both his medical education and orthopaedic training at Baylor College of Medicine, Dr. Hugh Tullos’ affiliation with the institution would continue for the remainder of his career . In 1974, Dr. Tullos became Chair of the Division of Orthopaedic Surgery at Baylor , where he served for more than 25 years before he passed in 2001. Although he saw patients at Methodist Hospital for more than 30 years, Dr. Tullos was a key player in recruiting several orthopaedic specialists to Texas Children’s. Furthermore, Dr. Tullos was also an avid clinical researcher. To commemorate his contributions to clinical research in orthopaedics, Baylor established the Hugh S. Tullos Research Award. Granted each year to an orthopaedic resident with stellar achievement in the field of research, the award also serves to honor Dr. Tullos’ long-standing contributions to the institution.
Figure 4. Paul Harrington, MD, operating privileges. June 1, 1971. Harrington Archives.
Dr. Joseph “Joe” Barnhart, of Beeville, Texas, was another prominent figure who greatly influenced the field of orthopaedic surgery in Houston. A 1943 graduate of the University of Texas Medical School in Galveston, Dr. Barnhart served as Chief of the Orthopaedic Service at both St. Luke’s Hospital and Texas Children’s during his 35 years of practice in Houston (Figure 5). When he passed in 1993, Dr. Barnhart left behind a lasting legacy and the Department of Orthopaedic Surgery at Baylor College of Medicine was renamed in his honor as the Joseph Barnhart Department of Orthopaedic Surgery. In the mid-1980s, Dr. Douglas Barnes (Figure 5) served as Chief of Orthopaedic Clinics within the Junior League Outpatient Clinic System at Texas Children’s before being appointed as Chief of Orthopaedics by Dr. Ralph Feigin. The Outpatient Clinic System would ultimately dissolve in 1991 and merge with the Feigin Center. In 1989, Dr. Michael E. Debakey established the Department of Orthopaedic Surgery at Baylor College of Medicine from the Division of Surgery. At this time, the members of the Division became full-time staff of the newly formed Department. Dr. Barnes played a vital role working at both Baylor and Texas Children’s as the first member of the newly formed Department at Baylor. Even after Dr. Barnes departure from Texas Children’s to become Chief of Staff at nearby Shriners Hospital, Dr. Barnes has continuously maintained an active, full-time role in educating residents and pediatric orthopaedic fellows with Baylor College of Medicine.
As the number of clinicians increased at Texas Children’s, so did the volume of patients and workload. In 1991, the team consisted of Dr. Barnes, Dr. Joseph “John” Gugenheim Jr., Dr. Nancy Hadley-Miller, and Dr. Gary Brock. Following Dr. Hadley-Miller’s departure for Washington, D.C., Drs. Barnes, Gugenheim, and Brock served the great majority of orthopaedic patients seen at Texas Children’s for several years. As Dr. Brock recalls, his team was the first to insist that all pediatric orthopaedic patients at Texas Children’s were seen by fellowship-trained pediatric orthopaedists, thus relieving the general orthopaedists from call duties at the hospital. To that end, the team of pediatric orthopaedic specialists picked up more shifts to provide patients with the highest quality of care.
Figure 5. Orthopaedic surgery Leadership and milestones at Texas Children’s Hospital. Information courtesy of hospital records and personal communication.
Dr. Charles Stephenson (Figure 5), a Houston native who was well-known for his work in pediatric orthopaedic surgery and cerebral palsy, joined Texas Children's Hospital from Methodist Hospital in 1991 to officially establish the Division of Orthopaedic and Scoliosis Surgery as its Chief. Following his graduation from Baylor College of Medicine in 1953, Dr. Stephenson completed a year-long internship in St. Louis, Missouri and subsequent residency training at Baylor-affiliated institutions and Shriners Hospital for Crippled Children in Los Angeles, California . Dr. Stephenson served as Chief at Texas Children’s until 1995 and was Professor of Orthopaedic Surgery at Baylor before he retired from practice in 1997.
Ultimately, it would be several years before the number of in-house specialists in the Division of Orthopaedic and Scoliosis Surgery at Texas Children’s grew to a size commensurate with the expanding Houston and regional communities. Still, it was Dr. Gugenheim, a respected member of the pediatric orthopaedics group at Texas Children’s, who truly personified the heart of the subspecialty community within Houston. A graduate of Northwestern University School of Medicine, Dr. Gugenheim completed his orthopaedic training at Baylor College of Medicine . Through his work with the Ilizarov external fixator device, Dr. Gugenheim assumed a national leadership role that propelled progress of the Division forward on a more expansive scale prior to his departure to the Texas Orthopaedic Hospital in the mid-1990s. As evidenced by the additions of Dr. Frank Gerow and Dr. Nelson Davino, the pediatric orthopaedic practice was booming. Despite the assistance of orthopaedic residents, the average attending worked more than 80 hours a week to meet the demands of a dynamic and growing practice.
As Dr. Stephenson’s successor, Dr. Wendell Erwin (Figure 5) worked to expand the orthopaedics division at Texas Children’s and recruited several pediatric orthopaedic surgeons to join the faculty during his tenure. Dr. Erwin, who graduated from Baylor College of Medicine in 1966, completed consecutive fellowships in scoliosis under the direction of Dr. Harrington at Baylor and Dr. John Moe at the University of Minnesota . Following his training, Dr. Erwin returned to Houston where he practiced with Dr. Dickson for roughly a year before he became Professor of Orthopaedic Surgery and Pediatrics at Baylor. Dr. Erwin served as Chief of the Division at Texas Children’s from 1996 until his retirement in 1999. Dr. Erwin said that the favorite part of his orthopaedic practice, outside of surgery, was getting to know his young patients and families extraordinarily well. He thought the ability to care for young patients with chronic orthopaedic conditions throughout their entire lives was one of the most rewarding aspects of his career. This mindset has continued to resonate with the pediatric orthopaedic surgeons at Texas Children’s.
Dr. William “Bill” Phillips (Figure 5) served as Chief of the Division of Orthopaedic and Scoliosis Surgery from 1999 to 2015. Recruited by Dr. Erwin, Dr. Phillips encouraged his team of orthopaedic specialists to deliver the highest quality of care as the subspecialty continued to expand. As Co-Director of the Pediatric Orthopaedic Fellowship Program, Dr. Phillips has trained nearly 20 clinical fellows at Texas Children’s. He recently expanded his educational responsibilities, taking on a new role as a Learning Community Senior Advisor, mentoring dozens of medical students on a weekly basis across the street at Baylor College of Medicine.
Visions for the Future
Figure 6. Orthopaedic surgery Leadership and milestones at Texas Children’s Hospital. Information courtesy of hospital records and personal communication.
Presently, Dr. John Dormans (Figure 5), who assumed the role of Chief of Orthopaedic and Scoliosis Surgery following Dr. Phillips in 2015, continues efforts to establish the orthopaedic program at Texas Children’s as one of the most reputable in the nation. Dr. Dormans became the first Chief of Orthopaedics at Texas Children’s to hold an endowed chair―the L.E. Simmons Endowed Chair. He also serves as a tenured Professor of Orthopaedics at Baylor College of Medicine. Dr. Dormans joined Texas Children’s from Children’s Hospital of Philadelphia (CHOP), where he served as Chief of Orthopaedic Surgery from 1996 to 2015 and helped pioneer developments in limb-sparing surgery for musculoskeletal tumors and sarcomas. In addition, he is widely recognized for his work treating pediatric and cervical spine deformities. At CHOP, Dr. Dormans expanded the orthopaedic faculty from three full-time surgeons to 35 providers and led the program to many years as the number-one-ranked children’s orthopaedic program according to U.S. News & World Report in the past decade. At CHOP, Dr. Dormans served as President of the Medical Staff and also as President of Children’s Surgical Associates for four three-year terms. In addition, Dr. Dormans has served as President of the Pediatric Orthopaedic Society of North America (POSNA), SRS, Orthopaedics Overseas, and the World Orthopaedic Concern and is in the presidential line for the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT).
Figure 7. Texas Children's Hospital Main Campus.
In 2015, Texas Children’s Orthopaedic Division faculty completed more than 34,000 visits at eight outpatient locations and performed over 2,400 surgical cases at the two hospital locations (Figure 6 and 7). This is a stark contrast to the early days of orthopaedic consults at the hospital, when as Dr. Malcolm Granberry recalls, “We were lucky if we saw 350 in a year’s time.” Dr. Dormans has been instrumental in developing and following through on an ambitious vision to expand from eight orthopaedic surgeons to the current 21 full-time surgeons (Table 1).
As Texas Children’s grows and adds a new hospital in The Woodlands in 2017, Dr. Dormans plans to increase the number of surgeons by another 10 in the approaching years to cover the three full-service children’s hospitals in Houston, Katy, and The Woodlands (Figure 8 and 9). The newly appointed Orthopaedic Lead at West Campus in Katy, Dr. Scott McKay, and the Chief Surgical Officer at The Woodlands Campus, Dr. Jeffrey Shilt, will play instrumental roles in continued expansion throughout the region.
Figure 8. Texas Children’s Hospital West Campus, which features 62 beds
In addition, the current roster at Texas Children’s is fortunate to include people like Dr. Howard Epps, who is Immediate Past President of the Texas Orthopaedic Association. After completing his undergraduate education at Harvard, Dr. Epps earned his medical degree from Johns Hopkins University School of Medicine in 1989. Since completing his postdoctoral training at Massachusetts General Hospital and Pediatric Orthopaedic Fellowship at The Hospital for Sick Children in Toronto, Ontario, Canada, Dr. Epps began his practice in Houston with the Fondren Orthopaedic Group in 1996. Although he worked at Texas Children’s since 1996, he joined the full-time faculty in 2012. Presently, Dr. Epps is the Medical Director of Pediatric Orthopaedics and Scoliosis at Texas Children’s and has accumulated over twenty years of dedicated service to the Houston community.
The pediatric orthopaedic department works closely with Dr. Thomas Hunt (Table 2) in transitioning patients from pediatric care to adult care. Dr. Hunt is the Chair of the Joseph Barnhart Department of Orthopaedics at Baylor College of Medicine and is an internationally renowned hand surgeon. Prior to coming to Baylor in 2012, Dr. Hunt served as Chair of Orthopaedic Surgery at the University of Alabama. His sports background consists of being the former team hand surgeon for professional programs, including the Cleveland Browns and the Cleveland Cavaliers, as well as collegiate programs, including the University of Alabama and Auburn University. The Houston Texans currently employ his services. Under the leadership of Dr. Dormans and Dr. Hunt, the pediatric and adult departments of orthopaedic surgery have collaborated in providing better transitional care for patients emerging into adulthood.
Figure 9. Texas Children’s Hospital The Woodlands, which features 60 beds. Rendering courtesy of FKP Architects.
In anticipation of the challenges facing healthcare delivery, the Division has implemented a productivity compensation model ensuring continued physician activity and access for patients well into the future. Current orthopaedic efforts within Texas Children’s involve collaboration with sports medicine, physical medicine and rehabilitation, radiology, neurology, genetics, and anesthesiology to solidify the multidisciplinary musculoskeletal program at the institution (Figure 10). The new Motion Analysis and Gait Lab, Human Performance Program, O-arm Intraoperative Surgical Imaging System, and EOS Imaging System will further facilitate diagnostic accuracy, improved surgical planning and safety, and, ultimately, patient care.
By engaging in both clinical and basic science research efforts, the Division of Orthopaedic and Scoliosis Surgery has recently made strong progress toward diversifying research involvement. During Dr. Dormans’ first year as Chief, the number of accepted publications produced by the Division more than doubled. As the L.E. Simmons Endowed Chair of Orthopaedics, Dr. Dormans was provided a funding mechanism for basic science research collaboration with Dr. Brendan Lee. Dr. Lee is a renowned physician-scientist appointed to the Robert and Janice McNair Endowed Chair of the Department of Molecular and Human Genetics at Baylor College of Medicine and is the founder and director of the Skeletal Dysplasia Clinic at Texas Children’s. The overall mission of Dr. Lee’s laboratory research program is to translate the study of structural birth defects and inborn errors of metabolism into an improved understanding of development, disease, and novel therapeutic approaches with a focus on musculoskeletal disorders.
Clinical research and efforts in education have also evolved through the years to include full-time research support staff and both clinical and research pediatric orthopaedic fellowship programs. By establishing a dedicated commitment to education, the faculty at Texas Children’s play an important role in training incoming generations of orthopaedic specialists. Furthermore, these opportunities have extended to advanced practice providers, which has led to the creation of the nation’s first Pediatric Orthopaedic Physician Assistant Fellowship Program under the leadership of Director Kolby Buckner, MPAS, PA-C.
With the rise of such highly subspecialized training, the field of orthopaedics looks largely different than it did when Texas Children’s first opened in 1954. The advent of pediatric specialists has deepened understanding of developmental and congenital musculoskeletal problems and allowed for pediatric surgical solutions to impact patient wellbeing through adulthood. “My hope,” Dr. Dormans explains, “is that we can all work together to support the efforts to build pediatric medicine and surgery in Houston, the state of Texas and beyond. I believe one of the major efforts that made pediatric medicine and surgery so strong in the last couple of decades is the emergence of the full-service teaching children’s hospital.”
In comparison to other hospitals across the country, Texas Children’s is still a young hospital. At just over 60 years old, it is the second youngest hospital to be ranked in the top 5 pediatric hospitals by U.S. News & World Report for 2016-2017. “While CHOP just surpassed its 160th anniversary,” Dr. Dormans explains, “Texas Children’s is just beginning to establish strong traditions in pediatric orthopaedic surgery and will become an international leader in the field.” To that end, Texas Children’s has been fortunate to have had so much growth and success in a relatively short time.
Figure 10. Texas Children's Hospital multidisciplinary musculoskeletal team, with orthopaedic surgeon Megan May, MD (right), operates in 2016.
Pediatric orthopaedic surgery began in Houston with pioneers such as Dr. Harrington. From the practices of private physicians to the establishment and rise of a prominent orthopaedic division at Texas Children’s Hospital and department at Baylor College of Medicine, the evolution of orthopaedics here has included a multifaceted team of talented and passionate clinicians. At Texas Children’s, the history of excellence in orthopaedic surgery and clinical expertise continues with a team-approach focused on efficiency, safety, and value. Additionally, the group plans to expand training opportunities for students from Mexico, and Central and South America. Through collaborations with POSNA, SICOT, and SRS, the individuals at Texas Children’s have developed a vision to become a world-renowned orthopaedic program and premier care destination for our patients. The Division of Orthopaedic and Scoliosis Surgery at Texas Children’s Hospital looks forward to continued progress in the future to meet the growing needs of the regional Texas community and beyond.
The authors would like to thank Dr. Douglas Barnes, Dr. Gary Brock, Dr. Jesse Dickson, Dr. Howard Epps, Dr. Wendell Erwin, Dr. Warren Malcolm Granberry, Dr. Joseph "John" Gugenheim Jr., Dr. Frank Gerow, Dr. Scott Rosenfeld, Dr. Charles Fraser Jr., Mark Wallace, and Dr. William Phillips, for their time and contributions to this manuscript. Photos courtesy of Texas Children’s Hospital.
As we acknowledge the important contributions of the aforementioned influential figures, we also humbly recognize the potential for anecdotal inaccuracies and limitations of this account. Despite approaching this project with the sole interest of providing an objective retelling of the Division’s story, we profess there exists potential for inadvertent omissions and discrepancies in this exposition.
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