The Rubin Institute for Advanced Orthopedics€¦ · The Rubin Institute for Advanced Orthopedics is bringing next-generation care to the community — and the world. Bradley Lamm,

The Rubin Institute for Advanced Orthopedics

Helping Patients Stand Tall

Build Strong Bones for Life

Finding the Path BackFrom Pain

SPRING 2016

Magazine

Deborah HollensteinVice President, Strategic Marketing and Communications

Jill BloomDirector, Strategic Marketing and Digital Media

Chantrese LesterSenior Graphic Designer

Scott WendlerMultimedia Specialist

LifeBridge Health Magazine is published by the LifeBridge Health Strategic Marketing and Communications Department.

2401 W. Belvedere Ave.Baltimore, MD 21215410-601-8347

Great Strides 4

Chiefs’ Corner 6

Protect All the Parts of Your Skeleton From Injury 7

Helping Patients Stand Tall 8

Joint Preservation Can Eliminate the Need for Replacement Surgery 10

Smarter Treatment Planning Leads to Better Outcomes for Joint Replacement Patients 12

Orthopedic Trauma Team Heals Patients After Serious Injury 14

Build Strong Bones for Life 15

Putting Relief Within Reach 16

Renowned Team Treats Complex Pediatric Orthopedic Cases 18

Providing Orthopedic Care to Those in Need 19

Finding the Path Back From Pain 20

Calendar of Events 22

What’s Inside

Stay Connected

4

Looking for a doctor?

Call 410-601-WELL (9355)for the area’s best!

10 15

2022

Letter from the CEO

Dear Friends,

T here’s the old cliché that coming up with a great idea is like a lightbulb turning on in your

head. For Jerome Reichmister, M.D., chief of orthopedics at Sinai Hospital, it was more like a light turning on in a movie theater.

It was a night about 16 years ago, and Dr. Reichmister was catching a movie with his wife. When the house lights came on, he saw a former colleague seated a couple rows ahead. They started chatt ing about their orthopedic work. The chat led to brainstorming over coff ee. The brainstorming led to trading ideas over late-night faxes. Finally, they had a plan: to build a destination that would provide world-class orthopedic care to patients of all ages, across the full

The Rubin Institute for Advanced Orthopedics:

The Guiding Light of Orthopedic Care

Spring 2016 www.lifebridgehealth.org 3

Expertise for All When you see all that the Rubin Institute has accomplished, you realize how incredibly fortunate we are to have it here in our backyard. The same doctors, nurses and physical therapists that patients journey thousands of miles to see are the ones we as a community can turn to for even our most routine orthopedic concerns. The aches and pains of an aging joint, an ankle fracture sustained on the soft ball fi eld — at the Rubin Institute, these are all treated with the same degree of expertise and compassion as the rarest bone disorders.

And now, we are fi nding new ways to make it even easier for you to get expert orthopedic care. We’ve added multiple locations to serve you closer to where you work and live and extended our hours to bett er fi t your schedule. But we’re not done innovating yet. If there’s one thing you can count on with the Rubin Institute — and with all of LifeBridge Health — it’s that visionary “lightbulb” ideas happen here almost every day.

Sincerely, Neil M. MeltzerPresident and CEOLifeBridge Health

continuum of care, from diagnosis to recovery. That place became LifeBridge Health’s Rubin Institute for Advanced Orthopedics.

The Destination for Visionary Care The Rubin Institute was, at its 2001 founding, one of the fi rst of its kind. Since then, many hospitals and health systems have developed similar models of orthopedic care. Nevertheless, the Rubin Institute still stands apart as the destination for visionary orthopedic care.

Every day, we advance the science of orthopedics through research, teaching and volunteer medical missions. We take on challenges that others shy away from. We treat conditions many consider untreatable. It’s why patients travel from all corners of the world to come here.

Neil MeltzerPresident and CEO

Roland Starr, M.S. Engineer, Wasserman Gait Laboratory at the Rubin Institute for Advanced Orthopedics

M ost hospitals don’t know what to do with a lab like ours,” admits Roland Starr, M.S. As the engineer for the Wasserman Gait Laboratory at the Rubin

Institute for Advanced Orthopedics at Sinai Hospital, Starr brings unique expertise to the team, using technologies such as motion capture systems, force-measurement plates and pressure-mapping software to help orthopedic doctors and

physical therapists develop treatment plans, measure patient outcomes and test the latest in-house research.

Unique expertise may very well be the calling card of the Rubin Institute. With specialists in areas as diverse as limb lengthening, foot and ankle surgery, orthopedic trauma, pediatric orthopedics, joint replacement and joint and limb preservation, the Rubin Institute has become the destination for pre-eminent orthopedic care in the Baltimore region and around the world.

“We have patients from every state in the nation and from over 50 countries,” says Jerome Reichmister, M.D., chief of orthopedics at Sinai Hospital and the chairman of the Rubin Institute. “Our expertise is one-of-a-kind, and it draws people here, not only for complex cases but also for everyday concerns.”

Cutting-Edge Research and LearningAccording to Dr. Reichmister, the team’s “quest for continuous learning” keeps the Rubin Institute on the cutting edge of orthopedic care. In the past year alone, institute members have published more than 100 research projects on topics such as robot-assisted total hip arthroplasty and limb lengthening treatments for dwarfism; served as editors for major research journals; and traveled nationally and internationally to lecture at hospitals and campuses as prestigious as Duke and Stanford universities.

The institute offers numerous resident and fellowship training programs in highly specialized areas, such as foot and ankle deformity correction. And each year, Rubin Institute physicians host continuing education courses that attract hundreds of doctors from around the world to Baltimore. “We have physicians who are among the world’s top research-ers in their fields,” says Lucy Ferko, R.N., M.A., vice president of service lines at LifeBridge Health. “It is incredibly unique to offer this level of research and teaching in an academic medical center with a community hospital feel.”

Delivering Better Patient OutcomesStill, the primary focus of the Rubin Institute has and always will be patient care. “Our goal is simple: Put the patient first,” says Ferko. “We are continually evaluating ourselves to make sure we’ve mapped out the best evidence-based clinical practices so that we can provide the best outcomes possible for the people we treat.”

Dr. Reichmister points out that the optimization of care extends through every phase of a patient’s treatment plan. “We have an excellent rehabilitation team,” he says. “Our surgeons and physical therapists have worked together to develop clear protocols to get our patients back on their feet in the safest, smartest way possible.”

The approach is working. Currently, Rubin Institute patients experience an average length of stay that is well below the national average and among the lowest in the state.

4 LifeBridge Health Magazine Spring 2016


Great Strides The Rubin Institute for Advanced Orthopedics is bringing next-generation care to the community — and the world.

Bradley Lamm, D.P.M., head of foot and ankle surgery at the International Center for Limb Lengthening, brings advanced expertise in the fields of foot and ankle deformity correction, ankle and toe-joint preservation, diabetic foot correction and toe lengthening.


The Complete Spectrum of CareThe Rubin Institute provides full-service orthopedic care, from diagnosis to treatment to rehabilitation. Specialties include:

Bone deformity correction

Bone infection

Cosmetic lengthening

Diabetic limb preservation

Foot and ankle surgery

Hand and upper extremity surgery

Hip and knee preservation and replacement

Limb lengthening (post-traumatic and congenital)

Orthopedic oncology

Orthopedic surgery

Orthopedic trauma

Pediatric orthopedics

Podiatry

Scoliosis

Shoulder preservation and replacement

Spine surgery

See all of our orthopedic services at www.lifebridgehealth.org/RIAO.

Growing to Serve the CommunityWith results like that, it’s no surprise that demand for the Rubin Institute’s services is growing. In response, the institute tripled its number of doctors and expanded from four to 12 locations around the community — including Northwest Hospital — all in the past four years. New services like fast-track injury appointments, free evaluation clinics and evening hours have also been added. More recently, Northwest Hospital’s newly appointed chief of podiatry, Dr. Noman Siddiqui, is leading efforts to bring more lower-extremity programs to Northwest, with a particular interest in limb preservation.

“It’s all about being more accessible to our patients and making it as convenient as possible for them to get the best care,” says Dr. Reichmister.

Back in the Wasserman Gait Laboratory, Starr shares his thoughts on why demand at the Rubin Institute is so high: “Patients see the level of care and under-standing we deliver to even the

John Herzenberg, M.D., director of the International Center for Limb Lengthening and Pediatric Orthopedics, provides specialized orthopedic care to patients from around the world.

Ronald Delanois, M.D., is one of the joint specialists providing cutting-edge orthopedic care to patients at the Rubin Institute’s Center for Joint Preservation and Replacement.

most difficult cases,” he says. “Once they see our team and how we work, they know they can count on us for the solution they’ve been searching for.”

Noman Siddiqui, D.P.M.Chief of Podiatry, Northwest Hospital



Chiefs’ Corner:Words From the Leaders of the Rubin Institute for Advanced Orthopedics

Paul M. Apostolo, M.D.Chief, Orthopedic Surgery, Northwest HospitalDirector, Center for Hand and Upper Extremity Surgery, Rubin Institute for Advanced Orthopedics

With our formal expansion to Northwest Hospital in April 2015, the Rubin Institute for Advanced Orthopedics now serves the entire northern and western Baltimore region. In addition to the full array of inpatient and outpatient services, Northwest Hospital is also home to the Center for Hand and Upper Extremity Surgery and the Center for Diabetic Limb Preservation, complementing orthopedic services ranging from care of the spine, hip, knee, shoulder, hand and

foot to physical medicine and rehabilitative services for all ages. We’ve dramatically expanded outpatient care with state-of-the-art exam rooms and dedicated X-ray and procedure rooms. Cutting-edge technology, quality of service and convenient locations allow our team of physicians, nurses and therapists to achieve the best quality of life possible for our patients.

Scott E. Brown, M.D.Chief, Department of Physical Medicine and RehabilitationMedical Director, Sinai Rehabilitation Center

Perhaps the thing we’re most proud of in the Department of Physical Medicine and Rehabilitation is our strong collaborative working environment with the Orthopedics Department and the Rubin Institute for Advanced Orthopedics. When patients come to Sinai Hospital for an orthopedic procedure, they see both our inpatient therapists as well as our rehabilitation doctors, who are specifically dedicated to determining each patient’s

rehabilitation needs. The same concern for the right rehabilitation care is also the focus at Northwest Hospital. When you have rehabilita-tion therapists and doctors across specialties working together seamlessly, patients get the right care at the right time. That’s what ultimately provides the best patient care and accelerates the process of getting patients home safely, where they can resume their activities of daily living.

Jerome P. Reichmister, M.D.Chairman, Rubin Institute for Advanced OrthopedicsChief, Orthopedics, Sinai Hospital

I have been the chief of orthopedics at Sinai Hospital for 25 years, and I have practiced orthopedic surgery for even longer — 40 years. So I have seen a lot of incredible developments over the course of my career. But nothing has stimulated me more professionally than what I see happening right now at the Rubin Institute for Advanced Orthopedics. I am continually

excited by the bright people who work here and by the jobs they are doing, from research, to teaching, to providing world-class patient care. Our team has ushered in so many advances, and with those advances come better and better results for our patients in Baltimore and through-out the global orthopedic community.


W hen the cartilage, ligaments, tendons and bones that make up your skeletal system are injured, daily activities become

diffi cult. Keep your entire skeletal system safe and healthy with these head-to-toe tips.

Protect All the Parts of Your Skeleton From Injury

SpineA common culprit of back pain is disc degeneration, when the discs that pad your backbone deteriorate or rupture. Keep your spine strong by exercising regularly, eating healthy food and practicing good posture. When you lift something heavy, keep your back straight and put the stress on your legs and hips.

WristTyping on a computer or frequently using a mouse can lead to carpal tunnel syndrome, a condition in which swelling compresses an important nerve in your wrist. Position your keyboard so that your wrists don’t bend upward when you type. Take frequent breaks. And try a variety of mousepads, keyboards and typing pads to create a comfortable workspace.

AnkleThe ankle joint is the most common site for sprains. To help prevent sprains, warm up thoroughly before exercise. Wear shoes that fi t well. Add balanceand agility exercises to your routine.

NeckPrevent muscle strain and tension in your neck by keeping your computer monitor at eye level and making sure your pillow comfortably supports your head and neck while you sleep. Ask your doctor or physical therapist to suggest stretching exercises you can do throughout your day.

ShoulderThe rotator cuff is a group of muscles that hold your shoulder joint together. They allow your arm to rotate as you reach, stretch and throw. Because the joint is so mobile, it’s also unstable. Strengthening exercises can prevent injuries. See a physician at the fi rst sign of pain, stiff ness or weakness.

HipAge increases your risk for hip injuries. Strengthen your hips by gett ing enough calcium and vitamin D in your diet. Nine in 10 hip fractures occur as a result of falls, so avoid tumbles with a balance-building exercise program, such as tai chi.

KneeThe knee bears much of our body weight, and it’s injured more than any other joint. Protect it by warming up thoroughly before exercise, maintain-ing a healthy weight, building your leg muscles and wearing shoes that fi t properly.

LegThe lower legs absorb most of the force when you run. To ward off shin splints and more serious leg injuries, run on soft er surfaces, build up any new exercise program slowly and get instruction on proper form.



F or many 15-year-old boys, playing basketball is justa normal Tuesday aft ernoon activity. But for Cole Childs, it’s something of a miracle. Cole was born

with congenital femoral defi ciency, a rare condition that stymies growth in the hip and leg. Doctors predicted that, if left untreated, his right leg would be 9 inches shorter than his left leg by adulthood.

When the pediatric specialists in the Childs’ home state of Colorado fi rst diagnosed his condition, they told the family that amputation was almost certainly in Cole’s future. But Cole’s parents refused to sett le for such a grim prognosis. Aft er much research, they discovered the team at the International Center for Limb Lengthening (ICLL), part of the Rubin Institute for Advanced Orthopedics at Sinai Hospital.

“Some of the conditions we treat have an instance of 1 in a million births,” says John Herzenberg, M.D., director of both the ICLL and pediatric orthopedics at Sinai. “People come to us from all over the country and the world because of our expertise and reputation.”

Fixing the ‘Unfi xable’Bradley Lamm, D.P.M., the ICLL’s headof foot and ankle surgery, echoes Dr. Herzenberg: “Many of our patients have issues that most doctors only see once or twice in a career, but we see once or twice a week. We fi x the unfi xable.”

Indeed, Cole’s “unfi xable” condition proved to be just the opposite in the hands of his ICLL team, led by Dr. Herzenberg and Shawn Standard, M.D., head of pediat-ric orthopedics for the center. When Cole’s treatment ends this year, both of his legs are expected to be of equal length. He anticipates a lifetime of walking, running — even shooting baskets — completely independently, without the use of prosthetics, shoe lift s or other assistive devices.

A Game-Changing TechnologyCole’s family and their doctors acknowledge that treatment isn’t easy. Cole has undergone 13 surgeries to date —

The International Center for Limb Lengthening at Sinai Hospital:

John Herzenberg, M.D.Director, International Center for Limb Lengthening and Pediatric Orthopedicsat Sinai Hospital

Helping Patients

Cole Childs travels from Denver, Colorado to receive treatment at the International Center for Limb Lengthening. He has been a patient at the center since he was 2 years old.

Bradley Lamm, D.P.M.Head of Foot and Ankle Surgery, International Center for Limb Lengthening


three of which required 12 weeks of on-site care at Sinai Hospital, followedby 12 weeks of recovery at homein Colorado.

But a recent advance called the PRECICE Limb Lengthening System has dramatically improved the process. Developed in part by Drs. Herzenberg and Standard, the PRECICE system features a telescoping titanium rod that is surgically implanted inside the patient’s bone. Patients then use a handheld remote control unit several times a day to magneti-cally extend the implant in very small increments. As the bone and skin are gradually (and painlessly) pulled apart, new bone and skin regenerate at an even, predictable rate. It’s a radical departure from the traditional method, which relies on cumbersome, cage like external fi xators to achieve the same results.

“This has been a huge game changer,” says Brandon Childs, Cole’s father. “Just the fact that Cole can now wear regular

pants makes such a diff erence in his day-to-day life.”

Bringing Expertise to the WorldThe goal of the ICLL is to make a diff erence in the lives of as many patients as possible — not just in Baltimore, but globally. The team regularly travels on surgical missions to developing nations (see page 19) and provides training to doctors, residents and fellows on an international level.

“We are recognized as a center where doctors from all over the United States and the world come to learn procedures that they can’t learn anywhere else,” explains Dr. Lamm.

For patients like Cole, regular trips to Baltimore are a small price to pay for the lifetime of basketball games ahead. “When I think about the outcome we’re working toward, I push through,” he says. “I’m blessed to have these doctorsin my life.”

The International Center for Limb Lengthening at Sinai Hospital:

Families Find Comfort atthe Hackerman-Patz House For families undergoing the long journey of complex orthopedic treatment, the Hackerman-Patz House across the street from Sinai Hospital provides a much-needed home away from home. Designed in the spirit of an extended-stay hotel, the house includes 18 deluxe guest suites as well as common areas such as a playroom, kitchen, laundry room and business center.

“For many of our patients, it’s not a typical surgery: Get your appendix out, go home and you’re done. It’s a gradual, prolonged process,” explains John Herzenberg, M.D., director of both the International Center for Limb Lengthening and pediatric orthopedics at Sinai. “Having the Hackerman-Patz House makes life so much easier for our patients because they can stay here for their whole treatment, in a place that’s safe, comfortable, convenient and affordable.”

“We also like it because it’s allowed us to connect with other families going through similar situations,” adds Brandon Childs, the father of patient Cole Childs. “It’s helped make Baltimore our second home.”

HEAR COLE’S STORYAnd learn more about the International Center for Limb Lengthening atwww.lifebridgehealth.org/ICLL. Helping Patients Stand Tall


Joint Preservation C an Eliminate the Need

for Replacement Surgery


Y our knee aches every time you take the stairs. Or maybe your hip gives you trouble when you walk the dog. “Uh-oh,”

you think. “It’s only a matter of time until I need joint replacement.”

Not necessarily, says the team at the Rubin Institute for Advanced Orthopedics’ Center for Joint Preservation and Replacement at Sinai Hospital.

“We have many techniques that can forestall a joint replacement or even avoid it altogether,” says joint specialist Ronald Delanois, M.D. “The earlier you see an orthopedist, the better. Don’t wait until your joint is totally destroyed.” More Treatment OptionsIndeed, the Center for Joint Preservation and Replacement boasts an impressive arsenal of joint preservation tools, ranging from the more traditional — physical therapy, steroid injections — to the most cutting-edge, including cartilage transplants and regeneration.

“For so long it was understood that you can’t regenerate cartilage,” explains Michael Mont, M.D., the center’s founder and director. “But now we have a number of evidence-based approaches that prove you can. We can inject cells into the joint to stimulate hormones that help cartilage repair itself. We can even grow cartilage cells in a lab setting and then transplant them to the patient.”

The Wasserman Gait LaboratoryFor many of the center’s patients, treatment doesn’t begin until after a visit to the Wasserman Gait Laboratory at Sinai Hospital, one of the first labs in the world — and currently the only lab in Maryland — dedicated to quantitative gait analysis. The lab uses sophisticated computer technology to analyze patients’ skeletal alignment, muscle function, range of motion and forces acting on the body during walking. It’s a unique perspective that enables the center’s joint specialists to create the most optimized treatment plan for each patient.

“For joint preservation to be effective, you really have to pinpoint where forces are in the body, how they are affecting the joint in question and how can we move those forces away from the joint,” explains Anil Bhave, P.T., director of the Wasserman Gait Lab. “All of that can be deter-mined here in the Gait Lab.”

For some patients, the problems aren’t limited to one joint; the hip, knee, ankle and back can all come into play. But, according to Bhave, a 90-min-ute evaluation in the Gait Lab can help orthope-dists determine which joints to target, and in what ways, even for incredibly complex cases.


DON’T IGNORE YOUR JOINT PAINTimely care can greatly expand your treatment options. Call 410-601-WELL (9355) to make an appointment with our joint specialists now.

Advances in ResearchThe Gait Lab is also a critical partner in helping the center conduct ongoing joint preservation research. For example, a recent study showed how new advances in knee braces can noninva-sively counteract the effects of osteoarthritis.

“Typically with knee arthritis, you begin to use the knee less and less due to pain, which only aggravates the condi-tion. It’s a cascade effect that usually leads to joint replacement,” says Bhave. “But the brace in our study unloads stress from the knee and forces it into full extension, which allows the patient to exercise and move about in his or her normal fashion. That minimizes the wear and tear on the knee and makes it possible to significantly delay surgery.”

The ultimate goal of joint preservation, however, is to do more than just delay surgery. “If seen by a specialist early enough, a patient can achieve lasting outcomes that eliminate the need for surgery — ever,” says joint specialist James Nace, D.O.

“Joint replacements are unquestionably valuable procedures,” says Dr. Delanois. “But you want to get as much mileage as you can with what you came to earth with.”

Anil Bhave, P.T.Director, Wasserman Gait Laboratory

Ronald Delanois, M.D.Joint Specialist,Rubin Institute for Advanced Orthopedics’ Center for Joint Preserva-tion and Replacement

James Nace, D.O.Joint Specialist, Rubin Institute for Advanced Orthopedics’ Center for Joint Preservation and Replacement



Smarter Treatment Planning Leads to Better Outcomes for Joint Replacement Patients

F or Barbara McKee, competitive cyclist, it’s perfectly normal to bike 50 or 60 miles at a stretch. But on a ride through

the Blue Ridge Mountains in 2014, her body sent her a warning signal.

“I couldn’t swing my left leg over the bike bar; it would just get caught up,” she recalls. “I knew it was time for a visit to the doctor.”

Barbara McKee is back to riding again, thanks to hip replacement surgery.

6 WAYS TO KEEP YOUR JOINTS HEALTHYKnowing Where to Go

McKee, a New Jersey resident, returned to the Rubin Institute for Advanced Orthopedics’ Center for Joint Preservation and Replacement, where she had undergone replacement surgery on her right hip six years earlier. The center is led by a team of joint replacement experts, including director and founder Michael Mont, M.D.; Ronald Delanois, M.D.; Janet Conway, M.D.; James Nace, D.O.; Barry Waldman, M.D.; Stephen Bell, M.D.; Paul Apostolo, M.D.; and Robert Saltzman, M.D.; and Bradley Lamm, D.P.M., an ankle replacement specialist and head of foot and ankle surgery for the Rubin Institute’s International Center for Limb Lengthening. (See page 8.)

“There was never a question in my mind of where to go,” she says. “I want to be at the best place for the surgery I’m having, and that will always be here.”

The center’s breadth of expertise at both its Sinai and Northwest locations are part of what makes patients like McKee want to return. “Every member of our team is well versed in the latest minimally invasive approaches,” says Dr. Mont, McKee’s two-time joint replacement surgeon. “We’re also on top of the latest pain management tech-niques to make treatment as painless as possible.”

“Our goal is to ensure each patient gets the treatment he or she needs with the least pain and the fastest return to function,” adds Dr. Apostolo, chief of orthopedic surgery at Northwest Hospital.

McKee, for one, was delighted to find that she was walking just four hours after her 2015 left hip replacement procedure. “We had a party in my room,” she says with a laugh. “I thought my right hip replacement was easy, but this one was even easier.”

Getting Patients Back on TrackAnother contributing factor to the center’s success is the extensive, individualized treatment planning and postsurgical rehabilitation its team does in conjunction with the Wasserman Gait Laboratory at Sinai Hospital. “It’s really important to understand how the mechanics of the body are working and integrate that into your surgical plan,” explains Anil Bhave, P.T., director of the Wasserman Gait Laboratory. “With the hip joint, for example, we can determine the exact direction in which the pelvis moves when the patient walks, which, in turn, allows the surgeon to determine the most precise location for the new hip joint.”

That level of detail is why McKee is certain she was able to go on a California bike trek a mere two months after her 2015 surgery. “Everybody goes the extra mile here,” she explains. “It’s just phenomenal.”


Is It Time for a Joint Replacement?If you have any of the following signs, speak with your doctor about joint replacement:

Your joint pain is disturbing your sleep.

You’ve tried different noninvasive treatments, including pain medications, and they’re not controlling your joint pain.

Your joint pain is limiting your ability to keep up a normal routine.

Your joint pain makes it hard for you to get out of a chair, go up stairs or get up from the floor.

FITNESS SERVICES CAN HELPLifeBridge Health & Fitness offers aquatics, group exercise classes, weight-loss programs and more. Visit www.bestbaltimorefitness.com to learn more.

Stay active.Regular physical activity can reduce joint swelling and stiffness, increase flexibility and ease pain. Weight training can also strengthen joint-supporting muscles.

Lose weight.Excess weight puts stress on your joints, particularly the knees, hips and feet.

Protect yourself against injury.When possible, avoid repetitive motions. Always warm up before exercising. If you are injured, seek medical attention right away. Do not ignore the pain.

Get enough sleep.Joints need rest. By getting enough sleep, you can avoid injuries and help prevent joint pain and swelling.

Try physical therapy.Swimming or water-based exercise can improve joint health while reducing pain. Wearing a splint or custom foot support may also help support weak joints.

Consult your doctor.Early treatment of joint problems can help prevent more serious joint damage.


W hat I like about trauma care is that we’re not focused on one area of the body. It’s something different all of the time,” says David Leu, M.D.,

an orthopedic surgeon with the Rubin Institute for Advanced Orthopedics and part of the team of orthopedic specialists for the Trauma Center at Sinai Hospital.

The Trauma Center is one of just four Level II trauma centers in Maryland, a status that ensures 24-hour immediate medical coverage by trauma surgeons — including orthopedic trauma specialists — for arriving patients. Many types of injuries can land a patient in the Trauma Center, but it’s typically one of two things: a car accident or a serious fall.

“Our role as orthopedic trauma specialists is to heal fractured bones and restore the alignment of the joint surfaces after these incredible injuries,” explains orthopedic surgeon and trauma specialist Stephen Bell, M.D. “The patient’s age and health, and the total scope of the patient’s injuries, add a complexity to each case that makes it unique.”

Solving Complex Puzzles The inherent challenge of operating on the musculoskeletal system adds to the complexity. Bones can break in multiple places, and there are various shapes — or types — of bone fractures, ranging from spiral breaks to impacted fractures. “You can’t just take a bone out of the body, put it together and then stick it back in,” says Dr. Leu. “You have to work with what you’re given, and that presents a puzzle that’s highly rewarding to solve.”


Solving that puzzle requires a sophisticated level of team-work — especially when the injury is life-threatening. “Our trauma team in the emergency room is the front line for us,” says Dr. Leu. “They do a fantastic job stabilizing patients, resuscitating them with fluids — all the things that are essen-tial to getting them safely out of that critical window.”

Preventing Lifelong Pain Not all orthopedic trauma cases start in the emergency room. Often patients come to the Rubin Institute’s trauma specialists seeking help after a fracture fails to heal, heals incorrectly or becomes infected. “These cases can lead to debilitating pain and even deformities if not treated correctly,” says Dr. Bell. “It’s not the same intensity as an ER call, but the stakes are often the same. Our job — no matter what — is to make sure our patients get back to their optimum quality of life.”

David Leu, M.D.Orthopedic Surgeon and Trauma Specialist

Stephen Bell, M.D.Orthopedic Surgeon and Trauma Specialist

Orthopedic Trauma Team Heals Patients After Serious Injury


I n addition to helping you walk and move, bones protect your brain, heart and other organs. They also store calcium and other minerals until your body needs them.

Learning how to keep your bones healthy can reduce your risk for osteoporosis, as well as other bone conditions.

Risk Factors Many factors can increase your chances of developing osteopo-rosis. Some you can’t control and some you can. Those that you can’t control include: Age. Older people are more likely to get the condition.Gender. Women have a higher risk for osteoporosis,

especially aft er menopause.Ethnicity. White and Asian women have a higher risk.Family history. People with family members who have the

condition are at increased risk.

Risk factors you can control include: Diet. Consuming enough calcium and vitamin D lowers

your risk.Physical activity. Being active

throughout your life can help your bones get and stay strong.

Body weight. Maintaining a healthy weight (but not too low) reduces your risk.

Build Strong Bones for Life Smoking. Not smoking helps your body use the calcium

you consume effi ciently.Alcohol. People who drink a lot of alcohol have an increased

risk for osteoporosis.Medication use. Certain medications that treat arthritis,

asthma, endometriosis and seizures can increaseosteoporosis risk.

Existing conditions. People who have anorexia, cancer, diabetes, liver or kidney disease, and rheumatoid arthritis are at increased risk.

Steps to Take Although 85 to 90 percent of bone mass is built by age 18in girls and age 20 in boys, it’s never too late to take steps to improve your bone health. Here are some tips to get started: Eat a balanced diet that is rich in calcium and vitamin D.

Experts advise women younger than 50 to get 1,000 mg of calcium daily. That number increases to 1,200 mg daily every year aft er that. For men the daily target is 1,000 mg of calcium until age 70, 1,200 mg from ages 71 on.

Exercise regularly. Get plenty of weight-bearing exercise such as walking, running, dancing and stair-climbing.

Don’t smoke or abuse alcohol.

Finally, talk with your primary care physician about your bones and whether you should have a bone density test to check your bone health.

NEED A PRIMARY CARE PHYSICIAN? Go to www.lifebridgehealth.org/Physicians or call 410-601-WELL (9355) to take advantage of our FREE physician referral service.


W hen it comes to your hands, pay attention to the small things. That’s one of the

most important pieces of advice Paul Apostolo, M.D. — chief of orthopedic surgery at Northwest Hospital and director of the Rubin Institute for Advanced Orthopedics’ Center for Hand and Upper Extremity Surgery — has for the patients he sees.

“People will think a clicking finger or some numbness is just a minor inconve-nience,” says Dr. Apostolo. “They are quick to brush it off, yet these are exactly the little things that shouldn’t be ignored. Small problems can lead to significant functional loss, but we can often alleviate them or reverse them with minimal intervention.”

His advice is not limited to the hands. Another commonly ignored area is the shoulder, where a slight loss of motion or function — or even trouble sleeping due to discomfort — can signal bigger problems down the road.

“There are so many simple ways to relieve the pain,” he says. “What I really encourage with patients is establishing a relationship with your physician, so when these things occur, they can be taken care of before bigger problems develop.”


The Center for Hand and Upper Extremity Surgeryat Northwest Hospital:

Brian Janz, M.D., hand and upper extremity surgeon, plastic and reconstructive surgeon

and chief of the Hand Surgery division at Northwest Hospital, and Paul Apostolo, M.D.,

chief of orthopedic surgery at Northwest Hospital and director of the Rubin Institute for

Advanced Orthopedics’ Center for Hand and Upper Extremity Surgery, know the importance

of paying attention to even the smallest changes in your hands and shoulders.

P utting Relief Within Reach


Healing HandsFaye Young of Baltimore is one of the many people who have benefi tt ed from Dr. Apostolo’s approach to care. She slipped gett ing ready to wash her car one day. Trying to break her fall, she put out her hand and broke her wrist.

“I went to ExpressCare (a LifeBridge Health partner) and they called Dr. Apostolo,” she explains. “He took X-rays and we decided I needed surgery. He went through everything; he made me feel confi dent. I’d never broken anything before, but I felt he’d be the right doctor. And he was.”

Young’s husband, Larry, decided to see him as well about his trigger fi nger, a painful condition that causes the fi ngers to lock when bent.

“I chose Dr. Apostolo aft er my wife’s experience,” Mr. Young says. “I had seen another doctor who gave me cortisone shots. I waited to see if there would be any change, and there wasn’t. I saw Dr. Apostolo, and he gave me the options we could consider. I researched trigger fi nger and also researched Dr. Apostolo. And I felt very comfortable with him and his recommendation for surgery. It was the right choice.”

More Convenient Care Stories like the Youngs’ are common, but Dr. Apostolo stresses that surgery is viewed as a last resort, aft er alterna-tive treatment methods have failed. “Our goal is to restore the maximum extent of pain-free function with the minimum amount of intervention,” he explains.

To bring that mission to more people, the center has signifi cantly expanded its footprint around Baltimore and the surrounding counties. “We’ve worked over the last several years to establish an inpatient and outpatient care system that is set up in the most convenient, patient-friendly way pos-sible,” says Brian Janz, M.D., a hand and upper extremity surgeon and chief of hand surgery. “So now, if you’re in Westminster, for example, your hand therapy is in Westminster. You don’t have to drive to Baltimore city.”

The center’s affi liated offi ces off er a full spectrum of specialized services. Patients can receive casts and splints. X-rays are available in each offi ce. If surgery is required, coordinators work hard to get patients into the closest facility.

“Everyone on our staff is dedicated to creating a caring atmosphere, which is something you don’t see in all medical sett ings,” says Dr. Janz. “That helps us stand apart, and I think it makes a big diff erence for our patients.”

Life-Changing ResultsOf course, what patients like most of all are the results they see. According to Dr. Apostolo, many patients are quick to point out aft er surgery or therapy how much they wished they had addressed their issues sooner.

“Until a problem is taken care of, most patients don’t realize just how debilitating it really was,” he says.

“It’s great to see our patients smile when they walk out,”adds Dr. Janz. “It lets us know we’ve made a diff erence intheir lives.”

Faye and Larry Young are both patients of Paul Apostolo, M.D. Mr. Young chose

Dr. Apostolo after his wife had successful treatment at the Center for Hand and Upper

Extremity Surgery.

HAND OR SHOULDER TROUBLE? Get help now — the sooner, the better. Call 410-601-WELL (9355) to make an appointment with our specialists.


W hen their 9-year-old son, Jackson, started complain-ing about soreness in the

mornings, parents Allen and Minzy Newman chalked it up to simple growing pains. But one morning Jackson woke up and couldn’t walk at all. The diagnosis: Perthes disease, a childhood disorder in which inadequate blood supply in the top part of the thighbone causes the bone to soften and break down.

The Newman family went to special-ist after specialist in their home country of Canada to no avail. Finally, a doctor in Montreal made a suggestion: Try the pediatric team at the Rubin Institute for Advanced Orthopedics at Sinai Hospital — a team internationally renowned for its expertise in childhood conditions such as clubfoot, complex leg deformities and Perthes disease.

Making a Full RecoveryWorking with Shawn Standard, M.D., head of pediatric orthope-dics at the Rubin Institute’s International Center for Limb Lengthening (see page 8), Jackson was given a


Renowned Team Treats Complex Pediatric Orthopedic Cases

READ ONSee more of the Newman family’s story and explore all our pediatric orthopedic services at www.lifebridgehealth.org/PediatricOrtho.

Shawn Standard, M.D.Head of Pediatric Orthopedics, International Center for Limb Lengthening

complete treatment plan, which included four months of wearing an external fixator to stabilize and lengthen his femur and stem cell injections to stimu-late bone growth and healing. Today, Jackson has entered the last phase of his treatment — leg braces and twice-weekly physical therapy — and is expected to make a complete recovery.

“He should be able to walk, jump and play like a normal boy,” says his father, Allen. “No one can understand the pain he has gone through, but he has done amazingly well.”

A Child-Friendly Approach“Part of what makes pediatric care so successful at the institute is the team’s child-friendly approach,” says John Herzenberg, M.D., director of pediatric orthopedics at Sinai Hospital and the director of the International Center for Limb Lengthening. “Sometimes it’s easy to fall into the trap of talking only to the

Jackson and his parents, Allen and Minzy, came all the way from Canada for Jackson to get treatment at the International Center for Limb Lengthening.

Jackson has physical therapy twice a week.

parents,” he explains. “We make the children the center of our attention. They deserve the same respect that any adult would expect.”

The child-friendly approach carries over to the Herman & Walter Samuelson Children’s Hospital at Sinai, which works closely with the Rubin Institute team. “Many of our kids don’t want to go home when they’re discharged,” says Dr. Herzenberg with a laugh. “The nurses create the most amazing, caring environment.”

There is no doubt for the Newman family that they made the right decision, despite the distance from home and battles they’ve faced with Canadian health care coverage.

“If coming here meant Jackson could live a life without pain, then there was never a question,” says Mr. Newman. “We are here because we want the best for our son.”


S ometimes small ideas grow into big things. The Save-A-Limb Fund is proof of that. It started in 2001 as a single

bike-ride event to help patients at the Rubin Institute for Advanced Orthopedics pay for health care expenses that insurance companies wouldn’t cover. But it has grown into something much greater.

“Now the fund can reach so many people and do so many things,” explains Shawn Standard, M.D., co-director of the fund and head of pediatric orthopedics at the Rubin Institute’s International Center for Limb Lengthening. “It’s become a year-round fund that has a fundraising event, instead of the other way around.”

Financial Help When It’s Needed MostToday, the fund supports children and adults around the world who are facing serious limb and joint disorders. Support often includes financial assistance.

“I had a boy who was finishing his limb lengthening treatment,” says Dr. Standard. “His family had a shortfall in coverage for his therapy, and his therapy was absolutely essential. Sometimes you’re talking thousands of dollars that the insurance company refuses to pay. It becomes financially disabling.”

The Save-A-Limb Fund:

Providing Orthopedic Care to Those in Need

HOW YOU CAN HELP Visit www.SaveALimb.org to donate to the fund and to learn how you can take part in the annual Save-A-Limb Fund Fest. This year’s event will be held on September 24 at Oregon Ridge Park in Cockeysville, MD.

While physicians and patients can appeal to insurance providers, the process takes time. Often, that’s not a luxury that patients have. There’s also no guarantee of payment. “We’re able to go ahead with our treatment plans knowing that the fund will be our fallback,” says Dr. Standard.

International ReachThe fund also allows the Rubin Institute staff to go on mission trips to countries like Haiti, the Dominican Republic, El Salvador and Ecuador, providing on-site consultations and surgeries to patient populations that otherwise wouldn’t have access to the appropriate specialists. In addition, one international patient is selected each year to travel to the Rubin Institute for treatment. The fund completely finances the trip and treatment.

“Because of the complexity of their conditions, these patients can’t be treated in their home country or on our mission trips,” says Dr. Standard. “So we bring them to the United States.”

The Spirit of GivingFor Dr. Standard, one of the most rewarding aspects of the fund is witnessing the spirit of giving it generates. “Many of the families that we’ve helped end up becoming some of our biggest contributors,” he says. “It’s a pretty incredible thing.”


Physical Medicine and Rehabilitation at LifeBridge Health

PhysicalMedicine and Rehabilitation:Rehabilitation:

Fin ding the Path Back From Pain

LifeBridge Health Physical Therapy in the Community LifeBridge Health, in partnership with Physiotherapy Associates, now has 13 convenient outpatient physical therapy clinics in the Baltimore region, providing bridges to the communities we serve, from Essex to Westminster. The clinics offer solutions for everyone from injured weekend warriors to total joint replace-ment patients and can treat all types of musculoskeletal conditions.

“We’ve built strong relationships and trust between physicians and our physical therapists,” explains Luann Hollenberger, director of patient care services for Northwest Hospital and liaison to LifeBridge Health Physical Therapy. “That way we can make sure the quality and outcomes of care are the same for all our patients, whether they go to our clinic in their neighborhood or they visit our hospital sites.”

The clinics offer a variety of services, including:Sports rehabilitationHand therapy and treatment of

overuse injuriesBack, neck and post-total joint

therapyDry needlingAquatic therapy (Pikesville)Functional capacity evaluations

To find a LifeBridge Health Physical Therapy clinic near you, go to www.lifebridgehealth.org/PhysicalTherapy.


I n 2010, Howard County resident Bette Holub checked into a local hospital for what she thought would

be a routine knee replacement. But when the surgery was over, she knew some-thing wasn’t right.

“I had issues immediately in physical therapy,” she recalls. “Over time, things weren’t getting better. The pain wasn’t going away. I wasn’t getting stronger.”

For two years, Holub sought help from orthopedists, physical therapists and neurologists around the region, only to be told they couldn’t help her. Finally, hope emerged in the form of Scott Brown, M.D., chief of physical medicine and rehabilitation at Sinai Hospital.

Dr. Brown confirmed what Holub had long suspected: Her femoral nerve — which helps operate the quadricep muscle in the thigh — had been severely damaged by the knee replacement surgery. “All the other parts of my leg were trying to do the work of my quad in order for me to walk,” Holub explains.

However, a nerve conduction study at Sinai Hospital gave Holub and Dr. Brown a reason to be optimistic. It showed that, although the nerve was damaged, it could still fire some signals. “Dr. Brown said, ‘Our goal was to figure out how to get the nerve and muscle to work more effectively,’” says Holub.

An Unconventional SolutionFiguring out how required some experi-mentation. Holub began physical therapy three times a week with physical therapist Carol Conrad at the Sinai Rehabilitation Center. There, Holub worked out using the Bioness L300 System — a wireless technology that uses electrical stimulation to activate the muscles and nerves in the leg. The system is typically reserved for patients who have experienced foot drop due to stroke, multiple sclerosis and other neurological conditions, which made it

an unconventional choice for Holub’s recovery.

According to Dr. Brown, however, the team at Sinai Rehabilitation Center is well versed in taking unconventional approaches. “Together with the Rubin Institute for Advanced Orthopedics, we have become a destination for complex orthopedic cases,” he explains. “People come to us with things like failed joint replacements, limb length discrepancies and complex fractures and infections. We have the cutting-edge tools, expertise and out-of-the-box thinking it takes to solve these challenges.”

Holub agrees. “At every physical therapy session, Carol would say, ‘Let’s try this,’ or ‘Let’s try that.’ We were constantly experimenting. She and Dr. Brown never once gave up on me.”

Finally, after several weeks of therapy, Holub and her team got what they’d been looking for: Her femoral nerve fired off an electrical signal. “When we saw that, I think I cheered so loud everyone in the building heard me,” Holub says with a laugh. A few weeks later, an evaluation in the Wasserman Gait Laboratory (see page 10) proved that Holub had achieved the maximum possible recov-ery in her nerve.

Today, life is very different for Holub than it was before her rehabilitation. She has retired the heating pads that she once carried with her to help manage her pain. She can walk around the mall now without thinking twice. And she has returned to one of her favorite hobbies: hiking with her son. Their first hike together happened just two months after her physical therapy at Sinai ended.

“I can’t even explain to you how that hike felt,” says Holub. “When we got to the top of that mountain, it meant everything to me. I could see for miles and miles. It was the most beautiful sight I had seen in years.”

Physical therapist Carol Conrad works with a patient using the Bioness L300 System, which uses electrical stimulation to help facilitate rehabilitation.


Calendar of EventsCommunity Calendar

Healthy Eating: Nutrition, Weight Loss & Cancer PreventionTuesday, May 3, noon – 1 p.m.Alvin & Lois Lapidus Cancer Institute, Sinai Hospital, 2401 W. Belvedere Ave., Baltimore, MD 21215

Join the Alvin & Lois Lapidus Cancer Institute for a FREE three-part series on nutrition strategies for cancer preven-tion. Learn how to lower your risk for cancer through healthy eating. Topics include healthy meals and snacks, antioxidant-rich food choices and weight management tips. We encourage you to att end

all three sessions. For more information, call 410-601-9020.

Life HappensA free educational series on healthy living, caring for our loved ones and planning for the futureTuesdays, May 3 – June 7, 7 – 8:30 p.m.

Are you prepared for the future? It can be hard to discuss what happens when you or a family member needs skilled nursing care or passes away.But taking time to explore and make decisions about these issues now will make it easier on your loved ones.

Facing these diffi cult issues can provide everyone with peace of mind for years to come. LifeBridge Health, the Jewish Community Center of Greater Baltimore, Jewish Community Services and Sol Levinson & Bros. want to make these hard conversa-tions easier for you. Join us for Life Happens, a six-week series where we will explore topics related to aging and planning for the future. Att endance is free and open to the community. To register for any or all of these Life Happens sessions, call 410-601-WELL (9355).

Save the Date! Race for Our KidsSunday, September 18Sinai Hospital

Mark your calendars for the 2016 Race for Our Kids. The event, which benefi ts the Herman & Walter Samuelson Children’s Hospital at Sinai, features 5K and 10K courses through rolling hills and beautiful scenery around the Mount Washington neighborhood. For families, there’s a 1 Mile Family Fun Walk around the Levindale and Sinai Hospital campuses. For more information, visit www.RaceForOurKids.org.

L ifeBridge Health has an online community calendar fi lled with upcoming events, screenings and support group meetings and webinars. These activities and

events feature LifeBridge Health community health advocates

and physicians who want to help you stay happy and healthy.Visit www.lifebridgehealth.org/CommunityEvents for the

event descriptions, dates, times and locations. Here are some of our upcoming events.

This event is a partnership of faith congregations in the Randallstown area

and Northwest Hospital.

FITNESS DEMONSTRATIONS,FREE HEALTH SCREENINGS,

TIPS ON HEALTHY LIVING & MORE!

SATURDAY, APRIL 3011 a.m. - 2 p.m.

TO REGISTER CALL 866-404-DOCS OR VISIT WWW.LIFEBRIDGEHEALTH.ORG/MOVINTOGOODHEALTH

Northwest Hospital | 5401 Old Court Road | Randallstown, MD 21133

The Rubin Institute for Advanced Orthopedics at Sinai and Northwest Hospitals

Getting you back to BEING YOU.

At the Rubin Institute for Advanced Orthopedics, our goal is simple: getting you back to being you. Whether you need a hip or knee replacement; treatment for a hand, wrist, elbow or shoulder condition; or complex orthopedic surgery; our team of specialists, including our world-renowned orthopedic surgeons, will provide you with excellent treatment from diagnosis to rehabilitation.

The Future of Health Care is Here

To schedule an appointment, call 410-601-WELL (9355), or visit LifeBridgeHealth.org/Future for more information.

~ LIFEBRIDGE H E A L T H.

2401 W. Belvedere Avenue Baltimore, MD 21215

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Documents

The Rubin Institute for Advanced Orthopedics€¦ · The Rubin Institute for Advanced Orthopedics is bringing next-generation care to the community — and the world. Bradley Lamm,