Pediatric Orthopedic Surgeon Embraces the Shriners Hospital Tradition

Patient care, teaching, and research combine for the perfect job

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LEXINGTON “It’s the perfect position for me, both sides of the coin,” says Todd Milbrandt, MD, pediatric orthopedic surgeon at Shriners Hospital for Children in Lexington and program director for the Department of Orthopaedic Surgery at the UK College of Medicine. “I can tend to the needs of children with orthopedic deformities, teach the next generation of orthopedic surgeons, and be involved in research that discovers biologic solutions to complex pediatric orthopedic problems.”

Milbrandt admits to “wearing several hats” throughout his busy week. As program director for UK’s Department of Orthopaedic Surgery he oversees 25 residents, (five residents per year for five years each) through their orthopedic rotations. In addition to the “nuts and bolts of orthopedic rotations,” Milbrandt says he ensures that each resident has the training in “ethics, professionalism, and practice management to be not only a good orthopedic surgeon, but a good doctor as well.”

The ability to teach and train his residents is enhanced by the “protected teaching time” at Shriners Hospital. “It is my best case scenario,” says Milbrandt. “We see the acute cases at UK where the pressure is on to make an evaluation and treatment quickly due to trauma or infection. At Shriners, our decisions have a different timetable because the surgeries are elective.”

The Shriners experience, philanthropic care for all children with orthopedic problems, was the impetus for Milbrandt’s move to Lexington in 2005 after his pediatric orthopedic specialty training at Texas Scottish Rite Hospital in Dallas. Milbrandt received his medical degree from the University of Virginia School of Medicine with a secondary degree, MS in surgical research. He completed his residency in orthopaedics at the University of Virginia Health Sciences Center.

Research is the creative part of his work week, says Milbrandt, “the time to think out of the box.”

“We have a continuing collaborative relationship with Dr. David Puleo, director of Biomedical Engineering at UK. We presented on scaffolding for regeneration of growth plate tissue. We have two current clinical studies: one is an infection model which treats osteomyelitis with an injectable and an injectable treatment for Legg-Calve-Perthes disease to restore blood flow to the head of the femur,” he says.

Shriners Hospitals has a long history of pediatric orthopedic research, over 50 years in Lexington from which Milbrandt and his colleagues can draw, “the biggest being clubfoot disease.” Milbrandt says they have developed a monitoring system to determine whether children are wearing their orthotics or braces. When data shows the brace is not being worn, “Then we can ask, what’s causing you not to wear the brace?” says Milbrandt. And, “How can we help?”

A pain study for reducing pain response in children with spine deformities is another research interest for Milbrandt.

Funding for orthopedic research at Shriners comes from various sources, in addition to Shriners International, the hospital’s research efforts are largely supported by Kosair Charities in Louisville. Additional funding comes from NIH grants, the Department of Defense, and the Pediatric Orthopaedic Society of North America (POSNA).

In recent years, the decision was made system-wide through Shriners Hospitals to accept payment for services through insurers. Shriners still provides philanthropic orthopedic and burn care to all children, regardless of ability to pay, but accepting insurance payment helps the economies of healthcare, says Milbrandt, and allows Shriners to continue its “any child, any time, mission.” Another change in the Shriners model is that referrals are not necessary; patients’ families may contact Shriners Hospital directly to schedule an evaluation by an orthopedic specialist.

There are five pediatric orthopedic surgeons on staff at Shriners Hospital in Lexington, which Milbrandt says is “very rare for a city the size of Lexington, and each staff member has a particular area of specialty expertise.” Janet Walker, MD, specializes in limb lengthening surgeries. Vishwas Talwalkar, MD, specializes in early onset scoliosis in infants. Ryan Muchow, MD, specializes in hip relocation and large hip procedures. Scott Riley, MD, is a congenital hand deformity specialist and complex hand trauma surgeon. Henry Iwinski, MD, chief of staff, is a spine expert.