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Orthopedic care, training and research coalesce at Case School of Medicine
Musculoskeletal medicine leaders and world-renown spine surgeons emerged from Case Western Reserve University’s orthopedic department, as did the concept of continuing medical education.
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The Department of Orthopaedics at Case Western Reserve University in Cleveland has changed considerably during its 103-year history.
Over time, the department expanded its ranks and scope and has consistently been a top recipient of National Institutes of Health (NIH) funding. Yet, it has remained true to its mission by making many innovative clinical, educational and research contributions to orthopedics.
Each advance and accolade in the department’s history has stemmed from someone who recognized a need or strove to make a difference by focusing on quality and seeking better ways of delivering orthopedic care or solving problems — from the research laboratory to the operating room. Former department chairmen Clarence H. Heyman, MD, and Charles H. Herndon, MD, exemplify this with how they turned orthopedic surgery into a leading area within the School of Medicine in the 1900s, while they were recognized for developing treatments for pediatric poliomyelitis and congenital and developmental pediatric conditions.
Collaboration between clinicians, researchers, engineers and others, has always been essential to the orthopedic advancements at Case Western Reserve University (CWRU) School of Medicine.
“For years we have tried to pair our clinicians with our scientists, which I think has allowed us to be successful in our research as well as our clinical missions,” said Randall E. Marcus, MD, chairman of the department and the third holder of the Charles H. Herndon Professorship.
John H. Wilber, MD, director of orthopedic trauma service at MetroHealth Medical Center, part of the University Hospitals network where Marcus’ department practices, said, “One of the things that stands our department apart is we have been able to develop expertise in all the specialties. No one area is better than the others. This dates back to Dr. Herndon who felt very strongly about having a well-rounded department.”
Early leaders
An orthopedic focus first materialized at CWRU School of Medicine in 1907 with Dudley Allen, MD, a general surgeon at Cleveland’s Lakeside Hospital. By 1910, the Clinic for Fractures and Dislocations was formed with Henry Becker, MD, Case Medical School’s second orthopedic leader, at its helm. As the orthopedic treatments being performed at Lakeside Hospital in 1911 gained attention, Gordon N. Morrill, MD, was appointed director of orthopedic surgery there and what was then Western Reserve School of Medicine.
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Heyman, the department’s next leader, was the first clinical professor of orthopedic surgery at the university. His interest in pediatric orthopedics is still felt as some of the Crippled Children’s Clinics he founded are active in rural areas of Northeastern Ohio and serviced by department members.
When George I. Bauman, MD, was chairman from 1920 to 1924, the first orthopedic resident was trained at the university. The department’s training program now includes residency and fellowship training options.
Maxwell Harbin, MD was the first chief of orthopedic surgery at Lakeside Hospital, Rainbow Children’s Hospital and Western Reserve University from 1924 to 1953. Under him, the orthopedic staff experienced many changes, including the uniting of the Lakeside, Babies and Children’s and maternity hospitals as the University Hospitals of Cleveland.
Herndon became chairman of orthopedic surgery at University Hospitals and Western Reserve University in 1953 and led the department into modern era. He was followed by Kingsbury G. Heiple, MD, Victor M. Goldberg, MD and Marcus, all of whom Herndon trained. Herndon was president of the American Academy of Orthopaedic Surgeons in 1968 and was one of the four past presidents of the American Board of Orthopaedic Surgery affiliated with Case. He is credited with substantially increasing the size of the faculty and establishing an endowment for departmental research.
Spine specialty established
“Another huge contribution of Herndon’s was recruiting Henry H. Bohlman, MD, from Johns Hopkins, probably one of the most renown spine surgeons in the world,” Marcus said. “Bohlman pioneered the anterior approach to the spine, developed an international clientele and trained 77 fellows throughout the United States who have become leaders at many major medical centers.”
Wilber, the inaugural Hansjoerg Wyss professor of orthopaedics traumatology, told Orthopedics Today, “There is no question that the department now sort of stands in tribute to what Dr. Herndon did in his career. He is the reason I went into orthopedic surgery.”
Herndon created and developed the first official Department of Orthopaedics at CWRU and was chairman until 1982.
Some of the department’s most recognized clinical areas trace back to Herndon. Total joint replacement (TJR) surgery came to CWRU in 1969 when he was among the first U.S. surgeons to perform a total hip arthroplasty. He recruited some now-famous figures in TJR history to work at CWRU, including Albert Burstein, PhD, and Victor H. Frankel, MD.
When Bohlman sought to subspecialize in spine care in the 1980s, which was unheard of at the time, Herndon not only supported him but helped establish the Case spine fellowship.
“Charlie Herndon was a major mover in the country … He alone started continuing education. No specialty had ever done that before. It was a unique development with this department,” Bohlman told Orthopedics Today.
Herndon fostered collaborations between members of the orthopedic department and the mechanical and aerospace engineering departments at the university, which resulted in several advancements in TJR and continue today, according to orthopedist Matthew J. Kraay, MD.
Clinical leadership
Department members have made contributions to pediatrics, trauma, spine, joint reconstruction and surgeon education.
“George H. Thompson, MD, chief at Rainbow Babies and Children’s Hospital, is extremely well-respected nationally and internationally for his expertise and reputation in orthopedic pediatric care and for the program he has developed here,” Wilber noted.
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As for trauma innovations, Wilber said, “Heiple was instrumental in developing some of our early fracture fixation techniques.”
Advances in spine care
Scott D. Boden, MD, a former Case spine fellow and member of the Orthopedics Today Editorial Board, said, “For more than 2 decades, CWRU Hospitals has been one of the top spine fellowships under the leadership of Dr. Henry Bohlman. He and his associates have trained many of the next generation’s leaders in spine surgery and spinal research.”
World-renown scoliosis surgeon Clyde “Les” Nash, MD, trained under Herndon and collaborated with a CWRU engineer to develop the intraoperative spinal cord monitoring systems that are in routine use.
Bohlman, who performed pioneering work on cervical extension osteotomy, anterior spinal cord decompression and piriformis syndrome cases, said, “We were the first center in the country to do spinal cord monitoring.”
Research center: 1967
The orthopedic materials and biomechanics laboratory at CWRU recently celebrated its 43rd anniversary; a credit to Goldberg and Marcus keeping the spirit of orthopedic research alive.
Edward Greenfield, PhD, the Figgie professor of orthopaedics and director of research in the CWRU Department of Orthopaedics, described Goldberg as a champion of research. “Goldberg established biology-based research here. Prior to that most of the research was more engineering-based,” Greenfield said.
Goldberg’s recruiting increased the number of researchers focused on biology and engineering and Marcus continued with that by recruiting more researchers and monitoring and fostering interactions between researchers and surgeons, Greenfield noted. Currently the musculoskeletal research program is strong, yet diverse. “We really cover the whole gamut of orthopedic research,” he said, noting the Functional Electrical Stimulation center started in 1991, which helps paralyzed people regain function, is a leading-edge program.
Orthopedic researchers at CWRU School of Medicine have received the Orthopaedic Research Society’s distinguished Kappa Delta Award for investigations ranging from implant loosening to cell-based therapies for skeletal repair. Rimnac’s 1989 study of polyethylene degradation helped justify development of crosslinked polyethylene.
“At Marcus’ instigation, we have made progress in integrating basic, clinical and translational research,” Greenfield added.
“We are about teaching. We have a very long history of having a quality residency training program,” Kraay said. Residents leave well-trained and typically go onto fellowships and about half of them eventually take academic positions, he added.
“Our hospital’s mission statement is actually very simple: To teach, to heal, to discover,” Kraay said.
The future
Kraay, who is proud of the new joint replacement registry, envisions the orthopedic program expanding in the next 5 to 10 years, particularly in TJR surgery: “We need to provide the care for the people in Northeast Ohio who need these procedures and we must train the residents who will perform these procedures.”
Marcus’ vision, as chairman, has involved redirecting the research focus and strengthening the pediatric and shoulder and elbow divisions through recruitment. “I want to pick up on Herndon’s original vision to spend time and effort building our endowment fund,” Marcus said, noting that thus far some of the his innovative approaches in these areas have caught the attention of the dean of the CWRU Medical School and the university president. Eventually all these steps will benefit the patients we serve, he said. – by Susan M. Rapp
- Scott D. Boden, MD, can be reached at 59 Executive Park South, Suite 3000, Atlanta, GA 30329; 404-778-7143; e-mail: scott_boden@emoryhealthcare.org.
- Edward Greenfield, PhD, can be reached at CWRU, 2109 Adelbert Road., Cleveland, OH 44106; 216-368-1331; e-mail: emg3@case.edu.
- Henry H. Bohlman, MD, 216-844-1050; e-mail: Julie.Bunkerman@UHhospitals.org.
- Matthew J. Kraay, MD, 216-844-8371; e-mail: Celeste.Sanders@UHhospitals.org.
- Randall E. Marcus, MD, 216-844-3041; e-mail: Christine.Mullins@UHhospitals.org;
- John H. Wilber, MD, 216-844-4929; e-mail: Karen.Martin@UHhospitals.org. Bohlman, Kraay, Marcus and Wilber can be reached at the Department of Orthopaedics, University Hospitals of Cleveland, 1100 Euclid Ave., Cleveland, OH 44106.
