Achieving Our Potential: A History of Orthopaedic Surgery at Texas Children’s Hospital
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.
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.
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).
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.
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). 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. 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.
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. Summary
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. REFERENCES
 Parish B. Legacy: 50 Years of Loving Care. Texas Children’s Hospital 1954-2014. Houston, TX: Elisha Freeman Publishing; 2006.
 Smith ET. A History of Orthopaedic Surgery in Houston, Texas. Austin, TX: Eakin Publications, Inc; 1982.
 Asher MA. Dogged Persistence: Harrington, Post-polio Scoliosis, and the Origin of Spine Instrumentation. Kansas, KS: Chandler Lake Books; 2015.
 Mattox KL. The History of Surgery in Houston: Fifty-Year Anniversary of the Houston Surgical Society. Austin, TX: Eakin Press; 1998.