Dr. Shawn Standard, Chief, Nemours Children’s International Limb Correction Center, Nemours Children’s Hospital, Florida

In an interview with Invest:, Dr. Shawn Standard, chief of Nemours Children’s International Limb Correction Center at Nemours Children’s Hospital, Florida, discussed the growth of the center in Orlando, the technologies shaping limb reconstruction, and the value of a multidisciplinary model in pediatric orthopedic care. “I think the innovation has really come and swung the opposite way, where now 90% of the patients I see with these conditions, their limbs can be saved,” Standard said.

What’s your background and how did you come into your position at Nemours Children’s Hospital, Florida?

I trained at the Medical College of Georgia in Augusta, Georgia, and then went to Nemours Children’s Health, Jacksonville, as a fellow in pediatric orthopedics. That is really where I started my pediatric orthopedic life and where I was introduced to Nemours Children’s as a larger enterprise, including Wilmington, Delaware, and the campuses in Florida.

After that, I stayed there for two years as a young limb-lengthening and limb deformity surgeon, and then I went to Baltimore, where I spent about 22 years at the International Center for Limb Lengthening. The opportunity then came to return to Florida and establish a center here. Dr. John Lovejoy reached out and invited me down, and showed me the Nemours hospital in Orlando, which was just a perfect place. I moved here about a year and a half ago, and we have set up the International Limb Correction Center, which is growing rapidly.

What does having a fully dedicated limb correction center, rather than a service, mean for patients and their families?

Some of that is semantics, because as a limb center we are still under the umbrella of orthopedics, and that is very important. I have nine partners, and we all lean on each other, even though we each have certain subspecialties. We can help each other with our expertise, even though some of the conditions are very different across the different areas of orthopedics.

What really defines a center is having more than one surgeon. Right now, we have two dedicated surgeons, and by June we will have three dedicated limb-lengthening surgeons. 

You also need a team around you. We have physicians assistants, nurse practitioners, a care coordinator, an international medicine department to help our international patients, and a specialized physical therapy team and OR team dedicated to limb reconstruction and limb lengthening.

The final element is having a hospital that is supportive and invests in that center, which Nemours Children’s has done. That has had a great impact. We are drawing patients from all over. The center here has had a huge impact on Central Florida by increasing access and availability to cutting-edge technologies and limb lengthening and limb reconstruction.

How has your work in developing devices and tools shaped the way you approach patient care?

Being on the innovative front means you are always looking for solutions to persistent problems. In my career, especially coming from Sinai Hospital in Baltimore where we were innovating multiple things, including apps and devices, that has always been part of the work. Coming to Nemours, I found that they are very aggressive about staying on the cutting edge and very supportive of innovation, and that really plays into patient care.

It improves problematic conditions, success rates, experiences, and hopefully helps the child overall. The technologies are tremendous because 30 or 40 years ago, most of the patients I take care of would have been relegated to amputation, which we call prosthetic reconstruction. That is still an important part of orthopedics, because prosthetics are necessary, but I think the innovation has really come and swung the opposite way, where now 90% of the patients I see with these conditions, their limbs can be saved. They can be salvaged, and they can be functional.

How have some of these tools worked in practice?

Two of the apps I have been part of are the Sinai Multiplier and the Bone Ninja app. The Multiplier is a phone app, and anybody can download it. It helps us predict leg length differences. If you have a child who is 3 years old and their leg is an inch and a half short, you can plug in data and it will tell you what that difference is likely to be at skeletal maturity. That helps you map out the child’s treatment journey, including how many surgeries they may require and what kind of surgeries you can do.

It also has a height multiplier, so if you measure your child and enter the age, it can estimate how tall your child will be at maturity. The leg length difference calculation is very accurate. Overall height is more of a ballpark, but it still helps because sometimes a child who needs limb equalization may opt for a slowing-down procedure instead of a lengthening. That surgery is much less invasive and easier, but it takes away from overall height.

The Bone Ninja app is more of an educational tool on the iPad. It helps me train other doctors by showing them how to analyze deformities, where the osteotomy or bone cut needs to be, and how to straighten the leg. From a parent and child point of view, I can take their X-ray, manipulate it on the screen, and show them what their leg is going to look like afterward. I can even take a picture of them standing and simulate what it will look like after surgery. That helps children prepare and understand what the final outcome is going to be.

How are you applying education to your work?

For more than 15 years, I have been involved in a chat room that started at Sinai Hospital and is now a collaboration between Nemours and Sinai. Another physician, Dr. Phil McClure, and I get on and answer questions from all over the world. What that is turning into at Nemours is a monthly or bi-monthly webinar where limb specialists from the different campuses, including Delaware and Orlando, will give a brief presentation on a topic and then open it up for questions and answers.

That is a big part of bringing awareness and making information freely and easily accessible. It has also been a huge part of my practice because I talk to people all over the world. Someone might be in Sri Lanka with a child who has a limb deformity and ask for advice. Some families have the means to come here, and if not, we can guide them to different locations throughout the world and to different mission hospitals. That is another part of the next step in the development of the International Limb Correction Center.

What made Orlando the right place to build this center, and what impact do you see locally?

As I was making the transition and thinking about where the perfect place would be to set up a limb center, I realized Orlando is ideal. It is already an international and national

destination. The international airport is very convenient and only 10 minutes from the hospital. Medical City and Lake Nona are fantastic.

From a community point of view, Nemours Children’s is a great hospital to work for, and as we grow and bring in more specialists and team members, that has an impact. We will probably be bringing between 500 and 1,000 patients to the area, and our patients are a little different because they stay for a period of time. They can stay anywhere from two weeks to three months to six months. That has a positive effect on the local economy and businesses.

How will the gait and motion analysis lab change diagnosis and treatment?

The future for us includes a new center that will have a modern therapy center, including hydrotherapy, land therapy, and a gait center. Gait analysis is a highly technical test where a child simply walks across a room while multiple cameras pick up how the body is moving in space. Force plates on the floor detect how the feet are striking the ground. You can also look at muscle strength, motion, and force vectors.

That helps us fine-tune care for a child with a complex situation. It helps us avoid doing unnecessary or wrong surgery that would not be beneficial, and allows us to really hone in on the problem and help the child in multiple ways. It will be a huge advance for our center.

It will also affect more than just my patient population. My partners include spine surgeons, neuromuscular surgeons, sports surgeons, and complex foot and ankle surgeons, and all of them can benefit from the gait analysis lab.

How does that broader team approach support the whole-child care model?

That is one of the huge benefits of joining this team. I now have partners across the institution, and it is a full-service children’s orthopedic hospital. Our children are complex. Just the other day, I operated on a little girl who needed ENT surgeons to make sure her airway was appropriate for surgery, and she also needed general medicine and pediatricians to keep her health at the highest level possible so we could help her. Nemours has really emphasized teamwork, and it has been a wonderful team to join.

I also think awareness matters a great deal. Some of my patients are seen prenatally, when a condition is picked up on ultrasound. For a mother in that situation to be able to look at an 8-year-old with the same condition who is running and playing soccer is a tremendous thing. That kind of awareness brings hope to parents and to the greater community.

Anything you would like to add?

We appreciate the time and the exposure, because when you start talking to people, everybody has been touched one way or the other. It might not be a congenital limb deficiency, but it could be something else. Nemours is here to help, and we value getting the word out so people know that we are here.