For infants born with limb deficiencies or deformities, early intervention is important for optimal development. However, many families learn of the congenital anomaly at birth and need time to process their own emotions regarding the limb loss/difference. The grieving process can take up to a year, which can delay making important treatment decisions that affect may development. Detection as early as the 2nd trimester when anomalies are first discovered, as well as counseling, can prepare families for the decisions ahead. For each family she sees whose developing child needs limb correction, reconstruction or rehabilitation, UNC Pediatric Orthopaedics Division Chief and Associate Professor Anna Vergun, MD, promotes this message.
Pediatric orthopaedists outline with parents the corrective surgical and/or prosthetic options that will enable their child to have a better life. At UNC, the critical action step for families is to bring their infant to see this treatment team as soon as possible. To this end, Dr. Vergun is collaborating with Weili Lin, PhD, of UNC Department of Radiology, to investigate using fetal MRI to better understand musculoskeletal system anatomy as early as the second trimester.
Dr. Vergun explained: “Fetal ultrasound is an important screening tool, but fetal MRI can give much better detail if an anomaly is detected on ultrasound. It can also help unravel how the neonatal brain and limbs develop together. The sooner we understand the anatomy of how the limb is different, the sooner we can work with a child’s family to find a treatment plan that makes sense. Understanding how the brain responds to a missing or partial limb could lead to innovative therapies.”
To determine surgical and/or prosthetic approaches with the most promising outcomes, Dr. Vergun’s team relies a well-coordinated, multi-disciplinary team of UNC School of Medicine (SOM) specialists. This network is comprised of orthopaedists, pediatricians, radiologists, neurologists, prosthetists, orthotists, physiatrists (Physical Medicine & Rehabilitation) and care coordinators. Under Dr. Vergun’s leadership, this SOM team’s work to centralize family outreach and surgical planning protocols has moved it a step closer to opening the UNC Center for Pediatric Limb Differences by August 2022.
Dr. Vergun noted: “If specialists across the hospital that UNC Pediatric Orthopaedics partners with continue investing their expertise and energies, we will pull off opening the doors to a center reaches so many.”
According to the North Carolina Birth Defects Monitoring Program, about one in 250 infants are born with a limb anomaly. Some are simple differences that require minimal or no treatment. More severe limb anomalies require as many as 5-10 major corrective surgeries during childhood to reconstruct the limb. Other limb differences may be best treated with a prosthesis or an artificial limb, entailing one or two surgeries to allow the prosthesis to fit better. Medical centers with a provider team of subspecialized experts can best serve families who are navigating the wide, often confusing spectrum of limb anomalies and treatment options for their child.
In early career at Shriner’s Hospital (2010 – 2014), Dr. Vergun found a mentor in Dr. Hugh Watts, considered by many to be a pioneer in pediatric orthopaedics. The renowned orthopaedist guided her through mastering their shared subspecialty and influenced her path in global health service. In partnership with the Palestine Children’s Relief Fund (PCRF), Dr. Watts was growing a network of volunteer orthopaedists to train surgeons from Palestine and worldwide on the fundamentals of correcting musculoskeletal problems in children.
After visiting Ramallah in May 2012, Dr. Vergun dedicated herself to the Pediatric Orthopedic Education and Training (POET) Program with PCRF to train local surgeons and provide on-going mentoring in the West Bank. Over a decade, Dr. Vergun’s leadership and expertise has built pediatric orthopaedic local capacity in an area of the world long affected by gaps in publicly accessible subspecialty care.
As the POET in Ramallah Program Director, Dr. Vergun initially led a comprehensive, hands-on didactics program developed to train residents and practicing surgeons in treating common and complex l (eg, clubfeet, congenital hip dislocation, hand surgery). At the Palestine Medical Center Department of Orthopedic Surgery, those in training benefit from POET-related daily didactic sessions, visiting specialists, medical equipment instruction, lectures and workshops.
Dr. Vergun noted: “Instead of focusing on case volume treated during a mission, our team of surgeons and educators developed a curriculum around the fundamentals of musculoskeletal growth and function and taught quickly mastered, high-impact surgical techniques. Over time, local and visiting surgeons built both friendship and trust. Intimately understanding each other’s skill sets allowed us to begin address increasingly complex orthopedic problems.”
Drawing from the POET program’s success, the PCRF has asked Dr. Vergun to develop a similarly focused surgical training/education program in Gaza. On a 2018 initial visit to Gaza, Dr. Vergun witnessed a different set of needs, among them, treatment of pediatric limb deficiencies/differences and child amputees. Since the inception of PCRF’s Children’s Gaza Amputee Project, she has made multiple trips to onboard specialists to grow this initiative from the ground up in serving child amputees in Gaza who have suffered psychologically from physical trauma. In 2019, the initiative hosted its first summer camp, providing child amputees a safe environment to receive comprehensive counseling and normalize their lives in the presence of peers.
In domestic and global commitments, Dr. Vergun makes her biggest strides when working with multiple stakeholders toward a common goal. As the 2020 – 2022 (Immediate Past) President of the Association of Children’s Prosthetic-Orthotic Clinics (ACPOC), her ongoing contributions help direct the organization’s aims in networking cross-disciplinary teams of specialists involved in the care of children, adolescents, and young adults with various musculoskeletal differences.
She concluded: “Pediatric orthopaedists must think outside of their expertise to achieve optimized outcomes in corrective, restorative and rehabilitative surgery. The answer lies in fostering collaboration among highly talented specialists who help shepherd decision-making in surgical approaches. My division at UNC Orthopaedics is humbled by the cross-disciplinary knowledge that informs case planning and enables us to drastically improve a child’s quality of life.”