LIMB LENGTHENING AND COMPLEX RECONSTRUCTION SERVICE The only program of its kind S. Robert Rozbruch, MD within an academic department Chief of orthopaedic surgery in the country, the Limb Lengthening Austin T. Fragomen, MD and Complex Reconstruction Service continues to maintain international recognition as a center of excellence for the care of children and adults with complex problems of limb length equalization and deformity correction. These include deformities related to knock-knee and bowleg, foot and ankle, as well as nonunion, malunion fractures, upper extremity deformities, and limb lengthening in patients with congenital conditions and syndromes, including Russell-Silver syndrome and achondroplasia.
CLINICAL HIGHLIGHTS • In 2013, the Service performed 395 inpatient surgeries and 311 ambulatory surgeries, with 3,679 patient visits. • The Service is one of the first in the country to use the intramedullary remote-controlled limb lengthening system, PRECICE®, the fully implantable limb lengthening motorized nail for lengthening procedures of the tibia and femur. This device can be applied in many cases and accomplish bone elongation without external fixation.
RESEARCH INITIATIVES • Service members continue to explore the use of bone morphogenetic protein to improve outcomes with complex limb salvage ankle fusions using external fixators. They also routinely use mesenchymal stem cells both in bone and cartilage regeneration, which
has proven to be very successful. • The Service recently completed a study looking at MRIs before and after ankle distraction arthroplasty with exciting preliminary results that show dramatic differences in the joint preoperatively, with little to no cartilage, and postoperatively with a newly created cushioned layer of cartilage, which correlated with the clinical improvements. • Service members presented five papers at the 2014 Limb Lengthening Reconstruction Society Annual Meeting, including one that examined the utility of a limb lengthening and complex reconstruction service within an academic department of orthopaedic surgery. The study found that 50 percent of patients are referred by orthopaedic surgeons and 50 percent self-refer. Of the orthopaedic surgeon referrals,
Dr. Austin T. Fragomen and Dr. S. Robert Rozbruch.
87 percent were from within HSS, demonstrating that a limb lengthening and complex reconstruction service within an academic center improves access to patients for this very specialized, complex surgery.
EDUCATION UPDATES • The Service offers one of only three limb lengthening fellowships in the country, providing in-depth experience in the management of patients with congenital, developmental, and post-traumatic limb deformity and leg length discrepancy to two fellows each year. Beginning in 2015, nine PGY-3 residents will complete a six-week rotation with the Service.
• In collaboration with Kahn Academy, a nonprofit organization that provides free educational resources worldwide, the Service is participating in a global initiative to develop patient education content about limb lengthening and deformity correction. • Drs. Rozbruch and Fragomen are editing a major reference work, Limb Lengthening and Reconstruction Surgery Case Atlas, with Springer. This 2,500 page, three volume textbook contains over 300 clinical cases and is comprised of six sections (Adult Deformity, Foot and Ankle, Trauma, Pediatrics, Tumor, and Upper Extremity).
Limb Lengthening and Complex Reconstruction Service
19