We have measured our clinical outcomes for the conditions that we treat. Some of these outcomes have been published in the following peer-review journals.
Fragomen AT. Transitioning to an Intramedullary Lengthening and Compression Nail. J Orthop Trauma Vol 31, Number 6 Supplement, June 2017.
The Intramedullary lengthening nail has allowed for treatment of tibia and femur problems without the use of an external device.
Adult Posttraumatic Reconstruction Using a Magnetic Internal Lengthening Nail. S. Robert Rozbruch, MD. J Orthop Trauma Vol 31, Number 6 Supplement, June 2017. DOI: 10.1097/BOT.0000000000000843.
Intramedullary lengthening is effective in treating deformity and shortening of tibial malunion and posttraumatic growth arrest of the femur.
Humerus Lengthening With the PRECICE Internal Lengthening Nail. Anton M. Kurtz, MD and S. Robert Rozbruch, MD. J Pediatr Orthop Vol 37, Number 4, June 2017. DOI: 10.1097/BPO.0000000000000941.
Intramedullary lengthening works well in the humerus.
Rozbruch SR. Why are we special? Limb deformity is more than an overlapping subspecialty. J Limb Lengthen Reconstr 2017;3:1-3.
Limb lengthening reconstruction is a specialization that is unique from the classical orthopedic specialties and is a practice that is proving to be more and more necessary.
Rozbruch SR, Fragomen AT. Tibial/Femoral Osteotomy. In Green A, and Hayda R: Orthopaedic Postoperative Rehabilitation. American Academy of Orthopaedic Surgeons; 2017
Prescribed exercises after surgery are effective in preventing joint stiffness.
Ankle Distraction Arthroplasty: Indications, Technique, and Outcomes. Mitchell Bernstein, Jay Reidler, Austin Fragomen, S. Robert Rozbruch. J Am Acad Orthop Surg 2016;0:1-11. DOI: 10.5435/JAAOS-D-14-00077
Ankle distraction is a reliable alternative to ankle arthrodesis or total ankle arthroplasty in young patients with arthritis. Although the initial goal of ankle distraction is to ankle arthrodesis many patients achieve the lasting benefit of the eliminating the need for ankle arthroplasty or fusion completely.
Prophylactic Postoperative Antibiotics May Not Reduce Pin Site Infections After External Fixation. Austin T. Fragomen, Andy O. Miller, Barry D. Brause, Vladimir Goldman, and S. Robert Rozbruch. The Musculoskeletal Journal of Hospital for Special Surgery. Vol. 12 No. 3; October 2016. DOI 10.1007/s11420-016-9539-z
Pin infection is a common problem at pin sites. Prophylactic antibiotics do not aid in the prevention of pin site infections in any way and should not be used on healthy patients.
Neglected Patellar Tendon Rupture with Massive Proximal Patellar Migration Treated with Patellar Transport and Staged Allograft Reconstruction. Osama Elattar, MD, Struan H. Coleman, MD, Russell F. Warren, MD,and S. Robert Rozbruch, MD. The Orthopaedic Journal of Sports Medicine. 4(11), 2325967116672175. DOI: 10.1177/2325967116672175
For patients with soft tissue contractures, adhesions, and fixed proximal patellar migration the use of pins and wires for external fixation is an effective way to treat and salvage neglected patellar tendon rupture.
Validation of a modified Scoliosis Research Society instrument for patients with limb deformity: The limb deformity—Scoliosis Research Society (LD-SRS) score. Peter D. Fabricant, Eugene W. Borst, Stuart A. Green, Robert G. Marx, Austin T. Fragomen, and S. Robert Rozbruch. Journal of Limb Lengthening & Reconstruction. Jul‑Dec 2016, Vol 2, Issue 2.
The new scale LD-SRS was shown to give a more accurate description of the quality of life in regards to people with nonarthritic lower extremity deformity than the global quality of life measurements.
Gradual correction of knee flexion contracture using external fixation. Ettore Vulcano, Jonathan S. Markowitz, Austin T. Fragomen, S. Robert Rozbruch. Journal of Limb Lengthening & Reconstruction. Jul‑Dec 2016, Vol 2, Issue 2.
Circular external fixation was found to be a reliable way of treating knee flexion contractures and concurrent ankle equinus as long as the correction with a brace continued on for 1-3 months following surgery.
Oxygen consumption testing and self-reported outcomes following limb salvage with tibiocalcaneal or tibio-talo-calcaneal fusion. S. Robert Rozbruch, Joshua R. Buksbaum, Austin T. Fragomen, Eugene W. Borst, Polly DeMille. Journal of Limb Lengthening & Reconstruction. Jul‑Dec 2016, Vol 2, Issue 2
Although our complex ankle fusion patients have elevated oxygen consumption levels compared to normal subjects, they have lower oxygen consumption levels than amputees, and thus are able to walk while consuming less energy.
Open Wedge Distal Femoral Osteotomy: Accuracy of Correction and Patient Outcomes. Osama Elattar, Ishaan Swarup, Aaron Lam, Joseph Nguyen, Austin Fragomen and S. Robert Rozbruch. The Musculoskeletal Journal of Hospital for Special Surgery. 5 July 2016. DOI 10.1007/s11420-016-9516-6
Distal femoral osteotomy was found to be a reliable procedure to treat valgus knee malalignment with accurate deformity correction and clinical improvement post surgery.
The use of blocking screws with internal lengthening nail and reverse rule of thumb for blocking screws in limb lengthening and deformity correction surgery. Muthusamy S, Rozbruch SR, Fragomen AT. Strat Traum Limb Recon. 11 September 2016. DOI 10.1007/s11751-016-0265-3
Common deformities that occur in femur and tibia osteotomies during the use of internal lengthening can be prevented with the use of blocking screws. The reverse rule of thumbs is useful for placing blocking screws.
What's New in Limb Lengthening and Deformity Correction. Hamdy RC, Bernstein MA, Fragomen AT, Rozbruch SR. The Journal of Bone and Joint Surgery. 17 August 2016. DOI 10.2106/JBJS.16.00460
Limb reconstruction is a fast growing practice with many new techniques appearing, this paper summarizes our most recent techniques.
Lengthening of the Femur with a Remote-Controlled Magnetic Intramedullary Nail: Retrograde Technique. Austin T. Fragomen, MD, S. Robert Rozbruch, MD, JB&JS Essential Surgical Techniques, Volume 6, Issue 2, May 11, 2016
When fixing a distal femoral deformity the retrograde technique is more effective than the antegrade technique and allows for corrections of distal deformities when the osteotomy is done at the time of the nail.
External fixation reconstruction of the residual problems of benign bone tumours. Levent Eralp, F. Erkal Bilen, S. Robert Rozbruch, Mehmet Kocaoglu, Ahmed I. Hammoudi, Strategies in Trauma and Limb Reconstruction, 26 January 2016.
The use of external fixators and distraction osteogenesis are effective in treating benign bone tumors and at minimizing the risk of recurrence of deformity.
Lengthening of the Femur with a Remote-Controlled Magnetic Intramedullary Nail: Antegrade Technique. S. Robert Rozbruch, Austin T. Fragomen, JB&JS Essential Surgical Techniques, Volume 6, Issue 1, January 13, 2016.
The intramedullary nail is good for lengthening of the femur as well as angular and deformity correction.
Talar body fracture nonunion and osteonecrosis with adjacent arthritis can be successfully treated with tibiotalocalcaneal arthrodesis using circular external fixation. Eugene Wilson Borst, Scott J. Ellis, Austin Thomas Fragomen. Journal of Limb Lengthening & Reconstruction. Oct-Dec 2015, Vol 1, Issue 1.
Circular external fixation was used for the first time to simultaneously treat a complex talus nonunion as well as ankle and subtalar arthritis. Our patient has been pain free, in neutral alignment, and back to normal activity after this complex TTC fusion.
Distraction osteogenesis for brachymetatarsia: Clinical results and implications on the metatarsophalangeal joint, Amgad M. Haleem, Angela Balagadde, Eugene Wilson Borst, Huong T. Do, Austin Thomas Fragomen, S. Robert Rozbruch, Journal of Limb Lengthening & Reconstruction, Oct-Dec 2015, Vol 1, Issue 1
DO is an effective method to treat brachymetatarsia, with high patient satisfaction. Larger studies are required to further investigate MTP joint complications and the optimal method of stabilization of the distraction.
What is the Utility of a Limb Lengthening and Reconstruction Service in an Academic Department of Orthopaedic Surgery?; S. Robert Rozbruch, Elizabeth S. Rozbruch, Samuel Zonshayn, Eugene W. Borst & Austin T. Fragomen; Clinical Orthopaedics and Related Research; Volume 473, Number 4; DOI 10.1007/s11999-015-4267-0
Based on referral data, surgical diversity, and academic productivity, our practice highlights the utility of a Limb Deformity Service to an academic hospital.
Does Integrated Fixation Provide Benefit in the Reconstruction of Post-Traumatic Tibial Bone Defects?; Symposium: 2014 Annual Meeting of the Limb Lengthening and Reconstruction Society; Mitchell Bernstein MD, Austin T. Fragomen MD, Samir Sabharwal BA, Jonathan Barclay BA, S. Robert Rozbruch MD, Clin Orthop Relat Res DOI 10.1007/s11999-015-4326-6
Integrated fixation reduces time in external fixation while increasing surgical efficiency of tibial reconstruction as compared to exclusive use of external fixation.
Metatarsophalangeal Arthritis Following Fourth Metatarsal Lengthening Treated With Distraction Arthroplasty: Case Report, Amgad M. Haleem, Douglas N. Mintz and S. Robert Rozbruch, Foot Ankle Int 2014 35: 1075 originally published online 18 July 2014 DOI: 10.1177/1071100714543648
Iliac Crest Bone Marrow Aspirate injections and distraction arthroplasty of the Metatarsophalangeal joint can effectively combat arthritis and stiffness in the joint after distraction osteogenesis of the metatarsal due to brachymetatarsia.
Knee Arthrodesis as Limb Salvage for Complex Failures of Total Knee Arthroplasty, Raul Kuchinad, MD, FRCSC, Mitchell S. Fourman, MD M.Phil, Raul Kuchinad, MD, FRCSC, Mitchell S. Fourman, MD M.Phil, The Journal of Arthroplasty 29 (2014) 2150–2155
Bone loss, soft tissue envelope, and overall bone health determine the best method of knee arthrodesis for limb salvage after a complex failed Total Knee Replacement. Knee arthrodesis is an effective technique for limb salvage after complex failure and infection following knee replacement.
Neglected rotatory knee dislocation: A case report, Saker Khamaisy, Amgad M. Haleem, Riley J. Williams, S. Robert Rozbruch, S. Khamaisy et al. / The Knee 21 (2014) 975–978
A unique rotary knee dislocation, in addition to a lateral patellofemoral dislocation was effectively treated after 3 years of neglect with a Taylor Spatial frame and multiple surgeries.
What Risk Factors Predict Usage of Gastrocsoleus Recession During Tibial Lengthening? S. Robert Rozbruch MD, Samuel Zonshayn BA, Saravanaraja Muthusamy MBBS, MS, Ortho, Eugene W. Borst BA, Austin T. Fragomen MD, Joseph T. Nguyen MPH, Clin Orthop Relat Res DOI 10.1007/s11999-014-3526-9
Patients with tibial lengthening greater than 42 mm or 13% of the overall segment lengths, as well as those with a congenital LLD are more likely to undergo a gastroc-soleus Recession during Tibia lengthening.
Motorized Intramedullary Nail for Management of Limb-length Discrepancy and Deformity. S. Robert Rozbruch, MD; John G. Birch, MD; Mark T. Dahl, MD; John E. Herzenberg, MD, J Am Acad Orthop Surg 2014;22:403-409, July 2014, Vol 22, No 7
Motorized Intramedullary Nails can lengthen both Femurs and Tibias internally, obviating the need for external fixation while providing stable fixation and lengthening.
Development and validation of a computational model of the knee joint for the evaluation of surgical treatments for osteoarthritis. R. Mootanah, C.W. Imhauser, F. Reisse, D. Carpanen, R.W. Walker, M.F. Koff, M.W. Lenhoff, S.R. Rozbruch, A.T. Fragomen, Z. Dewan, Y.M. Kirane, K. Cheah, J.K. Dowella and H.J. Hillstrom, Computer Methods in Biomechanics and Biomedical Engineering, 2014 Vol. 17, No. 13, 1502–1517
The computational knee model can accurately predict normalized intra-articular pressures and forces for different loading conditions, and could be further tuned to account for different surgical procedures.
Precision of the PRECISE® Internal Bone Lengthening Nail, Yatin M. Kirane, Austin T. Fragomen, and S. Robert Rozbruch, Clin Orthop Relat Res. ISSN 0009-921X, DOI 10.1007/s11999-014-3575-0, 2014
The PRECICE Internal Lengthening nail accurately and precisely lengthens bone, with minimal impact on knee and ankle range of motion and complications.
Recombinant Human BMP-2 Increases the Incidence and Rate of Healing in Complex Ankle Arthrodesis, Fourman MS, Borst EW, Bogner E, Rozbruch SR, Fragomen AT: Clin Orthop Rel Res. 2014 Feb, 472:732-9, Epub 2013 Aug 29.
Recombinant Human BMP-2 were significantly more likely to obtain fusion after initial surgery and spend less time in external fixation, while showing significantly more bone bridging on radiographic analysis.
Minimum Distraction Gap: How Much Ankle Joint Space Is Enough in Ankle Distraction Arthroplasty? Fragomen AT, McCoy TH, Meyers K, Rozbruch SR: HSS J 2014, 10:6-12.
Six mm of minimum tibiotalar joint distraction is sufficient to prevent contact between the tibia and talus during ankle distraction arthroplasty.
Circular External Fixator Assisted Ankle Arthrodesis Following Failed Total Ankle Arthroplasty. McCoy TH, Goldman V, Fragomen AT, Rozbruch SR: Foot Ankle Int. 2012, 33(11):947-955.
External Fixation and possible tibia lengthening, provides an excellent method with a high fusion rate to combat bone loss and possible infection after failed total ankle arthroplasty.
Growth Arrest of the Tibia after ACL Reconstruction: Lengthening and Deformity Correction with the Taylor Spatial Frame. Rozbruch SR, Schachter L, Bigman D, Marx R: Published online before print April 25, 2013, doi: 10.1177/0363546510369318; Am. J Sports Med, 2013, 41(7):1636-1641.
Tibia lengthening using TSF can be used to correct deformity in the tibia stemming from a growth arrest after ACL reconstruction in skeletally immature patients.
Distal Tibial Periarticular Nonunions: Ankle Salvage with Bone Transport. Schottel P, Muthusamy S, Rozbruch SR: J Orthop Trauma. Epub 2013 Sep 26.
Nonunions in the distal tibia can be challenging due to the lack of bone stock in the area. However, a three ring, double osteotomy frame can be used to excise the infected bone and transport proximal tibial bone to overcome the nonunion.
Femoral Deformity Planning: Intentional Placement of the Apex of Deformity, Peter D. Fabricant, MD, MPH; James M. Camara, PhD, S. Robert Rozbruch, MD, Healio.com/orthopedics, Search: 20130426-11, Volume 36, Number 5, May 2013
Intentional placement of a single osteotomy can be used to correct a multiapical deformity in the distal femur to minimize translation.
Limb Lengthening in children with Russell-Silver syndrome: a comparison to other etiologies; V. Goldman, TH McCoy, MD Harbison, AT Fragomen, SR Rozbruch, Journal of Children's Orthopaedics ISSN 1863-2521, Volume 7, Number 2 (2013)
Patients with Russell-Silver syndrome treated for Limb Length discrepancies healed faster than other patients treated for LLDs.
Antibiotic-Coated Nail for Fusion of Infected Charcot Ankles, Abhijit Pawar, MD, Goksel Dikmen, MD, Austin Fragomen, MD, and S. Robert Rozbruch, MD, Foot & Ankle International 34(1) 80-84, American Orthopedic Foot & Ankle Society, 2013
Antibiotic-coated retrograde nails were successfully used to achieve bony union, fusion of the ankle joint, and elimination of infection in our patients with infected Charcot ankles.
Limb Lengthening and Reconstruction Society AIM Index Reliably Assesses Lower Limb Deformity, James McCarthy MD, Christopher A. Iobst MD, S. Robert Rozbruch MD, Sanjeev Sabharwal MD, Emily A. Eismann MS, Clin Orthop Relat Res, DOI 10.1007/s11999-012-2609-8, March 2012
The LLRS’s AIM rating reliably classifies the complexity of a lower limb deformity.
Osteotomy, Arthrodesis and Arthroplasty for Complex Multiapical Deformity of the Leg, Alex C. Lesiak, MD, J. Turner Vosseller, MD, S. Rozbruch, MD, HSS Journal, The Musculoskeletal Journal of Hospital for Special Surgery, ISSN 1556-3316, Volume 8 Number 3 (2012)
Post-traumatic multiapical tibia deformities can be effectively treated with ankle fusion, tibial osteotomy, and total knee replacement. Techniques from less complex deformities are used in conjunction to attain pain relief and deformity correction in more complex cases.
Evidence-Based Indications for Distraction Ankle Arthroplasty, Nichoas C. Smith, MD, BA, Douglas Beaman, MD, S. Robert Rozbruch, MD, Mark A. Glazebrook, PhD, MD, Foot & Ankle International, 2012, by the American Orthopaedic Foot & Ankle Society
Ankle distraction is helpful in treating post-traumatic arthritis and is a conservative alternative to fusion or joint replacement.
Ashfaq K, Fragomen AT, Nguyen JT, Rozbruch SR: Correction of proximal Tibia Varus with External Fixation. Accepted for publication. J Knee Surgery. (in press, published online)
Bowleg Correction with external fixation results in highly accurate limb alignment. It is safe, effective, and results in high patient satisfaction.
Fragomen AT, Borst E, Schachter L, Lyman S, Rozbruch SR: Complex Ankle Arthrodesis Using the Ilizarov Method Yields High Rate of Fusion. Clin Orthop Rel Research. Epub ahead of print July 10, 2012.
Limb salvage with complex ankle fusion has 93% success in patients who do not smoke and do not have neuropathy.
Mahboubian S, Seah M, Schachter L, Fragomen AT, Rozbruch SR: Femoral Lengthening with Lengthening Over a Nail has Fewer Complications than Intramedullary Skeletal Kinetic Distraction. Epub 2011 Dec 6. Clin Orthop Rel Res. 2012, 470(4):1221-31.
Femur lengthening with the LON technique was safe and effective. Average lengthening was 4 cm. Time in external fixation was minimal and bone healing was fast (1.39 months per cm).
McCoy T, Kim HJ, Cross MB, Fragomen A, Healey JH, Athanasian EA, Rozbruch SR. Bone Tumor Reconstruction with the Ilizarov Method. J Surg Oncology. Epub ahead of print, July 17, 2012.
Bone tumor reconstruction with the Ilizarov method is safe and effective. The average bone lengthening was 7.1 cm.
Pawar A, McCoy TH, Fragomen AT, Rozbruch SR: Does Humeral Lengthening with Monolateral fixation Improve Function? Clin Orthop Rel Research. Epub ahead of print August 28, 2012.
Upper arm (humerus) lengthening is safe, effective, and results in improved function (DASH scores improved by 36%). Average bone lengthening was 7 cm.
McCoy TH, Goldman V, Fragomen AT, Rozbruch SR: External Fixator Assisted Ankle Arthrodesis Following Failed Total Ankle Arthroplasty. Foot Ankle Int. 2012, 33(11):947-955.
We have successfully treated failed total ankle replacements. After implant removal there was a bone defect of 5.1 cm. All patients had successful ankle fusion with equalization of leg lengths and no deformity.
Harbechuski R, Fragomen AT, Rozbruch SR: Does lengthening and Then Plating (LAP) Shorten Duration of External Fixation? Clin Orthop Rel Res. 2012, 470:1771-1781. Epub ahead of print November 15, 2011
We have used a hybrid technique where we insert internal fixation after lengthening with an external fixator. We lowered the time needed in external fixation by 27% using LAP. This decreased the incidence of pin tract infections.
Kahkaria S, Bigman D, Fragomen AT, Rozbruch SR: Comparison of PACS and Hardcopy 51-inch Radiographs for Measuring Leg Length and Deformity. Clin Orthop Rel Res, 2011 Jan; 469(1):244-250.
We currently use a digital x-ray system (PACS) to evaluate limb length and deformity. After measuring the reliability and reproducibility of PACS in 40 patients, we concluded that the new system was as accurate as hardcopy images and that there were a number of advantages to the digital system.
Seah KT, Shafi R, Fragomen AT, Rozbruch SR: Distal Femoral Osteotomy: Is Internal Fixation Better than External? Clin Orthop Rel Res. 2011, 469: 2003-2011.
We have accurately corrected femur deformity with both internal and external fixation. Alignment within 10 mm of goal was achieved in 88% of patients. Knee motion was not adversely affected. We choose the specific technique that best suits the individual patient.
Horn D, Fragomen AT, Rozbruch SR: Supramalleolar osteotomy using the Taylor spatial frame. Foot Ankle Int. 2011, 32: 986-993.
We have corrected complex ankle deformities with precision using the Taylor Spatial Frame. All patients had significant deformity correction and were within 0-4 degrees of normal. The AOFAS outcome scores improved by 78%.
Rozbruch SR, Segal K, Ilizarov S, Fragomen AT, Ilizarov G: Does the Taylor Spatial Frame Accurately Correct Tibial Deformities? Clin Orthop Rel Res 2010 May :468(5): 1352-61.
We reviewed our experience correcting complex deformity in 122 tibiae. Gradual correction of all tibial deformities with the TSF was highly accurate and with few complications.
Tellisi N, Fragomen AT, Kleinman D, O’Malley MJ, Rozbruch SR. Joint Preservation of the Osteoarthritic Ankle Using Distraction Arthroplasty. Foot and Ankle International 2009; 30:318-325.
We have used ankle distraction to treat ankle arthritis and avoid ankle fusion with success. Significant pain relief was achieved in 91% of our patients. There was a 35% improvement in AOFAS functional scores and ankle motion was preserved in all our joint preservation cases.
Khakharia S, Fragomen AT, Rozbruch SR. Limited Quadricepsplasty for Contracture during Femoral Lengthening. Clin Orthop Rel Research 2009 Nov; 467 (11):2911-7.
After femur lengthening of an average of 4.4 cm, our patients did not lose any knee range of motion. We developed a minimal incision technique that assures quick and reliable motion of the knee.
Rozbruch SR, Pugsley JS, Fragomen AT, Ilizarov S: Repair of Tibial Nonunions and Bone Defects with the Taylor Spatial Frame. J Orthop Trauma 2008; 22(2): 88-95.
Our treatment of a group of complex tibial nonunions with bone loss, infection, and deformity resulted in 95% success (bone healing and eradication of infection). Significant improvement in functional scores was also accomplished.
Tellisi N, Ilizarov S, Fragomen A, Rozbruch SR: Lengthening and Reconstruction of Congenital Leg Deficiencies for Enhanced Prosthetic Wear. Clin Orthop Rel Res 2008; 466:495-499.
Congenital limb deficiencies with severe shortening and/or deformity can be difficult to fit with a prosthesis. We have successfully treated patients with gradual lengthening and deformity correction using the Ilizarov/Taylor spatial frame. We achieved significant improvement in prosthesis fit, comfort, and gait.
Rozbruch SR; Kleinman D; Fragomen AT; Ilizarov S: Limb Lengthening and then Insertion of an Intramedullary Nail: A Case-matched Comparison. Clin Orthop Rel Res 2008; 466:2923-2932.
We have used a hybrid technique where we insert a rod into the bone after using the external fixator for lengthening. Our patients treated with LATN had a 74% decrease in time needed wearing the external fixator and a 53% decrease in time to bone healing.
Rozbruch SR, Ilizarov S, Blyakher AA: Knee Arthrodesis with Simultaneous Lengthening Using the Ilizarov Method. Journal of Orthopedic Trauma 2005; 19 (3)171-179.
We have used knee fusion to salvage limbs with a non-reconstructable knee joint, bone loss and infection. We achieved bone union and eradication of infection in all patients, and the average bone lengthening was 5.4 cm. Functional scores improved by 106%.