Limb Lengthening Quality Metrics
Quality Metrics: Standards of measurement by which efficiency, performance, progress, or quality of a plan, process, or product can be assessed.
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.
- 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%.
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