Iobst CA, Rozbruch SR, Nelson S, Fragomen AT. Simultaneous Acute Femoral Deformity Correction and Gradual Limb Lengthening Using the Retrograde Precice Femoral Nail: Technique and Clinical Results. J Am Acad Orthop Surg. 2018 Apr 1;26(7):241-250. doi: 10.5435/JAAOS-D-16-00573.
The Precice nail was effectively used to correct both limb-length discrepancy and deformity, with excellent overall outcomes. This surgical technique may help avoid the complications that can occur with prolonged postoperative use of an external fixator.
Fragomen AT, Rozbruch SR. Does the surgical correction of tibial torsion with genu varum produce outcomes similar to those in varus correction alone? J Knee Surg. 2018 Apr;31(4):359-369. doi: 10.1055/s-0037-1603797. Epub 2017 Jun 24.
The aim of this article is to study the relationship between tibia vara and external tibial torsion in adults. Based on the finding of this analysis, the incidence of rotational malalignment with genu varum is close to 50%. The recognition of this close association between external tibial torsion and tibia vara may allow for further insight into the role of rotation in varus deformity-related knee pathology and treatment. Patients can expect nearly identical outcomes.
James E, Corpus K, Fragomen AT, Rozbruch SR. Opening Wedge High Tibial Osteotomy, Microfracture, and Bone Marrow Aspirate Concentrate for Treatment of Varus Deformity and Osteoarthritis of the Knee. Ann Sports Med Res 2017, 4(2):110.
This report presents two patients with varus deformity and extensive grade IV medial compartment osteoarthritis treated with medial opening wedge high tibial osteotomy (HTO) and microfracture augmented with bone marrow aspirate concentrate (BMAC). Results demonstrate restoration of a neutral mechanical axis, filling of the osteochondral defect, and improvement in subjective outcome scores.
Rozbruch SR. Adult Post-traumatic Reconstruction Using a Magnetic Internal Lengthening Nail. J Orthop Trauma. 2017 Jun; 31 Suppl 2:S14-S19. doi: 10.1097/BOT.0000000000000843.
A new generation of internal lengthening nail is now available that has reliable remote-controlled mechanisms. This allows accurate and well-controlled distraction rate and rhythm, and early clinical results have been very positive.
Kleeblad LJ, van der List JP, Pearle AD, Fragomen AT, Rozbruch SR. Feasibility of correcting the mechanical axis in large varus deformities with medial unicompartmental knee arthroplasty. J Arthroplasty. 2018 Feb;33(2):372-378. doi: 10.1016/j.arth.2017.09.052. Epub 2017 Oct 5.
Patients with large preoperative varus deformities (7°-18°) could be considered candidates for medial unicompartmental knee arthroplasty (UKA), as 98% were corrected to optimal or acceptable alignment, although cautious approach is needed in deformities >15°. Furthermore, it was noted that the feasibility of achieving optimal alignment could be predicted using the preoperative mechanical axis angle (MAA), joint line congruency angle (JLCA), and age
Hammouda AI, Standard S, Herzenberg JE, Rozbruch SR. Humeral Lengthening with the PRECICE magnetic lengthening nail. HSS J. Accepted Sept 2017.
Intramedullary lengthening nails can provide successful and safe humeral lengthening. Specifically, the PRECICE nail has accurate control over the lengthening process.
Fragomen AT, Kurtz A, Barclay JR, Nguyen J, Rozbruch SR. A comparison of femoral lengthening methods favors the magnetic internal lengthening nail when compared with lengthening over a nail. HSS J. 2018 Jul;14(2):166-176. doi: 10.1007/s11420-017-9596-y. Epub 2018 Jan 5.
Femoral lengthening with magnetic internal lengthening nail (ILN) was more accurate than with lengthening over nail (LON). The magnetic ILN comports the additional advantage of greater precision with distraction rate control and fewer complications. Both techniques afford reliable healing and do not significantly affect knee motion at the final follow-up. The magnetic ILN method showed no superiority in regenerate quality and healing rate.
Harkin E, Rozbruch SR, Liskutin T, Hopkinson W, Bernstein M. Total Hip Arthroplasty And Femoral Nail Lengthening For Hip Dysplasia And Limb Length Discrepancy. Arthroplast Today. 2018 May 3;4(3):279-286. doi: 10.1016/j.artd.2018.03.001. eCollection 2018 Sep.
Staged ipsilateral total hip arthroplasty and retrograde intramedullary femoral nail lengthening allows for the correction of both deformity and limb-length discrepancy. Our results report leg-length equalization, independent ambulation without assistive devices, and excellent bone and functional outcomes without complications, demonstrating that this combined technique can be used to achieve targeted lengthening and deformity correction.
Buly RL, Sosa B, Poultsides L, Caldwell E, Rozbruch SR. Femoral Derotation Osteotomy in Adults with Version Abnormalities. J Am Acad Orthop Surg. 2018 Oct 1;26(19):e416-e425. doi: 10.5435/JAAOS-D-17-00623.
A closed, subtrochanteric derotation osteotomy of the femur is a safe and effective procedure to treat either femoral retroversion or excessive anteversion. Excellent or good results were obtained in 93%, despite the need for subsequent implant removal in more than two-thirds of the patients.
Fragomen AT, Kurtz AM, Wagner PJ, Nguyen J, Liu SS, Rozbruch SR. Anesthesia for removal of external fixation with hydroxyapatite-coated half pins. J Limb Lengthen Reconstr 2018;4:90-6.
IV sedation administered in the operating room provided adequate pain control to perform fixator removal and pin site debridement in most cases. Removal of external fixation used for foot and ankle reconstruction may be more painful.
Sheeha ED, Steinhaus ME, Kim HJ, Cunningham ME, Fragomen AT, Rozbruch SR. Leg-Length Discrepancy, Functional Scoliosis, and Low Back Pain. JBJS Rev. 2018 Aug;6(8):e6. doi: 10.2106/JBJS.RVW.17.00148
Patients with a limb length discrepancy (LLD), low back pain, and functional scoliosis should undergo radiographic evaluation with the pelvis leveled using blocks placed under the shorter limb. When the LLD or symptoms are minimal, patients may benefit from a shoe lift. Patients with an LLD of 20 mm may be considered for operative intervention.
Hamdy RC, Bernstein MA, Fragomen AT, Rozbruch SR. What's New in Limb Lengthening and Deformity Correction. J Bone Joint Surg Am. 2017 Aug 16;99(16):1408-1414. doi: 10.2106/JBJS.17.00464.
This specialty update provides a summary of the most impactful articles related to limb alignment, limb lengthening, and joint preservation that were published in 2017.
Lam A, Fragomen AT, Rozbruch SR. Metacarpal Lengthening in Adults With Brachymetacarpia. Hand (N Y). 2017 Oct 1:1558944717736859. doi: 10.1177/1558944717736859. Epub ahead of print.
Progressive distraction osteogenesis can obtain functionally successful results and improvement in aesthetics and body image without severe complications in skeletally mature adults with brachymetacarpia.
Vulcano E, Markowitz JM, Ali S, Nguyen J, Fragomen AT, Rozbruch SR. Assessment of Bone Healing During Antegrade Intramedullary Rod Femur Lengthening Using Radiographic Pixel Density. JAAOS - Journal of the American Academy of Orthopaedic Surgeons. September 15, 2018 - Volume 26 - Issue 18 - p e388–e394 doi: 10.5435/JAAOS-D-16-00949.
This study suggests that there may be a correlation between pixel density ratio (PDR) and clinical bone healing, and should be followed by additional studies to understand the relationship between PDR and bony union.
Richardson SS, Schairer WW, Fragomen AT, Rozbruch SR. Cost Comparison of Femoral Distraction Osteogenesis With External Lengthening Over a Nail Versus Internal Magnetic Lengthening Nail. J Am Acad Orthop Surg. 2018 Oct 1. doi: 10.5435/JAAOS-D-17-00741. [Epub ahead of print]
Although implants are more expensive for magnetic lengthening nails (MLN) than lengthening over nail (LON), this appears to be offset by fewer procedures. Overall, the two procedures had similar total costs, but MLN was associated with a decreased number of procedures and shorter time to union.
Bernstein M, Fragomen A, Rozbruch SR. Tibial Bone Transport Over an Intramedullary Nail Using Cable and Pulleys. JBJS Essent Surg Tech. 2018 Mar 28;8(1):e9. doi: 10.2106/JBJS.ST.17.00035. eCollection 2018 Mar 28
Massive bone defects (>8 cm) will not unite without an additional intervention., and require a predictable, durable, and efficient method to regrow bone. Our technique of tibial bone transport over an intramedullary nail using cable and pulleys combines internal and external fixation, allowing the external fixator to be removed at the end of the distraction phase. This increases the efficiency of limb reconstruction and decreases complications associated with external-fixators.
Green SA, Fragomen AT, Herzenberg JE, Iobst C, McCarthy JJ, Nelson SC, Rozbruch SR, Standard S. A magnetically controlled lengthening nail: A prospective study of 31 individuals (The PRECICE™ intramedullary nail study). J Limb Lengthen Reconstr 2018;4:67-75.
The PRECICE™ IM nail is a well-tolerated, reliable, fully implantable limb lengthening device that accurately elongates the femur or tibia in a variety of causes of limb length inequality, with a low implant failure rate, and few complications.