Limb Lengthening and Complex Reconstruction Fellowship (since 2004)

Department of Orthopaedic Surgery
Limb Lengthening & Complex Reconstruction Service
Hospital for Special Surgery

 

Austin T. Fragomen MD, Fellowship Director, Limb Lengthening and Complex Reconstruction Service (LLCRS)
S. Robert Rozbruch, MD, Chief, Limb Lengthening and Complex Reconstruction Service
Taylor J. Reif, MD, Director of Education, LLCRS
Jason S. Hoellwarth, MD, Director of Research, LLCRS

Duration: 1 year (August 1–July 31)
Stipend: $99,885.43 per annum/benefits (subsidized housing also available)
Positions: 2 Non-accredited
Location: Hospital for Special Surgery
Contact: Jennifer Johnson, 212.606.1594, johnsonj@hss.edu

Fellows immediately become a part of our team which includes four attending surgeons, along with PA’s, nurses, and research assistants. Fellow’s responsibilities prioritize patient care and education. The fellow will gain clinical expertise in diagnosis, treatment options, and surgery and will advance their research experience. The Ilizarov method is extensively used and applied to conventional approaches. We use an apprenticeship model which instills in the learner a profound skill set in preoperative planning, surgical precision, and postoperative care. The research opportunities focus on clinical investigations with the objective of a poster presentation at the HSS fellow research competition and abstract presentation at the Limb Lengthening & Reconstruction Society (LLRS) in July of the graduation year.

Curriculum and Expectations

Fellows will gain experience with the following:

• Adult and pediatric limb lengthening and deformity correction
• Lower extremity limb reconstruction: hip, femur, knee, tibia, ankle and foot
• Congenital conditions including fibular hemimelia, hemiatrophy dwarfism, short stature
• Developmental conditions: growth disturbance from trauma or infection in pediatric and adult patients
• The Ilizarov method
• Deformity analysis and detailed pre-operative planning
• Trauma: post-traumatic reconstruction: malunions, nonunions (septic and aseptic), bone defects, osteomyelitis, fracture related infection, complex circular fixation methods
• Knee reconstruction: osteotomy for realignment, arthrodesis
• Foot and ankle reconstruction: complex ankle fusions, multiplanar deformity correction, ankle distraction arthroplasty
• Upper extremity: humeral lengthening, forearm and wrist deformity correction
• Limb salvage surgery, infection, bone defect management
• Amputation reconstruction surgery, Osseointegration, Targeted Muscle Reinnervation (TMR), Regenerative Peripheral Nerve Interface (RPNI) surgery
• Tumor surgery, primary and secondary reconstruction
• Procedures: Hexapod circular external fixation (TSF and MaxFrame AutoStrut),Cable transport, Precice Bone Transport nail, intramedullary nail and plate assisted deformity correction, PRECICE magnetic internal lengthening nail, advanced blocking screw use, Osseointegration, PSI (NewClip and BodyCad), and preparation of antibiotic loaded cement/ceramic nails
• Complication management: soft-tissue releases, nerve decompression, residual deformity management

What Our Fellows Are Saying

“I was fortunate to complete the limb lengthening and complex reconstruction fellowship following my orthopaedic traumatology fellowship at HSS where I learned acute fracture management and nonunion techniques from a traumatologist perspective. This complemented my orthopaedic surgery residency training in Texas where I managed a considerable amount of high acuity blunt and penetrating trauma. We frequently encountered grossly contaminated fractures sustained in farm and ATV injuries. These were commonly managed with repeated debridement and open fixation destined for chronic infection. After seeing many patients undergo multiple surgeries for recalcitrant chronic osteomyelitis, I became interested in finding other options to treat these injuries hoping to mitigate the number of surgeries and improve patient outcomes. The utilization of distraction osteogenesis after treating these injuries with aggressive debridement of contaminated necrotic bone, inspired me to learn more. This interest festered early in the COVID-19 pandemic and since I had so much free time, I fed that interest with online courses. My interest in the LLCRS fellowship developed while attending a virtual trauma osteotomy/deformity course listening to one of the LLCRS alumni, Mitchell Bernstein, MD.

His knowledge of osteotomies and distraction osteogenesis sparked my interest; his knowledge was clearly at a different level from many of the other presenters. Once I learned that he had completed the LLCRS fellowship in addition to his trauma fellowship I became convinced that I needed this additional training.

The education I received during my LLCRS fellowship delivered exactly what I had hoped it would and much more.

It has provided me with a new outlook on the management of nonunions, malunions, leg length discrepancies, chronic osteomyelitis, hindfoot reconstruction, amputation, and so much more. Some of the useful tools I have taken from this fellowship are a new approach to nonunion management, distraction osteogenesis, infection eradication techniques, arthrodesis with nails and frames, osseointegration, and the ability to understand a deformity and how to treat. My understanding and ability to effectively prepare and execute a pre-operative plan for complex cases has radically improved. My ability to utilize new technology such as the internal lengthening nail and hexapod fixators now provides me with a solution for virtually any problem I may encounter in practice. Most importantly I have learned how to perform these surgeries safely and when to perform prophylactic procedures. The relationships I forged with Drs. Rozbruch, Fragomen, Reif, and Hoellwarth are mentorships I will relish and maintain throughout my career. I will emulate qualities from each of them in my practice and surely be calling for advice with complex cases. The LLCRS fellowship compliments virtually all subspecialties; however, it is particularly useful for a traumatologist and highly recommend this to others interested.

Knowing what I know now; I would complete the fellowship again if given a chance. The investment of an additional year of training is well worth the time and financial investment.”

– Brian Joseph Page, MD
LLCRS Fellow 2022-2023

Are you interested in a Fellowship with Limb Lengthening and Complex Reconstruction Service at HSS?

The next available positions are for the coming academic year. Fill out the application form to apply.

Application Deadline: We use a rolling admissions approach. Interviews and acceptances occur constantly.

Learn about the application process.