ILIZAROV Frame, Dr. Robert Rozbruch Featured on 20/20
Dr. Robert Rozbruch, director of the Institute for Limb Lengthening and Reconstruction at New York’s Hospital for Special Surgery, was recently featured in a story that aired on the ABC news program 20/20. The story was about a now 13-year-old boy who was rescued from the civil war in Sierra Leone in West Africa by another American surgeon and brought back to the United States for the medical treatment he needed to save his leg from osteomyelitis caused by infection from a snake bit that was never properly treated.
The boy, named Lansana, was bitten by a snake while chasing a soccer ball into the bush. With his mother dead and his father missing, an uncle abandoned Lansana at a hospital in Bo, a city in the south central portion of the country. There he stayed for nearly two years until Dr. Ian Zlotolow, an oral surgeon at the Memorial Sloan-Kettering Cancer Center in New York, visited the hospital as a medical volunteer. By this time, infection had set into his tibia resulting in massive bone loss of not only his tibia but also his entire ankle joint. Doctors in his native country recommended amputation, but Dr. Zlotolow thought a specialist like Dr. Rozbruch might be able to reconstruct the leg so he attempted to bring the boy back with him to the U.S.
After Lansana was granted a visa and allowed to return home with Dr. Zlotolow, he began to seek treatment for the boy’s leg and was referred to Dr. Rozbruch. With his right leg approximately six inches shorter than his left with a 45 degree internal rotation, Rozbruch used the Ilizarov device to gradually correct the deformity and lengthen the bone.
“We gradually pulled that piece of bone downward, towards the ankle, to fill in the defect,” Dr. Rozbruch said. “And, in that way, we were able to use the Ilizarov method to grow him new bone and essentially reconstruct his ankle and attach what was left of his leg to his foot.”
Dr. Rozbruch also performed a bone transport and ankle fusion to fill in the defect caused by the osteomyelitis. In all, Dr. Rozburch was able to lengthen the boy’s leg by 23cm through several stages of treatment. Lansana is doing well today with a stable ankle and the ability to run, play soccer and basketball. He has also been adopted by Dr. Zlotolow and Wendy Cohen.
Performing Closed Reduction in a Chronic Proximal Dislocation Following Total Hip Arthroplasty
The following case study conducted by R. Allen Butler, MD, Joseph R. Hsu, MD and Robert L. Barrack, MD, was published in the February 2006 issue of The Journal of Bone and Joint Surgery. To see the article in its entirety, please visit the following site: http://www.ejbjs.org/cgi/content/full/88/2/411
One of the major perioperative complications of total hip arthroplasty is dislocation. This complication was successfully treated in one patient with gradual closed reduction using the ILIZAROV distraction technique.
The patient, a 46-year-old male, underwent right total hip arthroplasty with multiple dislocations postoperatively. Six years later, radiographic evaluation revealed that the total hip replacement was dislocated posteriorly, causing 10cm of shortening. The patient complained of chronic pain in the buttock and a severe Trendelenburg gait. He walked with the use of a crutch and a 7.5cm shoe lift. Treatment options discussed included resection arthroplasty, revision surgery with residual limb-length discrepancy and soft-tissue lengthening with use of an external fixator. The patient opted for the lengthening procedure.
A spanning ILIZAROV device was placed over the right hip, and the patient was placed in the lateral decubitus position with transosseous wires proximally and half-pins distally. The patient was started on a lengthening regimen at a rapid rate of 4mm per day on the first postoperative day. The surgeons chose this rate because they were attempting to return the patient's neurovascular structures to their normal anatomic length.
After the ILIZAROV was removed, the patient was put in an abduction brace for three days followed by a hip pantaloon spica cast for eight weeks. He was then allowed to bear weight as tolerated and began physical therapy. During follow-up two years later, he was able to walk without assistive devices and had only a mild limp due to residual peroneal nerve palsy from his initial injury. Radiographs made at that time showed that the total hip replacement had remained reduced and his limbs were of equal length.
Although such procedures may have complications such as pulmonary embolism and pin-tract infections, this case was treated successfully using a rapid rate of distraction. The authors suggest educating the patient on the signs of neural irritation, as neurologic compromise can occur especially towards the end of the lengthening period. If any signs of neural irritation are noted, the distraction should be slowed or temporarily halted. The authors believe that gradual distraction with an external fixator is a viable option for the treatment of chronic dislocation following total hip arthroplasty. In this case, the treatment gave the patient a much higher level of function and equal limb lengths while avoiding an open procedure.