Pediatric Clinical Fellowship in Limb Lengthening and Reconstruction

The Limb Lengthening and Reconstruction Fellowship Program consists of two types of fellowships: clinical and research. Clinical fellows will acquire advanced experience to develop the knowledge, skills, and clinical judgment essential to the practice of limb lengthening and reconstruction. Research fellows will work on multiple research studies and submit several publications to peer-reviewed medical journals.

The International Center for Limb Lengthening is widely recognized for adult and pediatric limb reconstructive surgery and the treatment of a wide range of congenital, developmental, degenerative, and traumatic disorders of the upper and lower limbs. Our physicians and staff continue to innovate and transform the field of limb lengthening and deformity correction. Drs. Herzenberg and Standard were instrumental in the development of the Precice Intramedullary Limb Lengthening System. Since 2011, the physicians and staff have created educational tools such as the Bone Ninja app, Multiplier app, The Art of Limb Alignment textbook, and The Art of Limb Alignment: Taylor Spatial Frame textbook, which are used at the annual Baltimore Limb Deformity Course (DeformityCourse.com). This international symposium has been held since 1990, and registration fees are waived for our clinical and research fellows. Fellows are also encouraged to participate in an international mission trip (details provided during orientation). Our physicians treat a wide range of clinical problems including limb length discrepancy (LLD), fracture malunions/nonunions, osteomyelitis, angular deformities, and congenital deficiencies. Each week, the physicians see over 50 new patients and 120 follow-up patients. Fellows will learn to determine current LLD, predict LLD at skeletal maturity, evaluate limb alignment, and analyze single and multiapical deformities. We offer three clinical positions: two focus on pediatric orthopedics and one focuses on adult orthopedics. The pediatric fellows rotate with Drs. McClure and Standard. The adult fellow will rotate with Drs. Conway and Assayag.

At the end of the fellowship, the fellow should be able to competently perform limb lengthening and reconstruction surgical procedures and understand the technical aspects, indications, risks, results, prognosis, and limitations of these procedures. Per week, the physicians perform 25 to 30 surgical cases. Clinical fellows will apply external fixation and insert femoral and tibial intramedullary nails. They will also perform Gigli saw osteotomies, fixator-assisted nailing or plating, epiphysiodesis, hemiepiphysiodesis, and bone transport. Fellows will treat hypertrophic, atrophic, and infected nonunions and learn to resect necrotic bone to treat osteomyelitis. They will also correct foot deformities, including clubfoot. Our facilities include EOS Edge, standing foot CT, and gait lab.

Clinical fellows are required to collect data and produce at least one scientific paper that will be submitted to a peer-reviewed journal. They will attend orthopedic grand rounds, research meetings, and in-service training lectures. They will also help prepare for and attend weekly preoperative indications conferences.

NOTE: Because of the relatively new nature of the techniques and methodologies, ACGME has not published any guidelines for accreditation. Although this fellowship is not accredited by the ACGME, the program guidelines have been modeled after guidelines for similar programs.