The educational program in limb reconstruction includes treatment of a large range of congenital, developmental, degenerative, and traumatic disorders of the upper and lower limbs. Typical clinical problems include limb length discrepancy, fracture malunion and nonunion, osteomyelitis, angular deformities of the limbs, joint contractures, and congenital deficiencies. The educational program is organized to provide advanced experience to the fellow to acquire the competency of a specialist in the field of limb lengthening and deformity correction. There are academic and technical skills that the fellow must acquire. The academic component emphasizes a scholarly approach to clinical problem solving, analysis of deformity, self-directed study, teaching, and research. The technical component includes the ability to competently perform the surgical procedures required for limb lengthening and reconstruction. The fellow should develop an understanding of the indications, risks, and limitations of the procedures involved. The fellow (with the assistance of the residents) will prepare a weekly preoperative indications conference. Attendance is required at weekly orthopaedic grand rounds and monthly journal club meetings.
The fellow must assume a major role in the continuing care of patients and must maintain progressive responsibility for patient assessment and for making decisions regarding treatment, preoperative evaluation, operative experience, nonoperative management, rehabilitation, and long-term follow-up. Each Fellow must keep a written record of each operation with which he or she assists and that he or she performs. A copy of this record should become a part of the fellow's permanent personnel file.
Specific operative skills that the fellow is expected to master include but are not limited to the following:
- Limb lengthening using a variety of external fixators, including the Orthofix, Ilizarov, and Hex-Fix devices
- Bone transport to treat segmental bone defects
- Closed and open treatment of nonunions
- Treatment of complex congenital pseudoarthrosis
- Distraction treatment of joint contractures, including clubfoot
- Stature lengthening for dwarfing conditions
- Correction of angular and torsional deformities with intramedullary nails
- Lengthening of femur or tibia over intramedullary nails related soft tissue procedures, including tendon lengthening and transfers
At the end of the training period, the fellow should have acquired the skill, knowledge, and judgment with which to establish a limb lengthening and reconstruction program similar in capability to that of ICLL.