Limb Lengthening & Reconstruction Research

CENTER FOR EXCELLENCE IN LIMB LENGTHENING & RECONSTRUCTION

Scottish Rite for Children began its limb lengthening research program in 1992. The Center for Excellence in Limb Lengthening and Reconstruction employs a unique multidisciplinary team approach, including collaboration between our orthopedic surgeons alongside nurses, psychologists, physical and occupational therapists, and researchers of varying backgrounds and expertise. Initial research was based on the Ilizarov treatment method developed by Gavril Ilizarov, M.D., in Russia. The center’s original director, John G. Birch, M.D., was one of the first North Americans to visit Dr. Ilizarov and bring his techniques to the United States. We are lucky to have three physicians who trained directly under Dr. Ilizarov on our research team at Scottish Rite.

Led by clinical director David Podeszwa, M.D., and research director Alexander Cherkashin, M.D.*, the center continues to focus on improving lives of patients with various limb deformities and leg length discrepancies. Driven by the goal of making the entire lengthening process easier for the patient, Scottish Rite researchers have modified Ilizarov’s technique to develop the TRUE/LOK™ External Fixation System, which includes the TRUE/LOK™ HEX and TRUE/LOK™ Trauma systems. Areas of research for the Center for Excellence in Limb Lengthening and Reconstruction include refinement of current fixation systems, improvement of limb lengthening techniques and better management of limb deformities.

*Medical degree from Khabarovsk State Medical School, Russia.

Current Studies and Divisions

The purpose of this study is to create a registry of patients who are undergoing surgery with an external fixator or intramedullary device to lengthen their limb or correct a deformity. We are evaluating long-term (10+ years) physical and general outcomes by having patients complete questionnaires and complete assessments by the Movement Science Laboratory, in addition to their standard visits with their physician.

INCLUSION CRITERIA

Patients 25 years and younger
Will undergo or have recently undergone lengthening and/or deformity correction with an external fixator or intramedullary device

This study is bringing back former patients who had surgery for infantile or adolescent Blount’s Disease more than 20 years ago at Scottish Rite. We are studying physical outcomes and general functioning. Visits include X-rays, clinical exam, media photos and questionnaires.

INCLUSION CRITERIA

Patients treated at Scottish Rite between 1985 and 1995
Diagnosis of Blount’s Disease
Treated with a high tibial osteotomy

This study focuses on our patients who have external fixation for limb lengthening and deformity correction. Every patient who has an external Ilizarov apparatus or internal intramedullary nail is included in our Ilizarov database. The database includes clinical and radiographic data in addition to patient pictures and radiographs as well as lengthening information. This is a critical component to our ongoing clinical research and education, both locally and internationally.

Division of Tissue Adaptation & Growth Modulation

The Division of Tissue Adaptation and Growth Modulation, led by researcher Marina Makarov, M.D.*, focuses on the areas of new bone formation under the influence of tensional stresses and soft tissue adaptation to gradual traction during distraction osteogenesis. This division manages all experimental and clinical studies, and allows the our researchers and physicians to analyze and better understand the fundamental biological mechanisms of bone growth and its modulation.

*Medical degree from Omsk Medical School, Russia.

Division of Skeletal Fixation Systems Design

The Division of Skeletal Fixation Systems Design, directed by researcher Mikhail Samchukov, M.D.*, coordinates the new design, development, testing and implementation of the TRUE/LOK™ family of External Fixation Systems. One of the current goals of the division is to develop and improve new modular external fixation systems for acute fracture reduction, gradual deformity correction and lengthening.

*Medical degree from Khabarovsk State Medical School, Russia.

Division of Clinical Implementation & Outcome Studies

Led by researcher Alexander Cherkashin, M.D.*, the Division of Clinical Implementation and Outcome Studies coordinates all outcome studies involving computer-assisted collection, storage and analysis of clinical data. The division continues to advance the preoperative planning program, LegPERFECT®, which provides comprehensive planning and precise monitoring of surgical procedures. Under supervision of this division, new software was developed for the TRUE/LOK™ HEX multiaxial deformity correction analysis and planning. These advancements have created a foundation for multicenter clinical studies that seek to improve the effectiveness of pediatric limb reconstruction around the world.

*Medical degree from Novosibirsk State Medical School, Russia.

In 1993, by modifying Ilizarov’s original external fixator, Scottish Rite for Children's research team developed and patented a new device called the TRUE/LOK™ External Fixation System (TrueLok). The device was created to treat deformities and extremity trauma and to lengthen limbs with a simpler but more adaptable external fixator.

Subsequently, TrueLok was enhanced by innovative software – computerized deformity correction planning – empowering the surgeon with objective control throughout pre/intra/postoperation phases. Intraoperative neurological monitoring developed by researchers of the center offered additional support for proper frame application without accidental nerve damage. TrueLok has continued to evolve and has become easier to assemble and adapt to complex deformities, but more stable and comfortable for the patient. In 2012, a three-dimensional bone segment adjustment module called TL-HEX enhanced the TrueLok. As with other hexapod-based systems, TL-HEX required complex, three-dimensional software. TL-HEX Software was developed in collaboration with Orthofix International (USA) and New Orthopedic Instruments (Russia). Currently, TL-HEX represents the most advanced external fixation system in the field of orthopedics. In essence, it consists of circular and semicircular external supports secured to the bones by wires and half pins and interconnected by six struts. This allows multiplanar adjustment of the external supports. The position of the rings is adjusted either rapidly or gradually in precise increments to perform bone segment repositioning in three dimensions. Further development of the TRUE/LOK™ External Fixation System led to the design of TL-Trauma (TL-T). The system was created to secure fractured bone segments in emergency situations as a temporary spanning fixator. In the majority of cases, stability of the TL-T frame allows it to be used as a definitive treatment solution. Continuous development of the TRUE/LOK™ External Fixation System over the years has extended Scottish Rite's recognition in limb reconstruction, both in the United States and worldwide.