|LETTER TO EDITOR
|Year : 2016 | Volume
| Issue : 1 | Page : 59
The importance of limb deformity and lengthening training: A fellow's perspective
Department of Orthopedics, Limb Lengthening and Complex Reconstruction at the Hospital for Special Surgery, New York, USA
|Date of Web Publication||17-May-2016|
Limb Lengthening and Complex Reconstruction at the Hospital for Special Surgery, 519 East 72nd Street, Suite 204, New York 10021
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Vulcano E. The importance of limb deformity and lengthening training: A fellow's perspective
. J Limb Lengthen Reconstr 2016;2:59
I am currently a fellow in Limb Lengthening and Complex Reconstruction at the Hospital for Special Surgery (HSS) in New York. I want to be able to thoroughly understand, evaluate, and possibly treat any malalignment of the lower extremities.
In the USA, there are only three fellowship programs, directed by Dr. Paley, Dr. Herzenberg, and Dr. Rozbruch, respectively. Dr. Paley's Principles of Deformity Correction, in my humble opinion, is one of the greatest contributions to the field of orthopedics in the past 50 years.  Dr. Paley must be credited for the introduction of tools that allow to objectively assess the extremity alignment and deformity.  Over the past 20 years, said principles have been further investigated by Dr. John E. Herzenberg and Dr. S. Robert Rozbruch in the USA. They have had the vision and foresight of disseminating this knowledge to young surgeons by establishing their own fellowship program. The fellowship at HSS is the only one in an academic institution, but only over the past year have the residents been expected to complete a rotation on the service. Most residents were unfamiliar with the concept of lateral distal femoral angle, medial proximal tibial angle etc., to identify the type of deformity, the degree of deformity, the origin of the deformity, and the biomechanical impact of the deformity on the limb. In clinical meetings, we hear of knee replacements done in a patient with knee arthritis and extra-articular deformity or debate on the effectiveness of a triple arthrodesis for a rigid flatfoot in a patient who also has genu valgum. Would not realigning the knee after a triple affects the position of the foot?
Orthopedics, like many other specialties, is becoming more and more subspecialized.
Dr. Ranawat states that "the eyes see what the mind knows".  Unfortunately, many of us only have marginal knowledge of the principles of extremity deformity/alignment. How can this not have an impact on our practice?
More academic institutions should take action to account for this educational shortcoming because before being foot and ankle, knee, hip, hand, shoulder, or spine specialists, we are orthopedic surgeons.
The author would like to thank his mentor and fellowship director Dr. Austin T. Fragomen for his dedication in teaching the art of limb reconstruction.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Paley D. Principles of Deformity Correction. New York: Springer; 2002.
Callaghan JJ, Rosenberg AG, Rubash HE, Simonian PT, Wickiewicz TL. The Adult Knee. Philadelphia: Lippincott Williams and Wilkins, 2002.