Dr. Fragomen succeeds S. Robert Rozbruch, MD, who founded the service in 2005 and has led it with distinction over the past 20 years. Dr. Rozbruch will continue practicing at HSS, focusing on his clinical work and research.

In his new role, Dr. Fragomen will oversee one of the foremost centers dedicated to limb lengthening and reconstruction worldwide—a highly specialized service providing treatment for a broad spectrum of conditions affecting the limbs. Patients from across the United States and around the world have come to HSS for the special expertise that the team offers.

“We are immensely grateful and thank Dr. Rozbruch for his many years of leadership as a clinician, researcher, and educator,” said Douglas E. Padgett, MD, HSS Surgeon-in-Chief and Medical Director.  “Over the years, Dr. Fragomen has demonstrated his deep commitment to advancing the field of limb lengthening and complex reconstruction. He has played a key role at HSS and in the broader orthopedic community, often finding solutions for patients with the most complex conditions.”

Dr. Fragomen and colleagues provide expert care for patients with leg length discrepancies or deformities; limb malalignment and pain caused by bowlegs or knock knees; foot and ankle deformities; and complications related to bone healing, alignment or infection after trauma. Specialized practitioners also perform upper extremity lengthening and deformity correction; bone reconstruction or transport after tumor excision; limb salvage procedures; and osseointegration limb replacement for patients with an amputation.

“In addition to the skill and expertise of our highly specialized surgeons, our close collaboration with other services at HSS ensures coordinated and comprehensive care for patients with these complex medical problems,” Dr. Fragomen explains.

As Director of the Limb Lengthening and Complex Reconstruction Fellowship Program at HSS and a professor of clinical orthopedic surgery at Weill Cornell Medical College, Dr. Fragomen has a longstanding commitment to education and training. Over the years, he has served as a valued mentor to countless medical school students, orthopedic surgery residents and fellows.  

He has also welcomed surgeons from across the United States and around the world who come to HSS for monthlong observerships to learn advanced techniques and approaches to complex orthopedic challenges.

Dr. Fragomen is also deeply engaged in research and has published nearly 200 scientific papers and book chapters. He has presented his work at medical meetings across the United States and abroad and has lectured extensively on topics related to residency training programs. He is an active member of numerous professional organizations, including the Limb Lengthening and Reconstruction Society-ASAMI North America, serving as the group’s president from 2019 to 2021.  

In his new role, Dr. Fragomen includes among his goals maintaining and enhancing HSS’s reputation as a world leader in patient care, research and education in limb deformity, limb lengthening, limb reconstruction and replacement. “We will continue to train the next generation of highly specialized orthopedic surgeons so they can bring safe and effective treatments to populations around the globe,” Dr. Fragomen said.  “At the same time, we remain committed to ensuring that patients here at home have access to the services and expertise they need.”

Osseointegration prostheses are a relatively new form of prosthetic technology. The approach involves surgically installing a titanium rod into a patient’s remaining bone—such as the tibia or femur in the leg—which in turn attaches to a prosthesis that allows ambulation. The technology avoids the need for traditional sockets against which limb stumps rest, an interface that produces friction that can generate significant pain and discomfort for amputees and frequently requires repair or revision.

Although osseointegration devices are available to patients in Europe and elsewhere, the U.S. Food and Drug Administration has yet to approve the technology. But the agency allows a limited number of patients to receive the implants through humanitarian exceptions.

“This is a disruptive technology to improve the life quality of amputees,” said study co-author S. Robert Rozbruch, MD, Chief of the Limb Lengthening and Complex Reconstruction Service and Director of the Limb Salvage and Amputation Reconstruction Center at HSS. “With a direct skeletal connection of the prosthetic limb, amputees report big improvements in function, comfort, balance, proprioception and even emotional connection with their limb.”

For the new study, Taylor J. Reif, MD, an orthopedic surgeon and a member of the Limb Lengthening and Complex Reconstruction Service, Dr. Rozbruch and their colleagues reviewed the medical records of 31 men and women who underwent osseointegration procedures at HSS starting in October 2017 under compassionate use exceptions. Of those, 18 had implants in the femur, or thigh bone, and 13 had implants in the tibia, the bone below the knee.

The primary outcome of the study assessed changes in the Questionnaire for Persons with a Transfemoral Amputation (QTFA), which patients complete before and after surgery. The researchers used the same questionnaire for patients with tibial amputations. They also gathered data on a range of quality-of-life measures including patient-reported functional activity, mental health, pain and self-image, as well as adverse events such as serious infections, fractures at the site of the implant and other complications of the procedure.

Researchers found that scores across all domains of the QTFA improved significantly throughout the study period. Prosthetic mobility rose from 49.7 to 81.4, while prosthetic problems fell from 46.4 to 9.1. Patients also experienced substantial gains in function with the implants, as measured by 2- and 6-minute walking tests.

Dr. Reif said the benefits of the devices extend beyond the raw numbers. “The scores going up is great, but that doesn’t necessarily capture what we’re seeing in the clinic, which is smiles on people’s faces and the expressions of gratitude for how much their lives have changed. It’s totally life-altering.”

Although some patients did experience early complications, nearly all (93%) were managed without removing the implant. Encouragingly, while some patients developed minor infections where the titanium post exits the skin (an opening called a stoma), most of these resolved with the use of oral antibiotics. Only one patient had an infection in the bone itself leading to removal.

The bond between the titanium implant and the bone is so strong that patients are able to rapidly resume physical activity. In some cases, patients can return to vigorous, weight-bearing exercise such as running within six months to one year after the procedure.

As the data showed, patients who seek osseointegration prostheses tend to be young, and most had sustained catastrophic injuries to their legs in vehicular accidents or other traumatic events. “The older population of patients have become accustomed to their sockets or using a wheelchair,” explained Dr. Reif. “But as this technology expands and more surgeons start to employ it, I think the age that these are implanted also will expand in both directions.”

He added, “No implant has a perfect track record, but when you combine the functional gains that these patients are experiencing with improvements in their quality of life, a small risk of infection or fracture is acceptable to them, as well as to the orthopedic community.”

A generous grant to HSS from the “I’m Not Done Yet Foundation” had provided the impetus for a five-year research project to determine the changing needs of young patients as they become teenagers and young adults in the health care system.

Hamilton was thrilled to be accepted in the highly competitive research program. She would gain valuable experience and knew she could be of service. Her primary focus would be the psychosocial needs of adolescents having orthopedic surgery, a subject she understood firsthand. Starting at age 12, she had a number of surgeries at HSS to correct a condition that affected her legs. In the fellowship program, she would be working with S. Robert Rozbruch, MD, chief of the Limb Lengthening and Complex Reconstruction Service. In addition to performing her surgeries, he had served as a role model and mentor to her for more than a decade.

Hamilton, who is 25 and just completed her first year at Weill Cornell Medical College, was born with a rare bone disorder called X-linked hypophosphatemia, which leads to low levels of phosphate in the blood. Phosphate is a mineral that’s essential for normal bone formation. The condition also makes it difficult for the body to absorb calcium and vitamin D. When she was diagnosed at age 2, she was prescribed vitamins to control the condition. Still, as time went on, she became severely bow legged.

At age 11, Hamilton’s pediatric endocrinologist referred her to Dr. Rozbruch, an expert in the highly specialized surgery that could straighten her legs. He performed Hamilton’s first surgery when she was 12. It entailed the placement of an external fixator on both of her legs. A fixator is a stabilizing metal frame attached to the outside of the leg following surgery to correct a problem with a bone. It is attached with metal pins and screws that are inserted into the bone through small incisions in the skin and muscle. Little by little, day after day, Hamilton turned struts on the fixators that straightened and lengthened her thigh and shin bones a tiny bit at a time. She wore the frames on her legs for several months.

“I remember seeing my first X-ray after surgery. It showed an empty space where Dr. Rozbruch had made a cut in my bone, which would fill in as new bone regenerated,” Hamilton recalls. “I would go in for follow-up appointments every couple of weeks and see that new bone was gradually forming. This fascinated me and is what sparked my interest in medicine. I wanted to gain a better understanding of how the body works.”

Over the years, Hamilton saw Dr. Rozbruch for follow-up and had several additional surgeries to straighten her legs. She had her final procedure when she was in college. It entailed lengthening her right leg so it would be equal to her other leg.

Ten years had passed since Hamilton’s first surgery, and this time Dr. Rozbruch used a newer technique. He implanted a lengthening rod with a small magnet into her thigh bone, with no need for an external fixator. “As opposed to turning struts on a fixator, as I was accustomed to, this time I used a magnetic machine that communicated with the magnet in the rod to lengthen my femur each day,” she recalls. Today her legs are perfectly straight and of equal length.

Hamilton never let her condition slow her down. “I decided I wanted to be an orthopedic surgeon very early in life,” she says. “Having surgery as an adolescent was scary, but it also motivated me. After enduring so much as a patient, I know that orthopedic surgery is exactly what I want to do.”

“Amber had an intense experience as a patient, but had a positive attitude and was always upbeat,” Dr. Rozbruch says. “In my experience, I’ve found that most patients and families deal with health challenges in a positive way, but for Amber to be interested in medicine and aspire to be an orthopedic surgeon, that takes it to another level. She is extremely intelligent, engaged and highly motivated. I expect that she will achieve her goals.”

To date, they have followed similar paths to obtain career goals. They both graduated from the University of Pennsylvania for their undergraduate degrees. Hamilton is about to enter her second year at Weill Cornell Medical College, where Dr. Rozbruch attended medical school.

“Our relationship has evolved beyond the patient-physician dynamic,” she explains. “We’ve been able to keep in contact and maintain a relationship that has nothing to do with my surgery. Any time I have ever needed anything or asked for advice, he was always super-receptive. He has motivated me in so many ways.”

After her surgeries, Hamilton says she gravitated toward HSS. “My experience as a patient at HSS was amazing,” she says. “My ultimate goal is to train there as an orthopedic surgeon.” She began to volunteer in 2013 in the patient care unit, where she helped out in the Nursing Department and checked on patients. For the next few years, she also accompanied Dr. Rozbruch on his rounds. Most recently, he was her mentor in the HSS Summer Research Fellowship program.

Dr. Rozbruch values the important role Hamilton has played in his project. She helped develop the patient needs survey based on her own experience, has contacted and enrolled patients in the study, and is helping to analyze the data.

She has also been able to shadow Dr. Rozbruch this summer. She accompanies him when he sees patients and has gone into the operating room with him to witness the very surgery she had years earlier.

Hamilton continues to follow in Dr. Rozbruch’s footsteps, mentoring and advising young people considering a career in medicine. She says she knows from experience that “if your heart is in it, it can be achieved.”

Bobby had received care for over a decade at HSS to lengthen and realign his left leg which was fractured and deformed during a skiing accident at age 8.

HSS is launching the Bobby Menges Memorial Hospital for Special Surgery Limb Deformity Course which will be offered yearly to teach techniques for treating limb deformity and limb lengthening.

"He was a very special boy," said S. Robert Rozbruch, MD, chief of Limb Lengthening and Complex Reconstruction Service at HSS. "He had an inner strength and inner spirit that was very impressive. He had been through a lot, but he handled it very well. He was very strong and courageous and determined."

Read the full article at Newsday.com. This also appeared in a spread in LI Life's February 17, 2019 print issue.

A diagnosis of cancer, originally at age 5, and other health problems didn’t stop him from living life to the fullest. Despite the treatments, and despite multiple surgeries, a profound capacity for empathy compelled him to look outside of himself, and he sought to help others, according to Elizabeth Menges, Bobby’s mother. He devoted much of his life to community service and fundraising, hosting charity events and blood drives. 

Although Bobby passed away last year at age 19, his legacy lives on in a foundation that his family created in his memory. The "I’m Not Done Yet" Foundation, based in Garden City, helps adolescent patients with serious, long-term, and chronic illnesses transition from pediatrics to adulthood. 

As part of its mission, the foundation has pledged a five-year, $500,000 research grant to Hospital for Special Surgery (HSS) in New York City to establish best practices to meet the changing needs of young patients as they become teenagers and young adults in the health care system. 

At HSS, a specialty hospital dedicated to orthopedics, rheumatology and rehabilitation, doctors often follow patients from a very young age through young adulthood. The patient population includes babies born with musculoskeletal conditions such as cerebral palsy and young people with chronic rheumatologic diseases who are treated from the time they are children.  

Bobby recognized the need for health care providers to be mindful of the evolving psychosocial needs of young people with any chronic illness, not only cancer, according to Peter Menges, Bobby’s father. "HSS is a world class organization with the right resources, the right experience and the right expertise to undertake a comprehensive research initiative to really hone in on what this patient population needs, whether it’s physical space, specific services, a certain kind of care, or emotional support," Peter Menges said. "Although HSS will be the catalyst and epicenter of the research, our goal is to see the findings and best practices adopted throughout the U.S., and even worldwide."

The HSS grant, "The Bobby Menges ‘I’m Not Done Yet’ Initiative," will address the psychosocial challenges young patients face as they become adolescents and teenagers in the health care system. The foundation’s website explains: "Imagine you're a 19-year-old cancer patient. You've been in and out of treatment since the age of 5, and because you were diagnosed with a pediatric cancer, you continue to be treated as a pediatric patient. The supports for young children were just what you needed as a child, but now, as an adolescent, you have different needs: peace and quiet, a study room, a place to connect to Wifi... But often those services do not exist."

Dr. S. Robert Rozbruch will lead the research project at HSS. Chief of the hospital’s Limb Lengthening and Complex Reconstruction Service, Dr. Rozbruch met Bobby after a skiing accident and subsequent fracture, treatment at another hospital, and a complication left him with one leg that was shorter than the other. 

Without the proper and highly specialized care, Bobby’s leg could have been five inches shorter than his unaffected leg. After several surgeries by Dr. Rozbruch and successful treatment over more than 10 years, Bobby’s leg was straight and the proper length. During that time, Dr. Rozbruch worked closely with Bobby’s oncologists, and his cancer was in remission. 

Dr. Rozbruch developed a close relationship with Bobby and his family. "Bobby was a very special person, even when he was a child,” Dr. Rozbruch says. “He had a sparkle in his eyes. He had a positive outlook. He had a kind of wisdom and an inner peace that was very dramatic." 

"By the time patients turn 15, their needs start to change, and Bobby began to notice the void in health care as he got older," explained Elizabeth Menges. "He realized that some of his doctors didn’t understand some of the issues he faced. He wondered why doctors still addressed me, but not him when they spoke. Dr. Rozbruch was among those Bobby felt understood him. He said Dr. Rozbruch had a knack for that."

Dr. Rozbruch, who treats many patients starting at a young age, has been interested in the  developmental, emotional and psychological factors involved in caring for them as they get older.  

"The research initiative, which will include a psychologist, aims to evaluate the changing psychosocial and emotional needs of young patients in the health care setting and determine the best way to meet those needs. Surveys and questionnaires will be designed for past and current patients and their families," Dr. Rozbruch says. "We intend to publish and share our research findings with the broad medical community well beyond orthopedics and HSS." 

Carl Menges, Bobby’s great uncle, a life trustee of HSS and a significant financial supporter of the initiative, says the research grant is a way to honor Bobby’s memory. "The purpose of the initiative is to honor his deep concern for young people like himself facing complex conditions throughout childhood and young adulthood,” he said. “Bobby’s courage and spirit has been an inspiration to many, and this is a continuation of the work that he personally initiated and was so passionate about."

Additional Coverage:

• Garden City Life: cover story of January 2-8, 2019 print issue
• The Garden City News

"We offer solutions to patients that previously had no alternatives," said Dr. Rozbruch.

"We had all these new tools that we could start using to help people get back on their feet, instead of just living with the status quo or losing their limb because of a limb salvage situation that didn't have this availability," he added.

When asked to share his best limb lengthening advice for surgeons, Dr. Rozbruch said "be tenacious about achieving the goal that you have decided on."

This coverage originally appeared in reachyourheight.com. The original article is no longer available online.

She reports that HSS patient David Giaimo underwent 18 surgeries after a Vespa accident to try to save his leg. He had no choice but to amputate after an infection. Yet his residual leg was not fitting well with the traditional prosthetic and caused him pain.

Giaimo found S. Robert Rozbruch, MD, Chief of Limb Lengthening and Complex Reconstruction Service at HSS, who offered a new solution.

"My last amputation prior to David, that was the same way amputation was done 100 years ago. This is the first new development in amputation surgery, that's huge," said Dr. Rozbruch.

Dr. Rozbruch amputated the infected portion of his leg, implanted a 3D printed titanium rod into his femur and then implanted a post to the femur that attaches to the new prosthetic.

Dr. Rozbruch is one of four surgeons in the U.S. approved by the FDA to study this approach.

"It's connected to my bone, so I have a sense of it being attached to me. It's a prosthetic but it's now my leg," said Giaimo. He explains how he's taken his first steps in eleven years that did not cause him pain.

Dr. Rozbruch says he expects this approach to prosthetics to become the new standard, a shift that will alter the lives of many who may be able to avoid a life in a wheelchair.

This segment originally appeared at NY1.com.