Melissa Juried Kriebel
- Dr. S. Robert Rozbruch has led limb-lengthening and reconstruction surgery for more than 20 years.
- Rozbruch performs 350 to 400 limb-lengthening surgeries and deformity corrections a year.
- He disagrees with cosmetic limb-lengthening and says it’s only appropriate for certain patients.
This as-told-to essay is based on a conversation with S. Robert Rozbruch, a 57-year-old orthopedic surgeon and the chief of the Hospital for Special Surgery’s limb-lengthening and complex reconstruction service in New York City. The following has been edited for length and clarity.
I can’t remember a time when I didn’t want to be a doctor. My mom was a Holocaust survivor and was on her way to start medical school when the Nazis deported her and her family, so I kind of grew up with that story in my head, and it pushed me toward medicine. I’ve always enjoyed working with my hands, and I’m very creative with them — that drew me toward surgery. I also loved the TV show “M*A*S*H.” The character Hawkeye Pierce, who’s a surgeon, was like a mentor to me.
I went to the University of Pennsylvania for undergraduate school, and then Cornell Medical School. I did my orthopedic surgery residency at the Hospital for Special Surgery (HSS), and did additional training in the orthopedic-trauma subspecialty at the University of Bern in Switzerland.
The Swiss are the originators of fixing fractures. When Americans were still treating broken bones with traction — a process of pulling on a bone to reduce a fracture or straighten the bone — and casts, the Swiss were starting to put things back together with plates and screws.
In 1999, I did a second fellowship in Baltimore and learned advanced limb-lengthening techniques. After that, I came back to HSS and started a program here.
Many patients with orthopedic trauma problems were being neglected, but I wanted to take those on
Back then, in the early 2000s, there were a lot of patients with missing bone, big deformities, and leg-length discrepancies that we didn’t really have great solutions for. Many patients who had post-trauma, congenital, and developmental deformities were being neglected. Nobody knew how to deal with them, and I wanted to be the guy to take those on.
In the beginning of my career, I took care of an eight-year-old boy who was a refugee from Somalia. He and his family were attacked, and he was running through the forest, fell, and was struck by a snake. The boy ended up missing a big segment of bone in one of his legs and wound up in an orphanage. A surgeon from New York City was doing volunteer work there and became his guardian. The surgeon brought him to me, and I lengthened his leg about 23 centimeters. The surgeon ultimately adopted the boy and he went on to play sports.
I really like helping these kinds of patients and feeling their appreciation for something special that not every orthopedic surgeon can do. I was excited about this field because it was kind of brand new. For the past 23 years, I’ve been able to take it in the direction I wanted it to go and become a leader in limb-lengthening and reconstruction. I entered it because of empathy, altruism, personal satisfaction, and maybe a little bit of ego.
Cosmetic limb-lengthening surgeries are a one-off
I do limb-lengthening reconstruction, not that bullshit cosmetic limb-lengthening that was discussed in GQ. That article was very disheartening because it’s taken this incredible field and cheapened it.
The idea of some celebrity who’s 5-foot-10 getting stature-lengthening done to be 6-foot-1 isn’t appropriate. It makes me nauseous that those stories get labeled with “limb-lengthening” and everybody and their uncle sends me the article, saying “Oh, wow, did you see this?” That’s not what I am; that’s not what we are. Unfortunately, it sort of hijacks the attention away from what limb-lengthening really is. (Editor’s note: The patient that the GQ article focused on was 5-foot-8 before surgery and 5-foot-11.5 after, but some patients mentioned were as short as under 5 feet.)
Stature-lengthening is something we can do. It’s appropriate for carefully selected patients with very short stature that’s debilitating physically or psychologically. That’s very different from operating on someone who just wants to be taller and is already average height, which is 5-foot-9 for men and 5-foot-4 for women in the US.
People place a lot of importance on height and stature — it’s cultural, and it’s part of human evolution. We make a lot of quick decisions based on appearance, but stature-lengthening is a fringe application and it needs to be done responsibly. In every field, you can use fire for good or for evil. You can take anything important and make it frivolous, but I think things have to be done appropriately.
When I started in the field, we were using external fixators, or frames, which are apparatuses that we build on the outside of a patient’s limb, to correct deformities
It was amazing. We used this external apparatus to slowly lengthen a bone. That’s how bone lengthening works: You cut the bone and pull it apart slowly, and this incredible biologic miracle called distraction osteogenesis happens, allowing you to grow new bone.
Fixators are great, but they’re painful. They have pins that go through the skin and are attached to the bones. The bone is cut and, gradually, lengthening is done at a rate between 0.75 millimeters and 1 millimeter per day. After a 25-millimeter lengthening, the bone usually takes one to three months to heal, depending on the age of the patient.
It’s not so easy for patients. We wanted to decrease the time in the fixator. After my team at HSS and I figured out how to decrease the time using hybrid techniques, the second question was “Is there a technology available that’ll allow us to lengthen and straighten a limb without a fixator?” The answer was, in many cases, “yes.” We needed a mechanical lengthening device that was internal.
A wonderful device was developed by brilliant mechanical engineers at Ellipse Technologies, which was later acquired by the medical-device company NuVasive. That device, the PRECICE nail, came onto the US market in 2011. We started using the magnetic motorized internal lengthening nail and, all of a sudden, I could lengthen a bone by cutting the bone and inserting an internal implant without having to use a frame at all.
A fixator is like a car: You can turn this way or that way and go backward or forward, but an internal nail is more like a railroad track and you can only go one direction. The motorized magnetic nail is used to lengthen the bone, after you cut it, by pulling apart the two pieces so new bone will form in between them. It wasn’t as versatile, but it made the process so much easier for patients that needed straightforward lengthenings.
Some patients can’t walk unless they see us
I usually see about 45 patients per week. I’ll see about five or six new patients and about 20 follow-up patients in two days. I also usually operate three days a week and do about 350 to 400 surgeries a year. I’m entirely focused on limb-lengthening and deformity correction.
Now that it’s seemingly simpler, safer, and less complicated for the patient, we’ve noticed the threshold for wanting to do the surgery is lower. So I’m busier and we’re taking care of more patients because everything is more streamlined.
About half of our patients are local and the other half isn’t. We get a lot of patients from other parts of the US and even have patients coming from across the world. We’ve recently had patients from Italy, Brazil, the United Arab Emirates, Dubai, and Sweden. I’m always excited by the fact that people see the value in coming a distance to get care with us.
Insurance usually covers these surgeries, but we also perform unusual charity cases
Unless it’s somebody coming from another country, the procedures are covered by medical insurance. For a medically-indicated limb reconstruction, insurance pays for most of the surgery and patients pay a small percentage of the overall fee.
There are also charity cases. I’m currently taking care of a girl who’s a refugee from Ukraine. She has a congenital leg-length discrepancy of about four inches. As you can imagine, all elective surgery is completely shut down in Ukraine. Her family reached out to me and I met with them via telemedicine a few months ago. You never know if things are actually going to happen because there are a lot of hoops they have to jump through. But, one day, I got an email from her family saying, “We have a visa, we’re coming, can we see you next week in your clinic?” So we moved things around and got them on the operating room schedule, and we’re taking care of her.
Years ago, I took care of this boy with autism who had a leg-length discrepancy and was really having a difficult time walking and socializing. I operated on him and lengthened his femur eight centimeters, or three inches, and equalized his leg-length. You could see how it transformed his life in a functional and social way. It allowed him to feel better. He could walk comfortably and didn’t have to wear a special shoe. Transforming patients’ lives — that’s what we’re doing.
Limb-lengthening and reconstruction surgeons are a group of highly-skilled surgeons who are doing these highly complicated surgeries, doing God’s work, doing things that nobody else is doing by taking care of these neglected cases.