It was with great excitement that we arrived in Baltimore. Both Natasha and I had previously attended the Baltimore Limb Deformity Course and so we had great expectations for the upcoming week. Monday began with a workshop by Dr Herzenberg on the Multiplier Method using the Multiplier App.  It was fantastic to be able to work through some of the more complex calculations in limb length discrepancy predictions as well as being introduced to some of the additional features, such as the oblique plane deformity calculator.  The remainder of the day was spent in clinic with Dr Herzenberg and Dr Standard reviewing upcoming cases for the week as well as seeing complex deformity patients and children undergoing treatment for Perthes.  The day was rounded off with a crab feast with our families on the crab deck of Phillips Seafood against the beautiful backdrop of the Baltimore Inner Harbor.


Tuesday began with presentations by the fellows, followed by a day in the operating room observing Dr Herzenberg and Dr Standard.  Highlights of the day included an ankle spanning TSF for lengthening and deformity correction in a child with fibula hemimelia and curettage, bone grafting and IM nailing of a femur in Ollier’s Disease.


One of the key to successful outcomes at the International Center for Limb Lengthening is undoubtedly the physiotherapy program led by Anil Bhave.  We were fortunate to have a very interesting lecture on the principles of physiotherapy and splinting in limb lengthening with both practical advice and the theories behind treatment.  We also took a tour of the physiotherapy department, seeing patients undergoing stretches, heat treatment as well as the hydrotherapy pool. Most impressive of all was the gravity reducing treadmill, designed by NASA to simulate weightlessness, which would allow the therapist to dial in the exact amount of weight bearing allowed.


The evening was spent enjoying an Orioles game at the wonderful Camden Yards stadium, its distinctive retro styling made all the more impressive by the profile of the downtown Baltimore skyline.


On Wednesday morning we were fortunate to be able to observe Dr Herzenberg perform a fixator assisted nailing with the Precise system.  Dr H. imparted many pearls and insights into the intricacies of performing this procedure.   We were also able to witness Dr Standard’s technique for repeat osteoplasty following premature consolidation with a lengthening nail in situ. Following this was a highly educational afternoon spent reviewing power point presentations on limb deformity correction, SUPER hip and SUPER ankle procedures as well as joint distraction and advanced techniques for the treatment of Perthes disease.  At the end of the day we were treated to a fantastic dinner at the Food Market.


Thursday morning began with Pre-op conference where the cases for the week were discussed, as were the decision making processes which went along with each patient.  Later on we had a lecture on pre-operative planning for the Precise and were then able to put the theory into practice as we planned and ordered the nails required for the surgeries scheduled for the next week.  During the day we also had the opportunity to observe Dr Standard in his clinic and witness the impressive support team of graphic designers, fine artists, medical editors, photographers, managers and assistants at the ICLL. We were struck by how this dedicated group work tirelessly to provide the extremely professional standard of publications and course material that Baltimore is famous for.


Friday was a change of focus with a club foot day.  We observed a TAL, plantar fasciotomy, PL to PB transfer and tib ant transfer for a residual club foot deformity.  We then observed serial manipulation and casting in the club foot clinic, before heading to the frame lab.  Here we rounded off the week assembling a sawbones model of a TSF for Blount’s with a high riding fibula, including an additional half ring with fixation pins in the fibula for distal fibula transport to re-tension the LCL.


It is with mixed feelings that we now move on to Philly.  We have been touched by the generosity of Dr Herzenberg and his team this past week.  We are extremely grateful for the opportunity to interact on such a personal level with one of the great leaders in the limb deformity world and leave Baltimore having learnt a great deal.


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