Erin Honcharuk, a pediatric orthopaedic surgeon at Johns Hopkins, is leading the way to bring the latest techniques and multidisciplinary care to patients who require limb-lengthening and deformity correction.

For children born with congenital conditions or who experience traumatic injury, the availability of specialized surgical care can be critical. Approaches tailored to their individual needs can make a lifelong difference in function and appearance. Honcharuk is building a robust program at Johns Hopkins to provide such care.

“We treat these patients in a variety of ways, especially for the more complex lengthenings or reconstructions,” says Honcharuk. “Our techniques allow us to correct deformity in multiple planes, while lengthening the limb if needed, so the treatment is really fine-tuned.”

Depending on the needs of a given patient, Honcharuk works with colleagues in genetics, physical therapy, psychology and rheumatology, as well as her peers in adult orthopaedic surgery who specialize in upper extremity, foot and ankle, trauma and joints. “We work together to come up with a plan for these patients,” she says, noting in particular the importance of psychology. “I’ve found it to be really helpful in making sure that everyone is on board and prepared for the process of treatment and recovery,” she says. “Explaining it well to kids and to families is critical. The nice thing about Hopkins is, because there are so many top-notch physicians in so many disciplines, we have the ability to offer truly comprehensive care.”

As instrumentation and techniques evolve, Honcharuk has more options for her patients. Instead of traditional extramedullary nails for limb-lengthening, for example, she may use intramedullary nails. She also employs a technique to place the intramedullary nails next to the bone in patients whose bones are too narrow to allow insertion of a nail into the canal. She describes the technique as a “workaround” for her smallest patients to avoid using an external frame while still providing timely treatment. She also notes that a new nail is expected to reach the market in the next year that will allow patients to bear full weight on the treated limb.

Honcharuk says she enjoys the planning aspect of her work. “I spend a lot of time thinking about each step along the way so everything goes exactly as planned during surgery,” she says. “Afterward, you just see a miraculous change in these kids. It’s incredible, and it’s apparent pretty quickly, not just to us, but to the families as well. They can see the leg is growing, the leg looks straighter. It’s incredible to be a part of that.”

In addition to offering the highest level of clinical and surgical care, Honcharuk plans to increase our understanding of the outcomes of such treatment. She is in the process of partnering with the International Limb Differences Network to enable Johns Hopkins to begin contributing data to large, multicenter studies of pediatric limb length and deformity correction, ensuring the best possible treatment now and in the future.