Transforming Limb Reconstruction Care for Pediatric Patients in Pittsburgh
November 26, 2024
When Amanda McCoy, MD, MPH, FAAOS, FCS (ECSA), joined the Division of Pediatric Orthopaedic Surgery at UPMC Children’s Hospital of Pittsburgh in 2021, she brought with her a wealth of experience from years of training in the United States and time spent working in Kenya at a mission hospital. A Pittsburgh native, Dr. McCoy identified a significant gap in local care for children with complex limb deformities and limb length discrepancies. Families in the region faced the challenge of traveling to cities like Baltimore, Philadelphia, or Columbus for treatment, making it difficult for many to access the care their children needed close to home.
To address this, Dr. McCoy has been working to build a dedicated program at UPMC Children’s that not only provides state-of-the-art surgical interventions but also supports families with accessible, equitable care in the region within which they reside.
Identifying the Need for Localized, Comprehensive Care
Before Dr. McCoy began developing this program, children in the Pittsburgh and western Pennsylvania region who required complex limb reconstruction or lengthening often had to travel long distances for this type of specialized pediatric orthopaedic care. These procedures require intensive follow-up, often involving weekly or bi-monthly appointments postoperatively, which can be a substantial burden for families if they have to travel hours or hundreds of miles.
“If you’re traveling to another city, it could mean taking a whole day or even two off work and school, which is not feasible for many families,” says Dr. McCoy. “By offering this care locally, parents might only need to miss half a day of work, and kids can still attend most of their classes.”
Dr. McCoy’s program focuses on both congenital and acquired conditions. These include congenital limb differences, trauma-related deformities, and growth plate injuries that lead to developmental issues over time. This range of conditions requires a tailored approach that considers both the child’s current needs and their future growth potential.
A Multidisciplinary Approach to Limb Reconstruction
Dr. McCoy’s vision for the program extends beyond the operating room. She emphasizes a collaborative, team-based approach to ensure comprehensive care at every stage of treatment.
“Developing this program involved working with radiologists to create specialized imaging protocols, coordinating with supply chain managers to procure the necessary equipment, and partnering with physical therapists to establish effective rehabilitation protocols, among other team members,” says Dr. McCoy. “It’s not just about performing the surgeries. It’s also about building the infrastructure to support these children through the entire process.”
The surgical techniques used by Dr. McCoy often require the use of advanced tools like hexapod external fixators — computer-guided devices that gradually correct bone deformities — and internal lengthening devices for limb discrepancies. Each patient’s care plan is highly individualized from preoperative planning to long-term follow-up.
Building Expertise Through Mentorship and Fellowship
Dr. McCoy’s expertise in this niche field of orthopaedic surgery is the result of extensive training, including a traveling fellowship during the summer of 2023 through the Limb Lengthening and Reconstruction Society (LLRS). This program allowed her to work with some of the leading experts in limb reconstruction across the United States, gaining insights into advanced techniques and establishing invaluable mentorship relationships.
“The fellowship was transformative,” says Dr. McCoy. “Not only did I learn the technical aspects of these surgeries, but I also gained a network of mentors who continue to support me as I navigate complex cases. I often present cases to them for feedback before finalizing my care plans with our patients.”
This collaborative approach highlights the clinical dynamics and nature of limb reconstruction surgery, a highly specialized field with only a small number of practitioners nationwide.
“It’s a team-centric field, even across institutions,” says Dr. McCoy.
The Challenges of Treating Growing Children
One of the unique challenges of pediatric limb reconstruction is accounting for a child’s continuing growth. Unlike adult patients, whose bone structure is static, children may require careful timing and planning to ensure successful outcomes.
“For example, in conditions like juvenile Blount’s disease, we must anticipate that the deformity could recur as the child grows,” says Dr. McCoy. “We use techniques like temporarily modifying the growth plate on one side of the bone to prevent further deformities, but it’s a delicate balance.”
Decisions about when to intervene, how to correct deformities, and how to monitor growth over time require careful calculation and ongoing evaluation.
Postoperative Care: A Long-Term Commitment
The postoperative phase in limb construction or lengthening is critical to the success of these treatments. Children often need frequent follow-ups, particularly during the correction phase, which typically lasts four to eight weeks, but can vary widely depending upon the child’s underlying condition and the surgical methods used to address the issue.
“I see patients weekly after surgery to ensure the hardware is in place and the correction is proceeding as planned,” says Dr. McCoy. “We also work closely with families to ensure they’re comfortable managing at-home adjustments, like turning the struts on external fixators or using magnet-controlled lengthening devices.”
The rehabilitation process extends beyond the initial correction phase. Once the deformity is corrected or the bone is lengthened, patients must continue therapy to maintain joint mobility and strength. Depending on the child’s age and condition, follow-up care may last for years to monitor for potential recurrence or compensatory deformities.
Global Impact and Educational Outreach
Dr. McCoy’s commitment to limb reconstruction extends beyond Pittsburgh. She remains active in global orthopaedic education, particularly in low- and middle-income countries where access to advanced techniques is limited.
“By teaching the principles of limb reconstruction, we can help other surgeons develop the skills needed to provide care, even in resource-limited settings,” says Dr. McCoy. “It’s inspiring to see how sharing knowledge can open up new possibilities for children worldwide.”
Building a Sustainable Program at UPMC Children’s
While Dr. McCoy’s program at UPMC Children’s is still in its early stages of development, she is optimistic about its potential to transform orthopaedic care for children in the region.
“We’ve created the basic workings of the program so far, and our results have been promising,” days Dr. McCoy. “My goal isn’t to create a center that draws patients from across the country. It’s to provide equitable, high-quality care for the kids in our community who need it.”
Dr. McCoy’s work exemplifies the dedication and innovation required to meet the needs of a highly specialized patient population. Through her efforts and that of the Division of Pediatric Orthopaedic Surgery, children in the Pittsburgh region now have local access to specialized limb reconstruction procedures.
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