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Robert Douglas Fitch

Associate Professor Emeritus of Orthopaedic Surgery
Orthopaedic Surgery
Box 2911 Med Ctr, Durham, NC 27710
Lenox Baker CHLDRN Hosp, Durham, NC 27710
Office hours 7:30am-4pm  

Selected Publications


Implant Distribution Versus Implant Density in Lenke Type 1 Adolescent Idiopathic Scoliosis: Does the Position of the Screw Matter?

Journal Article Global Spine J · September 2021 STUDY DESIGN: Retrospective study. OBJECTIVE: Previous studies have demonstrated that increased implant density (ID) results in improved coronal deformity correction. However, low-density constructs with strategically placed fixation points may achieve sim ... Full text Link to item Cite

Staying ahead of the curve: the use of spinopelvic parameters to predict curve progression and bracing success in adolescent idiopathic scoliosis.

Journal Article Spine Deform · December 2020 STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To investigate radiographic sagittal and spinopelvic parameters of patients with adolescent idiopathic scoliosis (AIS) treated with bracing and assess differences among those treated successfully and un ... Full text Link to item Cite

Periapical Wires Result in Less Curve Correction Than Pedicle Screw Constructs in Idiopathic Scoliosis.

Journal Article Asian Spine J · December 2019 STUDY DESIGN: Retrospective study. PURPOSE: The objective of this study was to compare percent correction between apical and periapical pedicle screw (PS) and sublaminar wire constructs for Cobb correction and coronal balance correction. OVERVIEW OF LITERA ... Full text Link to item Cite

Gradual Deformity Correction in Blount Disease.

Journal Article J Pediatr Orthop · 2019 BACKGROUND: Blount disease is a disorder of the posteromedial proximal tibial physis which causes a progressive varus, procurvatum, and internal rotation deformity of the tibia. Untreated, it can cause significant limb malalignment. The goal of this study ... Full text Link to item Cite

Orthopedic and Surgical Management of the Patient With Duchenne Muscular Dystrophy.

Journal Article Pediatrics · October 2018 Orthopedic care is an important aspect of the overall management of patients with Duchenne muscular dystrophy (DMD). In addition to progressive muscle weakness and loss of function, patients may develop joint contractures, scoliosis, and osteoporosis, caus ... Full text Link to item Cite

The Use of Distraction Osteogenesis and a Taylor Spatial Frame in the Treatment of a Tibial Shaft Nonunion and Deformity in a Pediatric Patient with Osteopetrosis: A Case Report.

Journal Article JBJS Case Connect · 2018 CASE: Osteopetrosis is a heritable disease that causes brittle bones that are prone to fracture. Furthermore, these brittle bones have a poor healing response and a high risk of subsequent refracture. Many treatment strategies have been described for initi ... Full text Link to item Cite

Identifying molecular phenotype of nucleus pulposus cells in human intervertebral disc with aging and degeneration.

Journal Article J Orthop Res · August 2016 Previous study claimed that disc degeneration may be preceded by structure and matrix changes in the intervertebral disc (IVD) which coincide with the loss of distinct notochordally derived nucleus pulposus (NP) cells. However, the fate of notochordal cell ... Full text Open Access Link to item Cite

A novel technique for correcting a flexible internal rotation deformity following talectomy

Journal Article Techniques in Orthopaedics · June 9, 2015 Talectomy is a procedure that can be used to treat failed clubfoot corrective surgery. Talectomy helps to correct the equinovarus deformity by providing sufficient laxity to the foot. A complication of this procedure is the direct result of the increased l ... Full text Cite

Neuromuscular Scoliosis: Current Concepts.

Journal Article Orthopedics · June 2015 Scoliosis is a common deformity in neuromuscular disorders. This spinal deformity usually presents at an early age, rapidly progresses during growth, and continues to progress even after skeletal maturity. Neuromuscular scoliosis classically involves the e ... Full text Link to item Cite

A new non-enzymatic method for isolating human intervertebral disc cells preserves the phenotype of nucleus pulposus cells.

Journal Article Cytotechnology · December 2014 Cells isolated from intervertebral disc (IVD) tissues of human surgical samples are one of potential sources for the IVD cellular therapy. The purpose of this study was to develop a new non-enzymatic method, "tissue incubation", for isolating human IVD cel ... Full text Open Access Link to item Cite

Ultrasound for screening and management of developmental dysplasia of the hip.

Journal Article N C Med J · 2014 Developmental dysplasia of the hip (DDH) is a significant cause of disability in children and young adults. Early detection of this condition allows for nonoperative treatment, but the efficacy of DDH screening programs has not been clearly established. Th ... Full text Link to item Cite

Osteonecrosis of the femoral head in childhood malignancy.

Journal Article J Child Orthop · March 2013 PURPOSE: Children undergoing chemotherapeutic treatment of malignancies have up to a 9 % incidence of osteonecrosis. The purpose of this article is to determine the time from initiation of chemotherapy to the onset of symptoms and the diagnosis of osteonec ... Full text Link to item Cite

Radiographic outcomes of ring external fixation for malunion and nonunion.

Journal Article J Surg Orthop Adv · 2013 Ring external fixators such as the Ilizarov external fixator (IEF) and Taylor Spatial Frame (TSF) have revolutionized management of limb deformity. This study examines radiographic outcomes for treatment of malunions and nonunions with secondary emphasis o ... Full text Link to item Cite

Differential expression of galectin-1 and its interactions with cells and laminins in the intervertebral disc.

Journal Article J Orthop Res · December 2012 Galectin-1 (Gal-1), an endogenous β-galactoside-binding protein, binds to laminins, which are highly expressed in the nucleus pulposus (NP) of the intervertebral disc (IVD). The objective of this study is to evaluate the expression of Gal-1 protein in IVD ... Full text Open Access Link to item Cite

Attenuation of inflammatory events in human intervertebral disc cells with a tumor necrosis factor antagonist.

Journal Article Spine (Phila Pa 1976) · July 1, 2011 STUDY DESIGN: The inflammatory responses of primary human intervertebral disc (IVD) cells to tumor necrosis factor α (TNF-α) and an antagonist were evaluated in vitro. OBJECTIVE: To investigate an ability for soluble TNF receptor type II (sTNFRII) to antag ... Full text Open Access Link to item Cite

Interleukin-17 synergizes with IFNγ or TNFα to promote inflammatory mediator release and intercellular adhesion molecule-1 (ICAM-1) expression in human intervertebral disc cells.

Journal Article J Orthop Res · January 2011 Interleukin-17 (IL-17) is a cytokine recently shown to be elevated, along with interferon-γ (IFNγ) and tumor necrosis factor (TNFα), in degenerated and herniated intervertebral disc (IVD) tissues, suggesting a role for these cytokines in intervertebral dis ... Full text Open Access Link to item Cite

Anterior scoliosis rod migration to the lower extremity.

Journal Article Spine J · June 2009 BACKGROUND CONTEXT: Scoliosis rod migration has been reported rarely in the literature. We present a case study on three patients with distant migration of anterior scoliosis rod implants. PURPOSE: To report an unusual complication of rod migration of ante ... Full text Link to item Cite

The combined use of the Ilizarov method and microsurgical techniques for limb salvage.

Journal Article Ann Plast Surg · May 2009 The purpose of this article is to review clinical outcomes and propose a new classification scheme for combined use of Ilizarov Method with free tissue transfer for limb salvage. This is an Institutional Review Board-approved retrospective review of 62 pat ... Full text Link to item Cite

Expression of laminin isoforms, receptors, and binding proteins unique to nucleus pulposus cells of immature intervertebral disc.

Journal Article Connect Tissue Res · 2009 Intervertebral disc (IVD) disorders are believed to be related to aging-related cell loss and phenotypic changes, as well as biochemical and structural changes in the extracellular matrix of the nucleus pulposus (NP) region. Previously, we found that the l ... Link to item Cite

Revision tibiotalar arthrodesis.

Journal Article J Bone Joint Surg Am · June 2008 BACKGROUND: Contemporary recommendations for primary and revision ankle arthrodesis favor internal compression techniques involving the use of screw and/or plate fixation. While tibiotalocalcaneal arthrodesis with internal fixation may be a suitable method ... Full text Link to item Cite

Arthroscopic-assisted revision of telescopic rods in osteogenesis imperfecta.

Journal Article Arthroscopy · January 2005 Bailey-Dubow extensible nails are intramedullary stabilization devices designed to prevent deformities and recurrent long bone fractures in patients with osteogenesis imperfecta. The rods consist of a hollow outer sleeve and a solid inner obturator, allowi ... Full text Link to item Cite

Acute abdominal symptoms and signs in children and young adults with spina bifida: ten years' experience.

Journal Article J Pediatr Surg · September 2001 Featured Publication BACKGROUND/PURPOSE: Diagnosis and management of the acute abdomen in patients with spina bifida (SB) can be problematic. There are at least 4 clinical factors that can predispose to the development of acute abdominal symptoms and signs, and patients with a ... Full text Link to item Cite

Treatment of osteonecrosis in the hip of pediatric patients by free vascularized fibular graft.

Journal Article Clin Orthop Relat Res · May 2001 Featured Publication The purpose of the current study was to review the demographics and etiologies of symptomatic femoral head osteonecrosis in the pediatric and adolescent population and to assess the results of treatment using free vascularized fibular grafting. A group of ... Full text Link to item Cite

Knee arthrodesis with circular external fixation.

Journal Article Clin Orthop Relat Res · January 2001 Featured Publication Knee arthrodesis can enable limb salvage in patients with disability secondary to trauma, infected total knee arthroplasty, pyarthrosis, and other complications. Historically, intramedullary nailing has resulted in the highest overall knee fusion rates. Ho ... Full text Link to item Cite

Pediatric traumatic atlanto-occipital dislocation: five cases and a review.

Journal Article J Pediatr Orthop · 2001 Featured Publication Traumatic atlanto-occipital dislocation (AOD) has been thought to be a rare and fatal injury. Recently, more survivors, especially children, have been reported. During a 10-year period, the authors have encountered five children with traumatic AOD. A retro ... Link to item Cite

Possible interaction of genotypes at cystathionine beta-synthase and methylenetetrahydrofolate reductase (MTHFR) in neural tube defects. NTD Collaborative Group.

Journal Article Clin Genet · August 1999 Neural tube defects are a common, complex disorder with genetic and environmental components to risk. We investigated the previously reported interaction between homozygosity for the thermolabile variant at the methylenetetrahydrofolate reductase and heter ... Full text Link to item Cite

Severin classification system for evaluation of the results of operative treatment of congenital dislocation of the hip. A study of intraobserver and interobserver reliability.

Journal Article J Bone Joint Surg Am · May 1997 Featured Publication The Severin classification system frequently is used to evaluate the radiographic results of operations performed for the treatment of congenital dislocation of the hip. However, the reliability of this classification scheme has not been established, to ou ... Full text Link to item Cite

Distraction Histiogenesis: Principles and Indications.

Journal Article J Am Acad Orthop Surg · November 1996 Distraction histiogenesis is a biologic phenomenon that can be utilized to induce the formation of new bone and soft tissue. This technique has been used after corticotomy or osteotomy of bone to treat patients with limb-length inequality, angular deformit ... Full text Link to item Cite

Treatment of adolescent Blount disease with the circular external fixation device and distraction osteogenesis.

Journal Article J Pediatr Orthop · 1996 The purpose of this study was to review both the anatomic and functional results of treatment of adolescent tibia vara with distraction osteogenesis by using the circular external-fixation device. Twelve tibias in eight patients were treated. Preoperative ... Full text Link to item Cite

The effects of the Ilizarov distraction technique on bone and muscle in a canine model: a preliminary report.

Journal Article Iowa Orthop J · 1996 This study examined the functional and morphological changes experienced by bone and muscle during Ilizarov distraction osteogenesis. Although extensive research has been conducted in the area of regenerate bone formation, the effect of limb lengthening on ... Link to item Cite

Results after replantation and revascularization in the upper extremity in children.

Journal Article J Bone Joint Surg Am · December 1994 The rates of survival of the amputated part and the functional outcomes were studied retrospectively after seventy-three replantations and eighty-nine revascularizations in the upper extremity in 120 children. All operations were performed between January ... Full text Link to item Cite

Hip fusion in young adults. Using a medial displacement osteotomy and cobra plate.

Journal Article Clin Orthop Relat Res · March 1994 Eight consecutive patients, mean age 17.25 years, underwent a medial displacement osteotomy and hip arthrodesis with a nine-hole Cobra plate. A transverse innominate osteotomy facilitated medial displacement of the femoral head and acetabulum. Alignment of ... Link to item Cite

An assessment of the reliability of the Scoliometer.

Journal Article Spine (Phila Pa 1976) · May 1993 Accurate noninvasive measurements of spinal curvature are crucial in planning treatment and assessing curve progression in adolescent idiopathic scoliosis. An inter-rater agreement trial and an intrarater agreement trial were undertaken to estimate the rel ... Full text Link to item Cite

The medial approach to the hip revisited.

Journal Article Orthopedics · January 1993 Several muscular intervals have been described to approach the hip through a medial incision. We studied in detail the original descriptions of these surgical planes and found that several of them are nearly identical. We attempt to clarify the anatomic in ... Full text Link to item Cite

Bilateral transpedicular decompression and Harrington rod stabilization in the management of severe thoracolumbar burst fractures.

Journal Article Spine (Phila Pa 1976) · February 1992 Fifty-eight patients with severe thoracolumbar burst fractures were treated with bilateral transpedicular decompression, Harrington rod instrumentation, and spine fusion. Spinal realignment and stabilization was achieved by contoured dual Harrington distra ... Full text Link to item Cite

Growing pains.

Journal Article Orthop Rev · October 1991 Link to item Cite

Replantation in children.

Journal Article Microsurgery · 1991 The authors have replanted 162 parts in 120 children over the past 15 years. The youngest patient, undergoing successful replantation, was aged 7 months, 3 weeks. Unlike an adult, any child suffering a traumatic amputation should be considered for a possib ... Full text Link to item Cite

Comparison of Cotrel-Dubousset and Harrington rod instrumentations in idiopathic scoliosis.

Journal Article J Pediatr Orthop · 1990 An analysis of the efficacy of two techniques of posterior spinal instrumentation in patients with idiopathic scoliosis was performed. Thirty-two consecutive patients treated with Cotrel-Dubousset instrumentation and no external bracing were compared with ... Link to item Cite

One hundred eleven thumb amputations: replantation vs revision.

Journal Article Microsurgery · 1990 One hundred eleven patients who sustained isolated, complete thumb amputation between 1971 and 1985 were reviewed to assess results of replantation and to compare these with results of amputation revision. Routine postoperative evaluation was performed in ... Full text Link to item Cite

Plastic deformation in pediatric fractures: mechanism and treatment.

Journal Article J Pediatr Orthop · 1989 The plastic deformation often observed in children's long bone fractures is due largely to the complex nature of the molecular and histologic aspects of pediatric bone. Pediatric cortical bone has a lower mineral content than adult bone, accounting in part ... Link to item Cite

Neisseria gonorrhoeae foot abscess. A case report.

Journal Article Clin Orthop Relat Res · September 1988 A cutaneous abscess involving Neisseria gonorrhoeae is extremely rare outside the perineum. Such remote lesions are a result of disseminated gonococcal disease. A 12-year-old girl with arthrogryposis multiplex congenita developed a gonococcal abscess on th ... Link to item Cite

Demographics and replantation.

Journal Article J Hand Surg Am · September 1987 We reviewed demographic data on 761 patients who had one or more amputated parts replanted at Duke University Medical Center between 1972 and 1984 to learn more about the population that sustained amputation and replantation. Ninety-four percent were from ... Full text Link to item Cite

Continuous caudal block in an infant with arthrogryposis multiplex congenita

Journal Article Regional Anesthesia · January 1, 1987 Arthrogryposis multiple congenita is a syndrome for which multiple surgical procedures are often necessary to correct orthopedic deformities. Patients with this syndrome present multiple problems, and regional anesthesia has been specifically recommended f ... Cite

Lateral condylar fracture of the elbow.

Journal Article J Pediatr Orthop · 1986 Full text Link to item Cite

Tibial tubercle avulsions.

Journal Article J Pediatr Orthop · 1986 Avulsion of the tibial tubercle is not common. Sixteen cases are recorded, with a mean age of 15 years 2 months. All subjects were boys, 15 cases were left-sided, and three individuals had other associated knee injuries. All were treated operatively. Immob ... Full text Link to item Cite

Kawasaki disease--a cause of vasculitis in children.

Journal Article J Pediatr Orthop · 1986 Two cases of Kawasaki disease (mucocutaneous lymph node syndrome) with peripheral vasculitis of the extremities are described. Ischemia began 2-3 weeks after the onset of symptoms and was present for greater than 24 h before hospitalization. Despite suppor ... Full text Link to item Cite

Conjoined flexor and extensor pollicis longus tendons in the hypoplastic thumb.

Journal Article J Hand Surg Am · May 1984 A congenital anomalous band between the flexor pollicis longus and extensor pollicis longus tendons is, according to the literature, a rare condition. This anomalous junctura was recognized in three children with congenital thumb hypoplasia. Improved thumb ... Full text Link to item Cite

BIPOLAR AND EPIDURAL RESPONSES TO TIBIAL STIMULATION DURING SURGERY IN MAN

Journal Article ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY · January 1, 1984 Link to item Cite