THE HISTORY OF LIMB LENGTHENING AND THE BASICS OF THE ILIZAROV METHOD

The History of Limb Lengthening – The Origins of the Ilizarov Method

Limb lengthening is possible and has been successfully performed for about 50 years in the city of Kurgan, Russia. The procedure was developed by Gavriil Abramovich Ilizarov in 1951, after he began treating many World War II veterans with non-union fractures of the lower limbs.

Initially, Ilizarov developed an external fixation device that was secured around the limb. Knowing that pressure on the fracture site promotes bone healing, he designed a device capable of applying compression. He instructed one of his patients to gradually increase the pressure on the non-union by tightening the rod. However, the patient turned the rod in the opposite direction, causing distraction (separation) of the bone fragments.

Ilizarov observed that the gap between the bone fragments had filled with newly formed bone tissue. This marked the beginning of extensive research and development efforts, which demonstrated that limb lengthening is possible, safe, and effective.

The Development of Limb-Lengthening Techniques Around the World

Ilizarov and his colleagues performed thousands of limb-lengthening procedures in Kurgan. Unfortunately, Russian policies made it very difficult to exchange information and knowledge with the Western world. Finally, in the early 1980s, surgeons in Italy took an interest in the procedure, began to refine it, and established a large center in Lecco.

The first limb-lengthening procedure in the United States was performed in 1988. Initially, the method met with considerable resistance and skepticism within the American orthopedic community, but its effectiveness spoke for itself.

Ilizarov External Fixators – Principles of Operation

External fixators allow for control of the lengthening process. They form a sort of scaffold on the outside of the body, hence their name. These devices are made of durable metal, as their purpose is to stabilize the bone during the lengthening process.

Sometimes the bone that needs to be lengthened is too small to accommodate a modern magnetic lengthening nail in the medullary canal. In such cases, external fixation is necessary. An external fixator is mounted around the arm or leg, much like scaffolding on a building’s facade. Metal rings or rods are attached to the bone using pins or screws.

Every day, the bone fragments are moved by tightening special nuts or other components of the external fixator. The patient receives detailed instructions specifying how many turns to make each day. As the bone fragments are moved apart, the gap between them is first filled with bone graft material and then with mature bone tissue, thereby lengthening the bone. One example of an external fixator is the Ilizarov fixator.

How long does treatment with an Ilizarov frame take?

The duration of treatment using the Ilizarov device is determined on a case-by-case basis. It depends primarily on the indication, the extent of the planned lengthening, the patient’s age, the quality of the bone tissue, and the rate of regenerative bone formation and mineralization. Other factors that play a role include comorbidities, smoking, the condition of the soft tissues, and the consistency of rehabilitation.

The treatment involves several stages. The surgery is followed by a latency period of several days, and then a distraction phase, during which the bone segments are gradually pulled apart. A rate of approximately 1 mm per day is often used, divided into several smaller adjustments. This means that achieving a 5-cm lengthening may require about 50 days of distraction alone.

The Ilizarov Apparat – Advantages and Limitations of Treatment

Among the most important advantages of the Ilizarov device are the ability to precisely lengthen bones, correct alignment, and treat extensive defects, deformities, pseudoarthroses, and infected nonunions. The Ilizarov stabilizer allows for the adjustment of component positioning even during treatment, making it possible to correct any deviations that arise without replacing the entire structure. In complex cases, it can simultaneously be used for bone transport, compression of the nonunion site, and correction of limb alignment.

A limitation is the long duration of device wear, which includes the bone-lengthening phase and the consolidation phase of the new bone. The external structure may make it difficult to get dressed, sleep, maintain daily hygiene, and move around. It also requires regular cleaning of the areas where the wires and tips pass through the skin. Possible complications include infections around the implants, pain, loosening of the wires, limited joint mobility, muscle contractures, axial deviation, delayed union, and re-fracture of the regenerated bone after removal of the device. The risk depends on the indication, the extent of correction, the duration of treatment, and adherence to recommendations.

The success of treatment requires regular clinical and radiological follow-ups, as well as systematic physical therapy. The Ilizarov device remains an important tool in the treatment of complex deformities and bone defects; however, the decision to use it should be based on an individual assessment of the benefits and burdens for the patient.