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.