Contact Chapter One 1. Section I 2. Section II 3. Section III 4. Section IV 5. Section V 6. Section VI 7. Section VII 8. Section VIII 9. Section IX 10. Section X 11. Section XI Chapter Two Chapter Three |
Modern distraction osteogenesis evolved primarily from the work of Gavriel Ilizarov. Starting in the 1960’s in his modest clinic in Kurgan, Siberia, Ilizarov conceptualized the basis of this reconstructive method. He was confronted with many patients with difficult traumatic and developmental limb deformities. These complicated nonunions, malunions, and nonhealing wounds would be difficult to manage even in the most sophisticated medical center. Modern equipment and procedures available to other surgeons were lacking in his basic rural clinic. Ilizarov responded to this challenge by developing a new system of reconstructive surgery. Development of distraction osteogenesis required defining new concepts in regeneration of bone and soft tissue. To initiate and control the distraction process, surgical instruments specific to the biomechanical requirements of the technique needed to be developed. Rigorous analysis of the initial results were needed to define the biologic basis of the process. To reach the current state of this technology required many years. Over a period of thirty years, the clinic consisting of a single wooden building was replaced by a modern, state-of-the-art medical center engaged in a combination of patient care, clinical research, basic science research, and instrument development. In the beginning, the treatments involved use of available instruments and basic surgical techniques. The use of percutaneous wires to manipulate bone fragments is still an important part of the Ilizarov method. To gain control of the wires and thereby the bones, Ilizarov developed the ring fixator. The rings could be joined by a variety of threaded rods and hinges providing fixation which was versatile and adaptable. After Ilizarov’s work was recognized by the Soviet medical establishment, the modest wooden clinic evolved into a state-of-the-art medical center and research facility. Over a period of 30 years, Ilizarov explored the basic science, defined parameters for clinical application, and improved the instrumentation for the distraction osteogenesis process. Restricted communication between Soviet and western medical communities limited dissemination of the work outside of Russia. With recent improvements in relations between the former Soviet Union and the west, this invaluable work has been made widely available. Today, distraction osteogenesis surgery for management of orthopedic disorders is available in many major medical centers worldwide. The process involved creation of surgical fractures with minimal tissue reflection and manipulation of the fragments with percutaneous rods supported by an external frame. The technique combined minimally invasive surgery and application of a unique device which could manipulate bones and maintain fixation simultaneously. The device evolved into the components of the Ilizarov ring fixator used by orthopedic surgeons today. Ilizarov found that combining minimal tissue dissection, slow transport of skeletal fragments, near rigid fixation, and maintenance of skeletal loading, resulted in formation of both new bone and adjacent soft tissue. Achievement of stable, functional rehabilitation of combined osseous and soft tissue deformities represents a major achievement in reconstruction surgery. |