A Brief History of Limb Lengthening.

In the last 35 years, orthopaedic surgeons have witnessed 3 major advances in the technique of limb lengthening: "distraction osteogenesis" facilitated by Gavriil Ilizarov method and infinitely-adaptable circular fixator with fine-wire bone fragment fixation; the introduction of the "6-strut" computer program-assisted circular fixators to effect complex deformity correction simultaneously; and the development of motorized intramedullary lengthening nails. However, the principles and associated complications of these techniques are on the basis of observations by Codivilla, Putti, and Abbott from as much as 110 years ago. This review notes the contribution of these pioneers in limb lengthening, and the contribution of Thor Heyerdahl principles of tolerance and diversity to the dissemination of Ilizarov principles to the Western world.

The evolution of the Ilizarov technique: part 1: the history of limb lengthening.

The history of limb-lengthening surgery can be traced back to the nineteenth century. Since that time, the orthopaedic community has made tremendous progress in performing successful lengthening procedures. Among the important contributors to the field, Dr. Gavril Ilizarov remains one of the most significant innovators. Because of advancements over the past century, limb lengthening has become a viable method of treating severe bony deformities and defects. This article, the first of a two-part series, reviews the history of distraction osteosynthesis.

The evolution of the Ilizarov technique: part 2: the principles of distraction osteosynthesis.

The history of limb-lengthening surgery can be traced back to the 19th Century. Since that time, the orthopaedic community has made tremendous progress in performing successful lengthening procedures. Among the important contributors to the field is Dr. Gavril Ilizarov. Because of advancements over the past century, limb lengthening has become a viable method of treating severe bony deformities and defects. This article, the second of a two-part series, reviews the principles of distraction osteosynthesis, including a thorough discussion of indications, instrumentation, and surgical technique.

The Ilizarov paradigm: thirty years with the Ilizarov method, current concerns and future research.

The Ilizarov method of bone lengthening, reconstruction and osteosynthesis has developed immensely since its introduction by G.A. Ilizarov in the Soviet Union in the 1960s and in the Western countries in the early 1980s. It has become an integral part of the arsenal used by the orthopaedic community worldwide. The evolutionary development of the method and its current role has considerably improved the quality of life for millions of people around the whole world. Despite the great versatility of its possible applications for bone injuries and diseases, the Ilizarov method could not and cannot be the alternative to a range of other methods that are applied for some specific bone conditions, but rather is a method of choice. Its combination with the current methods of internal fixation or the means of internal fixation that use the biological principles that were laid down by G.A. Ilizarov have demonstrated the importance of tension stress, blood supply, functional loading, and fragment control during bone treatment. The objective of this study was to present an overview of the current state and concerns in the application of the Ilizarov method and define the prospective research trends aimed at regeneration stimulation, better control of treatment, infection barriers and patient comfort.

The history of external fixation.

Even though external fixation is considered to be a rather "new" trend in orthopedics and traumatology, in fact it has been something used by physicians and surgeons for thousands of years. In the mid 1800's, external fixation would see some substantial growth and evolution, pioneered by physicians and surgeons whose principles are still in use today. Through the 1900's, the indications and usage would continue to expand, not to mention the modernization of the external fixation apparatus. Many surgeons in this era are notable for their work with external fixation, especially Gavriel Ilizarov, considered to be the father of external fixation. Further research and development with external fixation needs to be performed and, with time, will more than likely become fully integrated into modern clinical practice.

Mandibular distraction osteogenesis: a historic perspective and future directions.

Although orthognathic surgery has gained a generalized acceptance for maxillomandibular deformity correction, several limitations are associated with acute advancement of osteotomized bone segments. Furthermore, large skeletal discrepancies, such as those seen in syndromic patients, require such extensive bone movements that the surrounding soft tissues will not adapt to their new position, resulting in relapse or compromised function and esthetics. Recently, a number of experimental and clinical investigations have demonstrated that gradual mechanical traction of bone segments at an osteotomy site created in the craniofacial region can generate new bone parallel to the direction of traction. This phenomenon, known as distraction osteogenesis, opens up new possibilities in the correction of craniofacial deformities by orthodontists and maxillofacial surgeons. Hence, the purpose of this article is to review the historic development and biologic foundation of mandibular distraction osteogenesis, critically evaluate the current mandibular distraction devices with their clinical applications, and predict the future evolution of mandibular osteodistraction techniques.

[Ilizarov reconstructive surgery--a solution for complex problems of the musculoskeletal system].

The Ilizarov technique is an important modality of reconstructive surgery for limb deformities, such as malunion and nonunion of fractures, persistent osteomyelitis, and bone loss following complex limb injuries, as well as in limb-lengthening procedures. It has received wide recognition in the Western world over the past decade. In MEDLINE we found 537 articles published between 1971-1995 that describe the use of this technique. Of these, only 18 were published between 1971-1975, while 261 were published between 1991-1995. The present paper describes the developments and updates in this method, as a result of the large experience gained by the authors in a number of centers in Israel using this technique. The Ilizarov apparatus is a circular frame that allows accurate control, much more than any other external fixator, during correction of limb deformities and limb-lengthening. It is minimally invasive, and open techniques and use of internal hardware and bone grafts are not needed. Based on our experience, we suggest that this method requires careful preoperative planning and meticulous surgical technique. More important, cooperation between surgeon and patient throughout the lengthy treatment is a prerequisite to ensure complete success, even in the most complicated cases.

[Bone lengthening. History of the development and field of applications]. / Knogleforlaengelse. Udviklingshistorien og anvendelsesmulighederne.

Leg lengthening has been performed since early in this century. The first successful lengthening was reported in 1905. Leg lengthening evolved from forced lengthening of the bone during anaesthesia, through use of cortical bone grafts, plate and screws to callus distraction (callotasis). Development of external fixators and evolution of biological concepts of bone regeneration has been important. In 1951 Ilizarov developed his apparatus. Ilizarov pioneered the biology of bone and soft-tissue regeneration. He performs a percutaneous subperiosteal corticotomy and waits five to seven days prior to distraction with a rate of 0.25 mm of length four times each day. The method has increased the opportunities in reconstructive bone surgery. The technique is difficult with many problems and obstacles which can be overcome.

Limb reconstruction after high energy trauma.

Limb reconstruction techniques rely on stable external fixation to provide early limb function after major long bone injury. Bone may be generated by callus distraction techniques and internal techniques of moving bone segments used to fill bone defects. Soft tissue defects may be treated by acute shortening, although skin defects will also close spontaneously during bone transport as the leading edge of bone is covered with granulation tissue. External fixation is also used to cross joints permitting rest and repair of the joint. Hinges placed within the bars of the fixation frame may be used to correct deformities in the bone and soft tissue contractures using closed distraction techniques. These techniques are appropriate to metaphyseal fractures and diaphyseal fractures with bone loss. A major advantage is the lack of donor site morbidity, associated with skin flaps and large bone grafts. Acceptance of these techniques is growing whilst the methodology continues to improve. In more complicated cases, specialist training and dedicated hospital units with multidisciplinary support is desirable.

Professor G. A. Ilizarov's contribution to the method of transosseous osteosynthesis.

The author of the article, Professor Vladimir I. Shevtsov, General Director of The Russian Center who worked together with Academician G. A. Ilizarov for almost a quarter of the century describes the main stages in the development of the Ilizarov method and apparatus in historical context, and concentrates on the main trends of traumatology and orthopaedics worked out by G. A. Ilizarov. G. A. Ilizarov's involvement in the experimental and theoretical substantiation of transosseous osteosynthesis is emphasized as well as the various studies that have resulted in the discovery of the stimulating influence of tension stress on the genesis and growth of tissues which have come to be known as the "Ilizarov Effect." Thus the article provides a review of the prominent contribution of G. A. Ilizarov to pioneering new ways of treating patients with fractures including severe open injuries of limbs, pseudarthroses and defects, limb length deficiency and deformities as well as the many other orthopaedic conditions to which a G. A. Ilizarov's method has been applied.

Use of the Ilizarov external fixator in the treatment of lower extremity deformities.

The authors present a brief history of the development of the Ilizarov external fixator, and the classic uses associated with it. A preliminary study of 3 patients using 56 frames is presented. The Ilizarov external fixator is successfully used in these cases in place of traditional fixation.

[The Ilizarov external fixator and method. Treatment of congenital and acquired deformities]. / Ilizarovs eksterne fiksasjonsapparat og metodikk. Behandling av medfødte og ervervede deformiteter.

The Ilizarov method, with external fixation by means of rings, rods and wires, has been used at the Norwegian National Hospital, Orthopaedic Centre, since 1992. The method is unique in correcting multiplanar deformities in one surgical procedure. We have treated 70 patients with a wide variety of orthopaedic etiologies. Soft tissue and bone deformities in the lower extremity have been corrected separately or combined. The frequency of complications has been relatively high, but we still think that the Ilizarov method is useful to correct complex deformities in children and adults alike.