History of the Ilizarovs wire-fixator, stages of hand surgery development at the Ilizarov Center
© Shevtsov V.I., Kirienko A.P., Shikhaleva N.G., Novikov K.I., 2021 DOI 10.18019/1028-4427-2021-27-3-299-306
V.I. Shevtsov1, A.P. Kirienko2, N.G. Shikhaleva1, K.I. Novikov1
1Ilizarov National Medical Research Centre for Traumatology and Orthopedics, Kurgan, Russian Federation
2Humanitas Clinical and Research Center, Milan, Italy
Introduction Hand surgery has its own history in each country which is done by outstanding doctors and scientists. Аcademician G.A. Ilizarov, the founder of transosseous osteosynthesis, is one of such personalities. Purpose of the work To analyze the stages of development and application of transosseous osteosynthesis in hand surgery, proposed by Academician
G.A. Ilizarov. Methods The process of creation and development of transosseous osteosynthesis for short tubular bones was analyzed. We present the main designs and developers of the inventions related to extrafocal osteosynthesis of hand bones. The structural divisions of the Ilizarov Center, in which medical care was provided to the patients with hand pathology, were stated. Results The entire existence and active use of the Ilizarov mini-fixator can be represented by five periods, starting from the period of comprehending the need for its design. Currently, we are in the period of its combined use in conjunction with the reconstruction of hand soft tissues. Conclusion The names of scientists who have made a significant contribution to the development of the Ilizarov method of transosseous osteosynthesis for the hand surgery were given in the final summary. Thanks to the results of their work, we have the opportunity to further develop hand surgery in accordance with the contemporary scientific requirements.
Keywords: hand surgery, Ilizarov apparatus, mini fixator, external fixation apparatus for the hand
Hand surgery as a specialty grew out of the experience of treating upper limb injuries during World War II. Sterling Bunnell (1882–1957), doctor of medicine, was a key figure in the creation of the hand surgery specialty in the United States of America. In 1944, he published a book “Surgery of the Hand” that was an authoritative publication for almost 30 years. Around the same time, he organized and managed nine hand surgery centers. The surgeons who ran those centers became the founders of the American Society for Surgery of the Hand . Based on the experience of American colleagues, the International Federation of Societies for Surgery of the Hand (IFSSH) was established in Europe in 1966. This organization was renamed into the Federation of European Societies for Surgery of the Hand (FESSH).
The Russian history of surgery also has many vivid examples of in-depth study of hand pathology. And here we need to start with the activities of the outstanding physician N.I. Pirogov (1810–1881),
who laid down the basic principles of traumatology, orthopedics and surgery . His initiatives were picked up by his disciples. Yu.K. Shimanovsky (1829–1868), in addition to various interventions on integumentary tissues, proposed a method of stretching the skin on amputation stumps .
The 20th century was the next stage in hand surgery. Well-known scientists and surgeons made significant contributions to the development of our specialty at that time: V.I. Rozov (1887–1960), A.A. Limberg (1894–1974), V.N. Blokhin (1897–1957), B.V. Parin
(1904–1968), V.K. Krasovitov (1904–1993),
V.V. Azolov (1937–2013), A.M. Volkov (1908– 2004) and many others. The name of G.A. Ilizarov belongs to this list and his scientific and practical contributions have been widely used in hand surgery nowadays [4–6].
Purpose To analyze the stages of development and application of transosseous osteosynthesis for short bones proposed by academician G.A. Ilizarov.
MATERIAL AND METHODS
The history of any scientific direction is closely and inextricably linked to the people who plan, build and implement this direction in life. The history of the development of the “hand” part of the method of transosseous osteosynthesis at the Ilizarov Center
was no exception. We should start from the very beginning.
The appearance of the Ilizarov apparatus in the 1950s was a revolutionary breakthrough in traumatology and orthopedics not only in our
Shevtsov V.I., Kirienko A.P., Shikhaleva N.G., Novikov K.I. History of the Ilizarovs wire-fixator, stages of hand surgery development at the Ilizarov Center. Genij Ortopedii, 2021, vol. 27, no 3, pp. 299-306. DOI 10.18019/1028-4427-2021-27-3-299-306
country, but throughout the world. The main attention of scientists at that time was concentrated on the development of reconstructive and restorative operations on large segments of the human musculoskeletal system. In 1966 G.A. Ilizarov, after creating an external apparatus of his own design, was appointed head of the problem laboratory at the Sverdlovsk Scientific Research Institute for Traumatology and Orthopedics. At that time, the Ilizarov method of transosseous osteosynthesis began its development and subsequent practical application.
The decision to use transosseous osteosynthesis in hand surgery was not accidental. On the one hand,
G.A. Ilizarov discussed the possibility of using the developed method in related specialties such as angiology, oncology, neurosurgery, dentistry and other disciplines. On the other hand, his fame served as the starting point that attracted patients with hand pathology to refer to the Ilizarov clinic. One of the first patients who underwent treatment with a mini- apparatus was the director of a plant from the city of Kurgan with a fracture of the 5th metatarsal bone. Being admitted to the institute for medical care, he was offered plaster immobilization, which he rejected due to a large amount of bandages, inability to use shoes, and the need to move with crutches. So, a customized and a very miniature assembly of the apparatus for fixing a broken bone was developed. And all the disadvantages of a plaster splint were avoided.
The final decision to speed up the development of a mini-fixator was made after one of the Institute’s employees applied to G.A. Ilizarov to treat her 6-year- old daughter who had brachisyndactyly of the fingers of both hands. Not only orthopedic traumatologists, but also
specialists from the engineering laboratory were invited to the surgical council that discussed the upcoming reconstructive intervention on the hand. According to the terms of a technical solution, the engineers had to develop the main parts of a mini-fixator from which it was possible to assemble the units for the longitudinal and transverse traction. Thus, the referral of patients with injuries, bone defects, congenital anomalies in the hand made the team of doctors headed by G.A. Ilizarov to develop and introduce into practice a design of the fixator for interventions on small tubular bones.
In the following years, the mini-fixator passed through several stages of improvement. The main requirements for the design of the transosseous osteosynthesis apparatus for the hand were its easy assembly in the operating room, financial cost- effectiveness, possibility of multiple use, ability to correct all types of displacement of bone fragments, stability of controlled fixation (compression or distraction), individual application depending on the location of a fracture, preservation of active movements in the adjacent intact joints, minimal damage to the soft tissues of the hand while maintaining blood supply to the fractured bones [7–11].
The first wire-based fixator for the hand (hand mini-fixator) was proposed by a group of authors (G.A. Ilizarov, I.A. Kataev,A.P. Predein) and registered on November 12, 1980 under No. 923535 . It was a bulky structure of a complicated technical design (Fig. 1).
The following year, the authors proposed a new modification of the apparatus for small tubular bones (patent No. 973115 dated 05/18/81) . The device was intended for fixation and work out of finger joints (Fig. 2).
Fig. 2 Diagram of a device for fixation and training of finger joints, patent No. 973115 dated 05/18/81
Those two designs did not find a wide application in practical work but were the foundation for a current design of the Ilizarov mini-fixator.
In 1983, a group of doctors and researchers started to treat patients with congenital developmental anomalies, correct post-traumatic and neurogenic deformities of the hand and foot. It was based at the second orthopedic department of KNIIEKOT for adults (head of the department, Murashko Vasiliy Ivanovich). In August 1983, nurses and junior medical personnel from this department were sent to equip a new department, which was decided to deploy on the second floor of block “B” of the new building of the Center. Among them were Klepinina L.Ya., Katkova R.P., Rechkina N.P., Kataytseva L.P., and others. On December 9, 1983, the department opened its doors to patients. The first head of the new department was
Okulov Gennady Vladimirovich.
The work of the department was aimed at the clinical implementation of new methods for treating patients with diseases of the hand and foot. Already in 1984, the staff of the department developed and used in practice five new methods which were used to treat 136 patients. The proposals of the staff were ten improvements of the inventions (department’s 1984 annual report). The first medical team of the department for hand and foot pathology was:
- Shatokhin V.D. – orthopedic resident, graduated from the medical faculty of the Orenburg Medical Institute in 1972;
- Skolkov V.N. – orthopedic resident, graduated from the medical faculty of the 2nd Moscow Medical Institute in 1983;
- Noskova (Ignatieva) S.M. – resident physician, graduated from the medical faculty of the Novosibirsk Medical Institute in 1984;
- Kirienko A.P. – junior researcher, resident physician, graduated from the medical faculty of the Blagoveshchensk Medical Institute in 1982 (Fig. 3).
Fig. 3 From left to right: A.P. Kirienko, V.I. Kusturov,
G.A. Ilizarov, A.D. Lee, Yu.G. Shaposhnikov (photo from
A.P. Kirienko’s archive, 1983)
In 1983 G.A. Ilizarov proposed a compression- distraction apparatus for treatment of patients with hand pathology (Inventor’s Certificate 1715333 USSR) . Its design, in comparison with the previous ones, was convenient to use, versatile, i.e. it could be used for various orthopedic and traumatic pathologies of the hand (Fig. 4).
Fig. 4 Diagram of a compression-distraction apparatus for treatment of patients with hand pathology (Inventor’s Certificate 1715333 USSR)