JOIN USMaking new bones
In the early 1950s, with the ravages of the World War II still unravelling, a Russian doctor named Dr Gavriil A Illizarov came across numerous disabled war veterans whose leg injuries would not heal because of severe open bone fractures. This led him to devise a revolutionary new technique using a fixation frame to compress the fractured parts of the bone. This helped new bone to form and the fracture to heal over time and became the basis of what is today known as the Illizarov procedure.
With much research and development having gone into it, the procedure today is finding wide acceptance across the world, including India, as a reliable method of healing severe bone injuries and performing limb lengthening or reshaping on people suffering from
abnormally less physical growth or bone disorders. Today, this bone reconstruction technique is used for filling up bone defects and correcting and lengthening bones with deformity, in both children and adults with congenital disease, bone loss or
traumatic limb length inequality.
The Illizarov procedure is based on the principle of distraction osteogenesis, a
revolutionary principle that confronted and overstepped the myth that bone cannot be grown or lengthened. Distraction osteogenesis, also called osteo-distraction, is a mechanism through which the bone is divided into two segments, and very gradually moved apart (in a distraction) allowing new bone to form in the gap. This helps correct skeletal deformities as also lengthen bones. When the desired or possible length is reached, the next phase lets the bone heal and the volume of surrounding soft tissue to grow. Bone can be lengthened up to 15-100 percent of its original length with this method.
The Illizarov technique is used in multiple ways. It is used to treat open or complex bone fractures, correction of deformities of the limbs, bone infections, treatment of malunited fractures and limb lengthening. It is also used as a method to augment height of a person. A complex but highly successful procedure to increase the length of the limbs, it also helps people saddled with dwarfism like achondroplasia to achieve normalcy in life. A rare genetic disorder of the bones, achondroplasia is roughly found in one in 25,000 people and basically translates to “without cartilage formation”. It is a condition that results in abnormally short stature and disproportionately short limbs. The average height of an adult with achondroplasia is just 52 inches.
The apparatus used today for the procedure comprises fixators, which have rings, rods and wires to gradually distract the bone parts and keep them fixed at the desired length.
The new bone formed in between the corticotomised bone surfaces which are carefully and gradually pulled in a controlled manner using the fixator. Over time, this process helps in bone growth between bone ends. The entire procedure is minimally invasive as it uses wires to fix the bones to the rings. It involves less tissue damage and ensures quick recovery. After the procedure, the Illizarov fixator is removed. The procedure is followed by a lengthy rehabilitation period and extensive physiotherapy to allow the body to get accustomed to the new bone development. The regenerated bone is normal and does not wear out, and the muscles, nerves and blood vessels grow in response to the slow stretch.
This procedure particularly helps in the following cases:
When a non-healing fracture of the bone leads to bone deformity. Sometimes, bones heal on their own but when they don’t, they need shape and form correction.
When bone is severely affected by a tumour, it can result in major bone loss. In such cases, new bone can be generated to fill in.
Sometimes, bone deformities are congenital and don’t cause any pain. Still, such children are at an increased risk of developing arthritis as a result of misalignment.
When people have been born with any form of dwarfism disorder that makes them abnormally short, limb lengthening can actually help increase their height.
(The author is senior consultant, orthopedic and joint replacement surgeon, Indraprastha Apollo Hospital, New Delhi)