Journal of Limb Lengthening & Reconstruction

: 2018  |  Volume : 4  |  Issue : 1  |  Page : 1--2

Editorial: The Janusian issue

Milind M Chaudhary 
 Centre for Ilizarov Techniques, Akola, India

Correspondence Address:
Prof. Milind M Chaudhary
Centre for Ilizarov Techniques, Akola

How to cite this article:
Chaudhary MM. Editorial: The Janusian issue.J Limb Lengthen Reconstr 2018;4:1-2

How to cite this URL:
Chaudhary MM. Editorial: The Janusian issue. J Limb Lengthen Reconstr [serial online] 2018 [cited 2019 Aug 24 ];4:1-2
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Welcome to the Vol. 4 issue 1 of JLLR. This issue has an interesting mix of current state of the art; a glimpse into the future, and a delving into the past. Tsuchiya, a world leader in bony tumor reconstruction, outlines the role of various biological methods. A visionary, he attempts to give maximum functional results despite the devastating morbidity of the destructive tumors. His methods of free and pedicled cooling with liquid nitrogen[1] have much promise. A hybrid of the external and internal fixation with newer biological methods will pave the way for bony regeneration after devastating bony loss in tumors.

The Mecca of Ilizarov techniques to surgeons across the world is the venerable RISC RTO at Kurgan. It was the birthplace of a new biological science. It continues to be a beacon of knowledge for surgeons across the developmental divide and shines its light on aspiring surgeons and patients from across the world. Gubin et al.[2] show that its leadership role continues unparalleled.

The Accordion maneuver emerged from the RISC RTO institute long ago. Baruah[3] revisits the reliable method of stimulating maturation in poor regenerate and kickstarting healing in recalcitrant nonunions. While bone graft substitutes, bone marrow concentrates and bone morphogenetic proteins have promise, many come with a high price tag. Simpler, noninvasive, and inexpensive methods can be equally effective. When Green[4] wistfully asked “whatever happened to the regenerate, what would Ilizarov say?,” he was referring to the many simple techniques that ensured a good regenerate in very short durations. Perhaps, prolonged walking is one more forgotten prescription that our patients need. The two faces of Janus[5] remind us the longer we turn back, the further we shall see and forge ahead. It reminds us to use older methods even as we seek and invent newer ones.

The most common use of the ilizarov method in trauma is for tibial plateau fractures. Lowery.[6] outlines the use of absorbable calcium cement in preventing bony collapse in these common and debilitating injuries.

Archer[7] revisits the role of pixel value ratio and its correlation with the RuLi and Donnan classification to determine the ideal time to remove external fixation in pediatric limb lengthening cases. We were happy to label regenerate types into three easily memorizable types: normotrophic, hypertrophic, and atrophic. The RuLi and Donnan classifications added a level of detail and depth and also unfortunately; confusing complexity to the description of the regenerate. The pixel value ratio gives a numeric objectively measurable indicator to classify the regenerate. Novikov et al.[8] use sonography to detect early patterns of regenerate formation and reduce radiation where frequent monitoring is needed, as in young children.

Fortin et al.[9] reexamine the role of Botox in limb lengthening in children and its possible use in decreasing pain and reducing contractures. Nogueira[10] elegantly shows the maintenance of molding of cartilage and bony surfaces in neglected clubfoot in an older child by magnetic resonance imaging, reiterating our faith in Ponseti method in older children. Lovisetti[11] reopens the debate about the cause of discordance in strut length and bone length while using hexapod fixators; food for thought for those who seek answers in trigonometry.

The Estoril Congress general body meeting reached no consensus on having a body of office-bearers of the combined associations of ASAMI-BR and ILLRS. It was decided that only conferences would be held every 2 years and that the office-bearers of the congress would be the ipso facto office-bearers. While this has simplified the structure of our organization, it has negated any possibility for our organizations to perform academic activities other than conferences. This ignores the elaborate analysis by Paley of how we are a different subspecialty and what we need to do to spread and promote it.[12],[13]

Since there is no treasurer, no membership fees and no funds, there is no possibility of international fellowships or of funding any educational ventures or promoting the official journal of our organization: the JLLR. “As an international group, we need to come together with a unified voice to help the world orthopedic community understand why we are special” quotes Rozbruch.[14] One wonders how we are likely to achieve this imperative goal.

Most world societies have such structures-despite difficulties in global communication-with an official journal, endorsed, supported, and manned by volunteers from within the societies. Our journal is on track for indexation but needs better articles and the trust and generous spirit of its members to grow and become the depository of knowledge for all things related to limb lengthening and reconstruction.


1Tsuchiya H. Editorial: Biological reconstruction after tumor resection. J Limb Lengthening Reconstr 2018;4:3-5.
2Gubin AV, Borzunov DY, Malkova TA, Belokon NS. Activities of a large limb lengthening and reconstruction center in the 21st century. J Limb Lengthening Reconstr 2018;4:6-10.
3Baruah RK, Patowary S. Accordion maneuver: A bloodless tool in Ilizarov. J Limb Lengthening Reconstr 2018;4:11-9.
4Green SA. What happened to the regenerate? What would Ilizarov say? J Limb Lengthening Reconstr 2016;2:3-5.
5Kouzes JM, Posner BZ. The Janusian leader. In: Chowdhury S, editor. Management 21C. London: Prentice-Hall; 2000. p. 17-32.
6Lowery K, Chatuverdi A, Blomfield M, Sharma H. Effectiveness of the management of bony articular collapse with bony defects in tibial plateau fractures with the use of Genex: An absorbable calcium composite synthetic bone graft. J Limb Lengthening Reconstr 2018;4:20-5.
7Archer LA, Dobbe AM, Chhina H, García HA, Cooper A. Inter-and intraobserver reliability of the pixel value ratio, Ru Li's and Donnan's classifications of regenerate quality in pediatric limb lengthening. J Limb Lengthening Reconstr 2018;4:26-32.
8Novikov KI, Menshikova TI, Subramanyam KN, Novikova OS, Mundargi AV. Sonographic evaluation of distraction osteogenesis in patients undergoing lengthening of tibia for increase in stature. J Limb Lengthening Reconstr 2018;4:33-40.
9Fortin M, Dahan-Oliel N, Montpetit K, Narayanan U, Saint-Martin C, Hamdy RC. Radiological and clinical findings following distraction osteogenesis of the lower limb in children with or without Botox injection: A preliminary report. J Limb Lengthening Reconstr 2018;4:41-8.
10Nogueira MP, Amaral DT. How much remodeling is possible in a clubfoot treatment? Magnetic resonance imaging study in a 7-year-old child. J Limb Lengthening Reconstr 2018;4:49-54.
11Lovisetti G. Letter to the Editor about article “Analysis of strut-to-bone lengthening ratio for hexapod frames using mathematical modeling” by Alex Cherkashin, Mikhail Samchukov, and Christopher A Iobst Published in the January-June Issue (Vol. 3, Issue 1, pp 45-51). J Limb Lengthening Reconstr 2018;4:59-60.
12Paley D. Why are deformity concepts still not a mainstream part of orthopedics? J Limb Lengthening Reconstr 2016;2:1-2.
13Paley D. Limb lengthening and reconstruction: A new subspecialty of orthopedic surgery? J Limb Lengthening Reconstr 2015;1:1.
14Rozbruch SR. Why are we special? Limb deformity is more than an overlapping subspecialty. J Limb Lengthening Reconstr 2017;3:1-3.