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HISTORY
Year : 2020  |  Volume : 6  |  Issue : 1  |  Page : 84-89

Ilizarov


Department of Medical Sciences, Laboratory for Diagnostic Imaging, Federal State Budgetary Institution, “National Ilizarov Medical Research Center for Traumatology and Orthopedics” of Ministry of Healthcare, The Russian Federation, Kurgan, Russia

Date of Submission15-Jun-2020
Date of Web Publication30-Jun-2020

Correspondence Address:
Prof. Galina Victorovna Diachkova
Department of Medical Sciences, Laboratory for Diagnostic Imaging, Federal State Budgetary Institution, “National Ilizarov Medical Research Center for Traumatology and Orthopedics” of Ministry of Healthcare, The Russian Federation, Kurgan
Russia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2455-3719.288557

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How to cite this article:
Diachkova GV. Ilizarov. J Limb Lengthen Reconstr 2020;6:84-9

How to cite this URL:
Diachkova GV. Ilizarov. J Limb Lengthen Reconstr [serial online] 2020 [cited 2020 Oct 31];6:84-9. Available from: https://www.jlimblengthrecon.org/text.asp?2020/6/1/84/288557



In 2018, in the Journal of Limb Lengthening and Reconstruction Surgery, Prof. Dror Paley published an article on the history of the Ilizarov method (Paley D. The Ilizarov technology revolution: History of the discovery, dissemination and technology transfer of the Ilizarov method. J Limb Length Reconstr 2018;4:115-28). We are grateful to Dr. Paley for the great role that he played in the dissemination, popularization, and development of the Ilizarov method around the world. He has been a great friend to Prof. Gavriil Abramovich Ilizarov and to many of us in Kurgan. We appreciate his recording as a detailed biographical account of G. A. Ilizarov. Dr. Paley is a world-renowned orthopedic surgeon who specializes in transosseous osteosynthesis and is well known for his contributions in the field of limb lengthening and deformity correction. He is the director of the Paley Orthopedic and Spine Institute at St. Mary's Medical Center, in West Palm Beach, Florida, USA. Dror and I have remained close colleagues and freinds since the time in 1987 when he visited Kurgan and spent a month under my tutelage. I recently had the opportunity to discuss his history article with him. He commented to me, Galina Victorovna, “My perception of Ilizarov is from my point of view. What was he like for you and those who worked with him in Kurgan every day?” I am writing this article in answer to Dr. Paley's question. Instead of a history article with dates and facts, I want to show what kind of person Ilizarov was, in that complex and contradictory reality in which he and we had to live [Figure 1].
Figure 1: Prof. Gavriil Abramovich Ilizarov and Dr. Dror Paley at University of Maryland, 1987

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Prof. G. A. Ilizarov administrated the Center (Institute) he established first as a basic research laboratory, then an affiliated institution between 1966 and 1992, a period of 26 years. During this time, he introduced a unique method of fixation in 1951 (Patent Application No. 102/17-762/447962, Author's Invention Certificate No. 98471 “Technique for healing of fractured bones and apparatus for the technique performance”), which is applicable to the entire musculoskeletal system to treat a wide variety of orthopedic and traumatologic pathology. Using this new fixation method, he uncovered new biologic and mechanical principles which evolved into what is now referred to as the Ilizarov method. While external fixation is considered difficult to use, and challenging for the patient to live with, it offers such unique solutions to many complex problems that the inconveniences of an external device are soon overlooked.

Few people know what uphill battles, the challenges, and the obstacles that Dr. Ilizarov had to overcome in the Soviet Union and worldwide. Ilizarov initially met great resistance in the Soviet Union and fought this closed mindedness at conferences, scientific board meetings, through lectures and presentations and through peer-reviewed publication of his scientific work. By the time the method reached the West (Italy, 1981), he had come out victorious after 30 years of struggles in the Soviet Union. For this reason, the dissemination in the West seemed to progress faster since most of the ground work had already been laid in Russia.

The first English language Ilizarov publication was in a Nursing Journal in 1972, followed by a similar article in a Podiatric Journal in 1973. The same year, an Italian journalist from Stampa Medica asked Prof. G. A. Ilizarov via Novosti Press Agency to describe his specific method of treatment. Reports of his incredible successes appeared in the lay press for the first time. Prof. Monticelli, Director of Institute for Clinical Orthopaedics and Trauma, University of Rome, commented in 1973, “Regarding bone growing by 20 or even 24 cm with the Ilizarov apparatus without surgery and grafting is very absurd and makes us think that Soviet Novosti Press Agency is likely to have misinterpreted the good intentions of the Russian colleague.” Ilizarov traveled outside the Soviet Union to other Iron Curtain countries including Poland and Mongolia in 1979 and East Germany in 1981 to share his experience. His first trip to the West came in June 1981 when he was invited to speak in Italy. This was followed by visit of Italian orthopedic surgeons to the Institute (KNIIEKOT) in the month of November the same year. Cooperation with the Italians leads to licensing of the Ilizarov device and technique, by the USSR to a company Medicalplastic, owned by Prof. A. Bianchi-Maiocchi in Italy. Mecialplastic began to manufacture the Ilizarov apparatus in Italy in 1983, selling to nine Western European countries. The Ilizarov method started spreading in the West. In 1982, the Association for the Study and Application of the Methods of Ilizarov (ASAMI) was established in Lecco, Italy, with Prof. R. Cattaneo as the President [Figure 2].
Figure 2: Prof. Gavriil Abramovich Ilizarov with Prof. R. Cattaneo. In the back is Dr. ?. Villa with Russian translator ?. Combi

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ASAMIs were set up in Spain, Germany, Portugal, and France. In 1986, an orthopedic surgeon from the University of Toronto, Dr. D. Paley attended a training program in KNIIEKOT. He was the first person from North America to come to Kurgan. At the personal invitation of Prof. Ilizarov Dr. Paley who taught himself to speak, read, and write, Russian came back to Kurgan in the early 1987. Paley helped facilitate for Prof. Victor H. Frankel, Chairman of Orthopedics, Hospital for Joint Diseases, in New York and Prof. Stuart Green, from Rancho los Amigos Hospital, University of California Irvine, to travel to Kurgan later that the same year. At the invitation of Drs. Paley and Frankel, Ilizarov traveled to speak at the firstFirst International Ilizarov Conference in North America that took place in November 1987. This was followed soon after by a second conference organized by Dr. Paley in May 1988 in Washington, DC. At these two conferences, Prof. G. A. Ilizarov gave his lectures in front of many prominent surgeons from across North America. Victor Frankel commented in 1988, “Edison persisted and we have light, Newton persisted and we have laws of mechanics, Ilizarov's persistence led to new biological regularity of bone growth and regeneration.” A several-year exposure to Ilizarov applications made the international orthopedic community aware of the benefits from the method.


  Work is My Priority Top


Ilizarov used to work for 18–20 h per day conducting experiments, reviewing the literature, and performing consultations and surgeries. He innovated new applications of his method for quicker healing of cancellous and diaphyseal fractures, lengthening by 10–15 cm, correction of any deformity, and more. This happened every day of his life until the last 2–3 years when he experienced some health challenges. He was working on a manuscript when he developed pulmonary edema and died in 1992. Ilizarov never left his office if there was a patient who needed his advice, an urgent issue to be settled, important papers to be scrutinized, questions from the staff to be answered, or a new article to be looked at. He worked at his office in the Institute in the daytime and into the late hours of night in his study at home (one floor above his apartment). In his study, he worked on scientific: papers, lectures, and case presentations. Year after year, he was driven by his work. He did not occupy his time with rest or leisure. This anecdote highlights his outlook on leisure: Ilizarov was offered a health resort package to Krasnodarsky region. He and his wife, Valentina Alexeevna, and his daughter Svetlana departed for the spa. Everyone at the institute breathed a sigh of relief: a chance to get a break; but that was not to be. Two days later, I got a telephone call from the Professor's Secretary asking me to come to his office. “He's back to his office!” When asked why his trip was so short, he responded: nothing to do there!

In rare leisure hours, during his trips abroad, he always found an excuse to open up the slide boxes, to look through presentations, clinical cases, and sometimes work the whole night. It pleased him so much since the presentations contained the unique material obtained in many years of experience and research. He gave a lecture on, Tension Stress Effect on Tissue Regeneration, at an orthopedic congress in Germany in 1989. Some of the slides were of electron microscopic findings. He was asked where the slides were produced. He answered: At our institute of course! The audience could hardly believe that this sort of material came from somewhere in Siberia. The remarkable morphological preparations were really unique and produced using cutting-edge equipment of that time. Their demonstrative and original value appears to be as spectacular today, so much so, that many of his slides and pictures were used for presentation and publication by others without permission or referencing Ilizarov. At the same time, he was reproached for keeping some of his techniques secret. Once at a meeting in Amsterdam, I asked an Italian professor who gave a presentation on repair of bone defects with transosseous osteosynthesis method why he made no reference to the original source. His answer was: everyone knows that this is Ilizarov's work. Ilizarov felt this that this should always be credited and articulated!


  Patients first and Foremost Top


Although there is no statistical report showing how many patients were seen by Prof. G. A. Ilizarov, we can suggest that there were hundreds of thousands because, some days, more than a hundred patients could receive consultations at the Centre and get an opinion from him. Every time, he moved to Moscow or any another city his hotel room at night was full of people who were eager to get his opinion and receive treatment in Kurgan. He was also preoccupied with numerous consultations during his trips abroad. On the other hand, he would not perform a surgery for a patient outside of Kurgan if there was no surgeon who could provide the postoperative care. He carefully examined every patient and then would do preoperative planning by making multiple schematic drawings and paper models. His approach to indications was very strict and especially with the opening of Medical Tourism Department of the Institute. He could never understand clinical negligence and malpractice or delay in treatment. He took complications very seriously and treated them very aggressively. He used to say: a patient would never present with complaints for no reason. In other words, if there was pain, there was a reason which had to be investigated and corrected including incorrectly mounted frames.

Ilizarov did his ward rounds in the evening or even at night time. Patients had to be examined when the phones were silent, and state institutions stopped working.

Gavriil Abramovich was very good at communicating with children. He knew how to make them, calm and happy. He could convince them to get out of bend despite the pain on the 2nd day after surgery. Polish children awarded him the “Order of the Smile.” Much attention and effort were invested in the children's departments at the Center. He had a School organized at the Institute, where children could study from grades 1 to 10. He created special, children's rooms for preschoolers. Children's exhibitions and performances were held. Gavriil Abramovich, when time allowed, always took part in children's events [Figure 3].
Figure 3: Ilizarov with children in the Department of Pediatric Orthopedics, KNIIEKOT (a). During the ceremony of awarding the Order of the Smile, Poland (b)

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  In Science, Everything Should Be the Latest! Top


To come up with a new technique, a new treatment method, a new frame, this was a constant need for Prof. Ilizarov, and very often, the patent department employees were called into the operating room to fix some kind of innovation (osteotomy, frame assembly, or method). G. A. Ilizarov received 217 copyright certificates and 10 foreign patents. He always tried to ensure that the Center had the newest equipment for scientific research. Thanks to these efforts, research at the Center was a top priority, distinguished by its uniqueness and relevance. This was facilitated by ample funding for basic science research, which Prof. Ilizarov strongly supported. Over many years of work, a vast amount of scientific and clinical material was collected.

In 1991, the first monograph by G. A. Ilizarov was published in English (edited by Prof. Stuart Green, USA). Almost all Center staff contributed to this huge effort for the English version. Prof. V. I. Shevtsov and I were prepared all of the photographic materials (slides) to submit in person to Springer-Verlag in Heidelberg, Germany. To acknowledge our contribution, a special edition monograph signed by Gavriil Abramovich was presented as a Momento to Prof. V. I. Shevtsov and myself [Figure 4].
Figure 4: During the preparation of the monograph, Germany, Heidelberg, 1991. Prof. Ilizarov Gavriil Abramovich, Prof. V. I. Shevtsov, Prof. G.V. Dyachkova ( first row), and employees of Springer-Verlag publishing house

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Undoubtedly, much has changed over 28 years, but the solid foundations of the method and the universality and modularity of the external fixator allow us to constantly innovate, improve, and even change the original fixation and method. The genius of the Ilizarov method and device lies in the fact that any orthopedist trained in the methods of transosseous osteosynthesis can expand its uses and capabilities.


  The Team Is the Basis Top


What were the relationships like at the center at the time of Ilizarov? Everyone knew each other because they constantly met at the Academic Councils, meetings, ceremonies, and laboratories. We understood the importance of collectivism and the need to work together. Gavriil Abramovich greatly appreciated the conversations with his colleagues, and everyone who wanted to meet with him. He tried to be available to talk about new ideas, problems, research, and articles. If he could not immediately find the time to do this, he would find time in a few days, or weeks, but no one was denied his time. He often gathered doctors and scientists and, for several hours, discussed the issues of new techniques, upcoming conferences, relations with foreign companies, and the construction of a new building at the Institute. He met with the doctors himself rather than delegate for them to meet with his administrators. Gavriil Abramovich also spent a lot of time reviewing cases and in postoperative discussions with foreign specialists [Figure 5].
Figure 5: Discussion of cases. International training courses

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Many people complained of “night gatherings” and lengthy discussions on various topics late into the night. Hence, many new ideas appeared at this time. The impact of these think sessions on young doctors and scientists was incredible. Preparation of new reports was also extremely instructive. Five to six scientists and doctors would gather in his office. Slides were selected and texts were written. New slides just printed in the darkroom were brought to the office to be incorporated in the presentation. Together, they figured out how best to photograph and present a new frame assembly, or patient treatment, or how to show all the advantages of the new method.


  Training – One of the Most Important Sections of the Center Top


Since 1979, when Academician G. A. Ilizarov created the Faculty of Traumatology and Orthopedics with a course of transosseous osteosynthesis, 11,000 doctors were trained at the Center. It was very prestigious, interesting, and informative to come to the Institute to study. Many world experts proudly showed off that they studied at KNIIEKOT, as students of G. A. Ilizarov [Figure 6] and [Figure 7]. Coming to the Institute became a rite of passage in the Ilizarov club (ASAMI) that was forming around the world. Dr. Paley said, You needed to go to Kurgan to get your ticket punched to become a card carrying member.
Figure 6: First Brazilian course 1989

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Figure 7: “The Ilizarov method is a historical event that embodied in reality something that was not even dreamed of” – T. Kurokawa, Professor of Tokyo University (Japan), Kurgan, 1989

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In 1983, the first International course outside of Kurgan on the study and application of the Ilizarov frame and method was held in Italy at Longone al Segrino [Figure 6]{Figure 6} and [Figure 7].

Some at the Institute said to Ilizarov: Why are you giving away all our secrets? He replied “We If teach them what we have, we will come up with new methods.” Holding international conferences and courses has always been priority for the Center [Figure 8].
Figure 8: Prof. Gavriil Abramovich Ilizarov, Prof. Y.G. Shaposhnikov, and Dror Paley during the International Conference, Kurgan, 1986

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  Relations With Colleagues Top


Yes, it was not easy to work with Gavriil Abramovich. He wanted to see dedicated, industrious, creative, and honest people around him. Telling a lie was like a life sentence; such a person was never trusted again: neither his/her words, nor his/her deeds, or actions. It was better to own up to a mistake or an impetuous remark. This allowed new understanding and trust to develop. He was very stern that if clinical case discussions were not properly prepared, a job was not done on time or especially if an assignment was not completed. He was very pleased when a doctor perfectly prepared X-rays for a consultation and presented a good clinical case report. Dr. D. Paley wrote in his article: “His personality was entertaining to those being hosted, stimulating to those being taught, but frightening and frustrating to those who had to work for him. In his own little world, he was a very powerful man and ran his institute in an authoritarian style acceptable in his place and time.” Why frightened and frustrated? Yes, work with him was not easy. I agree. Sometimes, we felt frustrated after seeing him because we had not lived up to his expectations. However, he was usually right and time would prove that over and over. He was respected, but many people were intimidated by him. Frightened…? No. As for the authoritarian style, I wish that I could see a leader who has a different style. Are there such leaders? I believe there are not. Besides, he could be persuaded to change his opinion, if the reasons were good enough.

He spent a lot of time preparing new reports and felt very happy when he could make interesting slides and precisely formulated ideas. In the last years, he often prepared new reports and articles together with a group of doctors and scientists discussing every word, photograph, or slide. He did many surgeries. He liked to do everything himself. The surgery almost always contained new elements and doctors benefited from it. It should be mentioned that doing a surgery together with him was difficult. He wanted others to understand his every move. He did not tolerate when people were slow, and he often changed the plan of surgery midstream [Figure 9].
Figure 9: Ilizarov conducts an important experiment

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  Unique Memory Top


Ilizarov had an incredible memory. He remembered hundreds of patients, X-rays, interesting cases, and facts and could talk simultaneously about different subjects. He read one of the first manuscripts I had written about “the condition of fascia during limb lengthening,” and he made a few comments, one of which was to change a word he did not like. Since he was very busy, I came to him with the amended manuscript half a year later, but I failed to edit that very word [Figure 10]. He started reading the manuscript, reached the word in question, and said: “I asked you to change that!” How he could remember such a small detail, half a year later, during which time he probably edited dozens of other manuscripts and reports, saw thousands of patients and did countless surgeries. His photographic memory was uncanny!
Figure 10: A work-related moment for me at the office of Prof. Ilizarov

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Once an X-ray of a patient with a tibial fracture was lost, a decision was made to prepare a slide with exactly the same injury. It was late at night, more than a thousand slides had been presented; however, when we reached that replacement for the lost slide, he said: “This is not this patient's X-ray!” His mind was so sharp that even after 18 h of working that day, and being of advanced years, he noticed this small irregularity.


  International Business Trips Top


Starting from 1982 Prof. G. A. Ilizarov participated in many international congresses, meetings, and symposia. in Italy, and France they were able to reproduce his results.

The subject matter became less incredulous but no less interesting [Figure 11].
Figure 11: Ilizarov and me in Germany. Congress on external fixation, 1989

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At the Institute when our faculty has a chance to get together, we frequently reminisce on Gavriil Abramovich. We would recount many interesting, sometimes funny incidents and anecdotes. For example: A trip to conferences in Jordan and Israel was being planned back to back. Israel and Jordan had no diplomatic relations at the time (this was before the 1994 peace treaty between the two countries). We therefore needed to fly to Amman and then return to Moscow and from there fly to Tel-Aviv. Gavriil Abramovich suggested that since he was so close geographically to Tel-Aviv, we instead try and cross from Amman to Israel via the Allenby Bridge over the Jordan River. I talked to the organizers in Amman and Tel Aviv, and they said that this was not possible since this bridge was only used to allow some Palestinian families to cross back and forth. Gavriil Abramovich set his mind to trying to make the crossing at the Allenby Bridge. A car with a sign “ILIZAROV” was supposed to wait for him on the Israeli side. The Israeli Military were extremely surprised to see two men (Ilizarov and Shevtsov), with suitcases walking over the bridge from the Jordanian side. Their passports were stamped with Israeli visas. After getting through Jordanian and Israeli passport control and security checkpoints, Ilizarov could not locate the car with his name on it. He wanted to return to Amman, but that was also not possible. He was stuck on the side of the road when finally the car that came to fetch them was found. The congress was saved.

Yes, many things have changed during these years, new materials and new devices have appeared: “The Ilizarov method remains one of the greatest achievements of the 20thcentury, along with joint replacement, endoscopic surgery, and spinal surgery, bearing the biggest philosophical meaning” (Michel CR. Bulletin des Orthopedistes Francophones. 1998;36:1-4).


  What Was Ilizarov Like in the Eyes of his Kurgan Colleagues? Top


Dr. Paley asked me this, when we discussed the article he had written. G. B. Shaw said: “There are great people among ordinary people and great people among the greats.” Prof. Ilizarov was the greatest person among the greatest people. However, he was also a regular man, who lived through challenges from his surrounding society. Problems, which he had to deal with, were a hundred times more than the other people around him. He prevailed despite these challenges. As a regular man, he did make mistakes. As the Spanish proverb goes, “Como distal el oriente del occidente, Asi aleja de nosotros nuestas rebeliones” (“As the East is far from the West, So our rebellions are far from us”). This applies to all people because God forgives our sins, and it applies to Ilizarov more because what he did for humanity is much greater than his shortcomings. I worked with him for 16 years, and I cannot say it was easy. Everything had to be done quickly and without mistakes. Huge piles of documents had to be prepared. However, the experience of working with Gavriil Abramovich was invaluable. I also had very demanding parents who taught me to work hard without putting things off till tomorrow.

A famous German philosopher G. C. Lichtenberg said, “I always feel pain when talented people die, because the world needs them more than heaven”. This is true about G. A. Ilizarov – academician of the Academy of Science of the USSR, Honored scientist of RSFSR, Laureate of the Lenin prize, Hero of the Socialist Labor, Holder of three Orders of Lenin, Order of the Red Banner of Labor, Honored Inventor of the USSR, Honored Doctor of RSFSR, and Honored member of many international academies.

Acknowledgments

We would like to thank Dr. Dror Paley for assistance in the editing and preparation of this manuscript.




    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 6]



 

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