From Russia With Love

Gavriil Ilizarov, MD

ilizarov_G A Ilizarov 2_optDuring those darkened years of the Eastern Front, when German Panzers pounded their way into the heart of the Soviet Union, Jews of any means fled wherever possible—even into the wilds of Siberia. Having recently graduated from Crimea Medical School in 1944, Gavriil Ilizarov, MD, born of illiterate Jewish peasants, was hurriedly sent off to Kurgan, Siberia—a place more suited to misfits and enemies of the state. He was the only doctor in an area the size of a small European country. Cut off from the rest of the world, it was not a place most people would have chosen to stay when the coast was clear, yet, stay Dr. Ilizarov did, practicing medicine, founding a hospital, and mending bones in obscurity for decades.

ilizarov_Siberia-HiRes_optIn fact, Dr. Ilizarov was doing much more than merely mending bones. He was actually growing them. Limbs that may have been amputated elsewhere were restored to full strength. His method? Circular metal rings, called external fixators, would hold broken bone sections in place with wires, instead of the more conventional rods and bolts, causing far less damage to the surrounding muscles and tissues. The patients themselves would turn screws on the fixators that would distract the bone a millimeter a day for a prescribed amount of time. As the bones were slowly separated to the correct position to fix the deformity, new bone would grow in the created space. Dr. Ilizarov had happened upon this method by chance when treating a patient with below-the-knee amputation. The knee was fused at a 90-degree angle and the patient asked Dr. Ilizarov to straighten it so he could use a prosthetic leg. Dr. Ilizarov decided to cut the bone and apply an external fixator. He told the patient to turn the screws on the device while Dr. Ilizarov was on vacation. When Dr. Ilizarov returned, he was surprised to find that the knee was not only straight but that new bone had grown in place. The patient was ready for his prosthetic leg without any further operations. Many years of studies and successful cases showed that Dr. Ilizarov had discovered a revolutionary biological potential of bone: that when separated at the correct rate—a millimeter a day—it will grow more bone. He termed it “distraction osteogenesis.” (In fact, there are almost no limits to how much bone can be grown; we could all be as tall as Sun Ming Ming, who at 7’ 9” is the world’s tallest basketball player. The limiting factor is the muscles and soft tissues. In the case of a mature adult, they don’t grow.) ilizarov_EarlyFixator2_optYet, for more than a decade, practically no one besides Dr. Ilizarov and his patients knew about his device or our bones’ hidden potential. In the mid-1960s, however, a Moscow surgeon, who had heard rumors of the mysterious doctor growing bones in Russia’s far east, went on leave to Siberia and saw what Ilizarov was doing. When he returned to Moscow, he reported it to his superiors—not necessarily a good idea. The hapless surgeon was quickly demoted to working in a local clinic. Splintered femurs couldn’t simply be grown back into place. This was heresy. But when the Russian high-jumping star of the 1960s, Valery Brumel, destroyed his tibia in a motorcycle wreck in 1967 and couldn’t get it corrected after 14 conventional operations, the demoted doctor secretly told Brumel about this unorthodox wizard out in Siberia. Within a year, Brumel jumped two meters. Soon thereafter, Dr. Ilizarov had a brand new 350-bed hospital and more patients than he could treat.

ilizarov_EarlyFixator1_optSince this was the Cold War era, news of Ilizarov’s method did not immediately spread to the United States. Instead, word slowly trickled out as more and more Soviet bloc countries established clinics throughout the world using Ilizarov’s external fixators. Italian vacationers would return from Yugoslavia with the Ilizarov fixation devices attached to injured limbs, and hopeless fractures would be solid bone in a matter of months. Eventually, after communist Italian politicians helped set up special visits to Kurgan, an Italian doctor got permission to market the device in Europe for $10,000 and a new Mercedes. The west was slowly won over.

In the mid-1980s, Stuart Green, MD, of Ranchos Los Amigos Medical Center in Los Angeles and one of the world’s foremost experts on external fixation found himself at a conference in Italy on limb lengthening. During a colleague’s presentation, he muttered his utter disbelief in the method to the man next to him, Dr. Dror Paley of Canada. In fact, what he remembers saying was, “Bullshit.” Dr. Paley, however, had studied the method in Italy and the Soviet Union on a fellowship. He was a true believer, and fairly soon so was Dr. Green—or at least enough of one to want to go see Dr. Ilizarov in Kurgan—a nearly impossible goal for an American at that time.

“I knew I needed an invitation from Dr. Ilizarov to make this happen so I wrote him, asking for permission to visit,” Dr. Green recalls. “He wrote back: ‘Yes, we have no objection.’ ” Not exactly the most encouraging invitation, but for Dr. Green it was enough. After countless rejections, he eventually got the necessary visa because Russian officials at the embassy in Washington had the mistaken impression that he was going to be able to circumvent the Italian doctor’s license and market the fixator in the United States.

ilizarov_Patient1_optIn May 1987, Dr. Green and Dr. Victor Frankel of the Hospital for Joint Diseases and Orthopaedic Institute in New York finally arrived in Kurgan. In a matter of days, they were both converts.

“Ilizarov had his patients parade before us. It was as if we landed on a planet in which people’s bones were made of wax,” Dr. Green remembers. “You could do anything you wanted with them. You could stretch them. Bend them. There was no limit. Dr. Frankel and I knew the rest of the world had to know about this.”

When Dr. Green and Dr. Frankel returned to Moscow, the officials in charge of licensing immediately met with them and asked how they could begin selling it in the United States. Dr. Green told them that he didn’t represent any business interests and thus couldn’t help them make a deal in America. Later, they took the doctors to a press conference attended by reporters from all over the world, except the United States. When Dr. Green expressed his dismay at this slight, it seemed to catch his handler’s attention. That night, they took him and Dr. Frankel to a restaurant that only the apparatchiks, the top-level communists, were allowed to enter and plied them with vodka, cognacs made in all the Soviet provinces, and “shrimp larger than anything I’ve seen to this day.” They even supplied them with two beautiful “opera singers” as dates. After much toasting and drinking, his hosts brought up the fact that no American newspapers, including the LA Times, were going on a media tour of Dr. Ilizarov’s facilities that was starting in a few days.

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“The LA Times? I’m a subscriber. They’ve got to go,” Dr. Green responded. So they gave him a phone that very moment and he dialed the reporter’s number. Dr. Green only managed to wake the reporter’s poor wife; the reporter was out of town on an assignment. When Dr. Green finally did speak with the reporter the next day, the reporter liked the idea but thought there was no way the paper would send him. Dr. Green didn’t give up, and as soon as he got back to Los Angeles he contacted the medical editor at the paper, who, after looking at Dr. Green’s photos of Ilizarov’s clinic and patients, eventually decided to send the reporter on the press junket. On June 15, 1987, a front-page story with this headline, “Soviet Wizard of Bones,” ran in the LA Times and was subsequently published in another 400 papers.

The rest, as they say, is history. Ilizarov’s method, and subsequent improvements to it, quickly became the preferred choice for bone lengthening and for fracture stabilization of certain types of bone repair and defects.

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Photo Credits
Photo of remote Siberian village, Corbis
Photo of Gavriil Ilizarov, MD, courtesy Stuart Green, MD
Photo of a diagram of the Ilizarov method, courtesy Stuart Green, MD
Photo of young girl with device, courtesy Stuart Green, MD
Photo of the stages of bone growth using the Ilizarov method, courtesy Stuart Green, MD
Photo of log home in Siberia, courtesy Stuart Green, MD
Photo of Soviet doctors learning to use the Ilizarov device, courtesy Stuart Green, MD
Photo of Stuart Green, MD, and Gavriil Ilizarov, MD
Photo of doctors operating using the Ilizarov method, courtesy Stuart Green, MD