I am pretty sure that most Americans have not thought about visiting Russia, especially to Siberia because of its reputation of being the place for misfits and enemies of the state. However, since the end of the Cold War, orthopaedic and podiatric surgeons around the world have traveled to this remote place to receive advanced training at the Gavriil Ilizarov Hospital in Kurgan, Russia. Known as the “Soviet Wizard of Bones,” Dr. Ilizarov was the original inventor of numerous external fixation techniques for trauma and limb lengthening techniques for deformity correction.
After traveling nearly 9,000 miles over a twenty hour period to Kurgan, Russia, I joined a team of physicians from the US and Canada. We were housed in modest hotel in close proximity to the hospital. For the next seven days, we interacted with the top surgeons in the world who were trained by Ilizarov himself. Our training was comprehensive centering on the treatment of complex ankle fractures, nonunion fractures, infected nonunion fractures, bone infections, deformity corrections, charcot deformity, compression and distraction treatments for nonunion, limb lengthening, and bone transport for bone regeneration.
The Ilizarov joint distraction is a relatively new technique involving the application of an external frame or fixator across the ankle joint. The Ilizarov frame supports the foot, ankle and tibia with fine tensioned wires similar to the suspension bridge principle. The frame is designed to allow full weight bearing after the procedure. As the ankle joint is immobilized by the wires, it may be necessary to wear a rocker sole shoe while it is in place.
The frame is used to open up the ankle joint. It can achieve this as it is fixed on either side of the ankle. The distance between the two points of fixation across the ankle joint is increased using bars and nuts. This stretches the soft tissues and opens the joint. The traction is maintained usually for three months; then the frame is removed. The initial operation is normally combined with an arthroscopic debridement of the ankle joint.
When our daily sessions ended, we socialized with the Russian physicians who opened up their homes and hearts to us. After much toasting and fellowship, I could not help reflect the progress that has been made since the early nineties. This experience was a real eye opener for me. As I returned home to the states I not only had a whole new perspective on medicine, but acquired new surgical skills for complex foot and ankle reconstruction.