Transosseus Osteosynthesis is a revolutionary concept in orthopaedics by which bone can be made to grow even after skeletal maturity. Not only bone, but nerves, vessels, tendons, muscles, ligaments, fascia and even skin can be made to grow. This is possible by a unique and revolutionary system introduced by G. A. Ilizarov of Kurgan, Siberia in 1951. The Ilizarov system produces miracles, which always cause awe, and elicits standing ovations in orthopaedic conferences, due to their apparently magical results.
This system gained popularity in 1990 and gradually rose to its peak until 2000, by when it had become popular all over the world, with surgeons producing similar reproducible results worldwide. Then came an era of wholesale modifications in the design of the apparatus, and an increasing tendency to replace the thin wires with thick Shanz pins. Around this time started a decline in the popularity of the system. Surprisingly, by 2015, the popularity of the system had declined to such an extent that it was infrequently used only in a few centres, and most younger generation orthopaedic surgeons were either unfamiliar, or afraid of, this system.
When I resumed orthopaedic practice after a thirteen year break, I was surprised to find that Ilizarov had completely gone out of fashion, and both surgeons and patients were scared of the system. Having experienced the unique capabilities of this system, I understood that the problems were manifold. A few badly-applied frames and improperly done surgeries, wholesale design changes deviating from the Ilizarov principles, the heavy frame and rings, improper indications, lack of thorough understanding of the scientific principles, and a paucity of training facilities probably caused this decline in popularity.
The first five patients I saw after my return were all complications of internal fixations, and I applied the Ilizarov frame in four. The results (as I expected) were spectacular, and my internet posts and shares to various orthopaedic groups brought many comments and more questions. I suddenly realized that a large number of orthopaedic surgeons are unfamiliar with this magical system, and existing books are voluminous and too theoretical to allow a surgeon to actually operate after reading them.
This book attempts to fill that gap. If you are a young surgeon, with limited or no experience in Ilizarov system, this book will at least dispel all your apprehensions and allow you to begin applying basic frames, and experience the magic of Osteosynthesis. If you are a practising Ilizarov surgeon or a specialist, you will find something to appreciate or criticize. I have shared my thirty years of experience with this system, and sincerely hope that my readers enjoy reading this as much as I enjoyed writing it in British English. L. Prakash
Chennai
1.3.2016
Foreword
Dr L.Prakash has been my close friend for the last thirty years. He was one of the early arthroplasty surgeons in this country, who was manufacturing cementless hips and ceramic heads way back in 1991.
I have always felt that Prakash has been extremely lucky to be at the right place at the right time. He saw hip replacements evolve, and saw history being made. His unending passion for arthroplasty took him to every surgeon of repute and he has worked under the legends in joint replacement, including Mullar, Ring, Freeman, Goodfelow, Monk, Wroblowski, Young, Taylor, and many others, each of whom bears a joint in their name.
He has donned many a hat, as a surgeon, industrialist, implant manufacturer, and then an author, artist, sculptor, designer, inventor, scientist and teacher. His current avatar as a medical illustrator and author is most welcome, because he has begun filling important gaps in medical literature. Orthopaedic books are usually written in a dull stiff language, making it difficult for non native English speakers to understand them fully. Using a simple language and short sentences, Prakash has written this book in his own narrative style.
The accompanying DVDs are shot really well from correct angles. The narration and text are perfect. The book is abundant in illustrations and short in words, explaining everything with great clarity.
The book would be of great use to any surgeon involved with arthroplasty and is a must-read for every young resident hoping to specialize in this exciting field. Written with great passion, full of personal anecdotes, this book reads like a story book, but is more informative than most text books on primary hip arthroplasty.
He has devoted an entire section on hemiarthroplasties, something I have never seen in most arthroplasty books. Sprinkled with personal advice and many tricks and tips one doesnt find in the literature, this atlas is a pleasure to read and savour.
It is a pleasure to write a foreword to this book.
Dr Mayilvahanan Natarajan
Former Vice Chancellor MGR Medical university.
Former President Indian Orthopaedic Association
INTRODUCTION
Knee replacements have now come of age. In the Asian continent, the importance of this method of treatment is paramount, because the incidence of knee arthritis in our parts is much more than that in the western world.
As opposed to the hip joint, which is hidden and camouflaged by layers of muscle and fat, the knee is an exhibitionist that the patient sees and feels each day. Globally there is a tremendous difference between the epidemiology of primary osteoarthritis of the knee and the hip. John Good fellow of Oxford and former editor of the JBJS always used to remark, “I am surprised that primary osteoarthritis of the hip is practically unknown amongst the Asians. I suppose that this is very well compensated by the extremely prevalent primary knee arthritis. I suppose that the extremes of flexion during squatting somehow protects the hip at the cost of the knee joint.”