WV Executive

IN AN EMERGENCY ROOM at Charleston Area Medical Center’s General Hospital, a young man by the name of Tony Skeens who has his whole life ahead of him is asked to sign a paper giving consent for an orthopedic surgeon to amputate his left leg below the knee. It is 1974 and he has just been in a motorcycle accident that will change the course of his life. Although the surgeons question if the limb is salvageable, Dr. Luis Loimil decides to give saving it a try. Over the next 10 years, Skeens will undergo 12 operations and a severe bone infection that will result in a left leg that is five centimeters shorter than the right leg, malaligned and producing arthritis in his ankle, knee and spine. Over time he develops back pain to the point where he can no longer work and he requires constant pain medication. Like many orthopedic patients in similar situations, he has been told that nothing can be done and he will have to live with it.

The year is 1946. World War II, or the Great Patriotic War as it is known in Russia, has ended and thousands of young men are returning to Siberia with infected, non-healed or poorly healed limbs. Dr. Gavril Ilizarov, a general practitioner, has never seen anything like it, but he refuses to accept that “nothing can be done.” Using the tools available to him, including rings and spokes from the bicycle factory across town and threaded rods, he constructs a halo frame to go outside the injured limb to provide stability for healing. A new era in orthopedics is born.

Over several years, Ilizarov discovered that not only did his frame, or “gizmo,” provide stability for bone to heal, but he could, over time, manipulate the bone to correct deformities in limbs. In short, something could be done. The Ilizarov Method, as it has become known, takes advantage of the body’s fundamental bone healing properties. When a bone is fractured, a complex cascade of inflammation and new bone formation is initiated, which results in specialized bone cells called osteocytes creating an immature new bone substance known as osteoid. Given the needed stability, such as the Ilizarov frame, the osteoid will calcify, become structurally hardened and develop into mature bone, thus resulting in fracture union.

Ilizarov learned by serendipity that he could manipulate the body’s natural bone healing not only to produce bone union but also to restore a limb to its natural shape and length. He came upon this revolutionary technique when he was opening a gap in a patient’s limb in preparation for a conventional bone grafting to fill the void and restore the limb’s correct length. He went on holiday and told his assistant to slowly move the rings on the patient’s halo frame apart through nuts on the connecting rods to pull apart the ununited bone. To his astonishment, when he returned he found he did not need to bone graft the patient as the body had filled the gap with new osteoid. In essence, the body had viewed the widening gap as a constant fracture of increasing size and continuously made new bone to heal the deficiency. The net result was a restored limb of the correct original length and angulation.

Over time through multiple experiments, Ilizarov learned that if he increased the gap one millimeter per day, the body could maintain the pace and create an adequate amount of bone. Amazingly, not only did the bone lengthen, but through mechanisms not even fully understood today, the muscles, tendons and nerves also lengthened to match the bone. Nevertheless, Ilizarov labored in relative obscurity until 1974 when, during the height of the Cold War, one of Russia’s star Olympic pole vaulters, Valery Brumel, was in a motorcycle accident and sustained an open tibia fracture, which also became infected and would not heal despite the best efforts of the finest orthopedic surgeons in Moscow and 14 surgeries. Brumel, like Skeens, was also given the recommendation of amputation. Fortunately, someone suggested a last opinion of evaluation by an obscure doctor in Kurgan, Siberia by the name of Professor Ilizarov. Not only did the Ilizarov Method heal this fracture but the infection was cured in “the fires of regeneration,” as Ilizarov was fond of saying, and Brumel returned to international competition. Today in Kurgan, Russia, Ilizarov’s hometown, there is a 2,000-bed orthopedic-only hospital with more than 200 orthopedic surgeons practicing Ilizarov’s technique on patients from all over Russia and Europe.

I first learned of the Ilizarov technique in Orthopedic Residency in Cincinnati and naturally gravitated towards it because of my engineering background, having obtained a degree in Aeronautical Engineering from the United States Air Force Academy. Subsequently, I learned the majority of the method from pioneers in the field such as Dr. Dror Pauley, Dr. Stewart Greene, Dr. Mark Dahl and Dr. Charles Taylor. Interestingly, the technique was not introduced in North American until the 1980s and has been slow in its adoption. Only now with Taylor’s new computer controlled “spatial frame” has the technique started to take hold. I feel blessed to have been able to use the technique to help many patients during my 14 years in West Virginia, including Clyde Tyler, an all-state Capital High School running back who suffered from a tibia nonunion after a tibial fracture prevented him from attending ECU on a football scholarship. I have also had the pleasure of caring for Rosalie Young, who had a shortened limb from childhood polio, and Danny Hicks, who walked on a tibial nonunion for 20 years. One of my more gratifying cases was helping a gentleman by the name of Jeff Turner who was injured in an explosion in 1969 that produced burn contractures of his ankle. From that time until 2000 when I began treating him, he was only able to walk on the ball of his foot. Today he can not only put his foot flat on the floor but he is back to work at the U.S. Post Office. For me, this is the essence of Orthopedics—to be able to restore someone as close as possible to normal function and allow them to work and play as they desire.

Because of the frame’s stability, pain quickly diminishes and patients can walk, shower or even swim in the frames. Many also return to employment or school during treatment.

This technique is not for everyone and often requires up to a year in the fixator and multiple surgeries to gain the desired result. Nevertheless, with a good family support structure and a strong desire, all of my patients have been able to obtain their goals. The method has a wide range of application, including congenital shortening, fracture malunions and even soft tissue contractures. The potential for this technology and its delivery in West Virginia is limitless. Not only are individuals’ lives restored but they are returning as working, productive members of society.

Skeens recently underwent a computer-assisted total knee replacement, also a new technology now available at Charleston’s St. Francis Hospital, to complete his treatment. Look for him to be umpiring women’s fast pitch softball this summer, which is his particular passion and was his motivation for the procedures. If this technology can flourish in Siberia, attracting patients from all over the world, it can take root here in West Virginia. They come from many backgrounds but all have one thing in common—they have been told “There is nothing that can be done.” Through Ilizarov’s revolutionary technique, I can now tell them something can be done.