Tiny Wires Stabilize Fractures : Soviet ‘Wizard of Bones’ Pioneers New Treatment

A dreary industrial city east of the Urals, Kurgan has little to attract visitors, but every day there is a steady stream of arrivals, Soviet and foreigners alike.

They are drawn here by a famous doctor, a “wizard of bones” who has defied the Soviet medical establishment to pioneer his own method of curing the lame and the halt.

He is Gavril Avramovich Ilizarov, and his system of treating the worst fractures and the worst examples of limbs gnarled by congenital defects has attracted increasing international attention and respect.

Ilizarov, a former country doctor who now has a 1,000-bed hospital and a staff of 1,500 medical specialists, says his method simply helps nature to grow new bone tissue.

But his combination of a unique device that holds bones in place with extremely thin wires and a theory of preserving blood circulation within the bone marrow is regarded as a potential breakthrough in orthopedics.

Dr. Stuart A. Green, a Los Alamitos, Calif., orthopedist who recently visited Ilizarov’s hospital, said in a telephone interview that there is no comparable treatment in the United States.

In the United States, a widely used standard technique to treat severe fractures uses thick pins screwed into the bone that protrude through the skin; these are connected to an external frame, according to Green. By comparison, the Ilizarov technique involves stabilization of fractures with numerous extremely thin wires that criss-cross the bone. These are anchored to a relatively complicated external frame made of rings that circle the broken limb and longitudinal bars that connect the rings.

“He’s invented a better mousetrap and the world is beating a path to his door,” Green said. He predicted that Ilizarov’s technique will be used widely in the West as more doctors become aware of it.

Already, Green said, the Ilizarov method and his bone-setting devices are increasingly popular in Eastern Europe and in Italy, France and Belgium. Many Americans, he said, have traveled to Italy to receive the treatment at a clinic near Milan.

Green himself, as well as doctors at Stanford University Medical School and at the Hospital for Joint Diseases in New York City, have begun to try the technique on patients in a few cases.

In the Soviet Union, the fame of Ilizarov’s clinic has led to an enormous backlog of would-be patients. The doctor acknowledged that some patients wait as long as 10 years.

If the Soviet government gives its permission, and Ilizarov expects it to do so, he will establish branch clinics in several other cities, including Moscow, and triple the number of patients who can receive his treatment. In addition, he told a group of visiting foreign correspondents, 1,200 doctors are being trained in his method at Kurgan.

So far, he said, about 900,000 patients have been treated with the aid of techniques that he first used in 1950, when he was a 30-year-old physician in the lower ranks of Soviet medicine.

Ilizarov’s accomplishments were demonstrated earlier this month to the foreign press in the auditorium of his concrete-and-glass hospital, built four years ago at a cost of 50 million rubles (about $80 million at the official exchange rate).

Photographs were shown of patients when they began the treatment--for a variety of deformities. Many had one leg shorter than the other; several had come to the clinic with such congenital defects as severely bowed legs, twisted arms and feet or with smashed hip joints.

As Ilizarov described their treatment, many of the patients appeared in person. None was completely cured but all appeared to show improvement when their condition was compared to the photographs taken before treatment.

Lengthening of legs by as much as six inches seemed to be commonplace. Persons who had arrived with twisted arms and legs appeared to be almost normal, and were smiling happily.

A dark-haired, 13-year-old girl named Nellie said she had come to the clinic with one leg about an inch and a half shorter than the other because of polio. Now, she said with a shy smile, treatment has reduced the difference to a tiny fraction of what it was.

Eight-Year Wait

Marina, a 29-year-old economist, suffered severe pelvic dislocation after childbirth. She had to wait eight years for admission to the clinic but now, near the end of an 18-month course of treatment, she walks with a barely perceptible limp and none of the pain she suffered before, she said.

Ilizarov’s method has been used to “grow” fingers from stumps and to add a foot or more to the height of dwarfs. In one of his more celebrated cases, he treated Soviet high jumper Valery Brumel, who had suffered injuries in a car accident that left one leg shorter than the other.

On a few occasions, Ilizarov acknowledged, he helped to add inches to the height of Bolshoi ballet dancers, but now he refuses to take such patients, on the grounds that the procedure is more cosmetic than medically necessary.

‘We Can Save Limbs’

Ilizarov, whose tall white hat and dark mustache give him the look of a French chef, said that using his technique, “we can save limbs rather than amputate them.”

Ilizarov’s method involves extremely thin wires.

“They go all the way through the bone and out the other side,” said Green, the California doctor, who observed Ilizarov’s procedure.

A drill is used to make an opening for the wires and they are then connected to a metal ring known as an “external fixator.” This holds the broken bones in place and allows gradually increased tension to be applied to the wires.

“We create strictly calibrated tension and that triggers growth processes in cells and cell division . . . ,” Ilizarov said. “Nature itself generates such tension in the years of most rapid growth” during childhood. Commented Green: “It’s as if you are growing again.”

Theory’s Key Point

The rig is awkward, but Ilizarov says it does not interfere with blood circulation, a key point in his theory, and it allows the patient to use the limb rather than spend weeks in a plaster cast.

Despite the awkwardness, patients at the hospital moved about freely, exercised and even played badminton in their rigs.

Some patients resist the treatment, Ilizarov said, because of “excessive fear--a psychological barrier” related to the use of wires going through bone. But he said it is no worse than an inoculation.

Ilizarov said his method can be used for simple fractures even though the best results are with the worst breaks.

Still Controversial

Despite his international reputation, Ilizarov was turned down recently for membership in the Soviet Academy of Medical Sciences. His method is still controversial among Soviet specialists, and he has openly challenged a Moscow institute working in the same field.

Asked about the rejection, Ilizarov shrugged and said, “They don’t have any achievements, so if they voted me in they would look bad by comparison.”

Although he was reluctant to talk about his patrons, it is obvious that Ilizarov has strong backing from the Ministry of Health and the Soviet Council of Ministers, as well as top party leaders. His hospital has the latest Western equipment, including electron microscopes, which other Soviet facilities lack.

What he has done is an impressive accomplishment for the 66-year-old son of illiterate peasants who belonged to a Farsi-speaking Jewish national group from the Central Asian region known as Dagestan.

Late School Start

Ilizarov said he was not sent to school until he was 11 years old and then was enrolled in a Russian-language literacy course that provided a stipend of six rubles a month. With that background, he entered the Crimean Medical Institute, but then had to move to Kazakhstan because World War II had started and German troops were advancing into the Crimea.

After graduation, he was assigned to the Kurgan region, a vast territory where he was the only doctor at a time of wide-ranging epidemics. Later, in 1950, his territory was limited to the city of Kurgan, which now has a population of 340,000.

Although he has often been invited to move his clinic to Moscow, 1,200 miles to the west, Ilizarov has balked.

“I am accustomed to this place,” he said. “It’s as good as anywhere else.”

Times medical writer Robert Steinbrook, in Los Angeles, also contributed to this article.