Based on the principles of distraction osteogenesis originally elucidated
by Gavriil A. Ilizarov, Limb Lengthening and Reconstruction Surgery
successfully covers the entire current spectrum of Ilizarov-based surgery. It
was not long ago that Ilizarov, who is now universally known as the father of
deformity correction, was working in Siberia and was unknown in the West.
Fortunately, a group of Italians "discovered" the Ilizarov
circular fixator in the early 1980s and brought a completely new branch of
orthopaedic medicine to the rest of the world.
Thereafter, awareness of Ilizarov and his contributions quickly increased,
especially after the 1992 English-language publication of his major work,
Transosseous Osteosynthesis, which detailed the principles he had
spent nearly his entire professional life developing and applying
clinically.
As "Ilizarov fever" began to hit the United States in the
mid-1980s, a number of American orthopaedic surgeons became dedicated
Ilizarovians, including John Herzenberg and Dror Paley. Both were instrumental
in solving and outlining the geometric basis of deformity correction, which
later became the foundation of the center of rotation of angulation (CORA)
method. With Herzenberg's assistance, Paley published Principles of
Deformity Correction, the preeminent reference on limb reconstruction
surgery, ostensibly based on the CORA technique.
S. Robert Rozbruch, a former fellow of Paley and Herzenberg, returned to
New York from Baltimore in the late 1990s to establish, along with Ilizarov's
daughter, Svetlana, the Institute for Limb Lengthening and Reconstruction at
the Hospital for Special Surgery. Svetlana Ilizarov, an expert in Ilizarov
surgery and rehabilitation, trained with her father in Kurgan, Siberia.
Building on their clinical training with the masters of the field, Rozbruch
and Ilizarov have produced a textbook that is different from those produced by
their mentors. The book is not based on theory or geometry; rather, it is a
highly inclusive and clinically-relevant synopsis of current Ilizarov
therapy.
This 695-page book is particularly appropriate for senior residents and
fellows—especially those specializing in trauma, pediatrics, joint
reconstruction, tumor, the upper extremity, and, of course, limb lengthening
and reconstruction. The book is also a great resource for experienced
surgeons, particularly with regard to the review of rarely encountered
deformities.
Written by a group of international leaders in the field, Limb
Lengthening and Reconstruction Surgery contains fortynine chapters and
includes a foreword by Paley. The text is very readable, even for junior
residents. Virtually all aspects of deformity correction (both congenital and
acquired), limb reconstruction, and limb lengthening are covered. Divided into
thirteen parts, the book begins with a fascinating biography of Ilizarov,
which was written by his daughter. Part II provides a review of the biological
and mechanical principles underlying distraction osteogenesis and the Ilizarov
method. Parts III and IV describe external fixation, both unilateral and
circular, in treating acute trauma, nonunions, and malunions, primarily of the
lower extremity. Parts V, VI, VII, and X cover specific applications of the
Ilizarov method to the foot and ankle, knee, hip, and upper extremity. Other
sections relate to pediatrics, reconstruction after tumor resection, stature
lengthening, technology, and postoperative care.
The text is effectively supplemented by many visual aids, without which
visualization of some complex procedures and techniques, such as application
of the Taylor spatial frame to tibial plateau fractures (Chapter 6) and
malunions (Chapter 12), would be difficult. Other particularly
well-illustrated chapters include Chapter 14 (Bone Defects) and Chapter 23
(Proximal Tibial Osteotomy for Medial Compartment Osteoarthritis of the Knee
Using the Taylor Spatial Frame).
In true Ilizarov style, the book also contains numerous case examples, many
of which are from the personal experience of the editors. These cases are
often followed by a section outlining common complications, such as pin-track
infection, joint contracture, residual deformity, regenerate fracture, or
docking failure of transported bone. Various treatment options and surgical
techniques are also reviewed and together provide good preoperative guidance.
Perhaps the most salient feature of the book is a "Review of
Literature" table, which is included in many chapters and facilitates
additional directed reading.
This book deserves much praise; however, a few aspects might be modified
for future editions. For example, although the extensive visual aids
throughout the text are welcome, many of them, especially the histologic and
intraoperative photographs, would be more illustrative if they were in color.
There are only two color figures: one is an illustration of the bone-forming
units at the osteotomy-distraction site, and the other is of the
Internet-based Taylor spatial frame program. Although certainly helpful, they
are randomly placed on an inserted page in the middle of the book. This reader
wishes there were more of the same throughout the book.
Supplementing textbooks with accompanying CD inserts has become a recent
trend. Many of the cases described in the book pertain to relatively rare
disorders, such as tibial or fibular hemimelia (Chapters 30 and 31), and a
complementary CD might serve to expand on the clinical case examples that are
provided in the textbook. Finally, for the novice, a glossary of terms would
be helpful.
The editors are to be congratulated on their fine selection of contributors
and for providing a comprehensive, invaluable resource that should accompany
the prior works of Ilizarov and Paley. The book is essential reading for
specialists with an interest in Ilizarov reconstruction and should be included
on the shelf of any medical library.