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Background and purpose:
Bangladesh Orthopedic surgeons have made a substantial contribution to the
development of Orthopedics in the world over. We make a brief review of
development of Ilizarov surgery in Bangladesh and I would like to intend to
give the way for farther understanding of Ilizarov surgery for the Orthopedic
surgeons all over the world.
Methods: Between January 2000 and January 2018,
28 patients (20 males and 8 females) with big defects following infection and
post traumatic injury of the tibia were treated. The mean age of the patients
at the time of surgery was 15.3 years (4-24 years). The Tibula was mobilized
medially to till the defect and was fixed with Ilizarov Fixator. The average
size of the defects reconstructed was 7.35 cm (6-10 cm). Patients were
evaluated functionally using the ASAMI scoring system.
Results: The Ilizarov technique, its biological law of tension stress theory,
experience and treatment strategies plays an important role in treating
Orthopedics and Trauma disorders in our country. For the last 3 decades
Bangladesh Orthopedic surgeons have made great gratifying achievements
Orthopedics and Trauma surgery.
Conclusions: Orthopedics and Traumatology is
constantly evolving, and we must strengthen the new Ilizarov innovation to
serve our poor patients.
Keywords: Ilizarov, Bangladesh Orthopedics and
Traumatologya
INTRODUCTION
With a
population 170 million, Bangladesh is a small country with substantial
diversity of economic development health care systems. A recent reported
demonstrates that the incidence rate for traumatic fractures was 4.5/1000 in
2018. After the liberation war in 1971 the Bangladesh Orthopedic surgeons have
made a substantial contribution to the development of Orthopedics and
Traumatology worldwide. Ilizarov compression-distraction osteosynthesis system
is an independent sector in Orthopedics & Traumatology has got definite
history of its own development [1]. Utilization of this method in orthopedics
attracts many scientists with opportunity without considerable surgical trauma
to eliminate severe congenital and acquired deformity which is connected with
great regeneration. Indisputably facts remain that compression distraction
method opens new era instead of using traditional methods of surgical
interventions [2-6].
In
1952, Academician Prof G. A. Ilizarov G A Ilizarov developed a principle of
trans osseous apparatus consisting of wires and metallic rings widely used in
Soviet Union. Since then this versatile method has been used in Kurgan of
Russia for the next 68 years [7]. In 1981 in Italian AO meeting in Bellagio,
Italy, Prof. Ilizarov presented three topics: Treatment of open fracture, the treatments of post- traumatic
osteomyelitis, bone lengthening. And that was the first western conference
outside Russia.
In Bangladesh this method becomes popularized in early late eighties. Now a quiet good number of orthopedic surgeons gathered knowledge and practice this method in their orthopedic management. In our country orthopedic surgeons invariably face some terrible situations like open fracture, open fracture with bone loss, post-operative or post traumatic osteomyelitis with implant in situ and chronic osteomyelitis along with low socioeconomic condition of our country. For all these cases there is no answer but Ilizarov. In some problems that have historically been refractory to standard treatments such as congenital pseudarthrosis of tibia and severe hemimelia’s, the Ilizarov solution should be considered primarily because of proven results. Amputation stump can be lengthened to facilitate prosthetic wear and, in some cases, eliminate need of prosthesis. Thin bone can be made wider both strengthening and cosmetically shaping limbs such as polio, club foot.
Many
tumors of bone can be managed by resecting tumor part and gap can be minimized
by bone lengthening. Now it is evident that Ilizarov method covers almost all
pathology of locomotor apparatus [8]. This method involves minimum invasive
procedure with least hemorrhage and joint sparing surgery permit early
mobilization and weight bearing which enhances early bony consolidation.
Deviation from normality is called deformity. Deformity cannot be accepted by
anyone. Academician Prof G. A. Ilizarov has introduced an excellent technique
for managing various problems of musculoskeletal system including fixed
deformity. The principle behind his technique has got 4 contributions:
1. Law of tension stress (Biological law) slow and steady
traction on a living tissue creates a stress that become metabolically
activated which results in an increase in proliferative and biosynthetic
functions
2. Methods of corticotomy
3. Distraction osteogenesis
4. Myriads of fixator [9]
Proper
passing of Ilizarov wires, exact point of entry and exit of wires and proper
placement of rings have definite role in excellent outcome. Academician Prof.
Ilizarov was always fond of saying “No surgeon is justified to do any
reconstructive surgery by Ilizarov technique unless he or she has got the
competent idea regarding the technique and apparatus” [10]. We should know the
basic principle of Ilizarov technique, the hardware, proper selection of
patients, safe corridors of the placement of wires. Understanding of
kinesiology and kinematics, anatomy and basic physiology are mandatory before
attempt to master this Ilizarov technique [2]. Development in orthopedic
surgery in the past 4 decades have indeed remarkable particularly so with
regard to compression-distraction method. Reconstruction by Ilizarov technique
is an art and skill, which can only be mastered by the discipline of
observation and practice. Ilizarov method has now gained a strong foot hold in
Bangladesh. Other techniques in orthopedics, one can learn in one or two weeks
but this technique one cannot learn in a short period of time. There is a
training Centre named Bari-Ilizarov Orthopedic Centre which is located at 1/1
block #E, Lalmatia, Dhaka-1207, Bangladesh. From 2015, 19 local Orthopedic
surgeons and 11 foreign (Nigeria-4, Malaysia-3, UK-1, India-1, Korea-1,
Jordan-1) Orthopedic surgeons got fellowship from this centre.
Introduction of Western
Orthopedics and Traumatology into Bangladesh
The plaster and fraction technology were also introduced in
Bangladesh long before because of their simple and effective results which
still in broad use today. Besides looking, facing, moving and measuring from
Orthopedics we get more objective examinations. Bangladesh Orthopedic society
is an Association of Orthopedics and Traumatology surgeons in Bangladesh. After
the liberation war under the guidance of the father of the nation Bangabandhu
Sheikh Mujibor Rahman. Dr. Ronald Joseph Garst, a missionary Orthopedic surgeon
from USA had come forward to give treatment to the war injured freedom
fighters. He established RIHD (Rehabilitation Institute and Hospital for
Disabled) which is now known as NITOR (National Institute of Traumatology &
Orthopedic Rehabilitation). Bangladesh Orthopedic Society was found on 24th
August 1979 with the objective to establish cooperation among the relevant
association in home and abroad for developing the Orthopedics and Traumatology
to world highest level.
Bangladesh road accident
Transportation
network in Bangladesh has progressed substantially in the past three decades.
In 20191075 Nobble accidents occurred with high mortality rate of traffic
injury. The major reason for so high mortality rate is the inefficiency of
Bangladesh traffic injury rescue system. Preliminary results showed that the
application of advanced rescue and treatment procedures could significantly
reduce the rate of fatality and disability of people involved in severe trauma.
At
least 5,227 people were killed while 6,953 injured in 4,702 road accidents
across the country (Bangladesh) in 2019. The number of road crashes and deaths
saw an alarming rise last year compared to the 2018. The victims who were
killed in road accidents in 2019 more than 50% were pedestrians. The statistics
has been prepared on the basic of reports 11 national dailies, online news
portals, TV channels and information collected from the branch offices of the
organization. Unskilled and uneducated drivers, faulty vehicles and roads, poor
traffic management, lack of awareness about traffic laws and use of road among
peoples, lack of political will and proper implementation of laws are to be
blamed for those crashes.
A total
of 3,103 road accidents killed 4,439 people and injured 7,425 others in 2018,
this was disclosed by “Nirapod Sharak Chai” safe road demand chairman [6].
Stage of Ilizarov surgery moves
towards world
Bangladesh
Orthopedic society has made brilliant achievement in Ilizarov. Spine, hand,
arthroscopy, arthroplasty and pediatric aspects particularly in the treatment
of orthopedic diseases and application of new technologies and our achievements
in Ilizarov surgery have reached the world advanced level. After more than 34
years of development of Ilizarov surgery Bangladesh Orthopedic society already
processes Ilizarov and Orthopedic rehabilitation other academic activities
nicely. Bangladesh Orthopedic society and its branches has greatly improved our
level of Orthopedic treatment and academic activities. In addition, BOS
(Bangladesh Orthopedic society) has joined several famous international
organizations such as ASAMI, APOA, SICOT, EFORT, EOF.
Minimally Invasive Surgery (MIS) by |Ilizarov technique has gained popularity in the last 3 decades and due to its minimal invasion, fewer complications, excellent recovery and expense is reduced. Biological Osteosynthesis (BO) is one of the excellent concepts in the management of deformity correction and orthopedic trauma which is widely applied in my country (Figure 1).
months (G) 5 months
follow-up (H ) 9 months follow-up (I) Radiograph of right tibia-fibul.
We have come to appreciate the
many indications for the Ilizarov method. I owe a great deal of gratitude to
Prof. G.A Ilizarov, the great self-taught orthopedic surgeon, a pioneer genius
with distinguished academic activities [3]. Ilizarov’s work inspired the
formation of ASAMI, which is an international academic society with national
branches and fortunately I am the President of ASAMI, Bangladesh Chapter at
present. I always encourage doctors who are interested in this field to become
the member of this association. lt is a place where we can learn, share ideas
and meet fellow “Ilizarovians”. In 2010, June 16-19, we attended 6th ASAMI
International Conference in Cairo for sharing new information regarding the
orthopedic problems. Bangladesh is the life member of this society. In June
2012, a 22-member group from ASAMI attended the 7th International Conference in
Greece. In September 18-21, 2014, 24 members attended the 8th International
Conference in GOA in 4th-7th November 1st Combined meeting of ILLRS-ASAMI, BR
meeting was held in MIAMI, USA, in 20th-24th September 2nd ILLRS-ASAMI
BR-Congress was held in Brisbane, Australia, 2016 with 38 members from
Bangladesh, in 29th-02nd September, 2017 3rd ILLRS-ASAMI BI Congress was held
in Estoril Congress, Portugal [4,5].
Bangladesh Orthopedic scholars
have made some gratifying achievements in the development of Orthopedics,
especially in Ilizarov surgery. However, we are still lacking in innovation of
basic research. This article reviews the history of Ilizarov Surgery in Bangladesh
and it gives a brief understanding of Bangladesh Orthopedics, especially
Ilizarov Surgery to the foreign orthopedic specialists. Orthopedics is
constantly evolving; we need to strengthen the ability of independent
innovation to achieve Orthopedic Surgeons Bangladesh in dream and better serve
to our patients.
ETHICAL
CONSIDERATIONS
Compliance
with ethical board review statement: This material has not been published and
is not under consideration elsewhere.
CONFLICT OF INTERESTS
The
authors declare that they have no conflict of interests. All authors clearly
stated that no benefits had received for this study.
FUNDING
There
is no funding source.
1. Bari
MM (2006) Management of Pes Equinus, Equinocavus and CTEV Deformities by G.A
Ilizarov Technique, pp: 7.
2. Bari
MM (2013) A color atlas of limb lengthening surgical reconstruction and
deformity correction by Ilizarov technique, pp: 13.
3. Bari
MM (2016) Ilizarov Compression Distraction Method in Pediatric Orthopedics, pp:
12.
4. Bari
MM (2014) Correction of leg deformities and restoration of function of lef
bones by Ilizarov Technique, pp: 9.
5. Bari
MM (2017) Ilizarov technique for ankle and foot reconstructive surgery, pp: 10.
6. Bianchi-Maiocchi
A, Aronson J (1991) Operative principles of Ilizarov: Fracture treatment,
non-union, osteomyelitis, lengthening, deformity correction. Baltimore:
Williams and Wilkins.
7. Paley
D (1998) Principles of deformity correction. Ilizarov GA: The principle of
Ilizarov method. Bull Hosp Joint Dis Orthop Inst 48: 1-11.
8. Paley
D (1990) Problems, obstacles and complications of limb lengthening by Ilizarov
technique. Clin Orthop Relat Res 250: 81-104.
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