The History of Circular Frames
The origins of using ring fixators with tensioned wires to treat orthopaedic injuries are inextricably linked with the man in the picture on the left – Gavriel Abramovitch Ilizarov. He was a Soviet Surgeon who was born in Poland in 1921, and grew up in modern day Azerbaijan, near the border with Dagestan. He went to medical school in Simferopol in the Crimea, and was sent to a rural hospital in the province of Kurgan. He became a surgeon in the regional hospital in Kurgan itself in 1950.
It is difficult to separate fact from myth, when looking at the origins of the circular frame and the ideas of Ilizarov. Some people believe that the idea came from looking at the spoke of a cycle wheel, while others believe that his ideas were much more due to considered thought and pragmatic treatment of war veterans, and less due to a single moment of inspiration. At the time, there were tens of thousands of men and women who had been injured in the war, and who could not be treated by conventional means due to infection, limited surgical equipment and expertise. Kurgan was also a centre for engineering in the Soviet era, and the availability of high quality steel means that the idea of using actual bicycle spokes may just be a myth.
Ilizarov became the Chief of the Department of Orthopaedic Surgery in Kurgan in 1955. He had a track record of treating difficult injuries successfully, but was treated with scepticism by other Soviet Surgeons, especially from Moscow, who viewed him as a rural quack. However, patients came to Kurgan from Moscow, after surgeons there had failed to successfully treat their fractures, and grudgingly, Ilizarov was accepted as a pioneer.
There were several other unconnected individuals around the world who had similar ideas about using ring fixators with tensioned wires. Unfortunately, they were also dismissed by the establishment doctors as quacks.
Although he was offered a post in Moscow, Ilizarov decided to remain in Kurgan, and built a centre – Kurgan Research Institute for Experimental and Clinical Orthopaedics and Traumatology. This opened in 1971.
Ilizarov was not known outside of the USSR until he treated some high profile patients from the West including Valiriy Brumel, an Olympic high jumper and Carlo Mauri, an Italian mountaineer. Mauri was involved in the Kon Tiki expedition, and the ship’s doctor was a Soviet. The doctor noticed that Mauri was dressing his leg – he had a wound breakdown over a non-healing bone. He suggested that Mauri visit Ilizarov, who successfully treated the fracture, despite 10 years of failed treatment in the West. Italian doctors invited Ilizarov to Italy in 1981. This allowed Western doctors to examine the techniques and use them themselves.
Initially, there was a lot of enthusiasm for the Ilizarov Method, but due to lack of understanding and adherence to the original method, there were a lot of failures and many abandoned the technique. It remains an important and powerful technique for treating orthopaedic problems.
A hexapod is a special type of circular frame that does not use straight metal rods to connect the rings of the fixator. Instead, special telescopic pistons or struts are used. These can be lengthened or shortened to change the orientation of the two rings to each other. The same principle is used in air simulators, and was developed as the ‘Stewart-Gough’ platform for testing tyres by Dunlop.
Charles Taylor, an American surgeon, is credited with developing the hexapod frame, although similar devices have previously existed, but not become popular. The hexapod allows the correction of deformities by a combination of sideways movement, rotation and angulation, that would be much more complicated with a straighforward Ilizarov frame. Computer software allows the gradual correction of deformities by gradually lengthening or shortening the six struts between the rings to achieve the correct orientation.