How much training with the Ilizarov ring fixator and implantable nails do orthopedists not specializing in the Ilizarov method typically have? Around the world there are many knee replacement surgeons, spine surgeons, etc., that also list cosmetic lengthening as one of the things they will do for patients who come to them, but when I had consultations with some of these orthopedic surgeons who didn't have fellowship training focused on the Ilizarov subspecialty, I'd get wildly different opinions on certain things. One example was a spine surgeon who preferred to do CLL with a monorail fixator and said that fibula fixation is not done because it is more or less a superfluous bone as necessary as our appendix. However, an Ilizarov trained surgeon told me that not fixing the fibula properly could lead to a host of long term problems.
So are most orthopedic surgeons introduced to the Ilizarov fixator and the general concepts of lengthening at some point, and it's just up to them how much training they want to put into it?
This is such an amazing question, and the specific case you picked is the perfect example of the dangers of a surgeon not knowing the intricacies of limb lengthening.
It really depends on which part of the world the orthopedist is trained.
It is safe to say that most orthopedic surgeon from the western world has minimal to no training on the Ilizarov Method, circular fixators and lengthening principles. If one is lucky enough to train in a city where there is a limb lengthening surgeon, they will be exposed to maybe a handful of cases?
Most of my practice is limb lengthening and deformity reconstruction and residents from Johns Hopkins, University of Maryland's and PCOM's programs rotate through our services. Every chance they get, residents would rather participate in a knee replacement or a femur fracture treatment, rather than assist an Ilizarov or lengthening case. It is not in the mainstream mentality to be interested in the Ilizarov Method. One may read about it once or twice if they are keen enough during training but that's it.
A surgeon saying the fibula is superfluous does not understand anatomy. He does not understand that the distal fibula is a key part of the ankle mortise joint. That even a few milimeters of proximal displacement can have crippling effects on the ankle function. He does not understand that the proximal fibula has important stabilizing structures attached to it such as the biceps femoris and lateral collateral ligament, and that pulling it down will invariably have an effect on the knee joint's biomechanics. They do not understand that the interosseous membrane is such a powerfull structure, that failure to fix the proximal and distal tibio-fibular joints will prevent the lengthening forces from concentrating at the regenerate site.
I will tell you even the most worrisome part: Now that implantable lengthening nails are an option, a lot of orthopedists think that lengthening is easy, because they know how to insert a regular trauma nail for fracture treatment. What they fail to recognize is that, the nail insertion itself is the easy part. Lengthening is still lengthening, and it is preventing and navigating through the obstacles that constitutes a thin line between success and complete failure.
for Lang319:
hello，Michael J. Assayag, MD，you are a orthopedic surgeon with a trauma and limb lengthening and deformity reconstruction specialization .
Thank you for answering my questions on other topics
Which city are you in? You have other operations besides LL, I have other questions and I want to consult you
I practice at the International Center for Limb Lengthening, based in Baltimore at the Rubin Institute for Advanced Orthopedics. I routinely perform bowleg (genu varum), knockknee (genu valgum) corrections, non union repair, malunion reconstruction, bone defect reconstruction, osteomyelitis treatment, and all kind of trauma except pelvic and spine trauma
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Topic: External doctors opinions on CLL (Read 484 times)