Volume 4, Number 1, February 2022

Historical Profile

Historical Perspective: Gavriil Ilizarov, MD

Christopher Iobst, MD1; Panel: Alexander Cherkashin, MD2; Robert Wigginton, Eng.3

1Nationwide Children’s Hospital, Columbus, OH; 2Texas Scottish Rite Hospital, Dallas, TX; 3Ortho Ideas, LLC, McKinney, TX
Correspondence to: Christopher Iobst, MD, Nationwide Children’s Hospital, Department of Orthopaedics, 700 Childrens
Drive, Columbus, OH 43205, E-mail: [email protected]
Received: January 20, 2022; Accepted: January 20, 2022; Published: February 1, 2022
DOI: 10.55275/JPOSNA-2022-0010

Robert Wigginton, Eng. (RW) – Mr. Wigginton is

currently the Chief Technical Officer at Metalogix
developing open posterior external fixator systems. He
was the Director of International Manufacturing for
Smith and Nephew and served as the surgical liaison for
North American visitors to the Ilizarov Center. For his
work, he was given the title of International Honorable
Professor by the Ilizarov Center and issued the decree
Christopher Iobst, MD; Alexander Cherkashin, MD; and “Friend of Russia” by President Vladimir Putin.
Robert Wigginton, Eng.

Christopher Iobst, MD (CAI) – Since 2016, Dr. Iobst Introduction

has been Director of the Center for Limb Lengthening and
Gavriil Ilizarov (1921–1992) would have celebrated his
Reconstruction at Nationwide Children’s Hospital. He has
100th birthday in 2021 (Figure 1). His contributions to
20 years of experience using circular external fixators but
the field of orthopaedic surgery are simply extraordinary.
never had the opportunity to meet Professor Ilizarov.
While he is most famous for the circular external fixator
Alexander Cherkashin, MD (AC) – Dr. Cherkashin system that bears his name, his principles of distraction
worked with Professor Ilizarov at the Center in Kurgan, osteogenesis revolutionized the field of limb lengthening
Siberia, from 1983 to 1995, and became the head of and reconstruction. Despite having no formal education
the hip pathology department. Since 1995, he has been in orthopaedics, he developed a method that became so
at the Texas Scottish Rite Hospital. He is currently the successful that an 800-bed orthopaedic hospital was built
Director for the Division of Clinical implementation for him in Kurgan, Siberia. The Russian Ilizarov Scientific
in the Center for Excellence in Limb Lengthening and Center for Restorative Traumatology and Orthopaedics
Reconstruction. became the largest orthopaedic clinic in the world.

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 Volume 4, Number 1, February 2022

RW: I think I was in awe when we first met him beside

the airplane. We had just spent a long time traveling from
Memphis to New York to Moscow to Kurgan. [We had]
very little sleep during that time. [When we arrived,]
we had a four-hour presentation from him presenting
case after case: “This is the patient, this is what I did,
and these are the results.” That would go on over and
over and over (Figure 2). You were just amazed at all the
indications that he could correct and the results that he
was getting. I was really amazed with him.

AC: My impression was a bit different.

At the time (as a frame of reference), that I was sent

to the Center in 1983, there were already some rumors
about Ilizarov. There was a book about him which
[provided] some details about the doctor from Kurgan.
There was even a movie about someone who was doing
magical [things] with bones. [However,] in this movie,
Dr. Ilizarov was a woman.

So, what was I expecting? I was expecting that upon my

entrance [to the Center], he would come meet me, and he
would be a great surgeon and a great teacher. I imagined
Figure 1. Doctor Ilizarov in surgery, Kurgan (photo courtesy him to almost hug me and start sharing his knowledge
of Dr. Cherkashin). with me.

So, my first impression was complete disappointment.

To commemorate his birthday, we thought it would For the first two or three months that I was there, I never
be appropriate to honor his memory with an article saw him. It was very difficult to get close to Ilizarov. He
dedicated to him. Unfortunately, the number of people was extremely busy. And who was I? I was just [fresh]
still alive that worked closely with him are dwindling. out of medical school, and initially, I was not allowed to
Consequently, the opportunity to get first-hand accounts take care of patients.
of him as a surgeon, innovator and human being is
CAI: Do you remember when you got to see him the first
priceless. We were fortunate to get two individuals who
time?
each worked closely with Professor Ilizarov, Alexander
Cherkashin, MD and Robert Wigginton, Eng., together AC: The first time I saw him, that was devastating too.
to discuss their relationships with him and provide He didn’t share anything. He anticipated that you would
insight into his personality. The following are excerpts watch and do what he is doing and absorb it. So, it was
from a 90-minute recorded virtual conversation held in an education by example. If you want to learn, you must
December 2021. learn to tolerate his character, to tolerate his way of
working, and tolerate his way of teaching.
CAI: Gentlemen, thank you for taking the time to discuss
Professor Ilizarov with me today. What was your first Now, I understand that that was his way of teaching. No
impression when you met him? one had taught him. He didn’t have any mentor in his

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 Volume 4, Number 1, February 2022

Figure 2. Grand Rounds review January 1988: Professor Ilizarov, Robert Wigginton, Jack Blair, Alex Lukianov with surgeons and
patients from the Russian Ilizarov Scientific Center (photo courtesy of Robert Wigginton).

life. So, he just probably didn’t know any other way of [In his defense,] he probably didn’t even have time to
doing it. He thought: “If no one was teaching me and I go and teach. He had so many patients. He had so many
achieved this, then why do I need to spend time to teach clinics. He also had a lot of responsibilities being the
you? If you are talented, you’ll stay and you’ll learn. If director of the Center (Figure 4). As the director, he would
not, I don’t need you.” tend to micromanage—that was his nature. He wouldn’t
let any detail slip: the color of the paint in the corridors,
CAI: That must have been difficult.
what ceramics to use in the OR, what equipment to buy, or
AC: Well, as soon as you understand his idea was what furniture should be in the doctors’ offices. He didn’t
to learn by example, you would want to stay… have time, and he was not a good manager of his time. As
because he was a genius. He was discovering things a result, that was probably the only way for him to teach.
that no one else could see (Figure 3). He was coming If you wanted to learn, you had to stay close to him.
up with new proposals that no one else was even
CAI: How was he to work with on a daily basis?
thinking about. But you had to be next to him to learn
it. You couldn’t wait for a time when he would explain RW: He was always very kind [to me]. Basically, [he]
it [to you later]. knew only two words in English and that was, “Bob,

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 Volume 4, Number 1, February 2022

Figure 4. Professor Ilizarov in his office. He had many

responsibilities as the director of the Center. Note the wrench
in his right hand (photo courtesy of RISC).

it was in a building which also belongs to the Center. So,

I was completely dependent on him, and when you are
Figure 3. Professor Ilizarov in surgery. He can often see what dependent on him, he would not necessarily be nice and
others cannot, Kurgan (photo courtesy of Alex Cherkashin, polite.
MD).
He was not a bad person on purpose. This was just
his way to achieve what he wanted. He was a huge
drink.” He was always there. If he couldn’t do it, then he workaholic, and he would expect everyone around him
would have someone else take care of my needs. So, for to work as hard as him or maybe even harder—definitely
me, he was very pleasant to work with (Figure 5). But I not less. If he ever saw any slack, even if it was not
also knew that he could be a terror too, and everyone at real slack but he thought you were slacking, he would
the Center was afraid of him. immediately tell you that you were not doing well or not
doing it properly.
AC: First of all, he was a very smart person. He was a
very good organizer. He knew how to behave differently He kind of—I hate to make it too strong—but he kind of
with different people. Depending on the expected treated us as his slaves. Not to the point that he would
outcome, he would act accordingly. We, the employees make you do something improper, but he anticipated
at the Ilizarov Center, were 100% dependent on him with that you would do exactly as he said and deliver the
our job placement and even with our apartment. I lived result that he expected. That’s it. And if not, then he
with my family in the dorm initially, which was property would become really, really mad. He had a very short
of the Center. Later, he would give you an apartment, but fuse. He could turn around and start screaming. When he

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 Volume 4, Number 1, February 2022

Figure 5. Ilizarov accommodating guests in his office, January 1988. Left to Right: Alex Lukianov,
Professor Ilizarov, Jack Blair, Robert Wigginton, Eng. (photo courtesy of Robert Wigginton, Eng.).

screamed, it was not because he wants to make you feel He was also very good with observation. If he found
bad but because he just could not behave differently. He something unusual, he would not stop. He would forget
had a very strong personality in everything. When he was time and he would concentrate on trying to understand
not happy with you, he would make sure that you felt it what was going on. He had a short temper, but if he
one way or another. found something unusual, he could spend hours just
trying to decipher the reason.
CAI: What were his biggest strengths?
Finally, although he was not an educated psychologist, he
AC: Because of his background (being self-taught),
was great at psychology. There were different strategies
he was not under the influence of [conventional]
that he used. When he was with a patient, he was the
rules. He also didn’t have a lot of detailed knowledge.
[quintessential] doctor. Every time a patient left a visit
Consequently, he was able to see things from a different
with Ilizarov, the patient felt better. Even if Ilizarov
perspective than other more “educated” people. This is
didn’t do anything—just talked to the patient—he made
what allowed him to make decisions about distraction
patients feel better. Similarly, with the doctors at the
osteogenesis. Because other people would never imagine
Center, if he wanted to achieve something, he made you
that by pulling two bones apart, new bone would start
achieve what he wanted you to do.
to grow there. The others had learned all their life that
you need compression, compression, compression. When he had guests coming to the Center, he knew
His mind was always open, and I think that was his that he was dependent on those guests’ opinions to
biggest strength. Sounds funny, but his lack of detailed spread [his methods] so he would be a wonderful
knowledge was a great strength. host. He would organize everything and would be

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 Volume 4, Number 1, February 2022

very attentive. He would do things to help them be AC: If it was a personal patient of Ilizarov, you would
accommodated better. He would share the knowledge— discuss the patient with Ilizarov, you would prepare the
maybe not all the knowledge—but try to give them patient, and you would get the plan from him (Figure 6).
what they wanted without giving what he did not want [In] surgery, you would start the frame application.
to give. Usually, you would put wires and supports and then he
would come in, often from another OR, and look at what
RW: He had two personalities: 1) What’s mine is mine,
you had done. He would give you (at least it was true
and what’s yours is mine because you work for me, or
for me) a very hard time, he would explain how stupid
you are working with me. 2) Like Alex said, he kept
you were, and how wrong the frame was assembled. He
the patient happy. He wanted to keep the foreigners
would say: “I didn’t say to do it this way! The plan was
happy too because he saw them as a source of income
completely different.”
for him. I had no problems with him at all. When we
would have surgeons present to him in the USA, the Often, he would change something: sometimes just
doctor would show him his patients and he would say, a wire or sometimes change the position of an entire
“That is not my method.” But he wouldn’t say what his support. Next, he would perform the osteotomy. Finally,
method was. you would do the x-rays and present the wet x-rays
to him. Usually, you had to chase him around in the
CAI: I understand there were approximately 50 surgeries
operating room to show him the x-ray. He might decide
a day going on at the Center. Did Ilizarov oversee all of
to do some additional manipulation and then go on with
these surgeries?
another surgery. He was always in between many ORs
AC: It would be very difficult to become one of doing different surgeries and keeping it all in his mind.
Ilizarov’s personal patients. Obviously, with 800 beds,
However, it could be quite unpredictable: sometimes he
you can imagine he could not physically treat all of the
would start the surgery with you—shooting the wires
patients. The majority of patients who became Ilizarov’s
himself and then leave you in the middle of the surgery
personal patients found their way to him through the
to see x-rays of a patient from another OR. You had to
Communist Party officials or through local government
be very attentive and understand that his mind worked
officials. The officials would write a letter to Ilizarov
differently. It was a nice education, but it was quite
requesting he take care of the patient. Another way to get
[nerve-racking].
to Ilizarov was via referrals from his old friends. If you
went the traditional route, you might not get to the Center CAI: What can you tell us about the stories of him
for 5 to 10 years. Depending on [the patient’s] pathology, smoking in the operating room?
the waiting line was pretty long. Still, there were a lot of
AC: As I explained, a typical day involved him walking in
patients, and he was not available to do surgeries on a
between multiple ORs. Sometimes [in between cases] he
regular basis.
would light a cigarette. He was a heavy smoker initially,
CAI: What was his typical surgical schedule? but he didn’t smoke much the last few years of his life. He
was warned that he was going to lose his limbs because
AC: He would have, depending on his schedule,
of diabetes. But early on, he was a heavy smoker, and he
anywhere from one to ten surgical days a month. When it
would smoke in the OR (Figure 7). He would look around
was a surgical day for him, I don’t think he ever did less
and sometimes the ash from the cigarette would fall on the
than five or six surgeries that day. Simultaneously, he
table and he would say, “Don’t worry, it is sterile.” He was
would have cases going on in at least five ORs.
spending the entire day in the OR and sometimes he would
CAI: What would it be like to operate with him? not change his sterile gown for three, four, or five hours.

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 Volume 4, Number 1, February 2022

Figure 6. Alex Cherkashin, MD, presenting a patient to Professor Ilizarov for the consultation after surgery
(photo courtesy of Alex Cherkashin, MD).

CAI: Since we are talking about surgery, I know that presentation where they would show their cases. They
trauma patients were treated at the Center. Did anyone would get up and say: “Ooh, look at me. I put this nail in,
ever get a plate or a rod instead of a frame? or I put these plates in and they failed. But I came back
and put on this beautiful frame. Look how good it is!”
AC: By default, you got a frame—frame, frame, frame— And the response was always, “Why didn’t you just put a
nothing else. frame on in the first place?”
The Center was built to prove that the Ilizarov method CAI: Did he have a favorite surgery?
was a valid concept and that it worked for each and every
orthopaedic or traumatology condition [where different AC: No, I don’t think he had a favorite surgery.
fixation methods were used]. I only remember one time He enjoyed challenges, that I can tell you for sure.
when a plate was placed there. I don’t think Ilizarov ever Remember, he started as a general surgeon doing
knew about it. That was a patient that was not able to go everything including obstetrics. He was even doing
plastic surgery. He once mentioned a patient that he had
into a frame.
[completely] reconstructed his nose. He had widespread
RW: I remember times when I would take orthopaedic interests. [Typically, he] had a huge line of surgeons with
surgeons there and they would do a grand rounds type patients waiting outside of his office. When something

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 Volume 4, Number 1, February 2022

patients like that, so it’s going to be very simple. No, he

was always on the lookout for something interesting.

CAI: Since he was self-taught, he must have had a lot of

complications, at least early in the process. How did he
deal with complications?

AC: Honestly, I never heard from Ilizarov that he had

any complications himself. According to him, “There
were surgeons who managed not to learn or be successful
in doing what I am [teaching].” Also, he would not
consider [calling it] a complication if something went
wrong but then was fixed. He would just find the person
who [was responsible] for this problem and he would
find a way to teach this person how to manage this
complication—how to bring it back to the initial plan.

For any questions about complications [he would say]:

“If you are diligent enough, my method doesn’t have
complications. If you know how to do it, then there won’t
be any complications. But if you are not willing to learn,
if you don’t understand, then don’t do it. Because there
Figure 7. Professor Ilizarov smoking while on break in the are no complications, you are just a bad surgeon.” I don’t
operating room (photo courtesy of RISC). remember him ever talking about complications, at least
not his complications.

interesting would appear, for example, just a stump of CAI: Why do you think that was the case?
a finger, he would spend an hour just looking at the
AC: Remember, he went through [a long] time when he
stump trying to see how to reconstruct it. He would look
was ridiculed and not recognized. His method was called
through the x-rays, think about interesting solutions, and
“the locksmith approach for orthopaedics”. [His method]
create a new frame construct. He loved challenges: he
was his baby and he was protecting it. Like any inventor,
would get involved very easily and forget about the time.
he was very jealous of his technique and didn’t want
On the other hand, for him, there was no routine surgery. it getting into the wrong hands. [Therefore], he would
For example, the pelvic support osteotomy [was an diminish the number of complications. Not because he
operation we were doing] in my department three or four did it on purpose, he was just thinking, “Ok, this was
times a week. It was routine for us. But he would find a little problem and I know how to solve it. So, you
something interesting. “You know what? Let’s do it a shouldn’t [label it a complication] because that could be
little differently. Let’s change the angle here… this is a easily solved.” That was his approach.
woman, and if you do this pelvic support, typically there
CAI: How did he evolve from being a small community
would be not enough access here in the perineal area.
surgeon to running an 800-bed hospital?
This is very important for women. Let’s do it differently
this time.” He often came with a different idea which was AC: He was a very hard worker and a very dedicated
frequently completely unexpected. You don’t anticipate person. He was also a visionary. He saw the possibilities
it. You think [to yourself], we’ve done hundreds of of the method he developed. Initially, I don’t think he

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 Volume 4, Number 1, February 2022

was planning to have a huge hospital. He was treating CAI: Where did the fixator equipment come from?
whatever patients he would get locally, and then word of
RW: The Center had its own manufacturing facility on
mouth started to bring him more patients from far away.
site on the hospital complex.
Some well-known and important personalities became
his patients. This gave him notoriety, even though he AC: The factory was part of the Center. It was
didn’t receive any support from the official government organized and built by Ilizarov. It had a separate budget
or interest from the official Minister of Health. Finally, it and separate accounting. We also re-used materials. I
become very controversial: people were getting in line to believe in the Center they are still re-using them. The
be treated in his hospital, but it was not even an officially last time I was in the Center in 2017 or 2018. I believe
recognized method of treatment. they are still using some parts from the time when I was
there.
The Central Institute of Orthopaedics and Traumatology
sent someone to audit what he was doing. Ilizarov RW: I had the responsibility of integrating the original
became very good friends with this person, Vladimir Ilizarov system into the USA. It was really a bucket of
Goliakhovsky. Vladimir then helped to propagate his rust. And it’s hard to sell sterile rust in the USA. [I was
ideas in the Central Institute and with the Minister of instructed] to ask Professor Ilizarov if we can change the
Health. Eventually, some famous government officials ring material to stainless steel so that it doesn’t rust and
were treated in the hospital and they got the government he said, “Oh, sure.”
to recognize [Ilizarov] and give him money for further
He had this theory that metal rings created a magnetism
development. And this is how it was. There was not any
around the wound and helped it heal. His theory was
magic. Just hard work and Ilizarov’s ability to believe in
never published. But if you look at it, [it is similar to]
himself and in what he was doing.
bone growth stimulators today. It is an electrical coil.
CAI: How was Ilizarov paid? He had already thought about the magnetic field that the
steel rings created.
AC: He had a salary. I don’t know what his salary
was, and I never heard about it. I don’t think it was huge. AC: He was a strong believer that [using] stainless steel
Based on the way he was living, I don’t think he was helps to treat bone pathology. And it was because of the
well paid. He was not spoiled by money. His salary was stainless steel that some of the properties of growing
maybe five or ten times bigger than mine but not more bone in his frame were so good. I don’t know how true it
than that. When he died, there was nothing left. is, but he was a believer in it.

He received a lot of support from patients. Gifts, food, CAI: How did new components get added to the system?
cakes, candies, trinkets. Most of his daily necessities
AC: The frame was always evolving. Ilizarov was always
(apartments, utilities, vehicles) were given to him for
working [on it]. He had a patenting department. They
free but moneywise, I don’t think he was very well
were a separate department in the hospital dedicated to
compensated. He didn’t need it, and he didn’t fight
patenting his ideas.
for it.
CAI: How did he like to spend his time outside of the
The Center had a garage with six or ten vehicles. He used
hospital?
each and every one of those cars. One vehicle (purple
Mercedes) was given to him by the Italians as a gift RW: His relaxation was that he loved nature and he
because he signed an agreement with Medical Plastics loved to be in it. I guess when he was in the USA, he
giving the exclusive rights to his name (Ilizarov) outside loved to shop. He would accumulate goods to take back.
of Russia. He loved Tic-Tacs.

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 Volume 4, Number 1, February 2022

AC: Whenever he had the chance (although later [in life] center of attention. He would do anything and everything
it was less and less possible), he would spend time in to keep it and tricks were his favorite way of doing it
nature. He would just spend time outside and he would (Figure 8).
walk around. When he was treated in New York for an
CAI: Bob, you had a unique experience being an
ulcer on his big toe, he was doing a lot of walks around
American traveling back and forth to Kurgan in the
Central Park. At a later time [in his life], he didn’t have
1980s. How many trips did you take back and forth?
much ability to do that.
RW: Over 35.
CAI: Did he have any pets? Or hobbies?
CAI: What was the climate like for Americans in Kurgan
AC: He had a dog and a couple of talking parrots. He
at that time?
liked to collect stuff such as pins and seashells. There
is a story about him going into a seashell store while RW: When I first started going there, you felt like you were
traveling. Ilizarov immediately went to some shell that being watched all the time. Really, I’ve had the opportunity
was absolutely unimpressive. He looked at it and said, to travel all over the world. People [all over the world]
“How much is that?” The owner said, “This guy knows want the same thing in life—food on the table, a roof over
his stuff because he went to the most expensive one.” He your head, and a better life for your kids. They’re (the
knew the rarest one. Russians) no different. One thing I can say is that once you
have a Russian friend, you have a friend for a lifetime.
When he was traveling and had time, he liked to show
tricks. He would show tricks to children sometimes in the I knew the KGB were always there. You knew your
hospital. Usually, when he was sitting at the dinner table, room was being bugged. You read the stories or see the
he always had a little kit of tricks with him and some movies about Russia and America and it’s basically true.
boxes where the coin would disappear. He liked to be the Everything was scrutinized the whole time. I was being

Figure 8. While waiting for his Mercedes to be repaired, Professor Ilizarov entertained the group with magic tricks in front of the
Shyka (Russian 57 Chevy stretch limo). Left to Right: Robert Wigginton, Eng.; Professor Ilizarov; Alex Lukianov, Nick Zelensky,
Professor Shevtsov, KGB (photo courtesy of Robert Wigginton, Eng.).

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 Volume 4, Number 1, February 2022

watched. One of the generals in the KGB was stationed temper and sharp tongue. He was examining the series
at the hospital. of radiographs and going back and forth reviewing them
while everyone was waiting to hear what he was going
I remember arriving the first time to the airport in
to say. Instead, he said, “Who was doing this? Could you
Kurgan. Everybody gets off the plane and Ilizarov’s
ask them to continue doing turns the same way?” He
stretch 1957 limo pulls up right next to the plane.
reviewed the radiographs again over the next few weeks
He came onto the plane and said, “You all come with and asked, “Do you see anything on these x-rays?”
me.”
“No, no,” was the answer.
Stupid me, I said, “What about our luggage?”
“Don’t you see the bone forming?” That is how the story
He said, “Oh, don’t worry about it. We will get it to the goes…
hotel for you.”
CAI: So, it was an anonymous nurse that we all must
I asked, “Well, how are you going to know that is my thank for the magnificence of distraction osteogenesis.
luggage?” The second myth involves the idea for his frame design.
Did it come from a wagon wheel or the spokes of a
He said, “Don’t worry. We’ll know.”
bicycle wheel?
The KGB was out.
AC: Ilizarov was travelling a lot since he was the only
CAI: Ha-ha. What a great story. Let’s finish our physician for a large geographical area. He used the horse
discussion with the opportunity to dispel several of the carriage as part of his traveling. He noticed the collar
orthopaedic myths about Ilizarov. First, the circulating around the horse connected to rods that pulled the sled.
story is that distraction osteogenesis was discovered by The horse would move everything through the collar
accident when a patient turned the fixation elements the and rods connected to the opposite rail. He was thinking,
wrong direction. “What if I had something not directly connected to the
AC: I heard the story from one of Ilizarov’s first bone but outside the bone to navigate…”
colleagues (Valeria Trokhova) who claims she was [Caveat to the above explanation] Ilizarov was known to
present at the time. The initial design of the frame was to be a big entertainer and liked to be the center of attention.
hold fractures or a knee arthrodesis in place. (Ilizarov’s He might sometimes tell different [origin] stories himself
first patent shows an example of a knee arthrodesis.) depending on his audience. Therefore, it is still not
Patients were asked to perform compression from time exactly known what the initial spark was which made
to time during treatment since tension in the crosswires him think about a circular fixator…
would often decrease over time. Because Ilizarov was
traveling so much, it was common that other physicians CAI: Is it true that he would cut the bone by performing
would care for his patients. Radiographs were regularly a corticotomy that spared the intramedullary blood
obtained to monitor the healing and callus formation. vessels rather than a traditional osteotomy that violates
the intramedullary space?
In this instance, the physician was scared to show the
radiographs to Ilizarov because the nurse had accidentally AC: Ilizarov would sometimes explain what he believed
turned the distraction nuts the opposite way. (All patients but do something completely different. He was a strong
in Kurgan were kept in the hospital for their entire believer that you must preserve the osteogenic tissues.
course of treatment.) Everyone was expecting to hear a That was not a joke. But [as for] the corticotomy, I don’t
stern critique, since Ilizarov was known to have a short think he ever did it the way it was described.

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 Volume 4, Number 1, February 2022

His principles were to avoid a large incision, never pull

the periosteum from the bone, and never use a huge
osteotome. He made a little incision, but there was no
soft tissue protection—there were no elevators. He used a
very narrow osteotome. But where did it go? It would go
everywhere. He would start with a cortical cut, but then
he would go through the bone—often too deep. He would
say: “Oh, you know, the arteries, they’re OK. They
actually move away from the object if you are not trying
to hit directly on the artery.” For the posterior cortex he
would put his narrow osteotome longitudinally and do
a couple passes along the posterior cortex. That was his
idea of avoiding the intramedullary vessels. However, he
never explained what he was doing.
Figure 9. Professor Ilizarov performing corticotomy, Kurgan
He would go through the bone in multiple passes— (photo courtesy of Alex Cherkashin, MD).
in and out, in and out. It would take sometimes 20
That was his way of making a “corticotomy”
or 30 minutes to finish the corticotomy. At the end,
(Figure 9).
he would grab the two rings and just crack the bone
using osteoclasis. When I first saw him performing the Surprisingly, Ilizarov himself never published it, so there
corticotomy, I thought, “#@$%^, he is going to crush is no picture or publication of the corticotomy as done by
this bone…” because he had done so many passes Ilizarov. Probably the first documentation was published
through the cortex. by Vladimir Schwartzman. Then Dror Paley did his
interpretation of the corticotomy with drawings showing
In the majority of cases, his corticotomy looked more
the use of periosteal elevators which Ilizarov never used.
like a shatter-otomy with multiple fragments. He has
There was no protection on the periosteum with his
a patent somewhere stating that the multi-fragmented
method.
osteotomy produces better regenerate because of
the huge area of healing. I don’t think it was ever CAI: Fascinating to hear the real story behind each of
proved on a scientific level though. Very often what these orthopaedic “urban legends” surrounding Ilizarov.
you would see on the x-rays was an oblique or spiral I can’t thank each of you enough for donating your
bone cut. It was not a straight line—almost never a time today and providing your insights about Professor
straight line. Sometimes the cut would propagate into Ilizarov. I am sure JPOSNA® readers will appreciate
the wires. He would look at them and say, “Let’s put this opportunity to get a better idea about who Professor
another wire to have better fixation of the fragment.” Ilizarov was as a physician, as a teacher, and as a person.

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