Reminiscences of Professor G. A. Ilizarov Visit to America

Background I visited Kurgan, USSR in May 1987, the first American to do so, joined a couple of days later by Dr. Victor Frankel, President and surgeon-in-chief of New York's Hospital for Joint Diseases (now called NYU Langone Orthopaedics). I learned of Gavriil Ilizarov's work while attending a meeting in Lago De Garda, Italy in 1986. There, orthopedic surgeons from northern Italy (who first visited Ilizarov in 1981) presented their early distraction osteogenesis cases. At the meeting in Italy, I met a young Canadian, Dror Paley, who had visited Ilizarov's clinic with a group of Italian surgeons in 1985. Paley confirmed the validity of what I was seeing. And so I decided to go to Russia in the spring of 1987 [Figure 1].Figure 1: Ilizarov welcoming Green to Kurgan, May, 1987.After a few days in Kurgan, seeing Ilizarov's limb lengthening and deformity correction cases, Frankel and I concluded that we had landed in a place where people's bones are made of wax, to be re-shaped at will to overcome any congenital or acquired skeletal abnormality. At the end of our visit to Kurgan, Frankel invited Prof. Ilizarov to New York as the guest speaker for the Alumni Association meeting of the Hospital for Joint Diseases, which eventually included a series of lectures and workshops by knowledgeable Italian Ilizarov Method surgeons, Dror Paley, and me. After New York, Ilizarov was scheduled to accompany me to California for a one-day symposium. This was to have been Prof. Ilizarov's first visit (November 1987). However, in August 1987 the Soviet government sponsored a Glasnost/Perestroika exhibit in the United States, the only positive outcome of the Reagan/Gorbachev Strategic Arms Limitation Talks (SALT II) in Iceland. At the last minute, Ilizarov was picked to formally open the exhibit in New Orleans in August 1987. Thus, Ilizarov's November visit to New York and California was actually his second trip to the United States that year. The Tuxedo Part of the HJD festivities in New York City involved a formal banquet, requiring tuxedos for the men in attendance. Ilizarov didn't own the tuxedo, calling it “A Capitalist Penguin Suit.” Eventually, Frankel persuaded Ilizarov to go with him to a tuxedo rental shop and get one fitted, rush-rush, for that evening. Ilizarov said he felt like a fool wearing the outfit, but was a good sport about it. Twa's Business Class Lounge After completing his activities in New York, Ilizarov was to flew with me to California for University of California, Irvine sponsored Symposium. Since we had business class tickets, we had access to TWA's lounge. We were followed to the airport by a send-off retinue of Russians from the USSR's United Nations embassy office, which Ilizarov briefly visited on our way to JFK. To my surprise, Ilizarov's countrymen followed us straight into the lounge, even though they weren't ticketed passengers. A uniformed security guard tried to turn the diplomats away, telling them that, without a ticket, they couldn't partake in the refreshments. At this moment, I reminded the guard that, a year earlier, President Reagan and General Secretary Gorbachev met in Reykjavík for the unsuccessful SALT II Summit. I informed the guard that if he created a “situation” with Russia's UN staff, he could trigger World War III. The guard paused for a second, decided that discretion was the better part of valor, and allowed the Russians in, to drink vodka to their hearts' content. The Clamshell While in California, I took Ilizarov to a shell shop, having noticed his personal collection of seashells in his apartment in Kurgan. Ilizarov spent quite a bit of time looking over the offerings, which included many beautiful and otherwise striking specimens. Finally, he selected the plainest, least attractive (to my eye) shell in the entire shop, and purchased it. As we walked out the door, the shop's owner said to me, “He sure knows his shells; that's the rarest one I had.” The Limousine I invited Ilizarov and his fellow traveler, Dr. Vladimir Shetstov, to my home for dinner. [Figure 2] I made sure that there were other Russian speakers at the table, to make our guests feel more comfortable. After eating, we headed to a magic show in Orange County. We all piled in to my eight-passenger Pontiac station wagon, a vehicle with two full bench-type seats, and two rear-facing third row seats that could be entered through the back door. (My wife used it to carpool children to sporting events.) Apparently, Ilizarov never saw passenger car capable of carrying so many individuals. He referred to it thereafter as “the big limousine.”Figure 2: Dinner at Stuart Green's home in California.Rancho Los Amigos Medical Center The day prior to the planned UCI Symposium, I brought Prof. Ilizarov to my Nonunion/Osteomyelitis Clinic at Rancho Los Amigos Hospital, where I had my first dozen frame patients available for review. He questioned me about the placement of this wire or that, or the logic behind hinge placement or translation assembly configurations. At one point, he saw a ring in a configuration that had no transfixion implants connected to it. He asked me about it; I told Prof. Ilizarov that there had originally been a tension wire connected to that ring but I had removed it for some reason or other. He told me there was no logic to having an empty ring on a frame. When the visit to Rancho was finished, I asked Prof. Ilizarov, through a translator, how I was progressing with his Method. His reply, loosely translated: “Not bad for a rookie.” Mcdonald's Since McDonald's restaurant chain had not yet established an eatery in the Soviet Union, I took Prof. Ilizarov and Dr. Shevtsov to McDonald's for lunch. Before sitting down, however, they asked to be shown to the washroom and were mortified that Americans did not routinely wash their hands before eating food without utensils. The Space Shuttle Thinking my Russian guests would enjoy visiting Rockwell's Southern California space shuttle fabrication facility, I arranged a tour of the factory, which featured a full-size mockup of the space vehicle. [Figure 3] As we entered machine lathe workshop, we all had to put on paper booties, identical to those we use in the operating room to cover our shoes. I asked our guide whether this was routine for all visitors. “No,” he said. “We only do this with Russian visitors, since they put stickum on the bottom of their shoes to pick up shaved metal.”Figure 3: Ilizarov in Space Shuttle mock-up, Rockwell factory, California.Marshall Urist Many orthopaedic luminaries from the western United States attended Prof. Ilizarov's California symposium, mirroring what happened in New York City. Among those in attendance was UCLA's Marshall Urist, discoverer of Bone Morphogenetic Protein (BMP) and editor-in-chief of Clinical Orthopedics and Related Research. At the end of Ilizarov's presentation, Dr. Urist asked Ilizarov to submit a manuscript to his journal for publication. As a result, just as Ilizarov was boarding an airplane to return to Russia, he handed me all of his lecture slides and the text of his presentations, asking me to prepare the material for publication in CORR. That was the beginning of my relationship as the English-language editor of Ilizarov's work, culminating in my work in Kurgan on his opus magnum, Transosseous Osteosynthesis, published by Springer shortly after Ilizarov's untimely death at age 70. Kurgan Surgery While in Kurgan to work on Prof. Ilizarov's book, I had the opportunity to scrub-in with him on surgical procedures. [Figure 4] One case, a humeral lengthening, involved inserting transosseous wires into the distal humerus, from the medial epicondyle to the lateral epicondyle. After the wire was in place, Ilizarov flexed and extended the elbow, pointing out that there was skin traction on either one side or the other side of the joint, caused by suboptimal placement of the implant. He removed the wire and reinserted it, repeating this procedure five times until he was a satisfied that he had placed the implant into the exact neutral skin axis, between flexion and extension. It was a lesson in wire fixation strategy that never left me.Figure 4: Green (left) and Ilizarov (center) in Kurgan Operating Theater.

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