Good news seen for bad breaks

Art Nadler

Monday, April 21, 1997 | 11:59 a.m.

Some severe bone fractures never heal, and amputation may be the only answer. Those that mend crooked usually have to be rebroken and set again.

A 50-year-old Russian procedure, currently being done by Dr. Vladimir Schwartsman, an orthopaedic surgeon at the University of Nevada School of Medicine, has inspired hope for individuals who otherwise would become disabled for the rest of their lives.

The Ilizarov procedure involves taking X-rays of severely fractured bones, aligning the fractures properly and holding them in place via wires inserted through the skin and flesh. The other ends are externally attached to a metal frame that encircles the injured area.

"It's much more stable than plates and screws," Schwartsman said. "The biological response to soft tissue is better, and the biomechanical stability is better, too."

Individuals with severely fractured legs can actually stand the next day, Schwartsman said, because the framing is so strong. And walking on an injured leg causes it to heal faster because blood flows more freely to the area, he said.

Schwartsman said he is one of a select group of orthopedic surgeons who use the Ilizarov procedure in North America. He also pioneered its use in fractures of the heel.

"Before, you would have to open the skin and put the fractures back together with plates and screws," Schwartsman said. "That leaves the patient open to infection, and it doesn't heal as fast."

Schwartsman said he has treated close to 400 patients since he began doing the Ilizarov procedure four years ago. The only danger is if the surgeon spears a nerve or blood vessel. That, he said proudly, has never happened to him.

"You have to know the anatomy of the body perfectly," the doctor said. "It's very labor intense. You wouldn't want to use this for simple fractures. Traditional procedures would work just as well."

Besides setting fractured bones to heal, the Ilizarov procedure can be used to grow bone, Schwartsman said. He had a man with six inches of bone missing in one leg, and over nine months he grew it back by properly aligning the fractures. The blood flow stimulated the ends to regrow.

Bones also can be stretched about 1 millimeter a day, which breaks down to an inch per month. Physical therapy is included throughout the healing process and for several months after the metal frame is removed.

The Ilizarov procedure was introduced in the United States about 10 years ago, Schwartsman said.

"This is a new chapter in orthopedic surgery," Schwartsman said. "A lot of people go home the next day. A person can take showers and lead as normal a life as possible. The healing process is twice as short."