Ilizarov treatment could prevent amputations

Many Malaysians are not getting the treatment they need to correct bone conditions, leaving some facing the prospect of amputation.

An orthopaedic device called Ilizarov apparatus could be used more widely as a last-resort alternative to losing a limb, if only there was wider awareness among the public of its availability, according to Dr Chua Yeok Pin, a foot and ankle specialist at Sunway Medical Centre. Today, there are fewer than 25 Ilizarov practitioners in Malaysia, he says, out of an orthopaedic community of some 600 surgeons.

Ilizarov apparatus is a mechanical device for external fixation used by orthopaedic surgeons to lengthen or reshape the bones in a limb due to birth defects. It is also used to treat complex and open bone fractures and infected non-unions of bones by anchoring the bone through the skin with an external framework spanning the limb.

“A lot of patients need this procedure, though many are not aware that something can be done,” says Dr Chua, citing the example of a young woman who he spotted by chance at Sunway Medical Centre with bent legs.

“I asked her if she had sought treatment. She said she had but had been told that nothing could be done for her. So I told her to see me; I can straighten it for you.”

The girl visited the hospital for Ilizarov treatment and now one of her legs is completely straight, with the second one soon to follow. Dr Chua calls it a “secret weapon” in treating conditions that traditional medicine often fails to address.

“The best approach is always internal fixation, but this is a long-term treatment and you opt for it when there is no other choice—and it is a very good option,” he adds.

The technique relies on the stimulation of new bone growth, so the affected bone is usually fractured then attached to the Ilizarov apparatus.

“After the fracture, we normally wait two weeks for adults and one week for children when a new bone is starting to form over the fracture site,” says Dr Chua. “Then we stretch the new bone before it gets hardened until it forms a strong bond.”

Sometimes the treatment can last a year, depending on the condition, as bone regrows at a rate of roughly one-and-a-half months for each centimetre.

“So if there is a 4-cm bone loss, they will have to wear the equipment for at least six months,” he adds.

Because of the nature of the apparatus, parents take on much of the responsibility for their treatment, and are told to stretch the new bone by one mm a day by cranking a screw on the frame as they recuperate at home. They must also clean their pin sites every day to prevent infection.

Dr Chua says the treatment is quite different to internal fixation because “after an operation, we put a plate or screw inside—everything’s done”.

“In this procedure, when we have finished, the patient’s work has just started.”

Malaysian researchers are among a large science community investigating improvements to the technology and other matters that affect patients being treated with the apparatus.

Because of the potentially long periods of time being limited by a metal frame, many patients experience stress and depression, though Dr Chua says this is almost always mild to moderate and does not require medication.

“During their journey, it might be stressful for the patient. We try and encourage patients to go out and walk, to swim and cycle.

Some patients in the past didn’t want to leave their homes as they couldn’t wear underwear, so while I was in University of Malaya, a team of researchers and I developed a special underwear that used Velcro to get around the problem,” he adds. “We look for trouble with the patients and find solutions.”

Though there is little awareness of Ilizarov apparatus in Malaysia, it is growing with more young doctors taking up the field. He says that Sunway, where he also teaches the next crop of Ilizarov practitioners, is gaining a reputation in Malaysia for the procedure. “This is good: we can use it to do a lot of things” he adds.

Dr Chua Yeok Pin is a foot and ankle orthopaedic surgeon at Sunway Medical Centre. His areas of expertise include limb lengthening and reconstruction with external fixators.

Sunway Medical Centre

5 Jalan Lagoon Selatan, Bandar Sunway

46150 Petaling Jaya, Selangor, Malaysia

Tel: +60 (0) 3 7491 9191

sunwaymedical.com