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Abstract
The history of limb-lengthening surgery can be traced back to the nineteenth century. Since that time, the orthopaedic community has made tremendous progress in performing successful lengthening procedures. Among the important contributors to the field, Dr. Gavril Ilizarov remains one of the most significant innovators. Because of advancements over the past century, limb lengthening has become a viable method of treating severe bony deformities and defects. This article, the first of a two-part series, reviews the history of distraction osteosynthesis.
The difficulties to be encountered in lengthening a shortened limb are found, in operation, to be greater as regards the fleshy parts, than as regards the bones. It is comparatively easy to remove the splinters of a fractured bone which is wrongly consolidated; to separate a curved bone; or to perform an oblique osteotomy, but a decided limit is arrived at in the correction of a displacement, or in the lengthening of the bones, by reason of the contraction, or resistance, of the muscles. - Codivilla 1905
Early Attempts at Limb Lengthening
The history of limb lengthening dates back to the 19th Century, ry, as surgeons struggled to treat the sequelae of war injuries, malunited femoral shaft fractures, and post-poliomyelitis deformities. Initial attempts at limb lengthening were performed as single stage lengthening osteotomies, performed by pioneers such as Von Langenbeck (1869), Hopkins and Penrose (1889), and Von Eiselberg (1897),1 (Fig. 1).
However, modern techniques of limb lengthening did not begin until the early 1900s with the work of Alessandro Codivilla in Bologna, Italy (Fig. 2). Codivilla was an Italian surgeon who practiced orthopaedics exclusively.2 He published 124 articles in 25 languages, reporting new ways to treat many conditions, including polio residuals, clubfoot, scoliosis, and congenital dislocation of the hip.2 His initial reports on the use of external pin fixation and traction for lengthening appeared in the Italian literature in 1903.3 This was followed by a presentation at the Annual Meeting of the American Orthopaedic Association in June of 1904 and the first English-language report in 1905.2,4
Codivilla recognized that others had previously tried limb lengthening, writing "The greater number have applied constant traction, after having separated the bone; others have used great stretching under narcotics, followed by constant extension of the muscles,...