People have broken leg bones for millennia. In Classical Greece, the famous physician Hippocrates described an external fixation apparatus composed of leather rings connected with four wooden rods from a tree to splint the fracture of a tibia bone.
A lot of time passed until the middle of the 19th century when French surgeon Jean-Francois Malgaigne described a spike driven into the tibia and held by straps to immobilize the fractured bone. While many surgeons in the modern era are known for their work with external fixation, Russian surgeon Gavriil Ilizarov developed a device that became known as the Ilizarov apparatus to fix the complex or open fractures of the bones of soldiers wounded during World War II.
Used to reshape or lengthen damaged leg or arm bones, these strange-looking metal devices have been quite a common but scary sight in modern orthopedic departments – but now, a new way has been developed to allow treatment of deep bone infection and promote bone regrowth without attaching an external fixative. The doctors of the Orthopedic Department at Hadassah-University Medical Center in Jerusalem’s Ein Kerem used a combination of modern technologies to achieve this.
On June 20, 2023, 39-year-old Matanya Olami was seriously wounded in an attack by terrorists whose bullets entered his leg bone and seriously shattered it, causing a severe internal infection. Four people were murdered in the terror attack, which took place near a petrol station. The young man, married with children who lives in Elon Moreh, was attacked 29 years after his father, Rabbi Ami Olami – a founder of the Otniel Yeshiva – was murdered in Otniel.
Hadassah’s orthopedists treated him using the latest technology for bone reconstruction, which is known as “bone transport nail.” Bone transport is a procedure to grow new bone in a region where there is a missing section of bone due to infection, trauma, or disease. If there is a gap in the bone due to serious injury or diseased bone from infection or other processes that have to be removed, the bone is left with an empty void. This space needs to be filled in with new bone to regenerate the bone’s continuity and give the person equal limb lengths and normal function.
Dr. Vladimir Goldman, director of the Deformation Service in the Orthopedics Department, said “the latest technology is a breakthrough in the field, and with it we can provide patients with the best treatment, regrowing the bone inside their leg with minimal pain and with the highest chances of success.”
The orthopedic solution combined the most advanced technologies of deep-infection treatment and new bone growth in a controlled medical process. Olami’s recovery from the innovative surgery he underwent at the medical center surprised even him.
“I knew this was the newest technology in the field, but the speed with which I started the rehabilitation process after the surgery is amazing,” Olami said.
The medical team that treated him also included colleagues Prof. Meir Liebergall, Prof. Rami Mosheiff, Prof. Yoram Weil, and Dr. Arie Chetboun.
“Matanya came to us with an open fracture in his left leg, with bone missing and severe infections,” Goldman recalled. “One of the bullets removed part of the soft tissue that is critical to the healing of the bone, so we started the treatment by closing the wounds, restoring the soft tissue, and treating the ongoing infections.”
After months of intensive treatments, the orthopedists were able to control the severe infections, among other things with the help of a special nail for the treatment of deep bone infections, and to restore the soft tissue and then began to treat the missing bone.
“It is known that a bone is a living organ that knows how to heal itself, and the Ilizarov technique of gradual and slow stretching of the bone using an external fixator has been used for years,” said Goldman. “The fixator is indeed effective as it pulls the bone and supports its growth, but there are also many disadvantages – frequent infections, a lot of pain for the patient, scars, and restriction of movement that also complicates the rehabilitation after and significant awkwardness.”
For the first time in Hadassah, the doctors decided to use the bone transport nail technique. Instead of a standard fixation nail that emerges through the skin, the doctors insert the bone transport nail that the power of a magnet “travels” and grows a new bone from the leg without the use of an external fixator or additional internal fixation.
After inserting the innovative nail into the patient’s leg, the patient receives a bag in which he places the magnet on the leg three times a day for about two minutes. The magnet causes movement of the bone, and during the entire period of bone transport, the patient can walk and step on the leg as usual,” Goldman continued.
Planning the surgery
When planning the surgery, the doctors also used 3D technology to assess the size of the missing bone, the exact location for cutting and fixing the bone, and which nail would fit the patient’s specific bone, all with a very precise calculation.
Olami has already begun an intensive rehabilitation process at the new Gandel Rehabilitation Centre at Hadassah Mount Scopus. “Throughout the long and intensive treatment, I received courteous, professional treatment that gave me great confidence. Talia Abder, the surgery coordinator in the Orthopedic Department who stayed with us from the beginning to the end with humanity and infinite attention, was also a godsend. After the surgery, relatively quickly, I could already start the rehabilitation treatments. I feel that my body is getting stronger and that the mobility is good for the recovery of the leg.”
This article was originally published at www.jpost.com
