Local Doctor Applies Russian Bone Method

by Sara Barry
From the Daily Progress

When the Berlin wall came down in 1989, more than just concrete barriers were broken. Doctors from both sides of the Cold war began exchanging research and medical technology, and they are still reaping the benefits. Dr. Joseph Disabato, a local foot and ankle surgeon, recently returned from Russia, where he studied external fixation, a way of fixing bones and joints originally developed in the Soviet Union. In some cases, Disabato said, the Russian procedure can be less invasive and prove quicker in healing injuries than traditional American approaches.

External fixation was first developed in Kurgan, Russia, more than 50 years ago. "Doctors were left to treat people with injuries with not much technology," Disabato said. "They had to figure out how to repair and stabilize a bone fracture." The solution was external fixation, which is based on a wheel and spoke concept. Steel rings circle the injured bone or joint, and thin metal rods run across the diameter of the ring, trough the patient's limb. In the wheel analogy, the rings are the tire, the rods are the spokes, and the bone is the hub through which all the rods intersect.

Although the contraption looks a little medieval, there are many cases where it is quite useful, and several where it is the only option. Disabato explained, "If there's any suspicion of a bone infection, you cannot use screws or plates," which are typically used to repair broken bones or joints in America and Western Europe.

Also, the external fixation often allows a patient to walk on the injured bone or joint, which can promote healing. "When the bone is bearing weight on it, it heals quicker," Disabato said. "That's the beauty of this technology." Dr. Michael Donato, a spokesman for the American College of Foot and Ankle Surgeons, said there are three major instances where external fixation outperforms the alternative.

The first is for patients with Charcot foot, a condition which often results from diabetes. "The bones literally just become mush,' Donato said. External fixation is used to stabilize and eventually even reconstruct the bone. The other instances are in the case of an extreme fracture, or in the case of a short or deformed bone. "You can lengthen bone," Donato said. "You turn the bolts and crank it out to length over a period of time."

The benefit of studying external fixation is Russia, Donato added, was that Russians would use it to treat a wider variety of cases. "They do so many of them, for indicators that we would never even consider over here," he said. Disabato saw and participated in his share of surgeries. He was studying at a 1,000 plus bed hospital that was built solely for external fixation. The University of Virginia Medical Center, by contrast, has 547 beds and treats all sorts of conditions. "They can lengthen or shorten bone gradually, they can fix a club foot, all done with small incisions or no incisions at all," Disabato said. "Russian doctors even used the technology to fix the broken handle of a coffee pot," Disabato said with a laugh.