Twenty years ago in summer, I had just graduated from the Fourth Military Medical University and was assigned to work in the surgery department of the Taiyuan Satellite Launch Center Hospital in Kelan, Shanxi. At that time, Dr. Gong Liqun, a colleague from our department, had just returned from an orthopedic fellowship at the Xinqiao Hospital of the Third Military Medical University. He brought back a book titled *Principles and Clinical Applications of External Bone Fixation*, edited by Professor Li Qihong from Southwest Hospital. Back then, there weren’t many orthopedic reference books available, so as soon as I saw this book, I devoured it with great enthusiasm. Unfortunately, the content was profound and difficult to understand, far removed from the concepts of plaster casts and splints that I had learned about in my university textbooks under the category of "external fixation." Moreover, this remarkable technology not only fixed fractures but also allowed for leg lengthening, which greatly piqued my curiosity.
Two years later, inspired by Professor Li Qihong, I enrolled as a master's student in orthopedics at the Third Military Medical University. Being close to the source, at the time when Professor Li Qihong’s semi-circular groove external fixator was being promoted, I frequently had the opportunity to learn how to use the Li-style external fixator in treating trauma patients during my work. The three years of graduate study passed quickly; although, limited by my age and knowledge, my understanding of the principles and performance of the external fixator was still very superficial. Nevertheless, the entirely new concept of external bone fixation had deeply taken root in my mind.
In subsequent work, I underwent professional training in microsurgery, trauma orthopedics, and spinal surgery. Particularly, using sophisticated microsurgical techniques to repair open injuries of the limbs gave me a great sense of accomplishment, and for a while, I believed that microsurgical techniques could solve all the difficult problems in orthopedics. However, as cognition evolves, with the accumulation of clinical experience and changes in my workplace, starting from 2001, my professional interest gradually focused on the restoration and reconstruction of limb trauma. Clinically, common sequelae of limb trauma include nonunion, osteomyelitis, malunion, bone defects, and soft tissue contractures or defects. In addition, various congenital and acquired limb deformities often brought patients seeking treatment. How to treat these problems posed significant challenges to me because the treatment requirements for many diseases exceeded what microsurgical and trauma orthopedic techniques could offer. I once felt lost and melancholic over this.
When I was hesitating due to the clumsiness of my professional skills, fortunately, I revisited *Principles and Clinical Applications of External Bone Fixation* in my collection. This book enlightened me and reignited my passion for developing external bone fixation technology. Although in clinical practice, simple unilateral external fixators were commonly used to treat fractures of the limbs, I had previously regarded the external fixator merely as a simple fixation tool without further exploration. After thoroughly reading *Principles and Clinical Applications of External Bone Fixation*, my horizons broadened. I gained a completely new understanding of the concepts, techniques, and efficacy of external bone fixation. The Ilizarov technique mentioned in the book pointed out the direction for my development. Subsequently, I gradually attempted to use the Ilizarov technique for various types of bone reconstruction and even for repairing soft tissue damage and correcting limb deformities, achieving satisfactory results. Regrettably, the early application of this technology was self-taught, like feeling one's way across the river by touching stones, without systematic textbooks or teacher guidance, leading to many detours.
The Ilizarov Research Center in Kurgan, located in the West Siberian region of Russia, is the world's largest center for bone lengthening and orthopedics and is the birthplace of the Ilizarov technique. The center holds annual training sessions dedicated to promoting and applying the Ilizarov method, making it the "holy land" in the hearts of doctors worldwide who are engaged in the research and application of external bone fixation technology. In August 2009, with the strong support of my mentor, Professor Zeng Bingfang, I went alone to this center to study, becoming the first Ilizarov Fellow from mainland China. During nearly two months of study, I witnessed the wide-ranging applications of the Ilizarov method in limb trauma, pediatric orthopedics, hand surgery, orthopedics, joint surgery, and spinal surgery. Especially, the effects achieved by this technology in limb reconstruction and bone reconstruction were astonishing, akin to "magic," truly captivating.
During my free time, I often went to the center's library to look for books, hoping to find a simple and understandable textbook on the Ilizarov technique to introduce to colleagues in China. Fortunately, I immediately noticed *The Basic Principle of External Fixation using the Ilizarov Device* written by Dr. L.N. Solomin from St. Petersburg. Compared to Ilizarov's posthumous work *Transosseous Osteosynthesis*, the former focuses more on basic principles and operational methods, suitable for beginners, while the latter is merely a case compilation, appropriate for experienced doctors familiar with the Ilizarov technique. With the assistance of the People's Military Medical Press, I began translating this monograph at the end of 2009, but the difficulty exceeded expectations. Although the book was written in English, the author's native language was Russian, and its "Russian-style English" grammar differed greatly from standard English. Understanding the original meaning was time-consuming and labor-intensive. Additionally, although printed by the internationally renowned Springer publishing house, the proofreading was not meticulous, with over 40 printing errors and even missing paragraphs, adding much trouble to the translation process. Furthermore, due to my own limited understanding of the essence of the Ilizarov technique, numerous professional terms and jargon needed to be reviewed and unified, and appropriately translated into Chinese. Often, I spent considerable effort trying to express a single word or sentence precisely. Therefore, the submission date of this book was repeatedly delayed, consuming nearly two years of my time.
Although the process of hard work was arduous, the harvest season was gratifying. Through translating and proofreading this monograph, my understanding of the Ilizarov technique underwent a qualitative leap. It answered many puzzles and difficulties I encountered in previous clinical practices, corrected the mistakes I made in installing the Ilizarov external fixator, updated my narrow understanding of the efficacy of the Ilizarov technique, and strengthened my belief in conducting external bone fixation technology in the future. In fact, during the process of translating this book, we have consciously or unconsciously applied the knowledge taught in the book to guide our work in clinical practice, such as: "the installation of the basic ring should be perpendicular to the axis of the bone segment, needles should be inserted through reference channels, skin release helps prevent joint contracture, and the applicable population and principles for lower limb cosmetic correction."
With the elevation of professional knowledge, I have gradually grown from a naive Ilizarov Fellow to a knowledgeable and thoughtful Ilizarovian. This book is the first English monograph on the Ilizarov technique written by Russians after the death of Academician G.A. Ilizarov in 1992. During the nearly two-year translation process, I deeply realized that this book is indeed an introductory text for learning the Ilizarov method. The focus of the book is to teach the basic principles and operational steps, techniques of applying the Ilizrarov method in different diseases and locations, down to the specific details such as the direction of needle insertion in a particular location, the number of needles, and the order of needle insertion, making it very suitable for beginners to read. The author's original "unified nomenclature for external fixation" provides a refreshing objective digital standard for the dissemination, exchange, and learning of external fixation technology. The author's elaboration on lower limb cosmetic correction also demonstrates his profound expertise in this field. Throughout the book, its writing style prominently features: basic, practical, objective, specific, precise, and digitized.
As the author said, among all current external fixators, the Ilizarov external fixator has the most complete functions, and its learning process is also the most complex. This book is a manual teaching principles and operational techniques, with almost no clinical examples, and most technical details are expressed through line drawings, differing from the writing style of common orthopedic professional books. Based on my understanding and translation of this book, I suggest readers pay attention to the following points when reading this book.
Firstly, this book is divided into four parts. The first part is the general introduction, explaining the indications, basic principles and methods of the Ilizarov external fixator, as well as the safe channels and reference channel positioning in the layered anatomical atlas of the limbs, and the construction principles of external fixation. The second part is the specific discussion, detailing the surgical methods for limb and pelvic trauma, post-trauma sequelae, limb deformity correction, and lower limb cosmetic correction, along with a detailed explanation of perioperative management of external fixators. The first two parts are the core of this book and require focused study. The third and fourth parts are appendices, introducing the author's research methods for determining the puncture channels of the limbs and the experience of mechanical testing, provided for reference and not mandatory reading. Unlike regular textbooks, the second part is based on the first part. Without a deep understanding of the contents of the general introduction in the first part, reading the second part rashly may make it difficult to comprehend. Therefore, readers should strictly follow the principle of gradual progression when reading the book to avoid losing interest.
Secondly, when mentioning the Ilizarov method, many doctors' first reaction is its application in limb correction. Indeed, in today's orthopedic clinical diagnostic and therapeutic technologies, the Ilizarov method stands out uniquely in the field of orthopedics, and this book devotes a considerable portion to detailing the specific aspects of using the Ilizarov external fixator to treat limb fractures, which might discourage some readers. Actually, reviewing the invention and development history of the Ilizarov external fixator reveals that this technology was conceived during the process of fixing fractures and later extended to other fields. Of course, this is not the real reason why the book extensively introduces fracture treatment. Carefully reading the book shows that in the chapter on fracture treatment, the author meticulously describes the steps of needle insertion for each type and location, as well as the configuration of the appropriate external fixator, and the reduction techniques for bone segments and fragments. In subsequent chapters, whenever discussing the installation of external fixators related to post-trauma sequelae and limb correction, the same fracture configuration of the corresponding location or similar ones are referenced. In other words, what the author really wants to convey is that mastering the installation and configuration methods of the Ilizarov external fixator for limb fractures is the foundation for treating other limb injuries. Therefore, learning the basic methods of using the Ilizarov technique to treat fractures is the first step in mastering this technology.
Thirdly, due to differences in language habits and regional cultures, the sentence structure and style of the author's expression differ significantly from Chinese, which is also the difficulty in translating this book. This book contains more than 800 figures, and many of the author's ideas are demonstrated through illustrations, even with lengthy textual descriptions in figure captions exceeding the meanings of the illustrations themselves. The caption content does not overlap with the main text but rather complements it, possibly a Russian style. Therefore, when reading this book, besides reading the main text, attention should be paid to the textual descriptions in the figure captions. I recommend combining the main text, illustrations, and captions for reading. Only in this way can the reader fully and correctly grasp the author's original intentions and avoid misunderstanding and misinterpretation.
Fourthly, this book is one that introduces principles. Principles refer to universal methods and basic guidelines of a certain technology, not specific instances. Mastering the application principles of the Ilizarov external fixator does not make one an expert. Only by adhering to the combination of theory and practice can one deeply understand the profundity of this method. My experience is that initially reading this book is purely theoretical learning, and using this theory to guide clinical practice inevitably leads to encountering problems. At this point, one should re-read this book, returning from practice to theory. Thus, through repeated cycles of theory-practice-theory, the doctor's Ilizarov skills can reach new heights through spiral upward progress.
The Chinese version of this book is set as a compiled translation because, in addition to the immense difficulty of translating the "Russian-style English" of the book, the compiler has also done substantial work, including correcting more than 40 textual expression errors, rewriting large sections of missing text in Section 2.2.2.1 regarding proximal one-third humeral shaft fractures based on context, modifying 14 line drawings, converting approximately 150 black-and-white cross-sectional anatomy diagrams into color diagrams, and having Kang Qinglin solely complete all proofreading work to ensure consistency in the writing style of the entire book. The compiled monograph strives to achieve smooth and clear writing, concise and accessible explanations, vivid colors. The participants in the compilation and translation are all young talents from the Department of Orthopedics at Shanghai Sixth People's Hospital. They sacrificed their spare time, overcame multiple difficulties, worked diligently and selflessly contributed to translate this book into Chinese, which is commendable. Especially, pediatric orthopedic expert Bao Kun and osteoporosis expert Shi Huipeng also participated in the translation work, enriching the book considerably. My work received strong support from my teacher Professor Zeng Bingfang and department leaders Zhang Changqing and Chai Yimin, which was my motivation to persist in completing the compilation and translation of this book. When I encountered difficulties, I often consulted domestic pioneers in the research and practice of external bone fixation technology, experts Xia Hetao and Qin Suhe, whose teachings benefited me for life. Despite striving to make the compilation and translation of this book as faithful, fluent, and elegant as possible, due to my limited knowledge and understanding of the essence of the Ilizarov technique, errors in the book are inevitable. I sincerely ask for the help and corrections from the readers. Related theme articles: Essence: Decoding the Tencent and 360 Event (Reprint) Cultural Revolution Secondary Influence