The origins of limb lengthening and reconstruction surgery date back to 1521 when the first intervention ever reported in history was performed on St. Ignatius of Loyola.

purposeTo explore the historical case of Saint Ignatius of Loyola's leg injury and subsequent surgical interventions as a potential early instance of limb lengthening and reconstruction surgery.

methodsA detailed analysis of "A Pilgrim's Journey" (Ignatius of Loyola's autobiography) was conducted, focusing on orthopaedic descriptions of his injury and treatments.

resultsIn 1521, Íñigo López de Loyola sustained a severe, comminuted open fracture of the tibia due to a cannonball wound during the siege of Pamplona. Initial attempts at reduction were unsuccessful, leading to a non-union with significant deformity and shortening. He underwent a revision surgery, a procedure described as "carnage" and endured without a single lament. Although the fracture eventually united, residual shortening and a prominent bone deformity persisted. Unwilling to accept this disfigurement for social reasons, Ignatius requested a second, highly painful osteotomy to remove the protruding bone followed by continuous traction for "days and days of martyrdom" for progressive lengthening. Crucially, after these arduous treatments, Ignatius was able to walk and even ride a horse again. The only significant residual symptom was swelling in his leg by evening.

conclusionSt. Ignatius of Loyola's case provides a compelling historical account of complex orthopaedic challenges in the early 16th century. The documented surgeries represent remarkably early attempts at managing non-union, deformity, and potentially achieving limb lengthening, predating modern reconstructive techniques by centuries. This historical narrative offers valuable insights into the nascent stages of orthopaedic surgery and highlights how a physical ordeal can profoundly shape one's life path.