ILLIZOROV TECHNIQUE

THE ILIZAROV METHOD OF TREATMENT

The Ilizarov Method uses Ilizarov’s Principle of DISTRACTION OSTEOGENESIS (osteo=bone, genesis=formation). This refers to the induction of new bone between bone surfaces that are pulled apart in a gradual, controlled manner. The distraction initially gives rise to NEOVASCULARISATION (Neo=new, vascular=relating to blood), which is what actually stimulates new bone formation. In addition, there is simultaneous histogenesis (histo=tissue) of muscles, nerves and skin; in bone diseases (osteomyelitis, fibrous dysplasia, pseudo-arthrosis) this new bone replaces pathological bone with normal bone. This is a revolutionary concept; diseases for which earlier there was no treatment are now successfully treated using the Ilizarov Method. Indications for use

    • Height Increase (for dwarfs)
    • Bone infections
    • Poliomyelitis Sequelae (limb lengthening and correction of deformities)
    • Treatment of non-unions and malunited fractures • Correction of deformities, both congenital & acquired, of the limbs
    • Badly comminuted fractures (multiple fragments) in the limbs, even with skin loss.
    • Lengthening of foot stumps, limb stumps and fingers (Amputation/foot formation) The Advantages
    • No skin incision is made as in a conventional operation. Incidents of haemorrhage, tissue trauma and infection are much fewer.
    • The whole procedure is minimally invasive as only wires fix the bones to the rings and there is very little soft tissue damage.
    • The Ilizarov fixator is very versatile; the cylindrical shape of the fixator allows deformities to be corrected simultaneously in 3 dimensions.
    • The patient remains mobile throughout the course of the treatment. Intensive physiotherapy is instituted early; as a consequence, problems of joint stiffness and contractures are rare. Further, the patient’s stay in the hospital is considerably reduced.

The Procedure Called TRANSOSSEOUS OSTEOSYNTHESIS (trans=across). Wires of 1.5 mm diameter are passed percutaneously (through the skin) through bones by means of a drill. The protruding ends of these wires are then fixed to rings with special “wire-fixation” bolts. These rings in turn are connected and fixed to one another by threaded rods. Once it is fixed, the Ilizarov frame affords a stable support to the affected limb. A CORTICOTOMY is then performed; it is an osteotomy (cutting the bone) where the periosteum of the bone is preserved. Adjustments in the rods produce compression or distraction as desired between the bone ends, and simultaneously, deformities are also corrected. The ring fixator is removed at the end of the treatment

An Ilizarov apparatus treating a fractured tibia and fibula. The Ilizarov apparatus is used in a surgical procedure that can be used to lengthen or reshape limb bones. In addition, the procedure is often used to treat complex and/or open bone fractures, where conventional treatment techniques cannot be used. It can also be used to treat infected non-unions of bones not amenable with other techniques.

Bone Lengthening/Reshaping Procedure

The device is a specialized form of external fixator, a circular fixator, modular in construction. Stainless steel rings are fixed to the bone via stainless steel heavy-gauge wire (called “pins”). The rings are connected to each other with threaded rods attached through adjustable nuts. The circular construction and tensioned wires of the Ilizarov apparatus provide far more structural support than the traditional monolateral fixator system. This allows early weightbearing. The frame can be used to support a fractured limb, but it is most commonly used to correct deformity through callotasis. The procedure consists of an initial surgery, during which the bone is surgically fractured and the ring apparatus is attached. As the patient recovers, the fractured bone begins to grow together. While the bone is growing, the frame is adjusted by means of turning the nuts, thus increasing the space between two rings. As the rings are connected to opposite sides of the fracture, this adjustment, done daily, moves the now-healing fracture apart by approximately one millimetre per day. The incremental daily increases result in a considerable lengthening of the limb over time. Once the lengthening phase is complete, the apparatus stays on the limb to facilitate healing. The patient can move about on crutches and pain is lessened. Once healing is complete, a second surgery is necessary to remove the ring apparatus. The result is a limb that is significantly longer. Additional surgery may be necessary, in the case of leg lengthening, to lengthen the Achilles tendon to accommodate the longer bone length. The major advantage of this procedure is that because the apparatus provides complete support while the bone is recovering the patient can remain active aiding recovery. A further use is of bone transport, whereby a defect in a long bone can be treated by transporting a segment of bone, whilst simultaneously lengthening regenerate to reduce the defect and finally dock with the other segment, producing a single bony unit. While the Ilizarov apparatus is minimally invasive (no large incisions are made,) it is not free of complications. Pain is common and can be severe, but is treatable with analgesics. Careful attention to daily cleaning and hygiene is necessary to prevent pin site infection. Other complications include swelling and muscle transfixion.

Bone Fracture Treatment Procedure

The Ilizarov method is widely used to treat complex and/or open bone fractures. This method is preferred over conventional treatment options (such as internal fixator or cast) where there is a high risk of infection or the fracture is of such severity that internal fixators are unworkable.

The following case study illustrates the Ilizarov apparatus treatment procedure for a fractured limb. The photographs are of the same patient during the course of treatment. If other individuals desire to post images, please create a separate gallery/case-study.

X-Ray of fracture and initial external fixator applied within 24 hours of patient’s admission to hospital.

Front-left view of Ilizarov apparatus treating fractured tibia and fibula Patient suffered open fracture. Fracture is located slightly above black metal ring. Photographs 1 through 4 are taken four weeks following fracture and two weeks following installation of Ilizarov apparatus.

Front (top) view with view of healthy leg. Patient is lying on his stomach.

View of several pin sites (two weeks following surgery).

X-Ray of fracture site immediately following application of Ilizarov method.

X-Ray of fracture site, part 2 (four months following fracture).

X-Ray of fracture site, part 1 (two months following fracture).

X-Ray of fracture site, part 2 (two months following fracture).

X-Ray of fracture site (three months following fracture). Note formation of bone callus around fracture site.

X-Ray of fracture site, part 2 (two months following fracture).