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Ilizarov Technique
Dr.Saleh Waslallah Alharby
Associate Professor,
Consulatant Orthopedic Surgeon.
College of Medicine,
King Saud University.
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
Outline 1-Historic review. 2-The system. 3-Basic principles. 4-Indications. 5-Deformities and applications. 6-Clinical examples. 7-Postoperative care. 8-Advantages and disadvantages. Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
Historical Review
1951 in Kurgan (USSR).
1980 attention outside USSR.
Carlo Mauri explorer..
1981 visited Italy in (AO meeting).
April 1982 Italian Surgeons visited Kurgan.
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
Historical review
• Osteoinduction and neogenesis.
• Accidental distraction.
• Normal new bone formation.
• Research laboratory in a small hospital.
• 1982 a new institute was established.
• 1200 bed and 12 operating rooms..Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
The apparatus
• Transosseous wires.
• Rings.
• Threaded and Telescopic rods.
• Hings, Posts and Nuts.
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
Technique
· Insertion of wires..· Pain
· Function
· Infection
· Fixation of Rings..
· Rods fixation..
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
3D ANATOMY
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
Indications
· Acute Fractures.
· Nonunion.
· Malunion.
· Chronic Osteomyelitis.
· Deformities and Shaping.
· Lengthening of short limbs and amputation stumps. Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
Concept based on Unknown Biologic Laws.
• Compression-Distraction.• Osteoinduction. AND• Tissue neogenesis.
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
Bone lengthening.• Bone regeneration.• Balance between integrity of
osteogenic tissue and it’s blood supply.
• Closed Osteotomy vs. closed Corticotomy.
• 1 mm per Day = 0.25mm / 6hrs.Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
Lengthening• 10-20% of segment per stage.
• Better staged.
• Avoid simultaneous ipsilateral femoral and tibial lengthening.
• ? BI-level lengthening.
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
ANGULAR DEFORMITIES
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
Deformity correction• Lever arm action.
• Use of hinges.
• Placement of hinges.
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
Deformity correction• Mechanical axis.• Anatomical axis.• Malalignment.• Lateral distal femoral angle(LDFA).• Medial proximal tibial angle (MPTA).
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
Center of rotation and angulation (CORA).
The point of intersection of the proximal and distal mechanical axis lines.
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
Deformity correction• Acute vs. gradual correction. 1-Gradual correction: -Better bone formation. -Decreased NV complications.
2-Acute correction: -Satisfaction -Easy pre-op plan -Simple post op care -? Accurate -Good bone formation-NV complication Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
• Congenital anomalies:
Upper Limbs
Hemimelias
Pseudarthrosis
Feet
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
• Post op care
Day one: 1-control pain
2-look for skin pressure
3-persistence bleeding
4-mobilization and physio
5-proper positioning of the limb
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
• Day 2
wt bearing
stretching exercise
ROM
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
• 5-7 days Distraction begins(pt most imp day)
Pin site and wound inspected
Pt training for pin site care
Preparation for discharge….
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
• Weekly OPD visit DISTRACTION PERIOD Check for 1- ROM
2- Deformity
3-Pin site infection
4-Wt Bearing
5-Callus formation..
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
• Period of Fixation 1-Full wt bearing
2-Dynamization
3-Prepare for apparatus removal
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
• Apparatus removal 1-one to 2 weeks of Dynamization
2-Splint vs. no splint
3-Back one step in wt bearing
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
• Rehabilitation Starts pre-op
cont post-op
psychotherapy and assurance….
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
Unlike most other surgical procedures where the work is done when the pt. Leaves the operating room, an external fixation “procedure” takes months to complete. For this reason,success or failure depends on post operative management.
Stuart Green.
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
• Achondropl.
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
• Cong pseudarth…..
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
• Growth plate inj
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
• Variety of deformities
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
• Cong short limb
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
• Ischemic limb
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
• Metabolic bone deformity
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
• Paralytic contracture
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
• Neglected fractures
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
• Never do this
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
• Problems and complications 1-muscle contractures….
2-joint stiffness or subluxation
3-axial deviation
4-NV injury
5-premature consolidation
6-delayed consolidation
7-wire site problems
8-refracture
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
• Advantages 1-universal system with multiple indications
2-relatively simple
3-minimally invasive
4-mobility and stability
5-3D correction
6-minimize bone grafting
7-simple hardware removal
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
• Disadvantages 1-difficult apparatus assembly
2-frequent monitoring
3-potential NV injury
4-pain
5-edema
6-joint stiffness
7-pin site infection
8-limit social life
9-depressionDr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
Ilizarov Technique
Thank you
Dr Saleh W Alharby
http:/faculty.ksu.edu.sa/DrSalehAlharby
