“Extreme remedies are very appropriate for extreme diseases.” ― Hippocrate


“Healing is a matter of time, but it is sometimes also a matter of opportunity.” ― Hippocrate

Ilizarov Technique

Ilizarov technique is a technique developed by a Russian Surgeon Prof Gavriil. Abramovich Ilizarov https://en.wikipedia.org /wiki/Gavriil_Abramovich_Ilizarov This is mainly done in case of nonunion, infection and shortening of bone. Here steel rings are attached around the limb both in upper limb and lower limb by means of shanz pin and ilizarov k wires. In case of nonunion either compress the nonunion site or distract it to develop union at site. The fixator is used to pull apart the bone (distraction) at the rate of 1mm/day in case of lengthening of bone. The gradual distraction over a period of time induces formation of new bone and soft tissues (blood vessels, muscles, nerves and skin). By using these principles, he described various clinical settings where excellent results could achieve.


History

Dr.JijeeshIlizarov used external fixation devices on patients to treat non-unions in the 1950s. Ilizarov observed the callus formation and discovered distraction osteogenesis when one patient lengthened his frame rather than compressing it. The technique gained fame across the Soviet Union when he successfully treated Soviet world-record holder, and gold medalist high jumper, Valery Brumel in 1968. Brumel broke his tibia in a motorcycle accident and had 20 unsuccessful operations over a three-year period to try to repair his non-union. Iliarov used distraction osteogenesis to heal the non-union and 3.5 cm (1.4 in) leg length discrepancy.] Ilizarov gained more fame in 1980 when he successfully treated Italian journalist and adventurer, Carlo Mauri. Mauri had broken his leg in a skiing accident ten years earlier and his tibia never properly healed.[1] When he was on an expedition across the Atlantic, the wound on his leg reopened and a Russian doctor advised him to see Ilizarov.[ When Mauri returned to Italy after his treatment, Italian doctors were impressed that his tibial non-union was repaired. They invited Ilizarov to speak at the Italian AO Conference in Bellagio. This was the first time Ilizarov spoke outside of the "Iron Curtain". The technique was brought to the US in 1987 by Victor Frankel, president of Hospital for Joint Diseases, Dr. Stuart Green who, in 1992, edited the first English translation of Ilizarov's book. The Ilizarov external fixators can be used to correct angular deformity in the leg, to correct leg-length differences, and treat non-unions. In most developing countries it is a highly specialized technique used mainly for deformity correction by experienced surgeons due to its complexity. Further development of the ring construct led to the Taylor Spatial Frame which is more versatile and far easier to use, but very costly. Intramedullary limb lengthening devices are also available, but are also a very costly option.


What is an Ilizarov Fixator?

The Ilizarov fixator or the ring fixator is an assembly of rings usually 3-4 rings applied to the bone using wires and pins. The rings are connected to each other by connecting rods. The apparatus is applied externally so that the bone ends can be moved and adjusted from outside as and when required. The flexibility of the Ilizarov technique is its biggest advantage and ensures a desired result.


Dr.Jijeesh
Dr.Jijeesh
Dr.Jijeesh
Dr.Jijeesh

What are the indication of ilizarov technique?

  • Fixation of complex fractures
  • Limb lengthening (making short legs longer)
  • Deformity Correction (straightening bent legs)
  • Arthrodesis (fusion or joining of two bones across a joint)
  • Peripheral Vascular Disease like Thrombo-angitis obliterans
  • Treatment of Arthritis (especially knee arthritis, in the early stages)
  • Bone transport & Osteomyelitis (treatment of missing bone in the limb, due to various causes)
  • Infected Non-unions and non infected nonunion (bones that have not healed after a fracture, and have infection)
  • Treatment of Joint Contractures e.g. resistant congenital talipes euinovarus, post burns contractures, post-traumatic stiffness
  • Congenital Pseudarthrosis (a condition which occurs in children, where the leg bone may fracture spontaneously and does not unite)

Dr.Jijeesh
Dr.Jijeesh
Dr.Jijeesh
Dr.Jijeesh

Using the principles of ilizarov now have the options of using fixators other than the ring fixator e.g. Dynamic Uniplanar Fixators – Orthofix, LRS (Limb Reconstruction System), Hexapod fixator(hexapod,SUV,TSF) (the versatile computer aided six-axis correction system).All the above mentioned systems refines the ilizarov ring fixators especially deformity corrections.We can also apply these principles in internal fixation achieving comparable results with added advantage of convenience.

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