Basics of ilizarov ring fixation

1. Failagao, Nel John
Level 1 Resident
ILIZAROV RING FIXATOR TIBIA-FEMUR

2. 3RD ANNUAL
ILIZAROV RING FIXATOR
WORK SHOP
University Of The
Philippines Manila Campus
Skills Laboratory And
Anatomy LAB COMPLEX
FEB 5, 2023

3. ILIZAROV TECHNIQUES
MANY ADVANTAGES:
1. Primarily percutaneous minimally
invasive, and typically require only
minimal soft tissue dissection
2. Can promote the generation of
osseous tissue
3. Versatile
4. Can be used in the presence of acute
or Chronic infection
5. Allow for stabilization of small intra-
articular or periarticular bone
fragments

4. ILIZAROV TECHNIQUES
MANY ADVANTAGES:
6. Allow simultaneous deformity
correction and enhancement of bone
healing
7. Allow immediate weight bearing and
early joint function
8. Allow augmentation or modification
of the treatment as needed through
frame adjustment
9. Resist shear and rotational forces
while the tensioned wires allow the
“trampoline effect” (axial loading–
unloading) during weight-bearing
activities.

5. ILIZAROV TECHNIQUES

6. • As the ring fixator is an
external fixator, it gives
RELATIVE STABILITY.
• As pins are inserted across
different planes in a
MULTIPLANAR FIXATION,
the construct provides great
stability.
PRINCIPLES

7. The stiffness of the construction can
vary depending on:
1. Configuration of the fixation
2. Number of rings used
3. Usage of different types of pins
such as k-wires or schanz screws.
• A common use for the ring fixator is
DISTRACTION OSTEOGENESIS to
correct bone loss, shortening and
deformity.
PRINCIPLES

8. COMPONENT RELATED FACTORS THAT INCREASE STABILITY OF
RING FIXATORS
1. Increase wire diameter
2. Increase wire tension
3. Increase Pin-Crossing angle to approach 90 degrees
4. Decrease ring size (distance of ring to bone)
5. Increase number of wires
6. Use of olive wires/drop wires
7. Close ring position to either side of fracture (pathology) site
8. Centering bone in the middle of the ring

9. INDICATIONS
In fresh fractures, there are several indications for using a ring fixator:
1. Severe soft-tissue compromise
2. Multifragmentary fractures
3. Fractures of the proximal or distal diaphysis, possibly with extension
into the metaphysis
4. Bone loss
5. Infection
6. Delayed presentation of the fracture (>3 weeks)

10. PARTS OF AN ILIZAROV RING
FIXATOR

11. EXTERNAL SUPPORTS OF DIFFERENT STANDARD SIZES:
•External Supports Of
Different Standard
Sizes:
• Rings
• Half Rings
• Sector Rings
• Two-Thirds
• Three-Quarter
• Five-Eighths Rings

12. CONNECTING PLATES OF DIFFERENT
STANDARD SIZES INCLUDING:
• Straight Plates
• Twisted Plates
• Curved Plates

13. POSTS AND PLATES
• One- To Four-Hole Male And
Female Posts
• Long And Short Connecting
Plates Of Different Lengths
• Long Connecting Plates With
Treaded Ends

14. DIFFERENT LENGTH CONNECTING RODS OF
DIFFERENT LENGTHS INCLUDING:
1. Partially Threaded
2. Fully Threaded
3. Telescopic Rods

15. RODS AND WIRES
• Slotted Threaded Rods: Traction Clips
• Smooth and Stop Wires of Diameter 1.5, 1.8 And 2.0
Mm.
• H Wire Fixation Frame (Russian Only); Wire-Fixation
Bolts.

16. BOLTS AND WASHERS
• J Bolts
• Nuts
• Lock Washers
• Slotted Washers
• Serrated Washers
• Conical Washers,
• Conical And Spherical Washers

17. • Threaded Sockets And Bushes
• K Regular Flat-Nosed And Round-Nosed Pliers
• Standard 10-Mm Spanners

18. TENSIONER

19. 3RD ANNUAL
ILIZAROV RING FIXATOR
WORK SHOP
University Of The
Philippines Manila Campus
Skills Laboratory And
Anatomy LAB COMPLEX
FEB 5, 2023

20. 4-9 PERSONS PER TABLE
GROUPED ACCORDING TO INSTITUTION/PERSONS PER TABLE

21. WORKSHOP AGENDA
• Basic principles in relation to technique
in the application of a ring fixator
1. FEMUR
2. TIBIA
• Four we started with the femur first
• Femur arch
• Femoral Arch Support

22. BENEFITS OF A CADAVERIC MODEL
• Presence of Soft tissues otherwise
not present on a saw-bone model
• Angulation and contours
• How the shape of the thigh does
not correlate with it axis
• Mechanical axis of the lower
extremity in relation to its
anatomical axis

24. DEMONSTRATION OF POSITIONING OF FEMUR COMPONENTS

25. CONTENTS OF WORK SHOP KIT

26. WORKSHOP KITS

27. LANDMARKS
• We were taught about the proper
positioning and how to measure
• Lack Radiographic modalities: create lines
with pen
1. MARK THE PATELLA
2. PATELLAR TENDON
3. MEDIAL AND LATERAL TIBIAL PLATEAU
4. OUTER RIM LINES AND ALSO THE
FEMORAL CONDYLES
Which we position the carryover into a
flexed knee position

28. LANDMARKS

29. SAFE ZONES
• Taught the safe zones pin placement
• The technique was your reference pin
which should be parallel to the joint line
• RING BLOCKS: composed of two Ilizarov
Rings

30. • RING BLOCKS:
composed of two
Ilizarov Rings 1ST RING BLOCK
2ND RING BLOCK

31. CONSTRUCT FABRICATION
• PREFABRICATE THE RING
CONSTRUCT PRIOR TO
ATTACHING IT TO THE LIMB
• Appropriate spacing of each
block segment
• Attachments connected,
oriented and fixed inplace

32. CONSTRUCT FABRICATION
• Finalized Your Construct
• Check Whether It's Everything Is
According To Specifications.
• Make Sure That It's Oriented Correctly
1. Pins are well angulated
2. Avoidance of Critical structures
3. Limb is centered in the construct

33. SEQUENCE OF REMOVAL OF IMPLANT
• Remove The Anterior Locking Nut And
Bolt
• Remove The Rancho Cube Attachment
But Keeping The Shawn's Pin In Place
• Loosen Attachment Points/Bolts Of
Threaded Connecting Rods
• Once You Have Detached, No
Connection Between Your Ring Fixator
And Drop Pins
• You May Now Cut The Transfixation Pins

34. • Schwann’s pins and transfixation
pins removed
• Releasing the tension proves
painful for the patient
• So that's the sequence is
necessary to prevent a sudden
release of tension and then hence
preventing discomfort for the
patient when removing the
construct
SEQUENCE OF REMOVAL OF IMPLANT

35. CORTICOTOMY
• Soft Tissue To Ring Distance Are
Equal On Most Rings
• Vertical Incisions Or Longitudinal
Incisions
• Corticotomy Technique: Only
Cutting Into The Cortex Leaving The
Medullary Canal Intact
• Drill In Sequenced Manner
• Closure Of Incision Site

36. FINALIZATION OF CORTICOTOMY
•Remove threaded
connecting rods of the
two rings that border
corticotomy site
•Externally rotate the
distal segment

37. THANK YOU!