history of ilizarov, basic apparatus, technique, use examples, complications and advantages, bone transport method. management of ilizarov apparatus. lomg term follow up and management. osteotomy vs corticotomy.

1. Ilizarov
Technique
Dr. saurabh agrawal
Assitant professor
Deptt of orthopedics
AIIMS udaipur

2. Ilizarov Technique
http:/faculty.ksu.edu.sa/DrSalehAlharby
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.

3. 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.

4. 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..

5. Ilizarov Technique
The apparatus
• Transosseous wires.
• Rings.
• Threaded and Telescopic rods.
• Hings, Posts and Nuts.

6. Ilizarov Technique
Technique
· Insertion of wires..
· Pain
· Function
· Infection
· Fixation of Rings..
· Rods fixation..

7. Ilizarov Technique
3D ANATOMY
http:/faculty.ksu.edu.sa/DrSalehAlharby

8. Ilizarov Technique
 Indications
 Acute Fractures.
 Nonunion.
 Malunion.
 Chronic Osteomyelitis.
 Deformities and Shaping.
 Lengthening of short limbs

9. Ilizarov Technique
Concept based on Unknown
Biologic Laws.
• Compression-Distraction.
• Osteoinduction. AND
• Tissue neogenesis.

10. 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.

11. Ilizarov Technique
ANGULAR
DEFORMITIES

12. Ilizarov Technique
Deformity correction
• Lever arm action.
• Use of hinges.
• Placement of hinges.

13. Ilizarov Technique
Deformity correction
• Mechanical axis.
• Anatomical axis.
• Malalignment.
• Lateral distal femoral angle(LDFA).
• Medial proximal tibial angle (MPTA).

14. Ilizarov Technique
Center of rotation and angulation
(CORA).
The point of intersection of the proximal
and distal mechanical axis lines.

15. Ilizarov Technique
http:/faculty.ksu.edu.sa/DrSalehAlharby
Deformity correction
• Acute vs. gradual correction.
1-Gradual correction:
-Better bone formation.
-Decreased NV complications.
2-Acute correction:
-Satisfaction
-Simple post op care
-Good bone formation
-Easy pre-op plan
-? Accurate
-NV

16. Ilizarov Technique
• Post op care
Day one:
1 control pain
2look for skin pressure
3-persistence bleeding
4 mobilization and physio
5 proper positioning of the limb

17. Ilizarov Technique
• Day 2
wt bearing
stretching exercise
ROM

18. 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….

19. Ilizarov Technique
• Weekly OPD visit
DISTRACTION PERIOD Check for
1- ROM
2 Deformity
3Pin site infection
4-Wt Bearing
5-Callus formation..

20. Ilizarov Technique
• Period of Fixation
1-Full wt bearing
2-Dynamization
3-Prepare for apparatus removal

21. Ilizarov Technique
• Apparatus removal
1-one to 2 weeks of Dynamization
2-Splint vs. no splint
3-Back one step in wt bearing

22. 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.

23. Ilizarov Technique
• Achondropl.

24. Ilizarov Technique
• Cong
pseudarth…..

25. • Cong pseudarth

26. Ilizarov Technique
• Growth plate modulation

27. Ilizarov Technique
• Variety of deformities

28. Ilizarov Technique
• Cong short limb

29. Ilizarov Technique
• Ischemic limb

30. Ilizarov Technique
• Metabolic bone deformity

31. Ilizarov Technique
• Paralytic contracture

32. Ilizarov Technique
• Neglected fractures

33. Other
deformities

34. Ilizarov Technique
• Problems and complications
1 muscle contractures….
2joint stiffness or subluxation
3-axial deviation
4 NV injury
5premature consolidation
6-delayed consolidation
7-wire site problems
8-refracture

35. Ilizarov Technique
• Advantages
1-universal system with multiple indications
2-relatively simple
3 minimally invasive
4mobility and stability
5-3D correction
6 minimize bone grafting
7 simple hardware removal

36. 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
8limit social life
9-depression

37. Ilizarov Technique
Thank you