A 46-year-old man presented with a 5-year history of difficulty walking following a road traffic accident that resulted in right leg fractures. He underwent three surgeries including intramedullary nailing, plating, and bone grafting, but developed a non-union. He was treated with fibular osteotomy and application of an Ilizarov external fixator to achieve bone transport and lengthening. Over the course of treatment, his leg length increased by 2 cm and he was able to walk without support upon removal of the fixator. The Ilizarov technique allowed new bone formation and healing without additional bone grafts or internal fixation.

1. Prof.Dr.Raviraman,
M.S (Ortho), D.Ortho Fellowship in Ilizarov surgery
HOD –Orthopedics.
Dr Venkatesh Karthikeyan,
CRRI.
Email : 4852012@gmail.com

2.  A 46 years old gentleman presented to Velammal
hospital with complaints of difficulty in walking for 5
years
 H/o RTA before 5 years

3.  H/o deformity in right leg
 H/o limping
 H/o restriction of day to day activities
 No h/o fever
 No h/o pain
 No h/o swelling
 No h/o stiffness
 No h/o any discharge

4.  Following RTA, the patient was diagnosed with Right
leg both bone fracture which was initially managed in
a Government hospital.
 Three surgeries were done in Government hospital

5. Intramedullary inter-locking nailing

6. Plate osteosynthesis & Bone grafting

7. Bone transportation
 Using
orthofix

8.  The patient is not a known case of
DM/SHT/BA/TB/CAD/CKD/CLD/CVA/Malignanc
ies
 Non smoker/ Non alcoholic

9. General examination
 GC fair/conscious/oriented/afebrile
 Moderately built and nourished
 Vitals
 Pulse : 80/min
 BP: 120/80 mmHg
 RR:16/min
 Temp: 98.6 F
 SpO2 : 98% with RA

10. Systemic Examination
 CVS : S1+, S2+
 RS : NVBS +
 CNS : NFND
 Abd: Soft, non tender, BS+

11. Local examination of Right lower
limb
 Inspection
 Shortening of limb +
 Multiple healed scars +
 Blackish discoloration of skin +
 Deformity +
 Muscle wasting+
 No discharging Sinus

14.  Palpation
 No warmth
 No tenderness
 Abnormal mobility +
 Active toe movements+
 Distal pulse +
 Shortening of limb +
 Right LL : 92cm
 Left LL : 96 cm

15.  Examination of right knee joint – Normal
 Examination of ankle joint - Normal
 Examination of left lower limb – normal

16. X ray
(13.10.2018)
 Fracture ends
sclerosed
 Medullary canal
closed
 Site of bone transport
going for non union

17. Diagnosis
 Right lower limb both bone fracture
 Non union

18. Management
 Fibular osteotomy +
Ilizarov fixator
application done on
15.06.2018

19. 18.03.2019

20. 02.12.2019

21. 10.02.2020

22. How it works?
 Ilizarov fixator works on the concept of law of tension
– stress, which is the process of new bone and soft
tissue regeneration under the effect of slow and
gradual distraction.

25. Why Ilizarov?
 Superior to other lengthening methods
 Allows new bone to spontaneously bridge the
distraction gap without the need for bone grafts and
internal fixation of bone ends

27. Early mobilization

29. Ilizarov removal done on
11.02.2020

30.  An increase of 2 cm was achieved.
 The patient was satisfied with the results and did not
opt for limb lengthening procedure. Adequate shoe
rise was given.
 The patient was able to walk out of the hospital
without any support.

32. Thank you!
Ilizarov – The answer!