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Ilizarov history.pptx
1. A Brief history of Man and Machine:
Circular external fixator, Road Travelled
so far
Dr. Vikram Khanna
Aakash Hospital, Dwarka
Sparsh Hospital, Dwarka, Gurugram
4. • Considered the 'father' of circular external fixators
• Soviet Surgeon who was born in Poland in 1921
• Grew up in modern day Azerbaijan
• Medical School in Crimea
• Rural Hospital, Kurgan, as a General Medical
Officer - Surgeon in 1950
• Treated war wounded with Fixator systems built
locally
• Ultimately, an independent Institute for research
and practice of Restorative Orthopedics –
Transosseous Osteosynthesis
Prof. Gavriel Abramovitch Ilizarov
5. • The legend about bicycle spokes is not true.
• He organized a workshop for the development of medical
instruments in 1946 for the purpose of treatment of the
war‐injured invalids that returned from the front.
• Through this workshop, he began working on the earliest
prototypes of what would become known as an Ilizarov circular
external fixator.
6.
7. • The index distraction osteogenesis case was a lengthening of an
amputation stump.
• Ilizarov was on vacation during part of the treatment and the
patient continued to distract the bone segments.
• Ilizarov returned to notice that distraction osteogenesis developed
between the bone ends.
• Distraction osteogenesis was recognized in the world literature as
early as 1904 by Codivilla and later by his disciple Putti in 1921.
8. • Ilizarov defined the optimal rate and rhythm of distraction, the
need for preservation of blood supply at the osteotomy site, and
the various other parameters important to distraction
osteogenesis.
• Due to the versatility of his apparatus, he developed many new
applications including physeal distraction, bone transport,
distraction of nonunions, bone widening, contracture corrections,
and foot and hand distractions.
14. • 1938 : Petrovsky - used it for limb lengthening
• 1939 : Haynes - screw device for repositioning
• 1946 : Grafensteiner - with POP
• 1951 : Wustmann, King
• 1950s : Kemkes : parallel bows
External Fixation : Tensioned wires
15. • Early 1950s
• Crossed wires in a ring + Combinations of various connecting
apparatus = Multi-use, universal design
• Wire fixation devices
• Buckle wire fixation bolt
• Wires
• Wires with a twist Olives
Ilizarov Fixator
16. • Rings
• Bulky rings with fewer holes - rings with more holes
• Tensioner
• Original wire turning technique - Mechanical tensioner -
Dynamometric tensioner
• Italian Contribution
• Arches for proximal femoral fixation
• Dynamometric tensionometer
Ilizarov Fixator
17. • Schanz pins : Italians
• Graduated telescoping rod - ASAMI, Italy
• Stuart Green ~ Titanium pins
• Rancho cubes - Rancho Los Amigos Medical Center
• Four sided nut - Richards
• Nylon nut - Smith & Nephew
Various devices
Ilizarov Fixator
19. • Pure Ilizarov
• All wire frames, exactly as taught 15 years ago
• Hybrid Ilizarov
• Wires and Schanz pins, practiced even in Russia today
• Newer Fixators – Unilateral Rail systems
• Newer Fixators – Hexapod frames like DEFTFIX,
SUV frame
Evolution - Apparatus
20. • Studies suggest that steel, titanium aluminium and carbon
composites are the preferred materials.
• Kalova et al. proposed the use of carbon fibre reinforced epoxy
resin based polymer composite
• Lobst identified braided carbon fibre
• Carbon fibre rings are light weight and radiolucent.
Rings
Evolution of material used in Ilizarov
21. • Commonly used pin materials are stainless steel and the titanium
alloy Ti-6Al-4 V
• HA coated pins have also been used in osteoporotic bones
Pins
22. • While earlier designs of EFs have used steel and titanium clamps,
recent versions have considered composite materials of lower
weight.
• The metallic alloys which were considered were AISI316L,
Ti6Al4V, Aluminium 7175 and Magnesium AZ80A-T5, whereas
high-density polyethylene, Polyethylene terephthalate, Polyether
ether ketone and Polycarbonate.
Clamps
23. • Stainless steel has been the most frequently used material for the
connecting rod.
• Studies provide evidence for the feasibility of carbon fibre
composites as the material of choice for the connecting rod.
Connecting rods
33. • Non Union
• Lengthening
• Deformity Correction
• Not esoteric - If you perform Orthopedic Surgery, you need to
know this system
(‘Standard’ Indications)
Ilizarov 1990s
Courtesy
CLLR Mumbai
37. • We have come a long way from simple Ilizarov fixators to
hexapod
• The future is now
• Integration of AI may be the way forward
Take home message
