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Ilizarov technique
The document describes the Ilizarov technique, a method of limb lengthening and reconstruction using an external fixator device. It provides background on its development in the 1950s in Russia and outlines the basic components of the apparatus. The technique allows for gradual correction of fractures, nonunions, deformities and limb length discrepancies through the biological process of distraction osteogenesis. Close postoperative management and monitoring is crucial to the technique's success.
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Ilizarov technique
- 1. Dr Saleh WAlharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 2. Ilizarov Technique Dr.SalehWaslallah Alharby Associate Professor, Consulatant Orthopedic Surgeon. College of Medicine, King Saud University. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 3. Ilizarov Technique 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. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 4. Ilizarov Technique HistoricalReview 1951 in Kurgan (USSR). 1980 attention outside USSR. Carlo Mauri explorer.. 1981 visited Italy in (AO meeting). April 1982 Italian Surgeons visited Kurgan. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 5. Ilizarov Technique Historicalreview • 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.. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 6. Ilizarov Technique Theapparatus • Transosseous wires. • Rings. • Threaded and Telescopic rods. • Hings, Posts and Nuts. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 7. Ilizarov Technique Technique · Insertion of wires.. · Pain · Function · Infection · Fixation of Rings.. · Rods fixation.. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 8. Ilizarov Technique 3DANATOMY Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 9. Ilizarov Technique Indications · Acute Fractures. · Nonunion. · Malunion. · Chronic Osteomyelitis. · Deformities and Shaping. · Lengthening of short limbs and amputation stumps. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 10. Ilizarov Technique Conceptbased on Unknown Biologic Laws. • Compression-Distraction. • Osteoinduction. AND • Tissue neogenesis. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 11. Ilizarov Technique Bonelengthening. • 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. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 12. Ilizarov Technique Lengthening • 10-20% of segment per stage. • Better staged. • Avoid simultaneous ipsilateral femoral and tibial lengthening. • ? BI-level lengthening. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 13. Ilizarov Technique ANGULAR DEFORMITIES Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 14. Ilizarov Technique Deformitycorrection • Lever arm action. • Use of hinges. • Placement of hinges. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 15. Ilizarov Technique Deformitycorrection • Mechanical axis. • Anatomical axis. • Malalignment. • Lateral distal femoral angle(LDFA). • Medial proximal tibial angle (MPTA). Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 16. Ilizarov Technique Centerof rotation and angulation (CORA). The point of intersection of the proximal and distal mechanical axis lines. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 17. Ilizarov Technique Deformitycorrection • Acute vs. gradual correction. 1-Gradual correction: -Better bone formation. -Decreased NV complications. 2-Acute correction: -Satisfaction -Easy pre-op plan -Simple post op care -? Accurate -Good bone formation -NV complication Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 18. Ilizarov Technique •Congenital anomalies: Upper Limbs Hemimelias Pseudarthrosis Feet Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 19. Ilizarov Technique •Post op care Day one: 1-control pain 2-look for skin pressure 3-persistence bleeding 4-mobilization and physio 5-proper positioning of the limb Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 20. Ilizarov Technique •Day 2 wt bearing stretching exercise ROM Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 21. 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…. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 22. Ilizarov Technique •Weekly OPD visit DISTRACTION PERIOD Check for 1- ROM 2- Deformity 3-Pin site infection 4-Wt Bearing 5-Callus formation.. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 23. Ilizarov Technique •Period of Fixation 1-Full wt bearing 2-Dynamization 3-Prepare for apparatus removal Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 24. Ilizarov Technique •Apparatus removal 1-one to 2 weeks of Dynamization 2-Splint vs. no splint 3-Back one step in wt bearing Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 25. Ilizarov Technique •Rehabilitation Starts pre-op cont post-op psychotherapy and assurance…. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 26. Ilizarov Technique Unlikemost 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. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 27. Ilizarov Technique •Achondropl. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 28. Ilizarov Technique •Cong pseudarth….. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 29. • Cong pseudarth Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 30. Ilizarov Technique •Growth plate inj Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 31. Ilizarov Technique •Variety of deformities Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 32. Ilizarov Technique •Cong short limb Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 33. Ilizarov Technique •Ischemic limb Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 34. Ilizarov Technique •Metabolic bone deformity Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 35. Ilizarov Technique •Paralytic contracture Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 36. Ilizarov Technique •Neglected fractures Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 37. Other deformities DrSaleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 38. Ilizarov Technique •Never do this Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 39. Ilizarov Technique •Problems and complications 1-muscle contractures…. 2-joint stiffness or subluxation 3-axial deviation 4-NV injury 5-premature consolidation 6-delayed consolidation 7-wire site problems 8-refracture Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 40. Ilizarov Technique •Advantages 1-universal system with multiple indications 2-relatively simple 3-minimally invasive 4-mobility and stability 5-3D correction 6-minimize bone grafting 7-simple hardware removal Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 41. 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 8-limit social life 9-depression Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby
- 42. Ilizarov Technique Thankyou Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby