Dr. Gavriil Abramovich Ilizarov (1921-1992)
 

  The Originator
Prof Gavril Abramovich Ilizarov (1921-1992) was a doctor working in Kurgan Siberia of erstwhile USSR. He was not trained as an orthopedic surgeon but he faced a wide variety of orthopedic problems like nonunions, infected nonunions, limb lengthening and complex deformity correction. In those primitive conditions in 1950s he devised and developed a circular external fixator and his research led him to the techniques of bone lengthening. The theory is known as “tension stress or distraction histiogenesis. In simple words when a tissue is stretched in controlled manner new tissue like bone, muscle, artery and nerve is formed. He was a self taught orthopedic surgeon who created a magical principle which has revolutionized the treatment of non unions infected non unions and limb lengthening.

Prof Ilizarov’s methods were introduced to the west by an Italian doctor, Prof A Bianchi-Maiocchi in 1961, after he came to know about the successful treatment of infected nonunion of an Olympic high jump champion Valery Brummel.

Technique and Technology
The Ilizarov technology has two parts one is the circular fixator developed by Prof. Ilizarov and the second is the principle of distraction histiogenesis. They can be used separately with other methods but give best results when used together.
The circular fixator is applied as an operation under general or regional anesthesia. Multiple thin wires are drilled through the limb avoiding important Neuro-vascular structures. These wires are then tensed and tightened to the circular rings. These rings are then attached to each other by threaded rods and nuts. In this way a support frame is prepared outside the limb.
The frame helps in various ways:

  1. 1. It holds the multiple pieces of bone in position in case of fresh fracture for sufficient time for them to unite with each other. This is very useful method in many instances where traditional methods of fixation are unable to give proper hold on the fracture fragments.
     
  2. 2. It holds the bone fragments and allows significant amount of compression in case of non unions (transosseus osteosynthesis)
     
  3. 3. It allows bone fragments to be pulled apart at a rate of 1mm per day after cutting the bone (corticotomy). As the gap between the two fragments increases new bone forms in the gap known as Regenerate. This way a bone gap arising from traumatic loss, infection or tumor etc. can be bridged by locally regenerated bone or a short limb can be lengthened.
  4.  

Indications of Ilizarov surgery

  • • Cosmetic bone lengthening
    • Congenital & acquired limb shortening for equalizing leg length
    • Limb deformity correction
    • Complicated and severe fracture management
    • Un united fractures (non unions)
    • Infected fractures and non unions
    • Long bone defects due to severe bone trauma, infection, tumor or birth defects.
    • Bone defects & pseudarthrosis due to osteomyelitis of childhood.
  • Post operative pain
    Immediately after surgery there is post operative pain which is controlled by analgesics. In case of bone transport or limb lengthening patient may feel pain due to stretching of the tissues which is again controlled by analgesic tablets etc...

    Post operative care
    The patient is advised and encouraged to move the neighboring joints through the full range. They are also encouraged to walk put the foot down and bear weight and walk as per the tolerance with the support of the crutches or the walker.
    Pin-site care.
    Initially the dressings are done by the hospital staff but the attendants are taught to take care of the pin-sites and do the cleaning and dressing at regular interval at home.

    Follow up
    Regular follow up is very important in this method of treatment. At every visit all the wounds are inspected, cleaned and dressed. The new X-rays are taken.

    Removal of frame.
    When the X- ray pictures are satisfactory then decision to remove the frame is taken. The frame is removed under short anesthesia.

    Complications of Ilizarov Technique
    Many complications may arise during the long course of treatment with the Ilizarov technique. Most however are preventable or correctable and will not interfere with successful results of treatment.
    Complications of the Ilizarov technique can be classified as

    1. 1. general due to method
      2. specific, related to the technique
      3. inflammatory

    Complication due to method or technique may become apparent soon after the surgery is performed. However some may develop late during the course of treatment. Correction of some complications may require the patient to be readmitted to the hospital because procedures must be performed that may require anesthesia.

    List of Complications of Ilizarov Technique
    General complications related to method

    Immediate

    1. 1. neurological compromise
      2. vessel penetration
      Delayed
      3. Pain
      4. compartment syndrome
      5. muscle contracture
      6. neurological compromise
      7. local edema
      8. hypertension
      9. joint subluxation

    Specific complications related to technique

    Early complications

    1. 1. Local skin tightness
      2. Local edema with compromise of circulation
      3. Premature healing at corticotomy site
      4. Local pain with motion

    Delayed complications

    1. 5. Break in wires
      6. Axial deviation of distracted fragments
      7. Joint stiffness
      8. Poor regenerate

    Late iatrogenic complications

    1. 9. Development of pseudarthrosis
      10. Angulation of regenerate
      11. Fracture of regenerate
      12. Psychological incompatibility

    Inflammatory complications

    1. 1. Pin tract infection
      2. Phlebitis
      3. Osteomyelitis

    THIS MATERIAL DOES NOT CONSTITUTE MEDICAL ADVICE. IT IS INTENDED FOR INFORMATIONAL PURPOSES ONLY. PLEASE CONSULT A PHYSICIAN FOR SPECIFIC TREATMENT RECOMMENDATIONS

     

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