Ilizarov technique

1. Dr Saleh W Alharby
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

2. Ilizarov Technique
Dr.Saleh Waslallah Alharby
Associate Professor,
Consulatant Orthopedic Surgeon.
College of Medicine,
King Saud University.
Dr Saleh W Alharby
[email protected]
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
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

4. Ilizarov Technique
Historical Review 1951 in Kurgan (USSR).
1980 attention outside USSR.
Carlo Mauriexplorer
..
1981 visited Italy in (AO meeting).
April 1982 Italian Surgeons visited Kurgan.
Dr Saleh W Alharby
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

5. 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
..
Dr Saleh W Alharby
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

6. Ilizarov Technique

The apparatus
•
Transosseouswires.
•
Rings.
•
Threaded and Telescopic rods.
•
Hings, Posts and Nuts.
Dr Saleh W Alharby
[email protected]
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
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

8. Ilizarov Technique
3D ANATOMY
Dr Saleh W Alharby
[email protected]
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
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

10. Ilizarov Technique
Concept based on Unknown
Biologic Laws.
•
Compression-Distraction.
•
Osteoinduction. AND
•
Tissue neogenesis
.
Dr Saleh W Alharby
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

11. 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.
Dr Saleh W Alharby
[email protected]
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
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

13. Ilizarov Technique
ANGULAR
DEFORMITIES
Dr Saleh W Alharby
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

14. Ilizarov Technique
Deformity correction • Lever arm action.
• Use of hinges.
• Placement of hinges.
Dr Saleh W Alharby
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

15. Ilizarov Technique

Deformity correction
•
Mechanical axis
.
•
Anatomical axis.
•
Malalignment.
•
Lateral distal femoral angle(LDFA).
•
Medial proximal tibial angle (MPTA).
Dr Saleh W Alharby
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

16. Ilizarov Technique
Center
of
rotation
and
angulation
(CORA).
The point of intersection of the proximal
and distal mechanical axis lines.
Dr Saleh W Alharby
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

17. Ilizarov Technique
Deformity correction •
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
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

18. Ilizarov Technique
• Congenital anomalies: Upper Limbs
Hemimelias
Pseudarthrosis
Feet
Dr Saleh W Alharby
[email protected]
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
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

20. Ilizarov Technique
• Day 2 wt bearing
stretching exercise
ROM
Dr Saleh W Alharby
[email protected]
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
[email protected]
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
[email protected]
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
[email protected]
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
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

25. Ilizarov Technique
• Rehabilitation Starts pre-op
cont post-op
psychotherapy and assurance
….
Dr Saleh W Alharby
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

26. Ilizarov Technique
Unlike most other surgical procedures where the wo rk is
done when the pt. Leaves the operating room, an ext ernal
fixation “procedure”takes months to complete. For t his
reason,success or failure depends on post operative
management.

Stuart Green.
Dr Saleh W Alharby
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

27. Ilizarov Technique
• Achondropl.
Dr Saleh W Alharby
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

28. Ilizarov Technique
• Cong
pseudarth
….
.
Dr Saleh W Alharby
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

29. • Cong pseudarth
Dr Saleh W Alharby
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

30. Ilizarov Technique
• Growth plate
inj
Dr Saleh W Alharby
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

31. Ilizarov Technique
• Variety of
deformities
Dr Saleh W Alharby
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

32. Ilizarov Technique
• Cong short limb
Dr Saleh W Alharby
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

33. Ilizarov Technique
• Ischemic limb
Dr Saleh W Alharby
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

34. Ilizarov Technique
• Metabolic bone
deformity
Dr Saleh W Alharby
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

35. Ilizarov Technique
• Paralytic
contracture
Dr Saleh W Alharby
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

36. Ilizarov Technique
• Neglected fractures
Dr Saleh W Alharby
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

37. Other deformities
Dr Saleh W Alharby
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

38. Ilizarov Technique
• Never do this
Dr Saleh W Alharby
[email protected]
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
[email protected]
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
[email protected]
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
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby

42. Ilizarov Technique
Thank you

Dr Saleh W Alharby
[email protected]
http:/faculty.ksu.edu.sa/DrSalehAlharby