Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby.

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Dr Saleh W Alharby

alharby@ksu.edu..sa

http:/faculty.ksu.edu.sa/DrSalehAlharby

Ilizarov Technique

Dr.Saleh Waslallah Alharby

Associate Professor,

Consulatant Orthopedic Surgeon.

College of Medicine,

King Saud University.

Dr Saleh W Alharby

alharby@ksu.edu..sa

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

Ilizarov Technique

Historical Review

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

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

alharby@ksu.edu..sa

Ilizarov Technique

The apparatus

• Transosseous wires.

• Rings.

• Threaded and Telescopic rods.

• Hings, Posts and Nuts.

Dr Saleh W Alharby

alharby@ksu.edu..sa

Ilizarov Technique

Technique

· Insertion of wires..· Pain

· Function

· Infection

· Fixation of Rings..

· Rods fixation..

Dr Saleh W Alharby

alharby@ksu.edu..sa

Ilizarov Technique

3D ANATOMY

Dr Saleh W Alharby

alharby@ksu.edu..sa

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

Ilizarov Technique

Concept based on Unknown Biologic Laws.

• Compression-Distraction.• Osteoinduction. AND• Tissue neogenesis.

Dr Saleh W Alharby

alharby@ksu.edu..sa

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

alharby@ksu.edu..sa

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

Ilizarov Technique

ANGULAR DEFORMITIES

Dr Saleh W Alharby

alharby@ksu.edu..sa

Ilizarov Technique

Deformity correction• Lever arm action.

• Use of hinges.

• Placement of hinges.

Dr Saleh W Alharby

alharby@ksu.edu..sa

Ilizarov Technique

Deformity correction• Mechanical axis.• Anatomical axis.• Malalignment.• Lateral distal femoral angle(LDFA).• Medial proximal tibial angle (MPTA).

Dr Saleh W Alharby

alharby@ksu.edu..sa

Ilizarov Technique

Center of rotation and angulation (CORA).

The point of intersection of the proximal and distal mechanical axis lines.

Dr Saleh W Alharby

alharby@ksu.edu..sa

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

alharby@ksu.edu..sa

Ilizarov Technique

• Congenital anomalies:

Upper Limbs

Hemimelias

Pseudarthrosis

Dr Saleh W Alharby

alharby@ksu.edu..sa

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

Ilizarov Technique

• Day 2

wt bearing

stretching exercise

Dr Saleh W Alharby

alharby@ksu.edu..sa

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

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

Ilizarov Technique

• Period of Fixation 1-Full wt bearing

2-Dynamization

3-Prepare for apparatus removal

Dr Saleh W Alharby

alharby@ksu.edu..sa

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

Ilizarov Technique

• Rehabilitation Starts pre-op

cont post-op

psychotherapy and assurance….

Dr Saleh W Alharby

alharby@ksu.edu..sa

Ilizarov Technique

Unlike most 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

Ilizarov Technique

• Achondropl.

Dr Saleh W Alharby

alharby@ksu.edu..sa

Ilizarov Technique

• Cong pseudarth…..

Dr Saleh W Alharby

alharby@ksu.edu..sa

• Cong pseudarth

Dr Saleh W Alharby

alharby@ksu.edu..sa

Ilizarov Technique

• Growth plate inj

Dr Saleh W Alharby

alharby@ksu.edu..sa

Ilizarov Technique

• Variety of deformities

Dr Saleh W Alharby

alharby@ksu.edu..sa

Ilizarov Technique

• Cong short limb

Dr Saleh W Alharby

alharby@ksu.edu..sa

Ilizarov Technique

• Ischemic limb

Dr Saleh W Alharby

alharby@ksu.edu..sa

Ilizarov Technique

• Metabolic bone deformity

Dr Saleh W Alharby

alharby@ksu.edu..sa

Ilizarov Technique

• Paralytic contracture

Dr Saleh W Alharby

alharby@ksu.edu..sa

Ilizarov Technique

• Neglected fractures

Dr Saleh W Alharby

alharby@ksu.edu..sa

Other deformities

Dr Saleh W Alharby

alharby@ksu.edu..sa

Ilizarov Technique

• Never do this

Dr Saleh W Alharby

alharby@ksu.edu..sa

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

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

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-depressionDr Saleh W Alharby

alharby@ksu.edu..sa

Ilizarov Technique

Thank you

Dr Saleh W Alharby

alharby@ksu.edu..sa

Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby.

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