Ilizarov apparatus

The Ilizarov apparatus is used in a surgical procedure that can be used to lengthen or reshape limb bones. In addition, the procedure is often used to treat complex and/or open bone fractures, where conventional treatment techniques cannot be used. It can also be used to treat infected non-unions of bones not amenable with other techniques.

History
Professor Gavril Abramovich Ilizarov invented this procedure in the 1950s after having to treat orthopedic conditions in the Kurgan region of Siberia. Originally bicycle parts were used for the frame.

This novel technique was introduced to the West in the 1980s, predominantly via Italian surgeons. It gained popularity in the 90s, and has been used successfully by many surgeons throughout the world now. In most 3rd world countries it is a highly specialised technique used mainly for deformity correction by experienced deformity surgeons due to its complexity. Further development of the ring construct led to the Taylor Spatial Frame which is more versatile and far easier to use, but very costly.Though, nowadays intramedullary limb lengthening devices are also available, they are not suitable for deformity correction of bones.

Bone Lengthening/Reshaping Procedure
The procedure involves breaking the bone to be adjusted. Metal rings are then attached to the bone sections by rods, wires and screws. The screws are then periodically adjusted while the bone is healing to get the required shape. Once this has been completed a second operation is performed to remove the apparatus. The major advantage of this procedure is that because the apparatus provides complete support while the bone is recovering the patient can remain active aiding recovery.

Harry Aitchison was one of the first people to have an Ilizarov frame used to mend a tuma on his leg the operation was very successful and he now can do everything a normal person can achieve. Harry Aitchisons tuma was removed by having a section of his left tibia completely removed the Ilizarov frame is what stretched it back together.

The device is a specialized form of external fixator, a circular fixator, modular in construct. Instead of the more traditional mololateral fixators, the circular construct, in addition to the novel tensioned wires provides far more structural support. This allows early weightbearing. The frame can be used to support a fractured limb, but it is most commonly used to correct deformity through the concept of callotasis. A surgical fracture is created, the bone allowed to commence healing, and then by distracting this new bone regenerate through the frame the deformity can be corrected. A further use is of bone transport, whereby a defect in a long bone can be treated by transporting a segment of bone, whilst simultaneously lengthening regenerate to reduce the defect and finally dock with the other segment, producing a single bony unit.

The Ilizarov apparatus is a powerful tool, and is not without problem. It is difficult to use, whilst it is minimally invasive in that no large incisions are made and no metalwork is applied directly to the bone, it is not free of complications. Pin site infection is very common, swelling, limb pain and muscle transfixion are all not uncommon.

Bone Fracture Treatment Procedure
The Ilizarov method is widely used to treat complex and/or open bone fractures. This method is preferred over conventional treatment options (such as internal fixator or cast) where there is a high risk of infection or the fracture is of such severity that internal fixators are unworkable.

Images (Case Study)
The following case study illustrates the Ilizarov apparatus treatment procedure for a fractured limb. The photographs are of the same patient during the course of treatment. If other individuals desire to post images, please create a separate gallery/case-study.