Who's Ilizarov?
Professor Gavril Abramovich Ilizarov was born in the USSR, in the Soviet Union in 1921. Although of illiterate parents, he advanced quickly through medical school, eventually going on to practice medicine in the Kurgan region of Siberia in 1943. In Kurgan, he devised his own, improved ring fixator in 1950. It was met with a lot of skepticism initially, but gradually people began to recognize the truth in his new technique. Ilizarov believed that no body could stop the progress. In 1950, in a small village (Dolgovka), he performed his first operation by using his first ring fixator for a patient with nonunion fracture of the leg during 15 years and...... the fracture healed very quickly! This operation was the first practical step of the Ilizarov’s method (Transosses osteosynthysis), which was a real revaluation in reconstruction bone surgery!
Who is a candidate for bone lengthening?
Patients with discrepancy of less than 3 cm. should avoid bone lengthening and go in for other alternatives. Bone lengthening is appropriate for discrepancies between 3 cm. and 40 cm.
What is a limb length discrepancy?
Limb length discrepancy (LLD) is a measurable difference in the length of the limbs (upper or lower). The lower limbs length discrepancy is more common and troublesome than upper limbs length discrepancy.
What kind of the problems can be caused if one leg is shorter than the other is?
Shortening one of the legs can cause a lot of problems for the patient: such as- low back pain, limping, lumbar Scoliosis, and degenerative changes in the opposite side and cosmetic problems
Why you prefer the Ring Fixator?
The ring fixator is better for the following: - Safety reasons - Simultaneous correction and lengthening of multi-plane deformities; - Wide variety of indications, treatable with one system; - Early patient activation; - Single surgical procedure; - High- stability. But, we use the monolateral fixators too, for upper extremity, and we use the hybrid systems for the femur and humerus bones lengthening. For the leg the Ring fixator is the best!
Are there any OTHER applications and uses for Ilizarov device?
YES!!! For Example: -Ilizarov’s method of treatment can be used for about one thousand different types of bone, joint and soft tissue cases. Ilizarov procedure can be used with perfect results for: - Cosmetic bone lengthening (for example- to increase height of dwarfs), - Congenital and acquired limb shortening for equalizing leg lengths, - Joints reconstruction, - Nonunion fractures (infected and not infected, , Osteomyelitis), - Long bone defects, due to Chronic bone infection, severe open trauma (gunshot fractures), tumours, in-born defects and others, - limb deformities, with shortening or without it, - Complicated and severe fractures management, - Poliomyelitis: lengthening, thickening and fine shaping of shin and foot, - Vascular disease, such as obliterating endarteritis and others.
Why you use only external fixators for limb lengthening? What you think about combination approach for lengthening and lengthening over nail technique?
This is a very important question….. We use only external fixation for limb lengthening, because our philosophy laying on Professor's Ilizarov understanding of his concept "minimal invasive surgery, with maximum stability" So the main reasons to refuse this combination are: Combination of intramedullary nail insertion and external fixation is an easy approach for the doctor, but not for the patient at all……WHY? Because the Ilizarov philosophy is based on "maximum stability with minimum vessels and other tissue damage"; SO the bone have three components for healing and revascularization "restoring of bone blood supply mechanisms" : Pereosteoal Factor (P.F) – this is a very important factor – it's located around the bone "pereosteom and muscles", Osteoal Factor (O.F.)– this is the bone it's self healing factor, Endosteoal Factor (E.F) - the internal "inside the bone" healing factor SO when the doctor decided to do a combination of external and internal fixation, he well destroys all these factors! It's means that Ilizarov concept not used at all! WHY? Because the intramedullary nail well destroyed the internal small vessels of the bone, and for insertion of the nail the surgeon have to do complete osteotomy by saw, and cannot do closed corticotomy, it's leads to bone burn, and destroying the osteal and extra osteal healing mechanisms, of course technically "lengthening over nail" easier for doctor, espicialy during lengthening period, but it's not better for patient health! Here, we must remember about very high infection rate "the external wires and pins are connected to the internal bone canal" so, if we well met some problems "infection" in wires or pins tracts, we can easy manage them, if we use external fixation only, BUT, if the internal fixator well be infected……. It's a Very big problem! Now some words about our technique for bone cut: we use only semi closed corticotomy for bone cut- this technique is difficult one for surgeon, needs a well training, but it's very important for the patient, because we use 0.5 cm. incision and we cut the bone very gently "low kinetic technique". This technique was suggested by Professor Ilizarov him self for maximum saving of all vessels and tissue around and inside the bone for getting best results.
How is bone regenerated or height increased?
A cut in the bone by using the Ilizarov ring external fixator, give us a possibility to pull the bone fragments (distraction maximum of 1.5 mm/day), and between them the bone well grow up. First Ilizarov low is: The very slow distraction allows bone to form new bone between two old ends. The device lengthens the bone and stimulates cells to regenerate, thus creating new bone that is as strong as the original bone.
How long does the bone-lengthening take?
- It’s dependents- what we want? But it’s usually one mm/day x 2 days for maturation. The time depends on the majority of the problem and on the long of new bone.
Do the wires hurt? Will the turning of the nuts or the actual lengthening hurt?
Generally, no, but some people experience discomfort immediately after they turn the nuts or a few minutes later. Others feel nothing after the turning. If you feel extreme discomfort, please let your doctor know, he well work to resolve some problems.
What is Ilizarov Surgery?
It’s a complex of minimal surgical interventions and procedures using a professor’s Ilizarov RING external fixator. Ilizarov ring fixator is a set of around 20 simple mechanical devices including rings, threaded rods, nuts, bolts and hinges. A metal frame that encircles the limb is attached to the underlying bone by pins inserted through the bone and limb. The external rings are linked to each other by threaded rods and hinges that allow the patient and medical team to move the bones position.
How long does the bone-lengthening take?
It’s dependents- what we want? But it’s usually one mm/day x 2 days for maturation. The time depends on the majority of the problem and on the long of new bone.
Is this the only approach to limb lengthening or straightening?
Besides common orthopaedic method of growing disorders correction such as orthesis, special footgear and so on , there is a single method to increase limb length- osteotomy with consequential callus distraction (callotasis). You may find literary description of this procedure at the CNN article "Woman undergoes drastic surgery to gain a few inches". At present there is no specific treatment to promote growth in achondroplasia. For example, recent molecular engineering techniques have made it possible to provide large amount of the various kinds of biofactors, such as erythropoietin, granulocyte colony stimulating factor and human growth hormone (GH), for clinical use. In fact, GH has been widely used to treat non-GH-deficient forms of short stature, such as Turner's syndrome, skeletal dysplasia, intrauterine growth retardation, chronic illness and idiopathic short stature, with beneficial effects. Growth-hormone treatment seems to increase the rate of growth during the first year of treatment, but may not increase adult height. The strategy of treatment and average lengthening widely vary. In differential clinical investigations the authors report, that the mean lengthening achieved in the femur was 7.2 cm (range, 4.5-12 cm) and in the tibia 7.1 cm (range, 4.5-13 cm). More lengthening was achieved in the more recent cases. The function of lengthened limbs, evaluated by physical strength tests, was better at follow up than before lengthening in the growing children, although the mechanical axes of the lengthened bones were not necessarily in correct alignment.
Will the patient need a cast or crutches after the device removal?
After the device is removed the patient may need a splint, or may not need anything, it's depends on the strength of the bone regenerate. The patient can help himself by early weight-bearing during the lengthening period. Your doctor will give a detail instruction.
What kind of scars the patient will have?
For the majority of patients, the wire and pin sites will heal into a small, circular scars about the diameter of the wire or pin themselves.
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