The Ilizarov Technique: A Dynamic Solution for Orthopaedic Challenges

Abstract

The Ilizarov technique is one of the most important tools that is currently employed in bone reconstruction surgeries. Its inception dates back to the mid-20th century and involves various bone reconstruction methodologies implemented using a circular external fixator system devised by G. A. Ilizarov. The key advantages of this approach include the generation of viable new bone via distraction osteogenesis, high union rates, and the functional utilization of the limb during the treatment process. The exploration of distraction osteogenesis phenomenon triggered by tensile stress with the Ilizarov device served as a catalyst for progress in bone reconstruction surgery. Subsequently, the original technique has been utilized alongside several adaptations resulting from the introduction of novel fixation tools and methods of their application, such as hexapod external fixators and motorized intramedullary lengthening nails. It is crucial to possess a precise comprehension of the Ilizarov principles of deformity correction in order to effectively utilize this fixation system. In this article, we will discuss the history of Ilizarov frame, the basic sciences behind it, the mechanical principles governing its use, and the clinical application of the fixation system in our daily practice.

Keywords

Deformity Correction / Ilizarov Frame / Ilizarov Method

References

[1] Gubin AV, Borzunov DY, Marchenkova LO, Malkova TA, Smirnova IL. Contribution of G.A. Ilizarov to bone reconstruction: historical achievements and state of the art. Strategies Trauma Limb Reconstr. 2016; 11: 145–152.

[2] Ilizarov GA. The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. ClinOrthopRelat Res. 1989; 238: 249–281.

[3] Ilizarov GA. Clinical application of the tension-stress effect for limb lengthening. ClinOrthop Relat Res. 1990; 250: 8–26.

[4] Ilizarov GA. In: SA Green, editor. Transosseous Osteosynthesis. Theoretical and Clinical Aspects of the Regeneration and Growth of Tissue. Berlin Heidelberg: Springer-Verlag; 1992. p. 802.

[5] Ilizarov GA, Ledyasev VI, Shitin VP. Experimental studies of bone lengthening. Eksp Khir Anesteziol. 1969; 14: 3.

[6] Vauhkonen M, Peltonen J, Karaharju E, Aalto K, Alitalo I. Collagen synthesis and mineralization in the early phase of distraction bone healing. Bone Miner. 1990; 10: 171–181.

[7] Ippolito E, Peretti G, Bellocci M, Farsetti P, Tudisco C, Caterini R, et al. Histology and ultrastructure of arteries, veins and peripheral nerves during limb lengthening. Clin Orthop. 1994; 308: 54–62.

[8] Galardi G, Comi G, Lozza L, Marchettini P, Novarina M, Facchini R, et al. Peripheral nerve damage during limb lengthening. Neurophysiology in five cases of bilateral tibial lengthening. J Bone Joint Surg Br. 1990; 72: 121–124.

[9] Cross AR, Lewis DD, Murphy ST. Effects of ring diameter and wire tension on the axial biomechanics of four ring circular external fixator constructs. Am J Vet Res. 2001; 62: 1025–1030.

[10] Rozbruch SR, Ilizarov S. Limb Lengthening and Reconstruction Surgery. New York: Informa Healthcare; 2007. p. 200.

[11] Ilizarov GA, Emilyanova HS, Lebedev BE. Some experimental studies. Mechanical characteristics of Kirschner wires. Perosseus Compression and Distraction Osteosynthesis Traumatology and Orthopaedics. Kurgan: Traumatology and Orthopaedics; 1972. p. 34–47.

[12] Calhoun JH, Li F, Bauford WL. Rigidity of half pins for the Ilizarov external fixator. Bull Hosp J Dis. 1992; 52: 21–26.

[13] Bove F, Sala F, Capitani P, Thabet AM, Scita V, Spagnolo R. Treatment of fractures of the tibial plateau (Schatzker VI) with external fixators vs plate osteosynthesis. Injury. 2018; 49(Suppl 3): S12–S18.

[14] Mostafa DG, Qavi MI, Bari MM, Arifuzzaman M, Kamruzzaman M, Saha MK. Evaluation of the results of Ilizarov ring fixation in Schatzker type VI tibial plateau fracture. Mymensingh Med J. 2018; 27: 136–143.

[15] Raza A, Kumar S, Kumar D, Qadir A, Muzzammil M, Lakho MT. Complex tibial plateau fractures: primary fixation using the Ilizarov external fixator. A two-year study at civil hospital Karachi, Pakistan. Cureus. 2019; 11: e5375.

[16] Dabis J, Templeton-Ward O, Lacey AE, Narayan B, Trompeter A. The history, evolution and basic science of osteotomy techniques. Strategies Trauma Limb Reconstr. 2017; 12: 169–180.

[17] Zaman AU, Javed S, Ahmad A, Aziz A. Massive segmental bone loss due to pantibial osteomyelitis in children reconstructed by medial fibular transport with Ilizarov frame. J TaibahUniv Med Sci. 2017; 12: 418–423.

[18] Paley D. Principles of Deformity Correction. Berlin: Springer; 2001.

[19] Frierson M, Ibrahim K, Boles M, Bote H, Ganey T. Distraction osteogenesis. A comparison of corticotomy techniques. Clin Orthop. 1994; 301: 19–24.

[20] Wagner H. Operative lengthening of the femur. Clin Orthop. 1978; 136: 125–142.

[21] Popkov A, Dučić S, Lazović M, Lascombes P, Popkov D. Limb lengthening and deformity correction in children with abnormal bone. Injury. 2019; 50(Suppl 1): S79–S86.

[22] Subik M, Shearer M, Saleh AM, LaPorta GA. The gradual and acute correction of equinus using external fixation. Clin Podiatr Med Surg. 2018; 35: 481–496.

[23] Peterson N, Prior C. Correction of the neglected clubfoot in the adolescent and adult patient. Foot Ankle Clin. 2020; 25: 205–220.

[24] Chan MC, Khan SA. Ilizarov reconstruction of chronic bilateral calcaneovalgus deformities. Chin J Traumatol. 2019; 22: 202–206.

[25] ElAlfy B, Ali AM, Fawzy SI. Ilizarov external fixator versus retrograde intramedullary nailing for ankle joint arthrodesis in diabetic charcot neuroarthropathy. J Foot Ankle Surg. 2017; 56: 309–313.

[26] Tomczak C, Beaman D, Perkins S. Combined intramedullary nail coated with antibiotic containing cement and ring fixation for limb salvage in the severely deformed, infected neuroarthropathic ankle. Foot Ankle Int. 2019; 40: 48–55.

[27] Cherkashin AM, Samchukov ML, Birkholts F. Treatment strategies and frame configurations in the management of foot and ankle deformities. Clin Podiatr Med Surg. 2018; 35: 423–442.

[28] Aronson J. Experimental and clinical experience with distraction osteogenesis. Cleft Palate Craniofac J. 1994; 31: 473–481.

[29] Coglianese DB, Herzenberg JE, Goulet JA. Physical therapy management of patients undergoing limb lengthening by distraction osteogenesis. J Orthop Sports Phys Ther. 1993; 17: 124–132.

[30] Velazquez RJ, Bell DF, Armstrong PF, Babyn P, Tibshirani R. Complications of use of the Ilizarov technique in the correction of limb deformities in children. J Bone Joint Surg Am. 1993; 75: 1148–1156.

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2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.