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

Dr Saleh W Alharby

[email protected]

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

[email protected]

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

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

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

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

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

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

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

Ilizarov Technique

The apparatus

• Transosseous wires.

• Rings.

• Threaded and Telescopic rods.

• Hings, Posts and Nuts.

Dr Saleh W Alharby

[email protected]

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

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

Ilizarov Technique

3D ANATOMY

Dr Saleh W Alharby

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Ilizarov Technique

Indications

· Acute Fractures.

· Nonunion.

· Malunion.

· Chronic Osteomyelitis.

· Deformities and Shaping.

· Lengthening of short limbs and amputation stumps. Dr Saleh W Alharby

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

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

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

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

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

Ilizarov Technique

ANGULAR DEFORMITIES

Dr Saleh W Alharby

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

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

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

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

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

Ilizarov Technique

• Congenital anomalies:

Upper Limbs

Hemimelias

Pseudarthrosis

Feet

Dr Saleh W Alharby

[email protected]

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

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

Ilizarov Technique

• Day 2

wt bearing

stretching exercise

ROM

Dr Saleh W Alharby

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

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

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

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

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

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

Ilizarov Technique

• Rehabilitation Starts pre-op

cont post-op

psychotherapy and assurance….

Dr Saleh W Alharby

[email protected]

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

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

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

Ilizarov Technique

• Achondropl.

Dr Saleh W Alharby

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

Ilizarov Technique

• Cong pseudarth…..

Dr Saleh W Alharby

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

• Cong pseudarth

Dr Saleh W Alharby

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

Ilizarov Technique

• Growth plate inj

Dr Saleh W Alharby

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

Ilizarov Technique

• Variety of deformities

Dr Saleh W Alharby

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

Ilizarov Technique

• Cong short limb

Dr Saleh W Alharby

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

Ilizarov Technique

• Ischemic limb

Dr Saleh W Alharby

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

Ilizarov Technique

• Metabolic bone deformity

Dr Saleh W Alharby

[email protected]

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

Ilizarov Technique

• Paralytic contracture

Dr Saleh W Alharby

[email protected]

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

Ilizarov Technique

• Neglected fractures

Dr Saleh W Alharby

[email protected]

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

Other deformities

Dr Saleh W Alharby

[email protected]

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

Ilizarov Technique

• Never do this

Dr Saleh W Alharby

[email protected]

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

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

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

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

[email protected]

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

Ilizarov Technique

Thank you

Dr Saleh W Alharby

[email protected]

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