Professional Documents
Culture Documents
Ilizarov Fixator: DR Pratik Agarwal
Ilizarov Fixator: DR Pratik Agarwal
DR PRATIK AGARWAL
Outline
History
Principles
Application of circular fixator
Basic principles of operative techniques
Stages of Ilizarov treatment technique
Post operative management
Dynamization and removal
Safe zones in tibia
Indication
Complication
Advantage
Disadvantage
Recent advances in Ilizarov
Different applications of Ilizarov
History
• Born in Soviet Union.
• In 1950, sent to Kurgan, Siberia to
look after injured Russian soldier.
• Inspiration- by shaft of bow harness
on horse carriage.
• Using spokes of bicycle from local
bicycle shop, he devised ring external
fixator.
• Accidently he found new bone
formation radiologically in a patient
who turned compressing rods
between rings in distraction rather
than compression.
• He revolutionized the treatment of Professor Gavril Abramovich Ilizarov (1921-1992)
difficult musculoskeletal problems.
“THE MAGICIAN OF KURGAN’’
RUSSIAN ILIZAROV SCIENTIFIC CENTRE OF RESTORATIVE TRAUMATOLOGY AND ORTHOPEDIC ,KURGAN ,RUSSIA
Principle of Ilizarov
Based on the principle ‘’that growing bone changes its form and volume according
to external stimuli’’ (Wolff’s law), Ilizarov subjected bone to continual external
tension in any direction, which can lengthen the bone or correct deformities.
Distraction osteohistiogenesis
Mechanical induction of new bone formation
Neovascularisation
Stimuli of biosynthetic activity
Activation and recruitment of osteoprogenitor
cells
Intramembranous ossification
Cont…
His biological principles can be
summarized as follow-
Minimal disturbance of bone and
soft tissues
Delay before distraction
Rate and rhythm of distraction
Site of lengthening
Stable fixator of external fixator
Functional use of limb and
intense physiotherapy
Distraction osteogenesis
• Defined as biologic process of new bone
formation between surfaces of 2 segments
of bone that are gradually separated by
incremental traction.
• Bone formation follows vector of
distraction.
• Bone is separated by corticotomy.
• Distraction is done @ 1mm/day in four
interval i.e. 0.25mm four times per day.
• When desired length is achieved
consolidation phase follows.
Instrumentation
• Primary components- elements
used to correct skeletal
deformities.
Eg- ring, wire, wire fixation bolt
and buckles, pin and pin clamps.
• Secondary component-
element necessary for
assembly of frame.
Eg- rods, plates, support, post,
hinge, washer , sockets, bushing,
bolts and nuts.
Rings
• Principle component
• All rings are placed perpendicular to
long axis of bone.
• Made up of stainless steel or carbon
fiber to bear high stress (up to 150 kg)
• Internal diameter measures from 80-
240 mm.
• Function-
Support transfixation of ilizarov, olive
wires and half pins
Builds a fixator frame connecting two or
more rings.
Props up frame’s supplementary parts
Rings
• Holes in the ring used for introduction
of threaded rod, a hinge or connector
plate.
• Two half ring can be connected to form
full ring or oval ring.
• Five-eight ring facilitate joint motion
and is commonly deployed near knee
and elbow joint.
• It also facilitate introduction of cross
wires, distinct advantage near these
joint.
• Omega rings is modified five-eight ring
fits deltoid area of shoulder.
• Five-eight ring and omega ring are weak
so needed 3 point fixation to a full ring.
Arches
• Larger diameter than
half rings.
• Extra holes for use at the
level of proximal femur
or humerus.
• Does not limit joint
motion.
Ilizarov wires
• Stainless steel of critical hardness and
elasticity.
Using of dynamometer-
Rotate handle anti clockwise until wire get
inside
Engage the fix jaw to the ring
Rotate handle clockwise until desired
tension is achived.
Tighten the nut at desired tension.
Rotate handle anti clockwise to loosen the
wire.
Assembly of circular fixator
Major considerations-
• Stability of fixation of the frame to the bone.
• The prevention of gross bone fragment motion.
• Ability to manipulate bone and to perform necessary fragment movement such as
straightening, bending, distraction, compression, rotation and combination of these
movement.
Hybrid fixator-
• Proximal ring connected to 2 or 3
pins distally with connecting rods.
• Mostly for proximal tibia fracture
Combined compression-distraction technique
Bone transport technique
Ilizarov to prevent
contracture
Correction of ankle joint fused in equinus position
Correction of club hand
Non union
Deformity correction
Treating neglected club foot with Ilizarov
Treatment of open fracture and bone loss
Difficult fractures
Congenital pseudoarthrosis
Limb lengthening
Infected nonunion
Berger’s disease
Thank you