1. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

2. Ilizarov Technique Dr.Saleh Waslallah Alharby Associate Professor, Consulatant Orthopedic Surgeon. College of Medicine, King Saud University. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

3. 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 alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

4. 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 alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

5. 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 alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

6. Ilizarov Technique The apparatus Transosseous wires. Rings. Threaded and Telescopic rods. Hings, Posts and Nuts. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

7. Ilizarov Technique Technique ·Insertion of wires.. ·Pain ·Function ·Infection ·Fixation of Rings.. ·Rods fixation.. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

8. Ilizarov Technique 3D ANATOMY Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

9. Ilizarov Technique Indications ·Acute Fractures. ·Nonunion. ·Malunion. ·Chronic Osteomyelitis. ·Deformities and Shaping. ·Lengthening of short limbs and amputation stumps. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

10. Ilizarov Technique Concept based on Unknown Biologic Laws. Compression-Distraction. Osteoinduction. AND Tissue neogenesis. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

11. 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 alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

12. 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 alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

13. Ilizarov Technique ANGULAR DEFORMITIES Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

14. Ilizarov Technique Deformity correction Lever arm action. Use of hinges. Placement of hinges. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

15. Ilizarov Technique Deformity correction Mechanical axis. Anatomical axis. Malalignment. Lateral distal femoral angle(LDFA). Medial proximal tibial angle (MPTA). Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

16. Ilizarov Technique Center of rotation and angulation (CORA). The point of intersection of the proximal and distal mechanical axis lines. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

17. 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 alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

18. Ilizarov Technique Congenital anomalies: Upper Limbs Hemimelias Pseudarthrosis Feet Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

19. 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 alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

20. Ilizarov Technique Day 2 wt bearing stretching exercise ROM Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

21. 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 alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

22. 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 alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

23. Ilizarov Technique Period of Fixation 1-Full wt bearing 2-Dynamization 3-Prepare for apparatus removal Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

24. 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 alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

25. Ilizarov Technique Rehabilitation Starts pre-op cont post-op psychotherapy and assurance…. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

26. 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 alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

27. Ilizarov Technique Achondropl. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

28. Ilizarov Technique Cong pseudarth….. Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

29. Cong pseudarth Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

30. Ilizarov Technique Growth plate inj Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

31. Ilizarov Technique Variety of deformities Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

32. Ilizarov Technique Cong short limb Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

33. Ilizarov Technique Ischemic limb Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

34. Ilizarov Technique Metabolic bone deformity Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

35. Ilizarov Technique Paralytic contracture Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

36. Ilizarov Technique Neglected fractures Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

37. Other deformities Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

38. Ilizarov Technique Never do this Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

39. 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 alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

40. 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 alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

41. 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-depression Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby

42. Ilizarov Technique Thank you Dr Saleh W Alharby alharby@ksu.edu..sa http:/faculty.ksu.edu.sa/DrSalehAlharby