Dr Saleh W Alharby

Ilizarov Technique Dr.Saleh Waslallah Alharby Associate Professor, Consulatant Orthopedic Surgeon. College of Medicine, King Saud University. Dr Saleh W Alharby

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

Ilizarov Technique Historical Review 1951 in Kurgan (USSR) attention outside USSR. Carlo Mauri explorer visited Italy in (AO meeting). April 1982 Italian Surgeons visited Kurgan. Dr Saleh W Alharby

Ilizarov Technique Historical review Osteoinduction and neogenesis. Accidental distraction. Normal new bone formation. Research laboratory in a small hospital a new institute was established bed and 12 operating rooms.. Dr Saleh W Alharby

Ilizarov Technique The apparatus Transosseous wires. Rings. Threaded and Telescopic rods. Hings, Posts and Nuts. Dr Saleh W Alharby

Ilizarov Technique Technique ·Insertion of wires.. ·Pain ·Function ·Infection ·Fixation of Rings.. ·Rods fixation.. Dr Saleh W Alharby

Ilizarov Technique 3D ANATOMY Dr Saleh W Alharby

Ilizarov Technique Indications ·Acute Fractures. ·Nonunion. ·Malunion. ·Chronic Osteomyelitis. ·Deformities and Shaping. ·Lengthening of short limbs and amputation stumps. Dr Saleh W Alharby

Ilizarov Technique Concept based on Unknown Biologic Laws. Compression-Distraction. Osteoinduction. AND Tissue neogenesis. Dr Saleh W Alharby

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

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

Ilizarov Technique ANGULAR DEFORMITIES Dr Saleh W Alharby

Ilizarov Technique Deformity correction Lever arm action. Use of hinges. Placement of hinges. Dr Saleh W Alharby

Ilizarov Technique Deformity correction Mechanical axis. Anatomical axis. Malalignment. Lateral distal femoral angle(LDFA). Medial proximal tibial angle (MPTA). Dr Saleh W Alharby

Ilizarov Technique Center of rotation and angulation (CORA). The point of intersection of the proximal and distal mechanical axis lines. Dr Saleh W Alharby

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

Ilizarov Technique Congenital anomalies: Upper Limbs Hemimelias Pseudarthrosis Feet Dr Saleh W Alharby

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

Ilizarov Technique Day 2 wt bearing stretching exercise ROM Dr Saleh W Alharby

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

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

Ilizarov Technique Period of Fixation 1-Full wt bearing 2-Dynamization 3-Prepare for apparatus removal Dr Saleh W Alharby

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

Ilizarov Technique Rehabilitation Starts pre-op cont post-op psychotherapy and assurance…. Dr Saleh W Alharby

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

Ilizarov Technique Achondropl. Dr Saleh W Alharby

Ilizarov Technique Cong pseudarth….. Dr Saleh W Alharby

Cong pseudarth Dr Saleh W Alharby

Ilizarov Technique Growth plate inj Dr Saleh W Alharby

Ilizarov Technique Variety of deformities Dr Saleh W Alharby

Ilizarov Technique Cong short limb Dr Saleh W Alharby

Ilizarov Technique Ischemic limb Dr Saleh W Alharby

Ilizarov Technique Metabolic bone deformity Dr Saleh W Alharby

Ilizarov Technique Paralytic contracture Dr Saleh W Alharby

Ilizarov Technique Neglected fractures Dr Saleh W Alharby

Other deformities Dr Saleh W Alharby

Ilizarov Technique Never do this Dr Saleh W Alharby

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

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

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

Ilizarov Technique Thank you Dr Saleh W Alharby