Ilizarov apparatus: Difference between revisions

Ilizarov apparatus
Ilizarov apparatus
	An Ilizarov apparatus treatment for the fractured tibia and fibula bones of the right leg.
ICD-9-CM	78.3, 84.53
MeSH	D018889
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In medicine, the Ilizarov apparatus is a type of external fixation apparatus used in orthopedic surgery to lengthen or to reshape the damaged bones of an arm or a leg; used as a limb-sparing technique for treating complex fractures and open bone fractures; and used to treat an infected non-union of bones, which cannot be surgically resolved. The Ilizarov apparatus corrects angular deformity in a leg, corrects differences in the lengths of the legs of the patient, and resolves osteopathic non-unions;^[1] further developments of the Ilizarov apparatus progressed to the development of the Taylor Spatial Frame.

Dr. Gavriil Abramovich Ilizarov developed the Ilizarov apparatus as a limb-sparing surgical remedy for the treatment of the osteopathic non-unions of patients with unhealed broken limbs.^[1] Consequent to a patient lengthening, rather than shortening, the adjustable-rod frame of his external-fixation apparatus, Dr. Ilizarov observed the formation of a fibrocartilage callus at and around the site of the bone fracture, and so discovered the phenomenon of distraction osteogenesis, the regeneration of bone and soft tissues that culminates in the creation of new bone.^[1]

In 1987, the Ilizarov apparatus and Dr. Ilizarov's surgical techniques for repairing the broken bones of damaged limbs were introduced to U.S. medicine.^[2] The mechanical functions of the Ilizarov apparatus derive from the mechanics of the shaft bow harness for a horse.^[3]

The apparatus

The mechanical functions of the Ilizarov apparatus derive from the tension mechanics of the shaft bow of a horse harness. (the decorated arch behind the head of the horse)

The Ilizarov apparatus is a specialized external fixator of modular construction, composed of rings (stainless steel, titanium) that are transfixed to healthy bone with Kirschner wires and pins of heavy-gauge stainless steel, and immobilised in place with additional rings and threaded rods that are attached with and through adjustable nuts. The circular construction of the apparatus, the rods, and the controlled tautness of the Kirschner wires immobilises the damaged limb to allow healing.^[4]

The mechanical functions of the Ilizarov apparatus are based upon the principles of tension (pulling force), wherein the controlled application of mechanical tension to the damaged limb immobilises the broken bones, and so facilitates the biological process of distraction osteogenesis (the regeneration of bone and soft tissue) in a reliable and reproducible manner. Moreover, external fixation with the apparatus allows the damaged limb to bear weight early in the medical treatment.^[5]

Once emplaced onto the limb, the top rings of the apparatus transfer mechanical force to the bottom ring through the rods, and so by-pass the site of the fractured bone, thus the Ilizarov apparatus immobilizes the damaged limb and relieves mechanical stresses from the wound, which then allows the patient to move the entire limb. The middle rings stiffen the support rods and hold the bone fragments in place, whilst supporting the immobilised limb. In by-passing the site of the bone fracture, the top and bottom rings bear the critical load by transferring mechanical force from the area of healthy bone above the fracture to the area of healthy bone below the fracture.^[6]

Clinical application

The Ilizarov surgical method of distraction osteogenesis (regeneration of bone and soft tissues) for repairing complex fractures of the bones of the limbs is the preferred treatment for cases featuring a high risk of bacterial infection; and for cases wherein the extent and severity of the fracture precludes using internal fixators to immobilise the damaged bone for proper repair.^[7]

In 1968, Dr. Ilizarov successfully treated the non-union osteopathy of Valeriy Brumel, a Soviet athlete, who suffered a broken ankle and a broken shinbone (tibia) of the right leg,^[1] had undergone more than twenty failed bone-repair surgeries in three years, and yet his broken leg-bones had not healed and the leg was shorter than before the motorcycle accident in 1965.^[3] By way of distraction osteogenesis and an external-fixation apparatus, Dr. Ilizarov resolved Brumel's osteopathic non-union, by growing new leg bone, which extended the athlete's leg 3.5 cm (1.4 in) to its normal length.^[3]

In 1980, Ilizarov successfully treated the osteopathic non-union of Carlo Mauri, a journalist and an explorer, who, ten years earlier, had broken the distal end of a tibia in an Alpine accident, yet his broken leg-bone had yet to heal.^[1]^[2] During an expedition in the Atlantic Ocean, Mauri's leg wound reopened; a concerned teammate, a Russian doctor, recommended that Mauri consult with Dr. Ilizarov for proper diagnosis, surgical repair, and treatment in the city of Kurgan, Russia.^[1]^[2]

In 2013, consequent to a PTSD-induced fall that broke his left leg, the British war correspondent Ed Vulliamy underwent limb-sparing medical treatment that featured surgeries and an Ilizarov apparatus to repair and heal the severely fractured bones in his left leg.^[8]

Clinical example

The photographs and radiographs illustrate the application and emplacement of an external fixator, an Ilizarov apparatus, to repair the open fracture of the lower left leg of a man. The photographs were taken four weeks after the patient fractured the shinbone (tibia) and the calfbone (fibula) of his left leg, and two weeks after the surgical emplacement of the Ilizarov apparatus to immobilise the leg and isolate the wound and fracture site to facilitate healing.

$X-ray of the open fracture of the left leg; the external fixator was installed ca. 24 hrs. in hospital.$

X-ray of the open fracture of the left leg; the external fixator was installed ca. 24 hrs. in hospital.
$X-ray of the open fracture site immediately after installation of the Ilizarov apparatus.$

X-ray of the open fracture site immediately after installation of the Ilizarov apparatus.
Superior perspective of the Ilizarov apparatus and the Kirschner pins in the left leg at two weeks post-surgical.
$The Ilizarov apparatus immobilising the fractured tibia and fibula bones; the open-fracture site is above the black ring.$

The Ilizarov apparatus immobilising the fractured tibia and fibula bones; the open-fracture site is above the black ring.
Superior perspective of the apparatus emplaced into the left leg of the patient.
$X-ray of the fracture site and the emplaced apparatus, two months post-fracture; perspective 1-4.$

X-ray of the fracture site and the emplaced apparatus, two months post-fracture; perspective 1-4.
$X-ray of the fracture site and the emplaced apparatus, two months post-fracture; perspective 2-4.$

X-ray of the fracture site and the emplaced apparatus, two months post-fracture; perspective 2-4.
$X-ray of the callus forming at the fracture site, three months post-fracture; perspective 3-4.$

X-ray of the callus forming at the fracture site, three months post-fracture; perspective 3-4.
$X-ray of the callus forming around the fracture site, three months post-fracture; perspective 4-4.$

X-ray of the callus forming around the fracture site, three months post-fracture; perspective 4-4.
$X-ray perspectives of the callus-formation progress and healing of the fractured tibia and fibula bones, four months post-fracture.$

X-ray perspectives of the callus-formation progress and healing of the fractured tibia and fibula bones, four months post-fracture.

Bone work

The Ilizarov apparatus corrects deformed bones by way of the process of distraction osteogenesis, which reproduces bone tissues. After an initial surgery during which the bone to repair is fractured, and the apparatus is attached to the limb of the patient; once the fracture has been immobilised, the bone tissues begin to grow and eventually bridge the fracture with new bone.^[9] In the course of the osteogenesis process, the bone grows and the physician extends the rods of the Ilizarov apparatus to increase the space between the rings at each end of the apparatus. As the rings are installed at and connected to the opposite ends of the fracture site, the adjustment, done four times a day, separates the healing fracture by approximately one millimetre per day; in due course, the millimetric adjustments lengthen the bone of the damaged limb. Upon completing the bone-lengthening phase of treatment, the Ilizarov apparatus remains emplace for a period of osteopathic consolidation, the ossification of the regenerated bone tissues. Using crutches, the patient is able to bear weight on the damaged limb; once healed, the patient undergoes a second surgery to remove the Ilizarov apparatus from the repaired limb. The result of the Ilizarov surgical treatment is a limb that is much longer than before the medical treatment.

In the case of lengthening a leg bone, an additional surgery will lengthen the Achilles tendon to accommodate the longer length of the treated bone. The therapeutic advantage of the Ilizarov treatment is that the patient can be physically active whilst awaiting the bone to repair. The Ilizarov apparatus also is used to treat and resolve a structural defect in a long bone, by transporting a segment of bone whilst simultaneously lengthening and regenerating the bone to reduce the defect, and so produce a single bone. Installing the Ilizarov apparatus requires minimally invasive surgery, and is not free of medical complications, such as inflammation, muscle transfixion, and contracture of the affected joint.

References

^ ^a ^b ^c ^d ^e ^f Spiegelberg B, Parratt T, Dheerendra SK, Khan WS, Jennings R, Marsh DR (2010). "Ilizarov Principles of Deformity Correction". Annals of the Royal College of Surgeons of England. 92 (2): 101–5. doi:10.1308/003588410X12518836439326. PMC 3025247. PMID 20353638.
^ ^a ^b ^c Svetlana Ilizarov (2006). "The Ilizarov Method: History and Scope". In S. Robert Rozbruch; Svetlana Ilizarov (eds.). Limb Lengthening and Reconstruction Surgery. CRC Press. pp. 15–16. ISBN 0849340519.
^ ^a ^b ^c Svetlana Ilizarov (2006). "The Ilizarov Method: History and Scope". In S. Robert Rozbruch; Svetlana Ilizarov (eds.). Limb Lengthening and Reconstruction Surgery. CRC Press. pp. 3–6. ISBN 0849340519.
^ “Ilizarov Principles of Deformity Correction”, Annals of the Royal College of Surgeons of England 2010; 92: 101.
^ Paley, Dror; Kovelman, Harry F; Herzenberg, John E (October 1993). "Ilizarov technology". In Stauffer, Richard (ed.). Advances in Operative Orthopaedics: Volume 1 (PDF). Mosby Inc. pp. 243–287. ISBN 978-0-8151-7939-9. Archived from the original (PDF) on 19 March 2012. Retrieved 14 January 2012.
^ “Ilizarov Principles of Deformity Correction”, Annals of the Royal College of Surgeons of England 2010; 92: 102.
^ Paley, Dror; Kovelman, Harry F; Herzenberg, John E (October 1993). "Ilizarov technology". In Stauffer, Richard (ed.). Advances in Operative Orthopaedics: Volume 1 (PDF). Mosby Inc. pp. 243–287. ISBN 978-0-8151-7939-9. Archived from the original (PDF) on 19 March 2012. Retrieved 14 January 2012.
^ Ed Vulliamy (13 December 2015). "How Comrade Ilizarov Saved My Leg". The Observer. Retrieved 13 December 2015.
^ Littlewood, Rebecca. "The Benefits and Risks of the Ilizarov Technique for Limb Reconstruction" (PDF). Oxford University Hospitals. Retrieved April 15, 2023.

External links

[Spiegelberg-1] ^ ^a ^b ^c ^d ^e ^f Spiegelberg B, Parratt T, Dheerendra SK, Khan WS, Jennings R, Marsh DR (2010). "Ilizarov Principles of Deformity Correction". Annals of the Royal College of Surgeons of England. 92 (2): 101–5. doi:10.1308/003588410X12518836439326. PMC 3025247. PMID 20353638.

[SIlizarovp15-2] Svetlana Ilizarov (2006). "The Ilizarov Method: History and Scope". In S. Robert Rozbruch; Svetlana Ilizarov (eds.). Limb Lengthening and Reconstruction Surgery. CRC Press. pp. 15–16. ISBN 0849340519.

[SIlizarov-3] Svetlana Ilizarov (2006). "The Ilizarov Method: History and Scope". In S. Robert Rozbruch; Svetlana Ilizarov (eds.). Limb Lengthening and Reconstruction Surgery. CRC Press. pp. 3–6. ISBN 0849340519.

[4] “Ilizarov Principles of Deformity Correction”, Annals of the Royal College of Surgeons of England 2010; 92: 101.

[5] Paley, Dror; Kovelman, Harry F; Herzenberg, John E (October 1993). "Ilizarov technology". In Stauffer, Richard (ed.). Advances in Operative Orthopaedics: Volume 1 (PDF). Mosby Inc. pp. 243–287. ISBN 978-0-8151-7939-9. Archived from the original (PDF) on 19 March 2012. Retrieved 14 January 2012.

[6] “Ilizarov Principles of Deformity Correction”, Annals of the Royal College of Surgeons of England 2010; 92: 102.

[7] Paley, Dror; Kovelman, Harry F; Herzenberg, John E (October 1993). "Ilizarov technology". In Stauffer, Richard (ed.). Advances in Operative Orthopaedics: Volume 1 (PDF). Mosby Inc. pp. 243–287. ISBN 978-0-8151-7939-9. Archived from the original (PDF) on 19 March 2012. Retrieved 14 January 2012.

[8] Ed Vulliamy (13 December 2015). "How Comrade Ilizarov Saved My Leg". The Observer. Retrieved 13 December 2015.

[9] Littlewood, Rebecca. "The Benefits and Risks of the Ilizarov Technique for Limb Reconstruction" (PDF). Oxford University Hospitals. Retrieved April 15, 2023.

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 In medicine, the '''Ilizarov apparatus''' is a type of [[external fixation]] apparatus used in [[orthopedic surgery]] to lengthen or to reshape the damaged bones of an arm or a leg; used as a [[limb-sparing techniques|limb-sparing technique]] for treating complex fractures and open [[bone fracture]]s; and used to treat an infected non-union of bones, which cannot be surgically resolved. The Ilizarov apparatus corrects angular deformity in a leg, corrects differences in the lengths of the legs of the patient, and resolves osteopathic non-unions;<ref name="Spiegelberg"/> further developments of the Ilizarov apparatus progressed to the development of the [[Taylor Spatial Frame]].
-The Ilizarov apparatus was developed by Dr. [[Gavriil Abramovich Ilizarov]], a Soviet surgeon, who, in the 1950s, used external fixation apparatuses to treat the [[non-union|osteopathic non-unions]] of patients with broken limbs.<ref name="Spiegelberg">{{cite journal |pmid=20353638 |authors= Spiegelberg B, Parratt T, Dheerendra SK, Khan WS, Jennings R, Marsh DR. |title= Ilizarov Principles of Deformity Correction |journal= Annals of the Royal College of Surgeons of England |year=2010 |volume=92 |issue=2 |pages= 101–5 |doi=10.1308/003588410X12518836439326 |pmc=3025247}}</ref> In the course of treatment, Ilizarov observed the formation of a [[callus]], and so discovered the phenomenon of [[distraction osteogenesis]] when one patient lengthened, rather than shortened, the frame of his external-fixation apparatus.<ref name="Spiegelberg"/>
+Dr. [[Gavriil Abramovich Ilizarov]] developed the Ilizarov apparatus as a limb-sparing surgical remedy for the treatment of the [[non-union|osteopathic non-unions]] of patients with unhealed broken limbs.<ref name="Spiegelberg">{{cite journal |pmid=20353638 |vauthors=Spiegelberg B, Parratt T, Dheerendra SK, Khan WS, Jennings R, Marsh DR |title= Ilizarov Principles of Deformity Correction |journal= Annals of the Royal College of Surgeons of England |year=2010 |volume=92 |issue=2 |pages= 101–5 |doi=10.1308/003588410X12518836439326 |pmc=3025247}}</ref> Consequent to a patient lengthening, rather than shortening, the adjustable-rod frame of his external-fixation apparatus, Dr. Ilizarov observed the formation of a [[fibrocartilage callus]] at and around the site of the bone fracture, and so discovered the phenomenon of [[distraction osteogenesis]], the regeneration of bone and soft tissues that culminates in the creation of new bone.<ref name="Spiegelberg"/>
-In 1987, Dr. Victor Frankel introduced to U.S. medicine the Ilizarov apparatus and Dr. Ilizarov's surgical techniques for repairing the broken bones of damaged limbs.<ref name= "SIlizarovp15"/> The mechanical functions of the Ilizarov apparatus derive from the mechanics of the [[shaft bow]] harness for a horse.<ref name= "SIlizarov">{{cite book |url= https://books.google.com/books?id=yNTED-6REewC&q=ilizarov+method+limb+lengthening |chapter = The Ilizarov Method: History and Scope |title= Limb Lengthening and Reconstruction Surgery |author= Svetlana Ilizarov |editor1= S. Robert Rozbruch |editor2=Svetlana Ilizarov |publisher= CRC Press |year= 2006 |isbn= 0849340519 |pages=3–6 }}</ref>
+In 1987, the Ilizarov apparatus and Dr. Ilizarov's surgical techniques for repairing the broken bones of damaged limbs were introduced to U.S. medicine.<ref name= "SIlizarovp15"/> The mechanical functions of the Ilizarov apparatus derive from the mechanics of the [[shaft bow]] harness for a horse.<ref name= "SIlizarov">{{cite book |url= https://books.google.com/books?id=yNTED-6REewC&q=ilizarov+method+limb+lengthening |chapter = The Ilizarov Method: History and Scope |title= Limb Lengthening and Reconstruction Surgery |author= Svetlana Ilizarov |editor1= S. Robert Rozbruch |editor2=Svetlana Ilizarov |publisher= CRC Press |year= 2006 |isbn= 0849340519 |pages=3–6 }}</ref>
 ==The apparatus==
 [[File:Shaft-bow-1.jpg|thumb|The mechanical functions of the Ilizarov apparatus derive from the tension mechanics of the shaft bow of a horse harness. (the decorated arch behind the head of the horse)]]
+The Ilizarov apparatus is a specialized [[external fixator]] of modular construction, composed of rings ([[stainless steel]], [[titanium]]) that are transfixed to healthy bone with [[Kirschner wire]]s and pins of heavy-gauge stainless steel, and immobilised in place with additional rings and threaded rods that are attached with and through adjustable nuts. The circular construction of the apparatus, the rods, and the controlled tautness of the Kirschner wires immobilises the damaged limb to allow healing.<ref>“Ilizarov Principles of Deformity Correction”, ''Annals of the Royal College of Surgeons of England'' 2010; 92: 101.</ref>
-As an [[external fixator]], the functional mechanics of the Ilizarov apparatus are based upon the mechanical principles of the theory of tensions, wherein controlled tension is mechanically applied to immobilise the bones in order to facilitate the biological process of [[distraction osteogenesis]] (the regeneration of bone and soft tissue) in a reliable and reproducible manner; immobilization with the apparatus allows the damaged limb to bear weight early in the medical treatment.<ref>{{cite book|last1=Paley|first1=Dror|author-link1=Dror Paley|last2=Kovelman|first2=Harry F|last3=Herzenberg |first3=John E|editor=Stauffer, Richard|title=Advances in Operative Orthopaedics: Volume 1|url=http://limblengtheningdoc.org/Ilizarov_techonlogy.pdf|access-date=14 January 2012|date=October 1993|publisher=Mosby Inc|isbn=978-0-8151-7939-9|pages=243–287|chapter=Ilizarov technology|archive-url=https://web.archive.org/web/20120319034110/http://limblengtheningdoc.org/Ilizarov_techonlogy.pdf|archive-date=19 March 2012}}</ref>
+The mechanical functions of the Ilizarov apparatus are based upon the principles of [[Tension (physics)|tension]] (pulling force), wherein the controlled application of mechanical tension to the damaged limb immobilises the broken bones, and so facilitates the biological process of [[distraction osteogenesis]] (the regeneration of bone and soft tissue) in a reliable and reproducible manner. Moreover, external fixation with the apparatus allows the damaged limb to bear weight early in the medical treatment.<ref>{{cite book|last1=Paley|first1=Dror|author-link1=Dror Paley|last2=Kovelman|first2=Harry F|last3=Herzenberg |first3=John E|editor=Stauffer, Richard|title=Advances in Operative Orthopaedics: Volume 1|url=http://limblengtheningdoc.org/Ilizarov_techonlogy.pdf|access-date=14 January 2012|date=October 1993|publisher=Mosby Inc|isbn=978-0-8151-7939-9|pages=243–287|chapter=Ilizarov technology|archive-url=https://web.archive.org/web/20120319034110/http://limblengtheningdoc.org/Ilizarov_techonlogy.pdf|archive-date=19 March 2012}}</ref>
-The Ilizarov apparatus is a specialized external fixator of modular construction, composed of rings ([[stainless steel]], [[titanium]]) that are affixed to the bone with [[Kirschner wire]]s, which are heavy-gauge wires of stainless steel. The rings are connected to each other with threaded rods that are attached with and through adjustable nuts. The circular construction of the apparatus and the controlled tautness of the Kirschner wires provide more structural support than does a [[external fixation|monolateral fixator]] system.
-The top rings of the apparatus (affixed to healthy bone with wires) allow the transference of mechanical force throughout the external frame (the assembly of rings and rods) in order to by-pass the fracture site of the bone. That mechanical force is transmitted to the healthy bone by the rods attached to the bottom ring (emplaced with taut wires), thus the Ilizarov apparatus immobilizes the damaged limb and relieves mechanical stresses from the wound, which allows the patient to move the entire limb, and allows the damaged limb to partially bear weight. The middle rings (and taut wires) stiffen the support rods and hold the bone fragments in place, whilst supporting the limb. In by-passing the site of the bone fracture, the top and bottom rings bear the critical load by transferring mechanical force from the area of healthy bone above the fracture to the area of healthy bone below the fracture.
+Once emplaced onto the limb, the top rings of the apparatus transfer mechanical force to the bottom ring through the rods, and so by-pass the site of the fractured bone, thus the Ilizarov apparatus immobilizes the damaged limb and relieves mechanical stresses from the wound, which then allows the patient to move the entire limb. The middle rings stiffen the support rods and hold the bone fragments in place, whilst supporting the immobilised limb. In by-passing the site of the bone fracture, the top and bottom rings bear the critical load by transferring mechanical force from the area of healthy bone above the fracture to the area of healthy bone below the fracture.<ref>“Ilizarov Principles of Deformity Correction”, ''Annals of the Royal College of Surgeons of England'' 2010; 92: 102.</ref>
 ==Clinical application==
+[[File:Valeriy Brumel 1968.jpg|thumb|right|Ilizarov apparatus: The Soviet athlete Valeriy Brumel holds a model of the external fixation apparatus that repaired the broken tibia bone and the broken ankle bones of his right leg. (1968)]]
-The Ilizarov method of [[distraction osteogenesis]] (regeneration of bone and soft tissues) for repairing complex fractures of the bones of the limbs is the preferred treatment for cases featuring a high risk of [[Bacteria|bacterial infection]]; and for cases wherein the extent and severity of the fracture precludes using [[internal fixator]]s to repair the damaged bone. The following photographs and X-ray images illustrate the Ilizarov apparatus treatment to repair an [[open fracture]]; the photographs were taken four weeks after the patient fractured the tibia and the fibula bones of his left leg, and two weeks after installation of the apparatus.
+[[Image:Tibia - frontal view.png|thumb|200px|Location and position of the tibia bones (red) in the legs.]]
+[[Image:Fibula - anterior view.png|thumb|200px|Location and position of the fibula bones (red) in the legs]]
+The Ilizarov surgical method of [[distraction osteogenesis]] (regeneration of bone and soft tissues) for repairing complex fractures of the bones of the limbs is the preferred treatment for cases featuring a high risk of bacterial [[infection]]; and for cases wherein the extent and severity of the fracture precludes using [[internal fixator]]s to immobilise the damaged bone for proper repair.<ref>{{cite book|last1=Paley|first1=Dror|author-link1=Dror Paley|last2=Kovelman|first2=Harry F|last3=Herzenberg |first3=John E|editor=Stauffer, Richard|title=Advances in Operative Orthopaedics: Volume 1|url=http://limblengtheningdoc.org/Ilizarov_techonlogy.pdf|access-date=14 January 2012|date=October 1993|publisher=Mosby Inc|isbn=978-0-8151-7939-9|pages=243–287|chapter=Ilizarov technology|archive-url=https://web.archive.org/web/20120319034110/http://limblengtheningdoc.org/Ilizarov_techonlogy.pdf|archive-date=19 March 2012}}</ref>
+In 1968, Dr. Ilizarov successfully treated the [[Nonunion|non-union osteopathy]] of [[Valeriy Brumel]], a Soviet athlete, who suffered a broken ankle and a broken shinbone (tibia) of the right leg,<ref name="Spiegelberg"/> had undergone more than twenty failed bone-repair surgeries in three years, and yet his broken leg-bones had not healed and the leg was shorter than before the motorcycle accident in 1965.<ref name= "SIlizarov"/> By way of distraction osteogenesis and an external-fixation apparatus, Dr. Ilizarov resolved Brumel's osteopathic non-union, by growing new leg bone, which extended the athlete's leg {{convert|3.5|cm|abbr=on}} to its normal length.<ref name= "SIlizarov"/>
+In 1980, Ilizarov successfully treated the osteopathic non-union of [[Carlo Mauri]], a journalist and an explorer, who, ten years earlier, had broken the distal end of a tibia in an Alpine accident, yet his broken leg-bone had yet to heal.<ref name="Spiegelberg"/><ref name= "SIlizarovp15">{{cite book |url= https://books.google.com/books?id=yNTED-6REewC&q=ilizarov+method+limb+lengthening |chapter = The Ilizarov Method: History and Scope |title= Limb Lengthening and Reconstruction Surgery |author= Svetlana Ilizarov |editor1= S. Robert Rozbruch |editor2=Svetlana Ilizarov |publisher= CRC Press |year= 2006 |isbn= 0849340519 |pages=15–16 }}</ref> During an expedition in the Atlantic Ocean, Mauri's leg wound reopened; a concerned teammate, a Russian doctor, recommended that Mauri consult with Dr. Ilizarov for proper diagnosis, surgical repair, and treatment in the city of [[Kurgan, Kurgan Oblast|Kurgan]], Russia.<ref name="Spiegelberg"/><ref name= "SIlizarovp15"/>
+In 2013, consequent to a PTSD-induced fall that broke his left leg, the British war correspondent [[Ed Vulliamy]] underwent limb-sparing medical treatment that featured surgeries and an Ilizarov apparatus to repair and heal the severely fractured bones in his left leg.<ref>{{cite web |url=https://www.theguardian.com/society/2015/dec/13/how-comrade-ilazarov-got-me-on-my-feet-ed-vulliamy |title=How Comrade Ilizarov Saved My Leg |newspaper=The Observer|date=13 December 2015  |author=Ed Vulliamy |access-date= 13 December 2015}}</ref>
+;Clinical example
+The photographs and [[X-ray|radiographs]] illustrate the application and emplacement of an external fixator, an Ilizarov apparatus, to repair the [[open fracture]] of the lower left leg of a man. The photographs were taken four weeks after the patient fractured the shinbone ([[tibia]]) and the calfbone ([[fibula]]) of his left leg, and two weeks after the surgical emplacement of the Ilizarov apparatus to immobilise the leg and isolate the wound and fracture site to facilitate healing.
 <gallery mode="packed">
-File:Ilizarov6.jpg|X-ray of the open fracture of the left leg and the external fixator, installed within 24 hrs. in hospital.
+File:Ilizarov6.jpg|X-ray of the open fracture of the left leg; the external fixator was installed ca. 24 hrs. in hospital.
+File:Ilizarov5.jpg|X-ray of the open fracture site immediately after installation of the Ilizarov apparatus.
+File:Ilizarov4.jpg|Superior perspective of the Ilizarov apparatus and the Kirschner pins in the left leg at two weeks post-surgical.
 File:Ilizarov1.jpg|The Ilizarov apparatus immobilising the fractured [[tibia]] and [[fibula]] bones; the open-fracture site is above the black ring.
-File:Ilizarov3.jpg|Superior view of the apparatus emplaced into the left leg of the patient.
+File:Ilizarov3.jpg|Superior perspective of the apparatus emplaced into the left leg of the patient.
-File:Ilizarov4.jpg|Sites of the Kirschner pins in the left leg, two weeks post-surgical.
+File:Ilizarov7.jpg|X-ray of the fracture site and the emplaced apparatus, two months post-fracture; perspective 1-4.
-File:Ilizarov5.jpg|X-ray of the fracture site immediately after installation of the Ilizarov apparatus.
+File:Ilizarov8.jpg|X-ray of the fracture site and the emplaced apparatus, two months post-fracture; perspective 2-4.
-File:Ilizarov7.jpg|X-ray of the fracture site and the emplaced apparatus, two months post-fracture; perspective 1-2.
+File:Ilizarov9.jpg|X-ray of the callus forming ''at'' the fracture site, three months post-fracture; perspective 3-4.
-File:Ilizarov8.jpg|X-ray of the fracture site and the emplaced apparatus, two months post-fracture; perspective 2-2.
+File:Ilizarov10.jpg|X-ray of the callus forming ''around'' the fracture site, three months post-fracture; perspective 4-4.
-File:Ilizarov9.jpg|Two X-ray perspectives show the callus forming at the fracture site, three months post-fracture.
+File:Ilizarov11.jpg|X-ray perspectives of the callus-formation progress and healing of the fractured tibia and fibula bones, four months post-fracture.
-File:Ilizarov10.jpg|Two X-ray perspectives show the callus forming around the fracture site, three months post-fracture.
-File:Ilizarov11.jpg|X-ray perspectives of the progress of the healing of the open fracture, four months post-fracture.
 </gallery>
-In 1968, Dr. Ilizarov successfully treated the [[Nonunion|non-union osteopathy]] of [[Valery Brumel]], a Soviet athlete who had broken the distal end of a [[tibia]] bone in a motorcycle crash,<ref name="Spiegelberg"/> had undergone twenty failed bone surgeries in three years, and yet his broken leg-bone had not healed.<ref name= "SIlizarov"/> Using distraction osteogenesis, Ilizarov resolved Brumel's osteopathic non-union, and extended the athlete's leg {{convert|3.5|cm|abbr=on}} to its normal length.<ref name= "SIlizarov"/> In 1980, Ilizarov successfully treated the osteopathic non-union of [[Carlo Mauri]], a journalist and explorer, who, ten years earlier, had broken the distal end of a tibia in an Alpine accident, yet his broken leg-bone had yet to heal.<ref name="Spiegelberg"/><ref name= "SIlizarovp15">{{cite book |url= https://books.google.com/books?id=yNTED-6REewC&q=ilizarov+method+limb+lengthening |chapter = The Ilizarov Method: History and Scope |title= Limb Lengthening and Reconstruction Surgery |author= Svetlana Ilizarov |editor1= S. Robert Rozbruch |editor2=Svetlana Ilizarov |publisher= CRC Press |year= 2006 |isbn= 0849340519 |pages=15–16 }}</ref> During an expedition in the Atlantic Ocean, Mauri's leg wound reopened; a concerned teammate, a Russian doctor, recommended that Mauri consult with Dr. Ilizarov for proper surgical repair in the city of [[Kurgan, Kurgan Oblast|Kurgan]], Russia.<ref name="Spiegelberg"/><ref name= "SIlizarovp15"/> In 2013, consequent to a PTSD-induced fall, the journalist [[Ed Vulliamy]] underwent leg-saving medical treatment that featured an Ilizarov apparatus to heal the severely fractured leg bones.<ref>{{cite web |url=https://www.theguardian.com/society/2015/dec/13/how-comrade-ilazarov-got-me-on-my-feet-ed-vulliamy |title=How Comrade Ilizarov Saved My Leg |newspaper=The Observer|date=13 December 2015  |author=Ed Vulliamy |access-date= 13 December 2015}}</ref>
 ==Bone work==
 {{Unreferenced section|date=December 2017}}
-The Ilizarov apparatus is also used to correct deformed bones, by way of distraction [[osteogenesis]]. After an initial surgery during which the bone is carefully fractured, and the apparatus is attached to the patient, the tissues of the fractured bone begin to grow and bridge the fracture. In the course of the osteogenesis, the bone grows and the physician adjusts the rods and the nuts of the Ilizarov apparatus to increase the space between two rings. As the rings are installed at and connected to the opposite ends of the fracture site, the adjustment, done four times a day, separates the healing fracture by approximately one millimetre per day. The daily millimetric increments will lengthen the bone of the damaged limb. Once the bone-lengthening phase has been completed, the Ilizarov apparatus remains in place for a period of osteopathic consolidation, to allow the bone to solidify. Using crutches, the patient is able to bear weight on the Ilizarov apparatus. Once the limb is healed, the patient undergoes a second surgery to remove the Ilizarov apparatus. The result of the Ilizarov treatment is a limb that is much longer than it was  before medical treatment.
+The Ilizarov apparatus corrects deformed bones by way of the process of [[distraction osteogenesis]], which reproduces bone tissues. After an initial surgery during which the bone to repair is fractured, and the apparatus is attached to the limb of the patient; once the fracture has been immobilised, the bone tissues begin to grow and eventually bridge the fracture with new bone.<ref>{{Cite web |last=Littlewood |first=Rebecca |title=The Benefits and Risks of the Ilizarov Technique for Limb Reconstruction |url=https://www.ouh.nhs.uk/limbreconstruction/information/documents/Ilizarovtechniqueforlimbreconstruction.pdf |access-date=April 15, 2023 |website=Oxford University Hospitals}}</ref> In the course of the osteogenesis process, the bone grows and the physician extends the rods of the Ilizarov apparatus to increase the space between the rings at each end of the apparatus. As the rings are installed at and connected to the opposite ends of the fracture site, the adjustment, done four times a day, separates the healing fracture by approximately one millimetre per day; in due course, the millimetric adjustments lengthen the bone of the damaged limb. Upon completing the bone-lengthening phase of treatment, the Ilizarov apparatus remains emplace for a period of osteopathic consolidation, the ossification of the regenerated bone tissues. Using crutches, the patient is able to bear weight on the damaged limb; once healed, the patient undergoes a second surgery to remove the Ilizarov apparatus from the repaired limb. The result of the Ilizarov surgical treatment is a limb that is much longer than before the medical treatment.
-In the case of lenghtening a leg bone, an additional surgery will lengthen the [[Achilles tendon]] to accommodate the longer length of the treated bone. The therapeutic advantage of the Ilizarov treatment is that the patient can be physically active whilst awaiting the bone to repair. The Ilizarov apparatus also is used to treat and resolve a structural defect in a long bone, by transporting a segment of bone whilst simultaneously lengthening and regenerating the bone to reduce the defect, and so produce a single bone. Installing the Ilizarov apparatus requires minimally invasive surgery, and is not free of medical complications, such as inflammation, muscle transfixion, and [[contracture]] of the affected joint.
+In the case of lengthening a leg bone, an additional surgery will lengthen the [[Achilles tendon]] to accommodate the longer length of the treated bone. The therapeutic advantage of the Ilizarov treatment is that the patient can be physically active whilst awaiting the bone to repair. The Ilizarov apparatus also is used to treat and resolve a structural defect in a long bone, by transporting a segment of bone whilst simultaneously lengthening and regenerating the bone to reduce the defect, and so produce a single bone. Installing the Ilizarov apparatus requires minimally invasive surgery, and is not free of medical complications, such as inflammation, muscle transfixion, and [[contracture]] of the affected joint.
 ==See also==
@@ Line 78: / Line 87: @@
 {{Commons category}}
 * [https://web.archive.org/web/20110930221126/http://www.newsmonster.co.uk/health/pioneering-surgery-offers-the-prospect-of-saving-the-legs-of-thousands-of-accident-victims.html Living with an Ilizarov/Taylor Spatial Frame UK newspaper article]
-* [http://www.ilizarov.com/en/ ilizarov.com (English)]
-* [http://www.ilizarov.org.uk/index1.htm The ILIZAROV frame wearer's support group]
 * [https://web.archive.org/web/20060815000944/http://www.vardaan.net/ilizarov.htm More information and pictures about the Ilizarov surgical technique]
 * [http://www.limblengthening.com Institute for Limb Lengthening and Reconstruction]
-* [http://www.bonefixator.com/fracture_fixation/taylor_spatial_frame_1.html Taylor Spatial Frame]
-* [http://www.rucosm.com Legs lengthening and correction with Ilizarov frame]
 * [https://web.archive.org/web/20160303192236/http://www.ilizarov.org/casemore.asp?id=218 Providing excellent case summaries for Ilizarov treatment of complex fractures, including X-rays]