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In 1968, Dr. Ilizarov successfully treated the [[Nonunion|non-union osteopathy]] of [[Valery Brumel]], a Soviet athlete who had broken a [[tibia]] bone in a motorcycle crash,<ref name="Spiegelberg"/> had undergone twenty failed bone surgeries in three years, and yet his leg 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 tibia of a leg whilst skiing, yet the wound in the leg never healed.<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> Later, during another expedition in Russia, Mauri's leg wound reopened, and a doctor recommended that he consult with Dr. Ilizarov for proper surgical repair, in the city of [[Kurgan, Kurgan Oblast|Kurgan]].<ref name="Spiegelberg"/><ref name= "SIlizarovp15"/> In the story ''How Comrade Ilizarov Saved My Leg'' (2015), the journalist [[Ed Vulliamy]] tells of undergoing leg-saving medical treatment that featured an Ilizarov apparatus to heal his 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>
In 1968, Dr. Ilizarov successfully treated the [[Nonunion|non-union osteopathy]] of [[Valery Brumel]], a Soviet athlete who had broken a [[tibia]] bone in a motorcycle crash,<ref name="Spiegelberg"/> had undergone twenty failed bone surgeries in three years, and yet his leg 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 tibia of a leg whilst skiing, yet the wound in the leg never healed.<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> Later, during another expedition in Russia, Mauri's leg wound reopened, and a doctor recommended that he consult with Dr. Ilizarov for proper surgical repair, in the city of [[Kurgan, Kurgan Oblast|Kurgan]].<ref name="Spiegelberg"/><ref name= "SIlizarovp15"/> In 2013, consequent to a PTSD-induced accident, the journalist [[Ed Vulliamy]] underwent leg-saving medical treatment that featured an Ilizarov apparatus to heal severely fractured leg bones, which he broke in a fall.<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==
==Bone work==

Revision as of 18:12, 28 December 2022

Ilizarov apparatus
An Ilizarov apparatus treatment for the fractured tibia and fibula bones of the right leg.
ICD-9-CM78.3, 84.53
MeSHD018889

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.

The Ilizarov apparatus was developed by Dr. Gavriil Abramovich Ilizarov, a Soviet surgeon, who, in the 1950s, used external fixation apparatuses to treat the osteopathic non-unions of patients with broken limbs.[1] 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.[1]

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.[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)

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.[4]

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 wires, 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 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.

Clinical application

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 bacterial infection; and for cases wherein the extent and severity of the fracture precludes using internal fixators 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.


  • X-ray of the open fracture of the left leg and the external fixator, installed within 24 hrs. in hospital.
    X-ray of the open fracture of the left leg and the external fixator, installed within 24 hrs. in hospital.
  • 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 view of the apparatus emplaced into the left leg of the patient.
    Superior view of the apparatus emplaced into the left leg of the patient.
  • Sites of the Kirschner pins in the left leg, two weeks post-surgical.
    Sites of the Kirschner pins in the left leg, two weeks post-surgical.
  • X-ray of the fracture site immediately after installation of the Ilizarov apparatus.
    X-ray of the fracture site immediately after installation of the Ilizarov apparatus.
  • X-ray of the fracture site and the emplaced apparatus, two months post-fracture; perspective 1-2.
    X-ray of the fracture site and the emplaced apparatus, two months post-fracture; perspective 1-2.
  • X-ray of the fracture site and the emplaced apparatus, two months post-fracture; perspective 2-2.
    X-ray of the fracture site and the emplaced apparatus, two months post-fracture; perspective 2-2.
  • Two X-ray perspectives show the callus forming at the fracture site, three months post-fracture.
    Two X-ray perspectives show the callus forming at the fracture site, three months post-fracture.
  • Two X-ray perspectives show the callus forming around the fracture site, three months post-fracture.
    Two X-ray perspectives show the callus forming around the fracture site, three months post-fracture.
  • X-ray perspectives of the progress of the healing of the open fracture, four months post-fracture.
    X-ray perspectives of the progress of the healing of the open fracture, four months post-fracture.

In 1968, Dr. Ilizarov successfully treated the non-union osteopathy of Valery Brumel, a Soviet athlete who had broken a tibia bone in a motorcycle crash,[1] had undergone twenty failed bone surgeries in three years, and yet his leg had not healed.[3] Using distraction osteogenesis, Ilizarov resolved Brumel's osteopathic non-union, and 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 explorer, who, ten years earlier, had broken the tibia of a leg whilst skiing, yet the wound in the leg never healed.[1][2] Later, during another expedition in Russia, Mauri's leg wound reopened, and a doctor recommended that he consult with Dr. Ilizarov for proper surgical repair, in the city of Kurgan.[1][2] In 2013, consequent to a PTSD-induced accident, the journalist Ed Vulliamy underwent leg-saving medical treatment that featured an Ilizarov apparatus to heal severely fractured leg bones, which he broke in a fall.[5]

Bone work

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.

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.

See also

References

  1. ^ a b c d e f "Ilizarov Principles of Deformity Correction". Annals of the Royal College of Surgeons of England. 92 (2): 101–5. 2010. doi:10.1308/003588410X12518836439326. PMC 3025247. PMID 20353638. {{cite journal}}: Unknown parameter |authors= ignored (help)
  2. ^ 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.
  3. ^ 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.
  4. ^ 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.
  5. ^ Ed Vulliamy (13 December 2015). "How Comrade Ilizarov Saved My Leg". The Observer. Retrieved 13 December 2015.
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