Gavriil Abramovich Ilizarov is the orthopedic surgeon who pioneered this technique. The Ilizarov technique is used in surgical processes to treat open or complex bone fractures, to reshape or lengthen the limb bones and also the cases of infected non-unions of bones that cannot be treated with any other technique.
The Ilizarov Apparatus is comprised of external fixators such as rods, Kirschner’s wires and rings. The Ilizarov apparatus is unlike the conventional external fixators. Those fixators consist of the limb just like in the shape of a cylinder and makes use of wires instead of pins so as to fix the bone to the rings.
The Ilizarov’s Principle of Distraction Osteogenesis is used for Ilizarov Limb Lengthening Method. The new bone is introduced in between the bone surfaces which has been carefully and gradually pulled in a controlled manner. The Neovascularisation is the result of the initial distraction that stimulates the formation of a new bone. Simultaneously, there is histogenesis of skin, muscles and nerves. The new bone in bone diseases (pseudo-arthrosis, osteomyelitis and fibrous dysplasia) replaces the pathological bone with the normal bone. This is regarded as the revolutionary concept and with the help of Ilizarov Technique, many diseases are successfully treated that earlier had no treatment.
Indications for ilizarov technique
- Comminuted fractures in the limbs and also with skin loss
- Correction of both acquired and congenital deformities of the limbs
- Height increase (specially for dwarfs)
- Bone infections
- Poliomyelitis Sequelae (correction of deformities and limb lightening)
- Treatment of malunited fractures and of non-unions
Ilizarov limb lengthening Procedure
Transosseous Osteosyntheis is the other name used for limb lengthening procedure. By making use of drill, the 1.5 mm diameter wires are then passed through the skin and bones. The extended ends of the wires are fixed to rings with unique wire-fixation bolts. All these rings are fixed and connected with each other with the help of threaded rods. When the rings are properly fixed, the Ilizarov frame gets a steady support to the affected limb. The Corticotomy procedure is then performed which means cutting the bone (osteotomy) where the bone’s periosteum is preserved. The distraction is produced by making adjustments in the rods as preferred in between the bone ends and all the deformities also gets corrected. After the procedure the external ring fixator is also removed.
Benefits of Ilizarov Treatment
- Intensive physiotherapy is used early as the result of which the problems of joint contractures and stiffness are considerably rare. Along with this the stay of the patient in the hospital is also reduced.
- In conventional operation, there is no skin incision. Incidents of tissue trauma, infections and hemorrhage are much lesser.
- The entire procedure is minimally invasive as it involves less tissue damage and wires are used to fix the bones to the rings.
- The cylindrical shape fixator simultaneously corrects deformities in three dimensions.
Leg Shortening Surgery
This surgery is also known as bone shortening, femoral lengthening, bone lengthening and femoral shortening. The aim of this surgery is to correct LLD and connected deformities by protecting the function of joints and muscles. The surgery is done for-
- An abnormally long leg is shortened by the means of this surgery. The patients whose bones are no longer growing (skeletal maturity) are usually indicated by this surgery.
- The surgery is performed to allow the growth of a short leg of matching length by limiting the growth of a normal leg.
- The surgery is done to lengthen an abnormally short leg (femoral lengthening or bone lengthening). The surgery is recommended for those children whose bones are skeletally not mature. The surgery can add at most 15.2 cm in length.
Causes of leg length inequality
- Tight and short muscles
- Birth defects of joints, tendons, ligament or bones
- Cerebral palsy, septic arthritis or poliomyelitis
- Weak small muscles
- Hip diseases
- Scoliosis (abnormal spine curvature)
- Bone fractures and previous injuries that have stimulated extra bone growth
Cosmetic Limb Lengthening
Height lengthening (limb lengthening) is a modern day procedure and this minimally invasive procedure is performed by making a surgical cut in the thigh bones or in the leg, in order to promote the mending and lengthening of any leg deformities. The deformity correction technique is used to replace the missing bone or to straighten or lengthen the bone deformed segments. Both children and adults can benefit from this procedure and it eliminates deformities which is due to injuries, birth defects, knock-knee deformities, trauma and the bow-legged patients having one leg shorter than the other leg. Distraction Osteogenesis is the procedure by which the correction of deformities and lengthening of the bones is done when there is gradually growing of soft tissue sand new bone.
FAQs of Ilizarov Technique
Ques: What is the Ilizarov Technique?
Ans: Ilizarov technique is a surgical procedure for treating composite bone fractures, reshape or lengthening of limb bones, and infected non – union bones which cannot be treated with other techniques. This procedure was founded by a senior orthopedic surgeon named Gavriil Abramovich Ilizarov and it is named after him.
Ques: What is the Ilizarov Apparatus
Ans: It is a device used by an orthopedic surgeon. It is used in surgery to encourage bone development and used in lengthening and straightening of limb bones. This apparatus is used in various conditions such as bone infection treatment, to increase the limb length, severe fracture, non-union bones, pediatric hip disorders, bow legs, knock-knees, and for foot and limb stumps lengthening.
Ques: Why is this surgery performed?
Ans: This surgery can be performed for treating the unequal length of legs in adults and children, for deformity correction in legs because of birth disease, defects or injury, for height increase, and for cosmetic reasons
Ques: What are the reasons due which the height of a person gets affected?
Ans: There are some major factors due to which a person’s height can be affected such as hereditary inheritance, malnutrition, lifestyle, and illness. Several types of illnesses during childhood can also stop the development of height. Young people who engage in regular sports activities and take a healthy diet got a good height in comparison to those people who do not engage in these activities.
Ques: Can my height increase with medicines?
Ans: Leg bones are an important contributing factor in height. As per the studies, it has not been verified that these medicines can help you to become taller, because once your growth is completed the growth plates fuse together which prevents any further development or increase in height.
Ques: How does this surgery work?
Ans: The very first step of surgery is Osteotomy, where the bone is cut to change the alignment. Then two separate parts of bone are distracted. In the last, the limb is stabilized while using many internal and external frames and devices. Our body redevelops soft tissues and bone cells to fill the space of broken parts on its own. The new bone will be hard in a year, and the patient will be walking within a few months of surgery
Ques: Is this a major surgery and how long does it take?
Ans: Yes, this is a major orthopedic surgery which may take at least three hours for completing the surgical part on one leg.
Ques: What will happen after the surgery?
Ans: On the next day of the surgery your physical therapy will start. The lengthening and distraction of bone will start in one or two weeks of your surgery. During this period, the joint movement plays a very important role and our body starts the bone regeneration process. Routine checkups and evaluations will be required to check the growth rate of bone and infection.
Ques: How long should I rest after the surgery?
Ans: Mostly, doctors recommend one day rest. From the next day, you can start walking slowly with the help of a walker and crutches because the development of legs starts the next day onwards.
Ques: Will there be any complications after the surgery?
Ans: Almost 80 percent of the patients experience irritation and infection. These are the very common complications which patients can experience after the surgery. Most of these are superficial infections which can be reduced by antibiotics. Other than this, the patient can also experience stiffness in the adjacent joints and ankle joints. There is some complication that can be preventable if the patient follows doctor instructions, in this case, the patient should do physiotherapy.
Ques: Will the procedure leave any scar after the surgery?
Ans: Yes, there will be small scars of pins, and from where the bone is cut. There may be some scars on the entry point of the nail but they can be hardly visible after healing. Doctors suggest some ointments to reduce the scars.
Ques: How much height will be gained after the surgery?
Ans: This totally depends on the results of pre-surgical examinations. The normal increase in height will be 2 to 3 inches.
Ques: What medications I will get after discharge from the hospital?
Ans: Medicines like pain killers, muscles relaxing medication, Vitamin D, Calcium, necessary minerals tablets, and blood-thinning medicines will be prescribed after the surgery.
Ques: How is height increased?
Ans: With the Ilizarov technique, a cut in bone using the Ilizarov ring external fixator gives an option to pull bone fragments up to 1.5 mm per day with bone growth. The very slow distraction allows the bone to form a new bone. Ilizarov device gives bone lengthening and encourages cells to regenerate. So creating new bone is as strong as original bone.
Ques: What is Ilizarov Fixator?
Ans: The Ilizarov Fixator is a round frame that surrounds the limb, with a mixture of wire pins and half pins. These pins are used in various ways to perform different functions. It acts as a stabilizing frame to hold the deformed limb. It helps in fixing fractures, lengthening a short limb, and to increase blood circulation in the limb.
Ques: What is Corticotomy?
Ans: This procedure involves cutting in the bone which can be done in two ways, first is surgeon can use an old fracture site and ends the bones during surgery. Secondly, he can create corticotomy by making new bones.
Ques: For how long does the external fixator stay on?
Ans: Generally, for 4 to 6 months this frame can stay on. However, the time period also depends on patients’ medical conditions such as if the patient smokes or not and progress made by frame.
Ques: How long does it take for me to resume my normal life?
Ans: While walking, toe-touch weight-bearing with the support of walkers or crutches which should be started from the next day after your surgery. In unilateral lengthening, patients can return to their work with a fixator after two to three weeks. They can do desk jobs and travel to small distances in their own vehicle. Whereas in bilateral lengthening, patients have to wait till the removal of a fixator and wheelchair can be used. After removal of the fixator patient can walk, swim, cycle, lifting lightweight. Sports activities can be started after 6 months with the approval of your doctor.
Ques: Will smoking affect recovery?
Ans: Yes, smoking can affect your recovery after your surgery as it slows down the process of healing, can cause infections, you can get a longer time in your recovery, a lot of pain and discomfort. So if you are a smoker then you should quit the same before your surgery only.
Ques: Will it be painful to have a frame on the leg?
Ans: Generally for a few days you will experience pain and discomfort, so doctors recommend strong painkillers to reduce the pain while you will be in the hospital. After a few days, the pain will settle and you will not be feeling pain.
Ques: How the frame will be removed after the surgery?
Ans: After 6 to 7 weeks of the surgery, the doctor will evaluate you and if he finds everything is fine then the frame will be removed under general anesthesia on a daycare basis.
Ques: For how long do I need to stay in the hospital?
Ans: Generally, you need to stay in the hospital for 5 to 6 days after the surgery. However, it depends on the medical condition of the patient. For this, you need to kindly discuss this with the doctor.
Ques: What is the approximate cost for the Ilizarov technique and how I can get an appointment?
Ans: To know about the Ilizarov treatment cost and appointment, kindly contact on below details:
Email: [email protected]
Mobile/Whatsapp: +91 9717766080