Ilizarov Technique in India
The Ilizarov apparatus is a type of external fixation used in orthopedic surgery to lengthen or reshape limb bones; to treat complex and/or open bone fractures; and in cases of infected nonunions of bones that are not amenable with other techniques. It is named after the orthopedic surgeon Gavriil Abramovich Ilizarov from the Soviet Union, who pioneered the technique.
The principles and technique of the treatment are:
- ‘Preservation of the blood supply
- Preservation of the osteogenic tissue
- Complete anatomic reduction
- Stable fixation
- Functional activity of the muscles and joints
- Early patient mobilization’
The Ilizarov apparatus is a set of external fixators consisting of:
rings, rods and kirschner wires, all made of stainless steel. It differs from the conventional external
fixators in that it encases the limb as a cylinder and it uses wires instead of pins to fix the bone to the rings. The circular construction and tensioned wires allow early weight bearing as it provides far greater support than monolateral (one sided) fixators. The top rings of the Ilizarov fixator allow force to be transferred through the external frame, bypassing the fracture site and transferring the force from healthy bone to healthy bone.
The purpose of the Ilizarov fixator is to stimulate bone growth, and this works by the principle of distraction osteogenesis, which is the pulling apart of bone to stimulate new bone growth. Distraction osteogenesis is a method for regenerating bone deficiencies in a number of situations,
for example correcting limb length, width or misalignment. It can also be used to treat non-unions and to regenerate bone lost due to infection. A break is made in the bone, and gradual distraction of
this bone results in new bone formation.
ilizarov technique is used for
- 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 leg lengthening surgery
The causes of limb-length discrepancy include:
- Trauma, especially fractures of the distal femur causing destruction of the growth plate.
- Severe infections, such as septic arthritis of the hip, neonatal osteomyelitis, and multifocal osteomyelitis. Another cause of growth retardation by infection is fulminating meningococcemia, which may lead to destruction of the growth plate in many sites.
- Pathological bone disorders, including osteogenesis imperfecta, metabolic bone diseases such as rickets and hypophosphatemia, and different types of skeletal dysplasia such as multiple enchondromatoses.
- Congenital anomalies of the lower limb. These include fibular hemimelia, tibial hemimelia, posteromedial bowing of the tibia, congenital pseudoarthrosis of the tibia, congenital short femur, and proximal femoral focal deficiency.
In the best limb lengthening surgery length of the bone can be lengthen by up to 20% to 25% of the original length usually gives good results. Lengthening more than 25% can lead to a higher incidence of all types of complications. The basic components of the Ilizarov fixator are smooth and beaded trans- fixion wires 1.5 or 1.8 mm in diameter. metal rings and arches, threaded rods, and an array of miscellaneous hardware for interconnecting the basic components. The technique for wire insertion includes passing the wire through skin and soft tissue, drilling it through near and far cortices of the bone, and then tapping it through the soft tissue and skin to avoid winding of soft tissue or neu- rovascular structures around the surgical instrument. The wires are attached to a series of half or full metal rings, which encircle the affected limb, and tensioned to enhance stability. The fixator is completed by connecting the rings with threaded rods aligned colinearly, in the case of straight lengthenings, or at angles by using hinges, A corticotomy is then performed through the metaphyseal portion of the bone. This is a special type of osteotomy wherein only the cortex of the bone is cut, leaving intact the periosteal and endosteal blood supplies, which are the most important elements responsible for osteogenesis . After a latency period of 5 to 10 days, distraction is begun by turning .the nuts on the threaded rods 0.25 mm four times per day, resulting in a total lengthening of 1 mm a day . 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.
Leg Shortening Surgery
Leg Shortening Surgery also known as bone shortening, femoral lengthening, bone lengthening and femoral shortening. this surgery is aimed to correct LLD and connected deformities by protecting the function of joints and muscles.
Leg shortening surgery is recommended for severe unequal leg lengths resulting from:
- poliomyelitis, cerebral palsy, or septic arthritis
- small, weak (atrophied) muscles
- short, tight (spastic) muscles
- hip diseases, such as Legg-Perthes disease
- previous injuries or bone fractures that may have stimulated excessive bone growth
- scoliosis (abnormal spine curvature)
- birth defects of bones, joints, muscles, tendons, or ligaments
Leg shortening surgery is performed under general anesthesia. Generally, femoral shortening is preferred to tibial shortening, as larger resections are possible. Femoral shortening can be performed by open or closed methods. The bone to be shortened is cut, and a section is removed. The ends of the cut bone are joined together, and a metal plate with screws or an inter-medullary rod down the center of the bone is placed across the bone incision to hold it in place during healing
In leg shortening surgery, two to three weeks of hospitalization is common. Occasionally, a cast is placed on the leg for three to four weeks. Muscle weakness is common, and muscle-strengthening therapy is started as soon as tolerated after surgery. Crutches are required for six to eight weeks. Some patients may require from six to 12 months to regain normal knee control and function. The intramedullary rod is usually removed after a year.
Cost of Ilizarov Treatment
The Ilizarov treatment in India is very low cost and have latest technologies with superior medical services.