Ilizarov frames are named after Gavril Abramovich Ilizarov, a Russian doctor, practicing at Kurgan, Siberia. He was the town doctor of Kurgan, and was inundated with non-healing bones and bone infections in Russian soldiers following the aftermath of World War II. Majority of these patients had severe fractures, lengthy treatments with casts, skeletal traction and internal fixation and endured very lengthy and often unsuccessful treatment.
Story goes, that while travelling in horse cart to see a patient one day, Ilizarov noticed wheel with spokes and got the idea of fixing bones with wires and rings. And thereby, Ilizarov frame was born. Wires and ring were manufactured in local bus factory and Ilizarov started treating patients with his new external (Ilizarov) fixator.
Ilizarov emphasized on closed stable bone fixation, preserving blood supply and preserving muscle and joint function by loading (mobilizing and weight bearing) them. Ilizarov external fixation revolutionized the treatment of these extremely difficult fractures, non-unions and bone infections.
His national fame came when he treated Russian Olympian high jumper and world record holder Valerie Brumel, who suffered open Tibial fracture and which got infected and failed to unite despite multiple surgeries by the most eminent surgeons of that time. Ilizarov corrected his leg length, cured the infection and healed the bone with his external fixator and Brumel went back to competitive high jump again.
Ilizarov also revolutionized the limb lengthening, and for the first time patients had predictable and consistent limb lengthening with out the use of bone grafts. He undertook extensive research at Kurgan, Siberia and following the treatment of Italian adventurer, Carlo Mauri, Ilizarov external fixator and principles were introduced to Western world in 1981.
Ilizarov surgery is a specialized technique, which requires specialized training and there are limited number of centres which provide comprehensive Limb reconstruction services in UK.
Since the time of Ilizarov, technological advances has ensured that now we have computer assisted Ilizarov frames (hexapods) which follow the Ilizarov principles and giving same results but in much simpler way.
Ilizarov external fixator is the most versatile device available in Orthopaedic surgery. However, it is an external fixation device and not always the most convenient to the patients. Ilizarov fixator previously was used in complex trauma and failure of other surgical methods i,e, salvage situations.
However, currently it is used for routine trauma to prevent long term problems associated with other devices and therefore to avoid the salvage situation altogether. Current indications are
- Complex lower limb intra articular or extra articular fracture
- Open fractures
- Infected trauma
- Limb lengthening – pt.’s born with short limb /s.
- Limb shortening associated with trauma and infections.
- Deformity correction – when bones unite in bend / rotated position.
- Non-union – often Ilizarov fixator can heal the bone without bone grafting or opening the non union site.
- Both in infected and non infected cases
- Ankle distraction – in sever arthritis of ankle, Ilizarov distraction can improve the joint cartilage and pain for number of years and thereby delay the ultimate salvage surgery like arthrodesis or ankle replacement. This treatment is particularly relevant in young patients, where ankle replacement is not an option and ankle arthrodesis is not ideal as, with time, can result in arthritis of other joints of foot.
- Bone infections
SURGERY AND FOLLOW UP
Surgical time can be very variable from 1 hour to few hours depending on the complexity of the case. Patient often stay first night in HDU and total hospital stay is 4 -5 days, depending on pain control.
Surgical planning is fed into the software and computer generates a correction chart. All hexapods have 6 struts with numbers and patients move the numbers as per the computer generated chart. This ensures that deformity / lengthening / corrections are gradually done by patients at home.
Patients are followed up in clinic every 2 weeks during the correction phase, and then every 4 – 6 weeks until the frame is removed. All patients require extensive physiotherapy, usually twice per week. Frame time is variable, and it can vary from 4 months to very long time depending on the complexity of the condition treated. For example in adult leg lengthening, approximately frame time is on an average of 2 months for every cm bone lengthened.
Prior to removal frame is adjusted to check whether bone is healed or not and then frame is removed in theatre.