In medicine, the Ilizarov apparatus is a type of

external fixation External fixation is a surgical treatment wherein rods are screwed into bone and exit the body to be attached to a stabilizing structure on the outside of the body. It is an alternative to internal fixation, where the components used to provide ...

apparatus used in

orthopedic surgery Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...

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 fracture A bone fracture (abbreviated FRX or Fx, Fx, or #) is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. In more severe cases, the bone may be broken into several fragments, known as a '' ...

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; 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 Gavriil Abramovich Ilizarov (russian: Гавриил Абрамович Илизаров; 15 June 1921 – 24 July 1992) was a Soviet physician, known for inventing the Ilizarov apparatus for lengthening limb bones and for the method of surgery ...

, a Soviet surgeon, who, in the 1950s, used external fixation apparatuses to treat the osteopathic non-unions of patients with broken limbs. In the course of treatment, Ilizarov observed the formation of a

callus A callus is an area of thickened and sometimes hardened skin that forms as a response to repeated friction, pressure, or other irritation. Since repeated contact is required, calluses are most often found on the feet and hands, but they may o ...

, and so discovered the phenomenon of distraction osteogenesis when one patient lengthened, rather than shortened, the frame of his external-fixation apparatus. 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. The mechanical functions of the Ilizarov apparatus derive from the mechanics of the shaft bow harness for a horse.

The apparatus

The Ilizarov apparatus is a specialized

external fixator External fixation is a surgical treatment wherein rods are screwed into bone and exit the body to be attached to a stabilizing structure on the outside of the body. It is an alternative to internal fixation, where the components used to provide ...

of modular construction, composed of rings (

stainless steel Stainless steel is an alloy of iron that is resistant to rusting and corrosion. It contains at least 11% chromium and may contain elements such as carbon, other nonmetals and metals to obtain other desired properties. Stainless steel's r ...

titanium Titanium is a chemical element with the symbol Ti and atomic number 22. Found in nature only as an oxide, it can be reduced to produce a lustrous transition metal with a silver color, low density, and high strength, resistant to corrosion i ...

) that are transfixed to healthy bone with

Kirschner wire Kirschner wires or K-wires or pins are sterilized, sharpened, smooth stainless steel pins. Introduced in 1909 by Martin Kirschner, the wires are now widely used in orthopedics and other types of medical and veterinary surgery. They come in differ ...

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. The mechanical functions of the Ilizarov apparatus are based upon the principles of

tension Tension may refer to: Science * Psychological stress * Tension (physics), a force related to the stretching of an object (the opposite of compression) * Tension (geology), a stress which stretches rocks in two opposite directions * Voltage or el ...

, 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. 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.

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 An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable di ...

; and for cases wherein the extent and severity of the fracture precludes using

internal fixator Internal fixation is an operation in orthopedics that involves the surgical implementation of implants for the purpose of repairing a bone, a concept that dates to the mid-nineteenth century and was made applicable for routine treatment in the m ...

s to immobilise the damaged bone for proper repair. The following photographs and

radiographs Radiography is an imaging technique using X-rays, gamma rays, or similar ionizing radiation and non-ionizing radiation to view the internal form of an object. Applications of radiography include medical radiography ("diagnostic" and "therapeut ...

illustrate the application and emplacement of an Ilizarov apparatus to repair an open fracture; the photographs were taken four weeks after the patient fractured the

tibia The tibia (; ), also known as the shinbone or shankbone, is the larger, stronger, and anterior (frontal) of the two bones in the leg below the knee in vertebrates (the other being the fibula, behind and to the outside of the tibia); it conn ...

(shinbone) and the

fibula The fibula or calf bone is a leg bone on the lateral side of the tibia, to which it is connected above and below. It is the smaller of the two bones and, in proportion to its length, the most slender of all the long bones. Its upper extremity ...

(calf bone) of his left leg, and two weeks after installation of the apparatus. 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

and

bones; the open-fracture site is above the black ring. File:Ilizarov3.jpg, Superior perspective of the apparatus emplaced into the left leg of the patient. File:Ilizarov7.jpg, X-ray of the fracture site and the emplaced apparatus, two months post-fracture; perspective 1-4. File:Ilizarov8.jpg, X-ray of the fracture site and the emplaced apparatus, two months post-fracture; perspective 2-4. File:Ilizarov9.jpg, X-ray of the callus forming ''at'' the fracture site, three months post-fracture; perspective 3-4. File:Ilizarov10.jpg, X-ray of the callus forming ''around'' the fracture site, three months post-fracture; perspective 4-4. File:Ilizarov11.jpg, X-ray perspectives of the callus-formation progress and healing of the fractured tibia and fibula bones, four months post-fracture. Valeriy Brumel 1968

In 1968, Dr. Ilizarov successfully treated the non-union osteopathy of

Valeriy Brumel Valeriy Nikolayevich Brumel (russian: Валерий Николаевич Брумель; 14 April 1942 – 26 January 2003)Great Russian Encyclopedia (2006), Moscow: Bol'shaya Rossiyskaya Enciklopediya Publisher, vol. 4, p. 243 was a Russian hi ...

, a Soviet athlete, who suffered a broken shinbome (tibia) and ankle in his right leg, consequence of a motorcycle accident, had undergone twenty-nine failed bone surgeries in three years, and yet his broken leg-bones had not healed. Using the surgical method of distraction osteogenesis and an external-fixation apparatus, Dr. Ilizarov resolved Brumel's osteopathic non-union, and extended the athlete's leg to its normal length. 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. 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 A kurgan is a type of tumulus constructed over a grave, often characterized by containing a single human body along with grave vessels, weapons and horses. Originally in use on the Pontic–Caspian steppe, kurgans spread into much of Central As ...

, Russia. In 2013, consequent to a PTSD-induced fall, the war correspondent Ed Vulliamy underwent leg-saving medical treatment that featured an Ilizarov apparatus to heal the severely fractured bones in his left leg.

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; onnce the fracture has been immobilised, the bone tissues begin to grow and eventually bridge the fracture with new bone. 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 The Achilles tendon or heel cord, also known as the calcaneal tendon, is a tendon at the back of the lower leg, and is the thickest in the human body. It serves to attach the plantaris, gastrocnemius (calf) and soleus muscles to the calcaneus ...

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 In pathology, a contracture is a permanent shortening of a muscle or joint. It is usually in response to prolonged hypertonic spasticity in a concentrated muscle area, such as is seen in the tightest muscles of people with conditions like sp ...

of the affected joint.

References

External links

Living with an Ilizarov/Taylor Spatial Frame UK newspaper article

ilizarov.com (English)

* ttp://www.limblengthening.com Institute for Limb Lengthening and Reconstruction
Taylor Spatial Frame

Legs lengthening and correction with Ilizarov frame

Providing excellent case summaries for Ilizarov treatment of complex fractures, including X-rays
{{DEFAULTSORT:Ilizarov Apparatus Orthopaedic instruments Soviet inventions Russian inventions Science and technology in the Soviet Union Orthopedic treatment

The apparatus

Clinical application

Bone work

See also

References

External links