Illizarov fixator surgery

The Ilizarov Apparatus is a set of external fixators comprising of rings, rods and Kirschner's wires. It differs from the conventional external fixators as it encases the limb as a cylinder. The limb itself being shaped like one and in this method wires are used as an alternative for pins to fix the bone to the rings.

The Ilizarov Method uses Ilizarov's Principle of DISTRACTION OSTEOGENESIS (osteo=bone, genesis=formation). This refers to the induction of new bone between bone surfaces that are pulled apart in a gradual, controlled manner. The distraction initially gives rise to NEOVASCULARISATION, which is what actually stimulates new bone formation. In addition, there is simultaneous histogenesis of muscles, nerves and skin; in bone diseases. This new bone replaces pathological bone with normal bone. This is a revolutionary concept; for diseases there were no treatments earlier, but are now being successfully treated using the Ilizarov Method.

Procedure

Wires of 1.5 mm diameter are passed percutaneously (through the skin) and through the bones with a drill. The protruding ends of these wires are then fixed to rings with special "wire-fixation" bolts. These rings in turn are connected and fixed to one another with threaded rods. Once it is fixed, the Ilizarov frame provides a stable support to the affected limb. A CORTICOTOMY is then performed; it is an osteotomy (cutting the bone) where the periosteum of the bone is preserved. Adjustments in the rods produce compression or distraction as desired between the bone ends, and simultaneously, deformities are also corrected. The ring fixator is removed at the end of the treatment.

Advantages

• No skin incision is made as in a conventional operation. Incidents of hemorrhage, tissue trauma and infection are reduced.
• The whole procedure is minimally invasive as only wires fix the bones to the rings and there is very little soft tissue damage.
• The Ilizarov fixator is very versatile; the cylindrical shape of the fixator allows deformities to be corrected simultaneously in 3 dimensions.
• The patient remains mobile throughout the course of the treatment. Intensive physiotherapy is instituted early; as a consequence, problems of joint stiffness and contractures are rare. Also, the patient's stay in the hospital is considerably reduced.

Authored By : DR. DAVID V RAJAN