Ilizarov Apparatus

An Ilizarov apparatus is an orthopedic device used to stimulate bone growth and is generally used to lengthen and straighten the extremities. It may also be used to treat complex and/or open bone fractures and in cases of infected non-union of bones that are not responsive to other techniques. The apparatus was named after its inventor, a Siberian orthopedic surgeon named ‘Gavriil Abramovich Ilizarov’. The Ilizarov fixator uses the principle of distraction osteogenesis which refers to the pulling apart of bone to stimulate new bone growth through neovascularization.

Indications

The Ilizarov apparatus is used in the following conditions:

  • Treatment of bone infections
  • Dwarfism – to increase the length of the extremities
  • Poliomyelitis – to lengthen the limb and correct deformities
  • In cases of acute fractures, mal-unions, and non-unions
  • Correction of both congenital and acquired limb deformities
  • Comminuted or segmental limb fractures
  • Lengthening of foot and limb stumps

Structure and function:

The Ilizarov apparatus is a set of external fixators consisting of rods, rings, and Kirschner’s wires. It is cylindrical in shape and encircles the limb using wires to connect the bone to the rings.
The apparatus functions by transferring force to the top rings of the outer frame and bypassing the fracture site. The force is then transferred back to the healthy bone through the tensioned wires and circular construction of the apparatus. This structure of the Ilizarov apparatus helps both immobilize the fracture site and relieve stress over the fracture.

Surgical Procedure

Patients undergo surgery to attach the Ilizarov fixator to the limb to be treated. This procedure is also referred to as transosseous osteosynthesis. Wires are passed by the surgeon through the skin and into the bone with the help of a drill. The protruding ends of these wires are then fixed to the external rings with special ‘wire fixation’ bolts. Thin threaded rods are used to connect and fix the rings to one another. The fixed Ilizarov device provides stability and supports the affected limb.

Following this, a Corticotomy or osteotomy (cutting of the bone) is performed to stimulate osteogenesis or formation of new bone. You will be instructed to make adjustments by turning the nuts on the rods four times a day. This is called “distraction” and produces tension between the bone fragments and stimulates the bone to grow back together gradually into a complete but longer bone. Once the bone is solid, the Ilizarov ring fixations are removed by the surgeon.

Advantages:

Some of the advantages of Ilizarov apparatus include:

  • Low incident rates of infection, hemorrhage, and tissue trauma when compared to the traditional method as it is an incision-free technique.
  • It is a minimally invasive technique with only wires used to fix the bones to the rings causing minimal soft tissue damage.
  • The cylindrical shape of the apparatus enables correction of the deformities in 3-dimensions simultaneously enhancing the versatility of the fixator.
  • No immobilization (means the patient can move throughout the treatment), so less chance of contractures and joint stiffness problems.
  • Short-term inpatient hospitalization
  • Normal Hand Anatomy
  • Trigger Finger
  • Dupuytren’s Contracture
  • De Quervain’s Tenosynovitis
  • Carpal Tunnel Syndrome
  • Arthroscopic Wrist Surgery
  • Congenital Hand Deformities
  • Microvascular Surgery
  • Peripheral Nerve Surgery

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