Ilizarov Surgery

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History

Professor Gavril Abramovich Ilizarov was born in Caucasia(USSR) in 1921. He started school when he was 11 years old due to difficulties; and worked in Kurgan, Siberia after he became a doctor. He worked as the only orthopedician in that region therefore he performed different treatment methods in various orthopedic problems. The term ‘distraction osteogenesis’ is the most important method and has significant importance worldwide. The technique was used in dogs for experimental studies first, and then was used in human. The method enables the reunion of problematic bone fractures, treatment of nonunion fractures and fixation of the malunions. Although, the method has been used since 1950s, the worldwide recognition was late. Ilizarov method became popular after Dr. Ilizarov had treated the ankle fracture of a worlwide famous athlete Valery Brumel in 1967. This problematic fracture could not be treated by the other surgeons. In 1971, he established “Ilizarov Restorative Traumatology and Orthopedics Institute” in Kurgan, USSR. Experimental studies were performed as well as the clinical practise in the institute. Dr. Ilizarov introduced his technique to western world after the invitation of Professor A.Bianchi- Maiocchi to Italy in 1981. Thus, the frequent use of method worldwide was possible.
Dr.Ilizarov won the reward of Soviet Academia Medicine and has 3500 scientific publishings and 9 books and he presented his studies in various congresses and meetings and shared his experiences. He left a great inheritance to orthopedics world when he died in 1992 at the age of 71.

The Technique

The extremity lengthening and reconstruction techniques are used in treatment of many problems such as to substitute of bone loss, deformity corrections and healing the nounions. Generally, circular devices are used in treatment however, monolateral devices may also be used.

  1. a) Bilateral leg X-rays must be taken involving the pelvis to heel before application of the method. Before the operation, ‘how to fix the curve, from where’ is identified on X-rays. In addition, The X-rays may also help to understand the length differences between the legs and to the required lenght to be performed.
    b) The frame(surgical device) in proper dimensions is prepared in accordance with the length of the patient and thickness of leg. The frame is replaced on the leg and X-ray is taken to check if the device is appropriate.
    c) During the operation, the frame is fixated on the bone using screw and wires. Then, osteotomy which means cutting of the bone, is performed in approximately 2 cm incision(cut). The operation is completed with very small blood loss and small injuries; and this technique is called minimal invasive surgery
    d) After the surgery the patient is rested(latent period) generally for 1 week to prepare the bone cells in the incision region for the procedure. Then, the bone is lengthened using the accessory components on the device and the curvature is corrected. This process may last approximately in 2-3 months with regard to the aim of the surgery. Generally, accessory components are rotated 4 times per day to prevent the damage to vital structures as vessels and nerves.

Rehabilitiation after surgery

Patients are generally mobilised the day after surgery using crutches. Rehabilitation is initiated in the first day after surgery. The aim is to preserve the range of motion, to prevent muscle stiffness which we define as contracture, and enable a normal muscle tonus. Patients are dicharged from hospital after 5-7 days of rehabilitation and adaptation period to the device. This period is maintained at home or in workplace until the bone reunions and the device is removed.

Bone maturation and removal of device

Patients pursue their hospital visits once in 2-3 weeks. During the examination of the physician, care of the device and the position of the wire/screws are checked. In every single visit the patients are informed about the care of the wire and screws. In addition, the position of the bone is checked with the X- rays. Generally, The bone maturation develops in 3 months and the device is removed if curvature correction surgery is performed. If lengthening is performed, generally 1 cm of lengthening is expected in 1.5 months. To give an example; if we are planning 5 cm lengthening then, the total period will be 7.5 months. However, the period depends on the age, general health and bone quality of the patient. Particularly, smoking may lengthen the period. The patients use plasters or plastic braces approximately 1-2 months after the removal of the device to strengthen the bone.

Important points

However, Ilizarov surgery seems simple to apply, the applications by inexperienced people and inproper way may result with failure. If all the principles of Dr. Ilizarov are not applied during the surgery and during treatment, there may be some distrestful problems which we define as complications both for the physician and the patient.
The surgeries must be performed by experienced orthopedicians in the health care centers.

The patients must be informed about the benefits and damage of the surgery, the possible risks, and another method must be preferred if the patient cannot compete with the surgery. Patient must carefully care the wire/screw and the device and fully obey the recommendations of the physician. The wire/screw care must be done with 70% absolute alcohol or betadine scrub using sterile gauze pads. In case of any symptoms of infection such as rash, discharge or enlargement in scar, immediately the physician must be visited.

The patients should not smoke because smoking delays the new bone formation and maturation. Another procedure must be performed for patients who cannot give up smoking. Patients must take care of their general health and obey the diet recommendations of their physicians.