History of Ilizarov

Prof. Gavriil Abramovich Ilizarov started his career

treating a number of patients in western Siberia,
who had returned from World War II having
sustained fractures
 History of Ilizarov

 In 1954, he successfully treated his first patient, a factory

worker with a tibial non-union. During this time, by chance,
he discovered distraction osteogenesis for bone lengthening
 In 1968, Valery Brumel, an Olympic champion high jumper
at the 1964 games  he had suffered a compound fracture of
his distal tibia in 1965  20 operations over 3 years,
developed an infected non union and significant LLD  His
resultant surgery was a widely publicised success
 In 1980, Carlo Mauri, a well-known Italian journalist and
explorer had suffered a distal tibial fracture 10 years before 
the surgeons were amazed by the healing that had occurred in
this long-standing non-union by ilizarov procedure
 Principles of Distraction
Osteogenesis
 Over a 10-year period, a series of experiments were
conducted using 65 dogs  These experiments found
that ideal conditions included :

1. stable fixation

2. a low energy osteotomy followed by 5–7-day latency

3. a distraction rate of 1mm/day

 Principles of Distraction
Osteogenesis
 Distraction osteogenesis (DO) is a surgical technique in which
the intrinsic capacity of bone to regenerate is being
harnessed to lengthen bones or to replace large segments of
bone

 During distraction, regenerate bone arises between the entire

cross-sections of each distracted bone surface with a central
radiolucent fibrous interzone comprising of type I collagen 
New bone trabeculae form directly from this central collagen
zone extending to both bone surfaces

 Substantial histopathological changes occur after lengthening

of 30%
Steps of the technique of distraction osteogenesis used for limb
lengthening :
A. Shows the bone to be lengthened; B. Application of the
external fixator; C. Osteotomy of the proximal tibia; D. Start of
distraction and E. End of distraction when desired amount of
lengthening is obtained.
 Bone and soft tissue are gradually distracted at a rate of
1mm per day in four divided increments :
1. Bone growth in the distraction gap is called regenerate
2. The interval between osteotomy and lengthening is called
the latency phase and is usually 7–10 days
3. The correction and lengthening is called the distraction
phase
4. The time from the end of distraction until bony union is
called the consolidation phase
 Mechanical Principles of
the Ilizarov Method
 The most fundamental components being rings and
connecting rods

 Full rings provide the most rigidity; partial rings and

arches are particularly helpful when working near
joints and allow wound access needed after trauma

 Rings of large diameter are less stable than smaller

rings. Reducing ring diameter by 2 cm increases axial
frame stiffness by 70%
 Mechanical Principles of
the Ilizarov Method
 rings that are far apart and connected with long rods
will be less stable

 The stability of the ring is further increased by using

two rings instead of one for each bone segment

 A minimum of four connecting rods between the rings

and at least two points of fixation or wires per ring are
required
Frame stability increases with increasing
wire diameter and tension, the use of
more wires per ring, and inserting wires
in different planes
 Clinical use of Ilizarov
external fixators
 To correct the leg-length discrepancy, a corticotomy is
performed, the bone is exposed and the periosteum
incised and elevated paying careful attention to
preserve its integrity  Using a 4.8-mm drill, holes are
made circumferentially through the cortex and the
corticotomy is completed using an osteotome
 Clinical use of Ilizarov
external fixators
 For tibial lengthening, the suggested site of
corticotomy is at the junction between proximal
metaphysis and diaphysis, distal to the tibial tuberosity.

 Femoral lengthening corticotomies are usually just

distal to the lesser trochanter.
 Clinical use of Ilizarov
external fixators
 To correct angular deformity, an awareness of the
normal mechanical axis is required.

 The site of the deformity must be identified and mid-

diaphyseal lines can be drawn on a radiograph on
either side of a deformity
Clinical use of Ilizarov
external fixators

A corrective osteotomy at CORA site will allow

angular correction without translation
 Complication

 Immediate complications : direct damage to

neurovascular structures
 Early complications : pain, bleeding that can result in
haematoma or compartment syndrome, and nerve
injury as a result of stretching
 Late complications : chronic recurrent pin-site
infections, osteomyelitis, premature union if distraction
is too slow or delayed or non-union, hardware failure,
reflex sympathetic dystrophy
Thank You