Leg Length & Deformity Correction – Ilizarov Tec
Professor Gavriil Abramovich Ilizarov graduated from medical school in the Soviet Union in 1943, near the end of World War II. After graduation, he was assigned to practice in Kurgan, a small town in western Siberia. He was the only physician within hundreds of miles and had little in the way of supplies and medicine. Faced with numerous cases of bone deformities and trauma victims due to the war, Professor Ilizarov used the equipment at hand to treat his patients. Through trial and error, with handmade equipment, this self-taught orthopedic surgeon created the magical combination that would cause the bones to grow again, similar to the adolescent growth state. Thus the Ilizarov technique was created.
For almost 45 years, Ilizarov and his co-workers have been perfecting their apparatus and helping individuals with severe orthopedic abnormalities. Reports of dwarfs made taller, and birth defects corrected were first observed in Italy, and then presented in the United States where Professor Ilizarov’s technique met initial skepticism.
Today, Professor Ilizarov’s methods are an acceptable means of correction of severe orthopedic deformities. Limb correction is a gradual process, which lengthens and straightens bone and soft tissue so a limb can function as normally as possible. There are many reasons why a person may be a candidate for limb correction. For many patients, the procedure is used to straighten or lengthen a bone. Others have a need because of a trauma, which has caused highly fragmented breaks, bone loss, or to encourage a bone which isn’t healing.
How the Procedure Works
This method takes advantage of the body’s remarkable ability to grow new bone tissue. It involves the surgical application of a circular metal frame called the Ilizarov fixator. Fixator rings are attached to each segment of the original bone through pins and wires, which hold each bone segment in place while new tissue is growing and maturing.
There are two main phases to the correction process: correction/lengthening and consolidation. The lengthening phase is the time needed to gradually achieve the desired correction/length of the limb. The consolidation phase is needed for the new bone tissue to harden and mature. Each individual’s body is different, but the total time of wearing the fixator is typically 4-12 months.
Lengthening refers to the period of time it takes to “grow the bone.” The lengthening phase begins after the surgeon cuts the bone and attaches the fixator. During this time the patient will be working with the physician and the physical therapist to make gradual adjustments to the fixator which increase the gap between the bone segments, adding “length” to the total limb. Over a period of months, new bone tissue will grow in the gap, ultimately hardening the area between the segment of the original bone.
When the physician is satisfied with the length and position of the new bone, the consolidation phase begins. During this phase, the bone tissue matures and becomes solid. The patient still wears the fixator, but no adjustments are made. The consolidation phase is the longest part of the Ilizarov process. It takes twice as long for bone to harden as to does to lengthen it, so the consolidation phase typically doubles the time spent in the lengthening phase.
Post Operative Course
During the lengthening phase, the patient will be seen by the physician every few weeks to monitor the progression of correction of the deformity. On each visit, X-rays are taken to monitor the progress of the lengthening and to assess the quality of the new bone. Office visits may range from thirty minutes to two hours, depending on what work needs to be done.
If a limb lengthening procedure is being performed, the patient will be required to assist in the process by making fixator adjustments at home. This is usually done every six hours. The physician will make sure that the patient is fully trained and understands how to make adjustments if need.
At times, some patients experience some failure of the mechanics of the fixator. The patient may have broken wires, bent rods, or be unable to turn one of the “clickers”. Through proper education of the physician and the patient, these problems can be solved without permanent sequela.
Other Uses of the Ilizarov Technique
Limb lengthening are not the only procedures that can be used with the Ilizarov frame. Ankle fusions, triple arthrodesis, midfoot fusions, etc. can be performed without prolonged cast immobilization and non-weight bearing. In most cases, partial to full weight bearing is suggested to encourage functional capabilities and healing.
Charcot reconstruction of the ankle or rearfoot is a prime example in which a fusion procedure can be performed with the patient full weight bearing on the involved extremity almost immediately. This diminishes the stress that is placed on the opposite extremity, which is prone to trauma due to increased stress of the uninvolved side.
The patient attitude throughout the Ilizarov process is very important to its success. The patient will have to find ways to cope with discomfort, pain, and frustration, plus the natural ups and downs of emotions during this long process. Knowledge of the process prior to surgery ensures proper patient compliance and minimal pain. Each individual experiences pain differently, so it is difficult to talk about norms when performing this type of surgery.