What is Ilizarov Surgery?

Ilizarov surgery is an orthopedic external fixation procedure performed to reconstruct, reshape or lengthen bones, especially the limb bones.

External fixation is a surgical treatment where rods are screwed through an incision into the affected bone and exit your body to be attached to a stabilizing structure outside of the body.

Ilizarov surgery involves the use of a special device called an ‘Ilizarov apparatus or Ilizarov fixator’. It is recommended in cases that are not amenable to other reconstruction techniques.

Ilizarov Apparatus

This is a set of external fixators comprising rings (2-6), rods, adjustable nuts, and Kirschner wires (a type of stabilization wire/pin used in orthopedic surgery). The device works by a principle called “distraction osteogenesis” (osteo – bone, genesis – formation).

Concept of Ilizarov Surgery

The procedure involves gradually pulling the bones apart (distraction). It uses the body's natural ability to generate and grow new bone between the surfaces that are pulled apart. This bony growth fills up the gap in a gradual, controlled manner with the help of the Ilizarov fixator.

Indications for the Procedure

Complex and compound fractures
Fracture non-union (not healed)
Fracture mal-union (incorrectly healed)
Unequal limb length and bone deformity
Bone misalignment or misplacement
Bone infection (Osteomyelitis)

Preparation

Before the surgery, your medical history will be evaluated to check mainly for anesthetic allergy. This may be followed by a blood test. Your surgeon will also instruct you to:

Stop medication (if taking any) that interferes with bone healing
Give up smoking (if applicable) as it can slow down healing
Arrange someone to drive you back home after the surgery

The Ilizarov Surgery

The length of Ilizarov surgery mainly depends on the type of bone your surgeon is treating as well as the extent of the treatment. The procedure is usually done under general anesthesia and typically involves two stages:

Traditional osteotomy - making a break through the bone
Corticotomy - cutting through the outer layer (cortex) of the bone

During the surgery,

The affected bone is drilled surgically and a break is made
Kirschner wires are percutaneously passed into the bone via the skin
The wires are then guided out the opposite side of the bone
The protruding ends of the wires are attached to metal rings
The rings are connected and fixed to one another by threaded rods
The wires are then held under tension to enhance stability
Subsequently, corticotomy is performed by cutting the cortex of the bone
Surgery is closed by making necessary adjustments in the rods between the rings

Osteogenesis occurs in the gap as the distraction continues. Once the distraction is over, the frame allows the new bone to harden. As soon as healing is complete, which may take between 3 to 12 months, the Ilizarov fixator is removed under general anesthesia.

Risks or Complications

Potential risks or complications of the procedure include:

Pain, bruising, bleeding, swelling
Infection
Blood clotting (deep vein thrombosis)
Nerve palsy (lack of nerve function)
Permanent stiffness of the joint
Temporary tingling sensation in the skin
Anesthesia reaction

After Surgery Care

As you recover from Ilizarov surgery, you are advised to:

Continue to take pain medication as prescribed.
Keep the operated part elevated to ease any swelling.
Maintain the external fixator frame by keeping it clean and dry.
Perform pin care as instructed by your surgeon.
Avoid baths due to the risk of infection in the pin sites.

Benefits of Ilizarov Surgery

Ilizarov surgery benefits you in several ways. They include:

Minimally invasive, customizable procedure
A substantially shorter period of hospital stays
Less bleeding, infection, and soft tissue damage
Good for multiple fractures or angular deformity
Effective for open bone injuries and infections
Allows necessary reposition of bone fragments
A rare instance of joint stiffness and contractures
Avoids amputation and/or joint replacement
Equalizes bone discrepancies of several inches
Faster healing time and speedy recovery
Allows early mobility and weight-bearing
Enhances stability and distributes stress evenly
Patient mobility throughout the treatment
Normal regenerated bone that does not wear out
Effective both in mature as well as young bones
Less disability or recurrence rate
Reduced treatment time as well as cost