Ilizarov method

1. What is the Ilizarov method?

The Ilizarov method of transosseous osteosynthesis is the system of surgical and bloodless techniques for treating a great number of orthopaedic diseases and injuries both congenital and acquired. This system has been developed in Kurgan (Transurales, Russia) by an orthopaedic surgeon Gavriil Ilizarov and his team, researchers and surgeons of the Kurgan Institute for Traumatoloy and Orthopaedics. The system has continued to be developed after Ilizarov’s death at the Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics named after him.

The system includes more than 800 techniques with the use of the Ilizarov external fixator for long bones, external minifixator for short bones, transpedicular external fixator for the spine and external systems that are used for pelvic orthopaedic conditions and skull pathology.

The Ilizarov and his team were the first in the world to discover biological regularities to control genesis and growth of bone tissue, and applied them for bone regeneration and shape-forming, bone reconstruction and restoration.

2. What is the history of the Ilizarov technique?

In 1951, Gavriil A. Ilizarov offered his external fixator for fracture union that consisted of two metal rings round the bone and a pair tensioned wires in each ring that transfixed the bone and crossed inside it. In 1952 he published his first lengthening experience of 12.5 cm in the local newspaper. But the innovative surgeon had to fight for 20 years to make the medical society acknowledge and accept his method in the USSR.

G. A. Ilizarov was first to develop and apply external compression and distraction osteosynthesis for closed reduction of acute and neglected fractures and bone nonunions (1952), for large joint arthrodesis (1951-1952), and was first to use corrective osteotomies (1960), bloodless compression osteosynthesis for deforming arthrosis in major joints and long bone pseudoarthrosis (1961). In 1965, he proposed innovative operative techniques for congenital pseudoarthrosis of the tibia accompanied by bone shortening or deformity and for management of bone defects by lengthening of one of the bone fragments. The techniques for bone lengthening and simultaneous deformity or malformation correction, reconstruction of the proximal end of the femur appeared in 1967. Later in 1972, techniques for infected nonunions and malunions and bone infection were proposed. His doctorate thesis came in 1968.

1970 was the year of acknowledgement of the innovative method and the All-USSR symposium on compression and distraction was held for the first time. But only in 1985, the State committee on inventions of the USSR registered his discovery “General biological property of tissues to respond to dosed distraction with growth and regeneration”, (Application number ОТ–11271 from 25 December 1985 with the priority of the first publication on 24 November 1970).

The Ilizarov method has been applied nowadays in more than 100 countries of the world since 1981 when the Italian orthopaedic community started to learn the technique and invited G.A. Ilizarov to the Italian Orthopaedic Asssociation congress in 1981 to share his knowledge. The method is widely used in the USA, Italy, Japan, South Korea, Egypt, Germany, Poland, Iran, the UK, France and some other countries.

3. How is it different from conventional orthopaedic techniques?

No treatment method in the history of reconstructive traumatology and orthopedics has had such an evolutional development as the Ilizarov method of transosseous osteosynthesis. The method has been called universal as it can be used for almost entire range of skeletal pathology that requires reconstruction and bone reshaping. Nowadays, it has been used in associated fields of medicine such as angiology, neurosurgery, oncology, stomatology, arthrology, veterinary, etc.

The Italian orthpaedic surgeons called the method the Revolution in Orthopaedics and named G. Ilizarov Michelangelo of Orthopaedics.

It has been unanimously recognized that the method enables improve treatment outcomes in patients with bone tissue diseases in the whole world, and especially in cases of congenital pathology or trauma sequelae. For 55% of those who are affected by orthopaedic pathology it is the only method that can recover them or improve their condition. It is less traumatic as compared to other methods; and the intervention procedures are less in volume in case the patient needs a complex operation or repeated surgeries. There are a lot of Ilizarov techniques that are bloodless and do not require bone grafting. Patients can start walking with the fixator on their legs on the second day after the operation and have normal self-service and life activities during the entire period of treatment.

4. Can this technique used for height growth?

Yes, this is the first method used for limb lengthening and height growth. In the recent years, the number of people who refer to orthopaedic surgeons with a wish to change their height has considerably grown. Since the middle of 1970s, more than 500 persons increased their stature at the Kurgan center due to indications to a lengthening procedure, and they are mainly patients with achondroplasia (dwarfs).

5. What is the future of Ilizarov?

The Ilizarov method has evoked the interest and development of both fundamental science that studies osteogenesis and technical means of external fixation. There have appeared hundreds of internal and external fixators that can compete in some ways.

But the principles of the treatment with the help of external fixation were developed by Ilizarov and his colleagues in Kurgan. Those principles were scientifically proven. The contemporary orthopaedics cannot do without them while managing the majority of orthopaedic conditions.

And moreover, reconstructive orthopaedics is impossible without the method of Ilizarov as it uses the inorganic potential of the human body to restoration and recovery. As far as reconstructive orthopaedics is only a part of the entire field of orthopaedics and traumatology, the use of Ilizarov techniques nowadays has been focused on managing complex and complicated fractures, their sequelae, defects, pseudoarthrosis and bone infection – the conditions that are common for practictioners. So, an orthopaedic surgeon should know and use the method for these conditions. And in this context, the Ilizarov method is the necessity in our century of high energy trauma, natural disasters and local wars.

6. Even though it is the most advanced & sophisticated technique, why it is not so commonly practiced in the world?

In order to master the method, one should study, and the Ilizarov method training takes a lot of time and also can be costly for most residents as the best training can be obtained in Russia where the method was born. That is why, there is a constant interest in the method but its practical application is performed by those surgeons who have been well trained and have experience. This is true and should be so. The method gains good results only in skilled hands.

Another difficulty that the method encounters is the politics of the hospitals and medical authorities, as the Ilizarov treatment procedure, though being advanced and with efficient outcomes, takes a lot of time. The economic situations of public hospitals are not good, they usually cannot afford long inpatient stay, and rural patients cannot come often for outpatient treatment or cannot afford it at all… So, there is a lot of work for charities and governmental medical authorities for improving the situation so that the Ilizarov treatment could be available to a bigger number of patients.

7. What research is currently going on in Kurgan to improve the Ilizarov techniques?

The Kurgan center has been doing a lot of research that is directed to the improvement of the Ilizarov method both in the way of technical and biological solutions. Thus, there have been developed automated fixators that perform a programmed automated procedure of lengthening. There has been developed a new Matsukatis-Shevstov variant of the fixator that produces corrections in all possible planes of bone deformity. To accelerate the regeneration maturation process, the concept for stimulating the osteogenesis using mechanical, biomechanical and cell methods has been proposed. Pharmacological stimulation has also been developed.