The Ilizarov apparatus is a type of external fixation used in orthopedic surgery to extend or reshape the leg bones; as a leg-saving technique for treating complex and/or open bone fractures; and in the case of people infected with bones who can not accept other techniques. It was named after orthopedic surgeon Gavriil Abramovich Ilizarov of the Soviet Union, who pioneered the technique.
Video Ilizarov apparatus
Histori
Ilizarov used external fixation devices in patients to treat non-unions in the 1950s. Ilizarov observed callus formation and found distraction osteogenesis when one patient extended the frame rather than compressing it. The procedure, and the first piece of equipment he designed for it, was inspired by a bowstring on a horse-drawn carriage (see photo on the right). Initially bicycle parts are used for frames.
This technique gained fame throughout the Soviet Union when he successfully treated the Soviet world record holder, and gold medalist Valery Brumel in 1968. Brumel broke the tibia in a motorcycle accident and had 20 failed operations over a three-year period to try to fix non -the union. Ilizarov uses distraction osteogenesis to cure unbalanced leg imbalances and 3.5 cm (1.4 inches).
Ilizarov gained more fame in 1980 when he managed to treat Italian journalist and adventurer Carlo Mauri. Mauri broke her leg in a ski accident ten years earlier and her tibia never healed well. As he made his expedition across the Atlantic, the wound on his legs reopened and a Russian doctor advised him to see Ilizarov. When Mauri returned to Italy after his treatment, Italian doctors were impressed that his unionized tibial was repaired. They invited Ilizarov to speak at the Italian AO Conference in Bellagio. This is the first time Ilizarov speaks outside "Iron Curtain".
This technique was brought to the United States in 1987 by Victor Frankel, president of the Hospital for Common Illness, and Dr. Stuart Green who, in 1992, edited the first English translation of Ilizarov's book.
The Ilizarov external fixators can be used to correct angular deformity in the legs, to correct foot length differences, and treat non-unionized workers. In most developing countries, this technique is especially useful for deformity correction by experienced surgeons because of its complexity. Further development of the ring construction causes the Taylor Spatial Frame to be more flexible and much easier to use, but very expensive. Intrusion member limb devices are also available, but also a very expensive option.
Maps Ilizarov apparatus
Mechanics and physics
This device is a special form of external fixator, circular fixator, modular in construction. Stainless steel (or titanium) rings are attached to the bone through a stainless-weight measuring wire (called a "pin" or Kirschner wire). The rings are connected to each other with threaded rods attached through a customizable nut. The circular construction and tightened wire from the Ilizarov apparatus provide much larger structural support than traditional monolateral fixator systems. This allows early birth weight.
This apparatus is based on a principle called Ilizarov as "the theory of tension". Through mechanically controlled and applied mechanical stresses, Ilizarov is able to demonstrate that bone and soft tissue can be made for regeneration in a reliable and reproducible manner. The upper circle of Ilizarov (fixed on healthy bone by tightened wire) allows the force to be transferred through an external frame (vertical metal bar), past the fracture site. The force is then transferred back to healthy bone through the lower ring and tightened wire. This allows the Ilizarov apparatus to act as a kind of bridge, both paralyzing the fracture site and removing it from stress, while allowing for movement of all limbs and partial loads. The middle ring (and tightened wire) serves to hold the bone fragments in place and provide greater structural support to the equipment and limbs. However, the critical load bearing rings are the upper and lower rings that transfer the force from the healthy bone to the healthy bone, past the fracture site.
Bone renovation/splitting
Besides being used to support the extremities, Ilizarov fractures are also commonly used to correct deformities through distraction osteogenesis.
This procedure consists of a preliminary surgery, in which the bone undergoes a surgical fracture and a ring tool attached. When the patient recovers, the cracked bone begins to grow together. While the bone grows, the frame is adjusted by turning the nut, thus increasing the space between the two rings. Since the ring is connected to the opposite side of the fracture, this adjustment, performed four times a day, moves a healing fracture now about one millimeter per day. The increased daily increase results in long extension of the extremities over time. After the elongation phase is completed, the apparatus remains on the extremities for the consolidation period. Patients can bear a full load on the Ilizarov skeleton, using the crutch initially and the pain is reduced. After healing is complete, a second operation is required to remove the ring equipment. The result is a significantly longer limb. Additional surgery may be required, in the case of elongation of the leg, to extend the Achilles tendon to accommodate longer bone lengths. The main advantage of this procedure is because the tool provides complete support while the bone is restoring the patient can still help the active recovery.
Subsequent use is in bone transport, where defects in long bones can be treated by transporting bone segments, while simultaneously extending the bone regeneration to reduce defects and eventually anchored with other segments, resulting in one bone unit.
While the minimally invasive Ilizarov apparatus (no large incisions are made,) it is not free from complications. Pain is common and can be severe, but it can be treated with analgesics. Careful attention to cleaning and cleaning is necessary to prevent pine infections. Other complications include swelling, muscle transfection, and joint contractures. Physical therapy is often indicated.
Treatment of fractures
The Ilizarov method is widely used to treat complex and/or open bone fractures. This method is preferred over conventional treatment options (such as internal or cast fixers) where there is a high risk of infection or fracture is such severity that the internal fixator can not run. Journalist Ed Vulliamy wrote a detailed explanation from the patient's perspective on the treatment of Ilizarov apparatus against a bad fracture.
Images
The following case study illustrates the procedure of treatment of the Ilizarov apparatus for a broken extremity. The photographs were from the same patient during treatment.
See also
- Healing bone
- Callus fibrocartilage
- Osteoporosis
- Stress fracture
- Fracture bursts
- Osteogenesis Imperfecta
- Pseudarthrosis
- List of Russian discoveries
- Instruments used in common operations
- Timeline of Russian invention and tech note
- Hemimelia fiber
References
External links
- Drale Paley Information site (part of Ortho's provisions including the Ilizarov method video).
- Live with UK Spatial newspaper articles from Ilizarov/Taylor
- ilizarov.com (English)
- ILIZAROV user frame support group
- More information and images of Ilizarov surgical techniques
- The Institute of Extension and Reconstruction of Motion Members
- Taylor Spatial Frame
- Legs lengthen and correction with Ilizarov frame
- Provides an excellent case summary for Ilizarov's treatment of complex fractures, including X-rays
Source of the article : Wikipedia
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