Circular external fixator Ilizarov: Circular external fixator Ilizarov Ashraf Atef Lecturer of orthopedics Tanta University
Ilizarov apparatus: Ilizarov apparatus Complex frame used for compression distraction maneuvers Ilizarov apparatus developed by Gavriil Ilizarov in 1951 Ilizarov concept ( tension stress law)
PowerPoint Presentation: Law of tension-stress (G.A. Ilizarov ) Living tissues subjected to slow steady traction become metabolically active in both biosynthetic and proliferative cellular pathway
Indications: Indications In traumatology: Comminuted fractures Intra-articular fractures Open fractures Non-union Infection (osteomyelitis)
Indications: Indications In orthopedics: Elongations ( therapeutic and cosmetic) Deformity correction (congenital or acquired) Arthrodesis arthrodiastesis
Components:: Components: Essential components Secondary components
Essential coponents : Essential coponents Rings Wires Shanzes
Secondary components: Secondary components Used to connect the essential components together to assemple the frame as: Rods Nuts Bolts Cubes ................................
Ilizarov vs. monolateral extrernal fixator: Ilizarov vs. monolateral extrernal fixator malleable assembly Elasticity --- dynamic fixation Control angulation and rotation
Components : Components
Half rings: Half rings
Half rings: Half rings Avilable in diameters of 120 -220 mm internal diameters Structure: Stainless steel Titaneum Carbon fibres
K wires: K wires
K-wire application: K-wire application
Tensioner : Tensioner Used to tension the k-wire before tightening it to the rings.
During tensioning: During tensioning
Tensioner : Tensioner
Tensioner : Tensioner The degree of tensioning ranges between 50 to 130 depending on Diameter of the wire Diameter of the ring Age of the patient Size of the osseous segment
PowerPoint Presentation: Half rings: 50 kgs Young patients: 110 kgs Adult patients: 120-130 kgs Heavy patients: 130 kgs
Schanz screw: Schanz screw
PowerPoint Presentation: Femoral arches
Rods : Rods
Telescoping rods: Telescoping rods
Oblique support: Oblique support
Sockets : Sockets
Simple hinges: Simple hinges
connected: connected
Universal hinge: Universal hinge
Washers : Washers
Plates : Plates
Posts : Posts
Male & female: Male & female
Twisted plates: Twisted plates
Prerequesities of good frame: Prerequesities of good frame The diameter of the ring should be 2-3 CM > limb diameter K wire diameter Correct tensioning of the wire Good stability of the rings ( no of rods & rings) Spacing between wires and shanzes Correct timing and intervals during elongation or compression
PowerPoint Presentation: Size of the ring
PowerPoint Presentation: Sites of pins and wires in tibia
PowerPoint Presentation: Safe zones for femoral pins
PowerPoint Presentation: safe humeral zone
PowerPoint Presentation: Assembly of tibial frame
PowerPoint Presentation: Assembly of tibial frame
PowerPoint Presentation: Preassembly of the frame
PowerPoint Presentation: Preassembled frame
PowerPoint Presentation: Augmentation of the frame
PowerPoint Presentation: Gigli Saw Osteotomy
Gigli saw Osteotomy: Gigli saw Osteotomy
PowerPoint Presentation: Multiple drilling osteotomy Finalized with osteotome
Types of osteotomy: Types of osteotomy
PowerPoint Presentation: Site of osteotomy Metaphysis ( Proximal and / or distal )
PowerPoint Presentation: Latency period 7-15 days according to different techniques
PowerPoint Presentation: Rate of distraction *0.75 -1 mm per day every level Rhythm of distraction: * 1/4 mm every 6-8 hours
PowerPoint Presentation: Successful Outcomes Requires: Minimal surgical trauma in both soft tissues and bone and their blood supply Stable fixation of the bone Proper rate and rhythm of distraction Preservation of the limb function
Patient Selection : Patient Selection Patients must understand that Ilizarov will be in place for a long time (frequently up to 1 year, sometimes 2) Patient will be in constant pain Meticulous pin site care twice daily Self-directed lengthening
Patient Selection : Patient Selection All options should be given and documented Other options (amputation, shortening) are usually easier and have shorter rehab, but may not have same ultimate function Ilizarov system is a poor choice for patients with anxiety disorders, psychiatric problems, and low pain tolerance.
17 years old: 17 years old
60 degrees medial angulation: 60 degrees medial angulation
PowerPoint Presentation: 50 degrees anterior angulation
PowerPoint Presentation: Overcorrection
After 3 months: After 3 months
Lengthening + deformity correction: Lengthening + deformity correction
Cosmetic lengthening in hypochondroplasia: Cosmetic lengthening in hypochondroplasia
Comminuted infected tibial fracture: Comminuted infected tibial fracture
Post burn contracture equinus: Post burn contracture equinus
PowerPoint Presentation: THANK YOU