ilizarov KAFRELSHEIKH

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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)

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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

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Half rings: 50 kgs Young patients: 110 kgs Adult patients: 120-130 kgs Heavy patients: 130 kgs

Schanz screw:

Schanz screw

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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

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Size of the ring

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Sites of pins and wires in tibia

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Safe zones for femoral pins

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safe humeral zone

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Assembly of tibial frame

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Assembly of tibial frame

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Preassembly of the frame

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Preassembled frame

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Augmentation of the frame

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Gigli Saw Osteotomy

Gigli saw Osteotomy:

Gigli saw Osteotomy

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Multiple drilling osteotomy Finalized with osteotome

Types of osteotomy:

Types of osteotomy

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Site of osteotomy  Metaphysis ( Proximal and / or distal )

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Latency period 7-15 days according to different techniques

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Rate of distraction *0.75 -1 mm per day every level Rhythm of distraction: * 1/4 mm every 6-8 hours

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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

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50 degrees anterior angulation

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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

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THANK YOU