|
Leg Length and Deformity Correction - Ilizarov Tec
Professor Gavriil Abramovich Ilizarov
graduated from medical school in the Soviet Union in 1943, near the end
of World War II. After graduation, he was assigned to practice in
Kurgan, a small town in western Siberia. He was the only physician
within hundreds of miles and had little in the way of supplies and
medicine. Faced with numerous cases of bone deformities and trauma
victims due to the war, Professor Ilizarov used the equipment at hand
to treat his patients. Through trial and error, with handmade
equipment, this self-taught orthopedic surgeon created the magical
combination that would cause the bones to grow again, similar to the
adolescent growth state. Thus the Ilizarov technique was created. For
almost 45 years, Ilizarov and his co-workers have been perfecting their
apparatus and helping individuals with severe orthopedic abnormalities.
Reports of dwarfs made taller, and birth defects corrected were first
observed in Italy, and then presented in the United States where
Professor Ilizarov's technique met initial skepticism. Today,
Professor Ilizarov's methods are an acceptable means of correction of
severe orthopedic deformities. Limb correction is a gradual process,
which lengthens and straightens bone and soft tissue so a limb can
function as normally as possible. There are many reasons why a person
may be a candidate for limb correction. For many patients, the
procedure is used to straighten or lengthen a bone. Others have a need
because of a trauma, which has caused highly fragmented breaks, bone
loss, or to encourage a bone which isn't healing. How the Procedure Works This
method takes advantage of the body's remarkable ability to grow new
bone tissue. It involves the surgical application of a circular metal
frame called the Ilizarov fixator. Fixator rings are attached to each
segment of the original bone through pins and wires, which hold each
bone segment in place while new tissue is growing and maturing. There
are two main phases to the correction process: correction/lengthening
and consolidation. The lengthening phase is the time needed to
gradually achieve the desired correction/length of the limb. The
consolidation phase is needed for the new bone tissue to harden and
mature. Each individual's body is different, but the total time of
wearing the fixator is typically 4-12 months. Lengthening
refers to the period of time it takes to "grow the bone." The
lengthening phase begins after the surgeon cuts the bone and attaches
the fixator. During this time the patient will be working with the
physician and the physical therapist to make gradual adjustments to the
fixator which increase the gap between the bone segments, adding
"length" to the total limb. Over a period of months, new bone tissue
will grow in the gap, ultimately hardening the area between the segment
of the original bone. When the physician is
satisfied with the length and position of the new bone, the
consolidation phase begins. During this phase, the bone tissue matures
and becomes solid. The patient still wears the fixator, but no
adjustments are made. The consolidation phase is the longest part of
the Ilizarov process. It takes twice as long for bone to harden as to
does to lengthen it, so the consolidation phase typically doubles the
time spent in the lengthening phase. Post Operative Course During
the lengthening phase, the patient will be seen by the physician every
few weeks to monitor the progression of correction of the deformity. On
each visit, X-rays are taken to monitor the progress of the lengthening
and to assess the quality of the new bone. Office visits may range from
thirty minutes to two hours, depending on what work needs to be done. If
a limb lengthening procedure is being performed, the patient will be
required to assist in the process by making fixator adjustments at
home. This is usually done every six hours. The physician will make
sure that the patient is fully trained and understands how to make
adjustments if need. At times, some patients
experience some failure of the mechanics of the fixator. The patient
may have broken wires, bent rods, or be unable to turn one of the
"clickers". Through proper education of the physician and the patient,
these problems can be solved without permanent sequela. Other Uses of the Ilizarov Technique Limb lengthening are not the only procedures that can be used with the Ilizarov frame. Ankle fusions, triple arthrodesis, midfoot fusions,
etc. can be performed without prolonged cast immobilization and
non-weight bearing. In most cases, partial to full weight bearing is
suggested to encourage functional capabilities and healing. Charcot reconstruction of the ankle or rearfoot
is a prime example in which a fusion procedure can be performed with
the patient full weight bearing on the involved extremity almost
immediately. This diminishes the stress that is placed on the opposite
extremity, which is prone to trauma due to increased stress of the
uninvolved side. Conclusion The patient attitude
throughout the Ilizarov process is very important to its success. The
patient will have to find ways to cope with discomfort, pain, and
frustration, plus the natural ups and downs of emotions during this
long process. Knowledge of the process prior to surgery ensures proper
patient compliance and minimal pain. Each individual experiences pain
differently, so it is difficult to talk about norms when performing
this type of surgery.
Back to Top
|
