Click Here for Previous Features

The Ilizarov Technique

By David M. Huebner, M.D.  Orthopaedic Traumatologist,
Drs. Gross, Iwersen, Kratochvil & Klein, P.C.

David M. Huebner, M.D.

The Ilizarov Technique is unique in all of orthopaedics in that it allows the surgeon to use the patient’s biology to form new bone. The technique is an invaluable tool for the orthopaedic surgeon when faced with bone loss, leg length discrepancy, congenital or post-traumatic deformities, and osteomyelitis. This article will give a brief overview of the Ilizarov Technique and some of its many uses.

Gavriel Abramovich Ilizarov, the “Magician from Kurgan”, was born on June 15, 1921 in the Caucasian Mountains in the Soviet Republic. He was the oldest of eight children - born to illiterate parents. Ilizarov did not attend school until he was 11 years old because he had no shoes. Ilizarov attended medical school in Crimea. Due to the war, the school was relocated three times in two years. After graduation, the Soviet government sent Ilizarov to work in Kurgan in Western Siberia where there was a shortage of physicians.

Ilizarov, the only doctor in an area the size of a small European country, had no formal orthopaedic training. He was also a self-trained internist, obstetrician, pediatrician, and general surgeon. He treated a huge number of wounded Russian soldiers in WWII and was faced with the daunting challenge of managing nonunions (bones that don’t heal) and osteomyelitis (infection in the bone) in the pre-antibiotic era.

Ilizarov developed his ring external fixator in 1951. The first bone lengthening happened quite by accident. He was planning to lengthen an amputation stump in a patient by distracting the ends of the bone after cutting it and then taking bone from the hip to fill the void. The patient was using the fixator to slowly increase the gap between the bone ends as directed. Unfortunately, Ilizarov went on vacation for several weeks and forgot about his patient. When he returned, the patient had lengthened his stump 8 cm (about 3 inches) and there was new bone forming in the gap! He never had to bone graft.

Ilizarov continued to refine his technique and had amazing success in treating difficult nonunions, malunions (bones that heal crooked) and infections. Word of his success was largely ignored by the mainstream medical authorities in Russia until 1967. Valery Brumel, an Olympic champion high-jumper and national hero had an infected tibial (shin bone) nonunion after a motorcycle accident. After 14 failed operations, he was finally referred to Dr. Ilizarov. Brumel was treated with the Ilizarov technique and one year later jumped 2 meters in a high jump competition. After this, word spread like wildfire. Ilizarov was granted permission and funding in 1971 to build the Institute of Orthopaedics in Kurgan. The center is now known as the Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics.

The Ilizarov technique involves the use of a ring external fixator placed around the leg (or arm) attached to tensioned wires that pass through the bone. Following a corticotomy (a surgical procedure in which the bone is cut), the fixator is used to slowly distract the two fragments of bone. As the bone is slowly “stretched”, new bone forms in the gap. When the desired length is achieved, the fixator is left in place until the new bone “matures” and heals. The fixator is then removed and the regenerate bone will eventually mature to achieve the strength of the normal bone.

While this technique is not used just to make people taller, it can be used to lengthen an extremity in a patient with a congenital or post-traumatic leg length difference. In deformity correction (congenial or post-traumatic) a series of hinges are attached to the fixator and the bone can be “bent” and/or distracted to correct both angular deformity as well as length difference.

In patients with severe bony infections (osteomyelitis), treatment is often very difficult. When other treatments fail, the section of infected bone can sometimes be removed entirely and a segment of bone is “transported” across the defect with new bone forming behind it. This same technique of bone transport can be used when people have lost segments of bone after a severe trauma. Finally, some joint contractures can be treated with the techniques of Ilizarov.

While providing an excellent solution for some of the most difficult problems in orthopaedics, the Ilizarov technique is not without its drawbacks. The technique requires frequent office visits and a great deal of patient participation. It requires a very compliant and motivated patient to achieve a good result. Treatment is often quite time-intensive as well. Most patients are in the frame for over six months, with some requiring treatment for over a year! The frames do allow joint motion, and in many cases the patient is allowed (an encouraged) to bear weight in the frame.

Potential complications include residual deformity (both length and angular), pain during the distraction phase, and problems with healing at the docking site in bone transport. Finally, everyone who has an Ilizarov will end up getting pin tract infections (where the pins enter the skin). While these require attention and treatment, they can usually be treated with oral antibiotics and rarely require early removal of the fixator.

The accidental discovery by Dr. Ilizarov in the remote wilderness of Siberia has been a major advance in orthopaedics. The Ilizarov technique has become an invaluable tool for the pediatric orthopaedist as well as the orthopaedic traumatologist. While this technique can help solve some of the most difficult problems faced in orthopaedic surgery, it has its pitfalls and certainly is not for everyone. However, with a surgeon trained in this technique and a motivated patient, the results can be very satisfying.

This Page Updated On:   07/09/2002 11:30 AM