ILIZAROV METHOD

Treatment of Short Stature and Leg Curvatures

What is the Ilizarov method?

This method is used in the treatment of many different deformities, from short stature to bone loss. Successful results are obtained in both pediatric and adult patients. Ilizarov method can also be used in achondroplasia, that is, short stature (dwarfism). People whose height is under 135 cm can go over 150 cm in 2-3 sessions.The difference in length on the legs; shortness compensation can be equalized by shortening the long leg and lengthening the short leg, the limping condition in patients disappears. In addition, deformities in the legs called X or Y legs can be eliminated.Treatment of arm shortness can also be done with Ilizarov.With this method, both arms and legs can be extended in children in about two years. 

In adults, if some of the bone is lost due to a traffic accident or firearm injury, if the bone is not to be brought to the area by microsurgery, the bone can be made with the Ilizarov device. For example, bone loss of 10 cm is completely filled in 100 days by extending 1 mm per day. The bone lost by the patient, whose treatment was completed within six months, can be created in the same quality and volume.In this way, the lives of people who have surgery change. 

Ilizarov is a system that can give controlled movement to the bone parts with the help of hinges and rods, where the bones are fixed with thin wires and circles.This method basically relies on the practice of completing the part of a bone that is destroyed by lengthening it with a piece cut from the bone again. With this method, which is applied without placing a new bone on the corrected area, the existing bone can be extended by 1 mm per day and 30% of the short bone length can be achieved in congenital shortness.Surgical interventions can be applied to child or adult patients with arm and leg inequality developing after congenital diseases, bone loss and traumas (such as early closure of growth cartilage). In this process, a low-energy fracture is created in the bone and it is extended (1mm / day). Elongation up to 80% of the original length of the bone can be achieved. In parallel with the developing implant technology in appropriate cases, the use of new techniques and technology alternative to the Ilizarov technique are also carried out.

In which diseases Ilizarov method is used as a treatment?

• Closed and open fractures
• Non-union fractures
• Bone lengthening treatment (lengthening, polio sequel, post-traumatic, post-infection growth shortenings due to early closure of cartilage and leg length inequalities)
• Correction of arm and leg curvatures
• Bone loss (usually occurs after tumor, after trauma or after infection)
• Treatment of untreated developmental hip dislocation
• In foot diseases
• Bone infections
• Joint movement restrictions
• In metabolic diseases
• It is applied in bone structural disorders.

Application areas of Ilizarov method

Length inequality in the legs: Shortness of the legs can develop due to many reasons. It should be addressed under 3 subtopics:

1. Congenital,
2. Developmental
3. Shortening that cause shortening of bone ends
4. There are three ways to equalize the length difference:
5. Shortness compensation (with lifters added under the shoes)
6. Shortening the long leg
7. Elongnation of the short leg

Most congenital leg shortness patients can be treated with lengthening and reconstruction. In many cases, it is preferable to start lengthening and reconstruction surgery before the age of 4, often before the age of 2.

Developmental leg shortness cases can be treated with one or two lengthening operations. Most of the post-traumatic leg shortness (malunion) cases occur in adults and are resolved only by an lengthening operation. Most of these patients can be treated with lengthening over screw or a full implanted screw.

How is it applied?

Dwarfism Treatment with Ilizarov Method

Consultation and initial evaluation: Detailed history of the patient applying for treatment and information of previous surgical interventions are obtained.

Following a detailed clinical examination, radiological and sometimes laboratory examinations are performed at appropriate positions and evaluated. If the patient is decided to undergo surgical treatment, this situation is shared with the patient and relatives. Details of the surgical treatment to be applied are explained.

Surgical treatment: Generally, the device to be used before the surgery is prepared in accordance on the patient in order to save time. The device is fixed to the bone with the help of wires and screws in surgery. It is made with small skin incisions, the purpose of which is to minimize damage to the surrounding soft tissues while bone cutting.

Post-operative treatment and rehabilitation: Lengthening the bone usually begins 7-10 days later. Although it varies according to the patient and pathology, it is usually divided into 1 mm 4 equal intervals per day and applied as 0.25 mm every 6 hours. However, during this period, the team of physiotherapy specialists lifts the patient on his/her feet, teaches walking with support and exercises to the necessary muscles. The purpose here is:

• To prevent the disadvantages of being dependent to the bed by lifting the patient immediately,
• Ensuring the patient's participation in active treatment,
• To maintain joint range of motion,
• To keep the muscles tight.

Patients usually stay in the hospital for 3-7 days. However, in complicated cases, they may need to stay longer. During this period, the maintenance of the wires and screws at certain times is carried out by the support staff and the patient is given the necessary training for his/her own application at home.

Physical therapy should be applied after the patient is discharged. The doctor's recommended exercises can be done by the patient or he/she can get help. However, professional physiotherapist support may be required in patients who are found to have insufficient mobility in subsequent controls. After the surgery, patients are encouraged to participate in daily activities as much as possible in school and work environments.

Lengthening: In the Caucasian race, the lower limit of normal height for males is 166 cm and 153 cm for females. Patients with a height below the normal limit are not treated until their elongation is complete. To shorten the period of the lengthening, lengthening over screw or self-lengthening screw techniques are preferred. The aim is to achieve 5-7.5 cm elongation in patients with a height below the normal limit. It can be assumed that each 2.5 cm lengthening takes 1 month. The lengthening procedure does not start until one week or 10 days after the operation. Therefore, a lengthening of 5 to 7.5 cm takes place in a period of 2-3 months. In the lengthening technique over screws, after the lengthening is finished, a second operation is performed and locking is done through the screw holes.At the end of the extension, giving weight on the body is not allowed, except for the transition from bed to chair or toilet. This means using a wheelchair for 4 - 5 months during the lengthening period. The total wheelchair duration of 5 - 7.5 cm extension reaches 4 - 5 months. Physical therapy is performed especially to restore ankle movements and ankle thrust.

This requires a few more months. Removing screws is not a critical situation. This can be done safely after the bone heals. It is generally preferred 1 year after the lengthening is over.

Leg curvatures: The curvatures seen on the legs generally occur in two forms with the appearance of “X” or “parenthesis”. The curvature of the X leg is outward, and inward on parenthesis the leg. Due to the curvature, the loading axes of the hip, knee and foot joints in the body change. Thanks to these operations, the walking axis is changed and the person is walks in a healthy way.

What are the advantages of the Ilizarov system?

• Stimulates bone construction.
• Increases vascularization. This increases the blood supply, so the rate of bone union increases.
• Increased blood supply also speeds up the healing of inflammation (osteomyelitis) that may occur or exist.
• Curvatures that may occur at any stage of treatment or that already exist can be corrected without the need for anesthesia.
• After the operation (if there is no obstacle), the patient can walk immediately. Therefore, it does not cause serious disruption in the patient's economic and social life.

FREQUENTLY ASKED QUESTIONS ABOUT ILIZAROV METHOD

When is the Ilizarov method applied?

For the treatment of dwarfism with the Ilizarov method, the child's development must be completed. This period is stated as 16 for girls and 17-18 for boys.

Is leg lengthening treatment more effective in children?

Although this treatment is thought to be beneficial for children, the same results can be achieved for adults. However, the fact that children recover much faster and their bones form much faster causes this kind of perception. While the 6cm defect in adults can be closed in eight months, this period can be completed in five months in children. Pediatric patients can adapt to the device much more quickly. They can run, fall and play games by acting as if there are no devices in their bodies. Families experience the biggest concern in this regard because they think that children will be uncomfortable with this. However, treatment can be started in children who have reached the age of three and it can be seen that they adapt very easily.

What are the points that the patient should pay attention to after the procedure?

• First of all, it is very important for the patient to carry out daily wire medical dressing as described, to pay attention to the cleanliness of the device and, if possible, to protect the system from the external environment with a special garment.
• The patient should perform the movements described by the doctor regularly in order not to encounter joint movement limitation.
• Unless stated otherwise, should be walked with as much weight given as possible to speed up the treatment process and prevent problems that may develop.
• To complete the treatment successfully, smoking should be avoided and smoking environments should be avoided.
• Medicines containing vitamins and calcium recommended by the doctor should be used regularly.
• It is important to consume plenty of milk and dairy products (yogurt, cheese, etc.).

Prepared by Memorial Medical Editorial Board.