The use of Ilizarov external fixation continues to grow and evolve in foot and ankle reconstructive surgery we must have the clear understanding of basic principles of Ilizarov fixation technique. Ilizarov fixation has its own unique properties and the orthoapedic surgeon most have fundamental knowledge of basic Ilizarov fixation principles. Without good understanding of the indications and mechanics and application the orthopaedic surgeon will never reach their full expectation.
Ilizarov technique requires a thorough knowledge of indications, physical properties, frame constructs and materials. The Ilizarov surgeon should plan ahead. We must have an idea of Ilizarov fixator which can fit the situation and desired outcome. With Ilizarov fixator the indications are endless in the lower extremity.
Safe corridors are must important in the setting of the through and through wires of the Ilizarov fixator must be applied with anatomic and biomechanics restrictions in mind.
The basic things for Ilizarov application include the fixator itself and a way to connect to the osseous structures of the patient. The workhorse for Ilizarov system is the transosseous fixation wire.
STEP BY STEP APPROACH TO TRANSOSSEOUS WIRE INSERTION AND TENSIONING METHOD.
Ilizarov wires are the primary methods of connection between the fixator and the bone. Transosseous Ilizarov wires range from 1.5 to 1.8 mm in thickness have either a bayonet point or as drill tip and they come in either smooth or olive configuration olive wires, entrance buttress strength, are more stable them smooth wires and counteract deforming muscle forces especially with limb lengthening. Transosseous wires may be tensioned from 50 to 90 kg of force on open rings or posts and up to maximum of 130 kg of force on a full enclosed ring.
STEP BY STEP APPROACH TO STATIC ILIZAROV EXTERNAL FIXATION.
Better understanding of the fundamental principles and designs of Ilizarov fixation can prevent the risk of potential complications. Static Ilizarov external fixation provides osseous stability for various foot and ankle pathologies. By Ilizarov fixator we have dynamic function such as joint distraction (Orthodiestesis) or compression if needed.
The goal of this chapter is to describe the technical parts and meticulous details of the technique and to discuss the indications in which it is advantageous for the orthopaedic surgeons which can provide step by step technical approach to its application in foot and ankle disorders.
STEP BY STEP APPROACH TO ANKLE AND PILON FRACTURE AND ILIZAROV TECHNIQUE.
Ilizarov fixation for the management of acute ankle trance is the most choice for definitive fractures reduction. Ilizarov fixator can be applied to stabilize the majority of tibial pilon fractures. Open ankle fractures and high energy tibial pilon fractures presents with a poor soft tissue envelope. Definitive Open Reduction and Internal Fixation (ORIF) can only be performed in a staged procedure. When there is adequate resolution of the soft tissue injury. Ankle and tibial pilon fractures may be simple or complex with various associated injuries or comorbidities.
STEP BY STEP APPROACH TO FOOT AND ANKLE OSTEOMYELITIS AND ILIZAROV TECHNIQUE
Osteomyelitis of the foot and ankle is a common complication associated with traumatic, diabetic and ischaemic etiologies. Advances in modern technology helps the orthopaedic surgeon to diagnose and treat osteomyelitis of the foot and ankle. The use of Ilizarov technique and apparatus with wide surgical debridement, soft tissue coverage procedures and arthrodesis has become a useful treatment in foot and ankle salvage surgery.
Aggressive surgical reduction, intravenous antibiotic and stabilization of bony segments by Ilizarov apparatus are standard for managing infection extremity osteomyelitis. Definitive reconstruction of why defects through arthrodesis of affected joints with a stable and functional soft tissue coverage represents the final goal in creating a functional plantigrade foot. For significant bone loss it requires more challenging procedures like distraction osteogenesis, alone or in combination with soft tissue reconstructive surgery.
STEP BY STEP APPROACH TO ADULT AND PAEDIATRIC FOOT AND ANKLE DEFORMITY, MALUNIONS, NONUNIONS AND ILIZAROV FIXATION.
Management of foot and ankle deformities as a result of a malunion and nonunion is a challenging problem for orthopaedic surgeon. Most of these deformities arise from complex pathology or failed surgical intervention. Correction of severe deformities in the ankle and foot can commonly complications. Internal fixation may not be feasible with a poor soft tissue envelope and absolutely contra indicated in the pressure of infection.
Ilizarov external fixation is best suited for the management of complex deformities or bone loss with a poor soft tissue envelope. The technique of Ilizarov fixation allows for skeletal or soft tissue correction either through acute or gradual controlled coordinated correction Ilizarov allows for percutaneous techniques, minimally invasive procedure. In some complex cases Ilizarov is used in combination with internal fixation to provide extra support to avoid implant failure and probable deformity.