Ilizarov described the biologic and technical conditions under which a gradually widened osteotomy forms new bone in his circular tensioned‑wire fixator, and how he applied them clinically.
Synthesis of the author's canine tibia experiments, reported in earlier papers, and clinical work at the Kurgan center, USSR.
Methods
Indication
Stature increase in some forms of dwarfism
Deformity correction
Limb‑length inequality
Stump elongation
Approach
Circular fixator on tensioned transfixion wires
Rings linked by threaded rods
Motorized distraction for continuous lengthening
Outcomes
New bone formation in the distraction gap
Key Findings
In the canine tibia, distraction at 1.0 mm/day gave the best results, while 0.5 mm/day often consolidated prematurely and 2.0 mm/day damaged periosseous soft tissue and gave poorer bone.
Frame stability set the type of healing, with loose‑wire frames producing fibrous nonunion and four‑ring frames producing direct bone formation with no cartilage stage.
Better marrow preservation went with better new bone in the gap when full transection, one‑third transection and closed osteoclasis were compared.
An autodistractor making 60 steps a day (16.6 microns every 24 minutes) produced lengthening tissue with histologic and electron microscopic features of embryonic, fetal and neonatal growth.
The regenerate forms a physis‑like central growth zone that ossifies toward both the proximal and distal ends during distraction.
Ilizarov considered lengthening contraindicated in spondyloepiphyseal dysplasia and other dwarfism with distorted joints, because lengthening pressure on the joints may hasten osteoarthritis.
Board pearl
Ilizarov's neutral fixation (consolidation) phase usually lasts at least as long as the distraction phase, and possibly longer, so the regenerate can fully ossify.
Authors' conclusion
Clinical application of the author's techniques permits stature increase in certain forms of dwarfism, correction of deformities and limb-length inequalities, and stump elongation.
Ilizarov described the biologic and technical conditions under which a gradually widened osteotomy forms new bone in his circular tensioned‑wire fixator, and how he applied them clinically.
Synthesis of the author's canine tibia experiments, reported in earlier papers, and clinical work at the Kurgan center, USSR.
Methods
Indication
Stature increase in some forms of dwarfism
Deformity correction
Limb‑length inequality
Stump elongation
Approach
Circular fixator on tensioned transfixion wires
Rings linked by threaded rods
Motorized distraction for continuous lengthening
Outcomes
New bone formation in the distraction gap
Key Findings
In the canine tibia, distraction at 1.0 mm/day gave the best results, while 0.5 mm/day often consolidated prematurely and 2.0 mm/day damaged periosseous soft tissue and gave poorer bone.
Frame stability set the type of healing, with loose‑wire frames producing fibrous nonunion and four‑ring frames producing direct bone formation with no cartilage stage.
Better marrow preservation went with better new bone in the gap when full transection, one‑third transection and closed osteoclasis were compared.
An autodistractor making 60 steps a day (16.6 microns every 24 minutes) produced lengthening tissue with histologic and electron microscopic features of embryonic, fetal and neonatal growth.
The regenerate forms a physis‑like central growth zone that ossifies toward both the proximal and distal ends during distraction.
Ilizarov considered lengthening contraindicated in spondyloepiphyseal dysplasia and other dwarfism with distorted joints, because lengthening pressure on the joints may hasten osteoarthritis.
Board pearl
Ilizarov's neutral fixation (consolidation) phase usually lasts at least as long as the distraction phase, and possibly longer, so the regenerate can fully ossify.
Authors' conclusion
Clinical application of the author's techniques permits stature increase in certain forms of dwarfism, correction of deformities and limb-length inequalities, and stump elongation.