• استشاري جراحة اليزاروف للكسور ولتطويل العظام وتعديل التشوهات / شلل ألأطفال / عمليات تطويل العظام وعلاج الكسور والتشوهات الخلقية / علاج الكسور غير الملتئمة ومضاعفتها / علاج الكسور ومضاعفتها في الاردن / اطباء لعلاج الكسور ومضاعفتها / طريقة اليازاروف / استشاري جراحة العمود الفقري / تطويل العظام / قصر القامه

1. Limb Length Equalization
& Deformity Correction

2. Initial trials for leg lengthening

3. Prof. Codivilla
of Italy- 1905
The first successful lengthening.
Osteotomy  immediate traction
force to a calcaneal pin, with or
without the use of narcotics.

4. Ombredanne 1913
The first to use E. fix for lengthening.
Oblique osteotomylengthening at a
rate of 5mm/ day
Putti 1921
Lengthening at a rate 2-3mm/ day
with a monolateral fixator and half-
pins.

5. Putti apparatusOsteotomy

6. Abbott 1927
=Step-cut osteotomy, with
preservation of the
periosteum,
=After 7-10days period
distraction through
aspring-loaded controlled
device1-1.5mm/day

7. Joseph E. Bittner 1929
= Circular tensioned-wire external fixator
for fracture reduction.
= Wires tightened by expanding hinged ring.
= Device is removed then cast is applied.

8. Ilizarov worked as a GP in the small
industrial town of Kurgan, Siberia,
after World War II. In 1943

9. =800bed, 17 specialized departments
=200Orthopaedic Surgeons
=60Scientists with Ph.D. degrees

10. One patient had bony ankylosis of his
knee in the flexed position osteotomy 
distraction gradually to straighten out the
limb.
To his surprise, Ilizarov found a newly
regenerated bone at the site of osteotomy
when distraction was finished.
Ilizarov discovery

11. The first case of leg-lengthening by Prof.
G. A Ilizarov in 1972, for a dwarf on both
lower limbs.

12. Causes of LLD
Congenital.
Growth arrest.
Trauma ,infection
Neoplastic.
Neurological.

13. Biological principles of
lengthening
Closed osteotomy (5-7 days delay)
DistractionTension.
Distraction Osteogenesis

14. Ilizarov Tension Stress Theory
Bone and soft tissue, including
skin, muscle, &NV structures, will
heal and regenerate in a
predictable manner under
tension.
Distraction Histogenesis

15. Effects of >2cm LLD
1. Asymmetrical gait.
2. Pelvic obliquity
3. Scoliosis
4. Hip & Patello F. OA on the
long limb side
5. Cosmetic.

16. =70%had some LLD
=25%had 1-1.5cm LLD
=5%had 2-2.5cm LLD
LLD in general population

17. Advantages of LLD
Stiff knee.
Paralytic limb.

18. Preop Assessment of LLD
# Exam of the patient.
# Types of LLD.
# Radiological.
# Expected LLD at maturity
# Photography.
# Patient education.

19. Three length measurements
at minimum intervals of 12-18
months are required for a
reasonably reliable prognosis.
Expected LLD at maturity

20. 1.2cm
0.9cm

21. Contraindications to lengthening
Sensory & motor deficit.
Unstable joint.
Psychological problem.
Inability to discard the orthosis post op.
Uncooperative patient.

22. Principles of correction
1. Deformity first.
2. Leave paralytic limb shorter.
3. Length of shortening. (<2cm)

23. = Shoe elevation or orthoses
= Epiphysiodesis
= Surgical leg shortening
= Surgical leg lengthening.
Options for treating LLD

24. Epiphysiodesis
Shortening

25. LLD Treatment
>2cm =None (or lift in shoe(
2-6cm =Epiphysiodesis or shortening
<6cm =Lengthening
<15-20cm =Lengthening
(staged or combined
with epiphysiodesis(.
General Guidelines for
the R of LLD

26. Surgical Technique
Image I.
Fixator.
Fibular division for leg.
Periosteal respection.
Cortical osteotomy.

30. Advantages of Metaphyseal
osteotomy
=Greater blood flow,
=Better collateral circulation,
=Greater trabecular surface area, a thin
cortex that
=Facilitates separation with a chisel, and
=Greater inherent stability.

31. Post operative
Pin site dressing.
Analgesia - ? Compartment
synd.
Physiotherapy.
Patient education.

32. Complications of lengthening
1. Bone
Consolidation problems.
Axial deviation.
Fracture.

33. 2. Joints
Contracture & subluxation.
Loss of ROM.
3. Nerves
Direct injury.
Traction injury.

34. 4. Blood vessels
Hypertension.
Compartment syndrome.
DVT.
Direct injury.
5. Pin sites.
Infection.
Tethering.

35. 6. Psychological
7. Wound.
Pain.
Infection.

36. Current modes
of lengthening

37. 1-Circular Bone Lengthener

41. -Non-standardized techniques
-Dependence on personal creativity of surgeons
-More labour-consuming assembly
-Multiple outpatient visits necessary
-Decreased quality of life while fixator in place
-Problems with non-compliant patients
-High incidence of pin-site infection
-Contractures of adjacent joints caused by
transfixation of muscles
Problems of ilizarov method

42. Automatic lengthening

43. 2-Unilateral External lengthener
Orthfix

44. 3-Intramedullary Skeletal
Kinetic Distractor- ISKD
It is designed to lengthen for a
predetermined distance, then stop.

47. 4-Combined external and
internal bone lengthening system

48. =The only device that uses a powered system
=The nail is connected to an induction receiver
that is placed just under the skin.
=An external control unit powers the telescope
nail though the induction plate.
=A similar technique has been used to power
artificial heart.
5-Limb lenghtening with a fully
implantable, computer controlled
distraction device

49. The Fitbone device

50. 6-Taylor Frame

52. Which patients can be helped
by ilizarov method?
=Any type of fracture at any site&
their complications.
=Any type of deformity at any site.

54. Rigid recurrent CTEV

55. Joint contracture

56. Post Burn Contracture

57. Chronic osteomylitis

60. Limb Salvage Reconstruction

61. Stumps
5.5cm
12.5cm

62. ‫صر‬17‫الفخذ‬ ‫عظم‬ ‫في‬ ‫سم‬
‫اليسرى‬ ‫الركبه‬
‫اليمنى‬ ‫الركبه‬

63. ‫بشكل‬ ‫الفخذ‬ ‫عظم‬ ‫اعوجاج‬

64. ‫تصحيح‬ ‫عملية‬ ‫بعد‬ ‫الثانيه‬ ‫المرحله‬
‫والتطويل‬ ‫العوجاج‬12‫سم‬

66. Deformity & shortening

69. Deformity & Shortening

71. Deformity & Shortening

74. Congenital shortening

77. Small bone lengthening

78. Bone defects in skull

83. =Peripheral vascular disease
=Decreased Cerebral perfusion
=Cosmetic lengthening
=Diabetic foot

84. Sad but not bad story

90. Can we lengthen fruits & vegetables?