Ilizarov Technique Nisantasi

The “Holy-Fix” Methodology – This is a fully external methodology for Limb or Leg Lengthening; whereby rod-alike external metal fixators are attached to each of the legs of the patients by means of pins affixed from the outside of the operated bones. During the lengthening stage, patients are required to turn screws on the device, simultaneously on both the treated legs, to achieve their daily distraction of 1mm per day. Currently, this is the most economical methodology practiced around the world; with the only disadvantage that the patients are stuck with the devices for a period between 9 to 12 months; meaning that they have to walk, sleep and live their daily lives with the devices attached to their treated legs. The biggest problem with this methodology is that that the devices cannot be removed in the consolidation and strengthening stages, or until the bones fully return to their pre-surgery density and integrity and are able to fully bear the patients weight. This consolidation period is obviously very long and uncomfortable for the patients and usually tends to test the patience of many patients and may cause them stress at the same time.

The Ilizarov’s surgical method for limb lengthening was developed by a Russian orthopedic surgeon, Gavriil Ilizarov and was first successfully applied in World War 2 and since has been in surgical practice, till today. It is an external only methodology for bone lengthening, whereby the bone is affixed with thin wires and hoops; with an external fixator or Ilizarov’s device. Although Ilizarov’s surgical methodology seems quite direct and simple, the result may sometimes be quite frustrating, if not performed by competent hands, thereafter, and the surgical method is not applied as per the expectations of the patients. It is important to note that were during the surgery or the post-op treatment, the medical team does not strictly comply with the principles laid down in Ilizarov’s methodology, and complications can arise, leading to gloomy outcomes for both, the patients and the medical teams involved. Regular care and maintenance of the device, its wires & screw; is crucial with this methodology, from the very beginning. As per the recommendations of the medical practitioner’s guidance patients must strictly care and sterilize the devices, its wires, and screws, daily; with 70% Pure Alcohol or a 10% Betadine solution, with sterile gauze. If the patient notices any indication of infections, such as redness, swelling and/or wound growth, around the device or its extensions, that they should immediately seek medical help from the surgical team who performed the surgery. The biggest problem with this method, apart from the strenuous daily regular care, is the chances of an infection, especially where sterilization is nor carried out daily; since the wounds are open and affixed with wires; the chances of infections increase. The problem is that if an infection does happen, during the lengthening phase; the infections become a priority; thus the lengthening process is halted till the time the infection subsides. 

“LON” Limb Lengthening Methodology (Combination internal and external) - is almost practiced in similarity with the “Holy-Fix” methodology regime; i.e. that it also involves the use of the same external device, but the major difference is, there are internal stabilizers implanted as well; in the shape of thin metal rods which are implanted into the bone cavity during operation. These internal nail system, with the help of external distractor, significantly reduces the time spent in lengthening phases. And soon after the lengthening phase is completed the external fixators are removed, and the consolidation & strengthening phase could easily begin; as early signs of consolidation already begin to appear on the patient’s X-rays, soon beforehand. With this combinational methodology and early removal of the external fixators, the patient’s comfort factors dramatically increase and with early removal of external devices, the consolidation period begins quickly. The weight of the patients during the consolidation phases is borne by the internally embedded nails, till the time that the bones have fully consolidated; soon after, these internal nails are surgically removed, with the help of a minor surgical procedure, which lasts around 30 minutes at best. This combination system has allowed quicker recovery times, in comparison to “Holy-Fix”; and with better quality of life for the patients, during the recovery phases, who opt for such a limb lengthening surgical procedure. 

PRECICE limb lengthening methodology is based on state-of-the-art innovations, the most medically recommended, comfortable and with the best height lengthening results; most patients opt for “PRECICE”. One of the major differences between the “LON” and “PRECICE” methods is that, with “LON” methodology, the intramedullary nail is extended with an external fixator; however this latest innovation and technology, “PRECICE” methodology, is standalone, i.e. it does not need any external fixator, because the intramedullary nail is electromagnetic and motorized, thus allows for bone extensions with just a remote control; providing the patient more comfort and much shorter recovery times in total. Furthermore, the device is internally embedded into the patient’s bone, thus does not cause any discomfort and significantly limiting any risk of infections at a minimum. Moreover, it reduces the total recovery period to just 2.5 months; but, it is a newer technology and currently much more expensive that “Holy-Fix” & “LON” methodologies and there are only a handful of doctors who practice with this methodology. With “PRECICE”, the surgeon makes a small incision and inserts the motorized intramedullary nail into the bone (either Femur or Tibia), and closes the wound; hence reducing the risk of any open wound infections. Soon after, the lengthening process is realized with the help of an electromagnetic remote control device; hence there is no device or fixator, visible on the patient’s body. This methodology is currently, the most comfortable amongst any other methodology of height lengthening available. The operated leg can easily bear weight, but partially in the beginning and gradually, during the lengthening phase, it can easily recover to a full weight bearing, in a matter of a few months. This allows patients to return to their personal and professional lives much earlier, than any other methodology, currently available.