2005 Pakistan Earthquake: Experiences of a Multidisciplinary Surgical Team

Asim Rajpura,MRCS;Ihab Boutros,MRCS;Tahir Khan,FRCS (T&O);
Sohail Ali Khan,FRCS (T&O)

2008: Vacuum-assisted wound closure (VAC) with simultaneous bone transport in the leg : A technical note

Brinda Vihari SOMANCHI, Sohail KHAN

2010 Gaza : Orthopaedic initiative for the Gaza Strip, Palestine

Sohail A Khan and Peter A Naylor

2012: The use of bone morphogenic protein-7 (OP-1) in the management of resistant non-unions in the upper and lower limb

M.C. Papanna, N. Al-Hadithy, B.V. Somanchi, M.D. Sewell, P.M. Robinson, S.A. Khan, R.A. Wilkes

2019: Lengthening of a below knee amputation stump with Ilizarov technique in a patient with a mangled leg

Dong Hao Toon*, Suheal Ali Khan, Kevin Ho Yin Wong

2019: Ilizarov reconstruction of chronic bilateral calcaneovalgus deformities

Ming Chun Chan, Suheal A. Khan

2019: Epidemiology of inpatient tibia fractures in Singapore. A single centre experience

X Premchand, J Dacruz, SA Khan.

2023: Reverse sural flap with simultaneous open bone transport in the leg: A novel method

Wei Ping Sim, Antony Xavier Rex Premchand, Si Jack Chong, Xiang Ying Tay, Yee Onn Kok and Suheal Ali Khan

Hgoug’s Story: Gaza 2010

In January 2009 13 year old Hgoug – a keen footballer – was shot in the leg [by a helicopter gunship] whilst helping his father in his olive grove.

Find out more about Hgoug’s story

The Ilizarov frame, born from Gavriil Ilizarov’s innovative work in the 1950s, transformed orthopedic surgery through the discovery of distraction osteogenesis. Its applications span bone lengthening, fracture management, and deformity correction, with ongoing developments like hexapod fixators and hybrid techniques enhancing its efficacy. Despite its global adoption, the method’s complexity limits the number of true experts to a specialized group, primarily in developed orthopedic hubs and regions. The Ilizarov method remains a cornerstone of bone reconstruction, with its principles driving continued advancements in the field.

Discovery and Origins of the Ilizarov Frame

The Ilizarov frame, a revolutionary orthopedic external fixation device, was developed by Soviet surgeon Gavriil Abramovich Ilizarov (1921–1992) in the early 1950s in Kurgan, Western Siberia. Ilizarov began experimenting with external fixation designs to treat patients with complex bone fractures, particularly those returning from World War II with non-unions (bones that fail to heal properly). In 1954, he successfully treated his first patient, a factory worker with a tibial non-union, significantly reducing healing time

The pivotal discovery associated with the Ilizarov frame was distraction osteogenesis, the process of new bone formation through controlled, gradual stretching. This occurred serendipitously when a patient mistakenly distracted (lengthened) the frame instead of compressing it, leading Ilizarov to observe the formation of a fibrocartilage callus at the fracture site, which eventually developed into new bone. Ilizarov’s method was inspired by mechanical principles, notably the tension-based mechanics of a horse’s shaft bow harness, which informed the modular, circular design of the apparatus.

Uses and Applications of the Ilizarov Frame

The Ilizarov frame is a versatile external fixator composed of stainless steel or titanium rings, Kirschner wires, pins, and threaded rods, designed to stabilize and manipulate bones. Its primary applications include:

Bone Lengthening and Deformity Correction: The frame facilitates distraction osteogenesis to lengthen limbs or correct congenital and acquired deformities, such as those caused by epiphyseal injuries or infections.

Fracture Management

It is highly effective for complex fractures, non-unions, and osteopathic conditions, especially in cases with a high risk of infection or where internal fixation is not feasible.

Bone Reconstruction

The technique is used for bone defects, bone transport, and reconstruction in trauma, tumors, or infections, often as a limb-salvage alternative to amputation.

Foot and Ankle Deformities: The frame corrects complex foot deformities, such as clubfoot, through gradual soft tissue distraction and osteotomies, achieving pain-free, functional outcomes.

Chronic Conditions: It has been applied to stimulate vascularity in ischemic diseases and treat conditions like osteogenesis imperfecta or osteoporosis.

The Ilizarov method’s advantages include high union rates, minimal invasiveness, early weight-bearing, and the ability to adjust the frame post-operatively for precise correction.

Development and Dissemination

Ilizarov refined his technique through extensive experimental studies in Kurgan, investigating the tension-stress effect on tissue regeneration using radiographic, histological, and biochemical methods. The method, initially termed transosseous compression-distraction osteosynthesis, was certified by Soviet authorities and gained traction in the USSR during the 1960s.

The Ilizarov method remained largely unknown in the West until the 1980s due to Cold War barriers. Its international breakthrough came in 1980 when Italian journalist Carlo Mauri, treated by Ilizarov for a long-standing tibial non-union, showcased the method’s success in Italy. This led to Ilizarov presenting his findings at the AO Conference in Bellagio in 1981, sparking global interest.

Innovations

Innovations stemming from Ilizarov’s principles include

Hexapod Fixators (e.g., Taylor Spatial Frame, introduced in 1997), which enhanced precision in deformity correction.

Hybrid Fixators and intramedullary lengthening nails, reducing external fixation time and complications.

Automated Distractors and guided growth plate systems