Abstract

Fracture dislocations around the wrist are managed either by scaffolding it with a plaster or with internal fixation devices. The present video below presents forward a third option i.e. Closed ligamentotaxis with ilizarov frame. This is an extremely simple, atraumatic and wonderful solution.

Introduction

Transosseus Osteosynthesis is a revolutionary concept in orthopaedics by which bone can be made to grow even after skeletal maturity. Not only bone, but nerves, vessels, tendons, muscles, ligaments, fascia and even skin can be made to grow. This is possible by a unique and revolutionary system introduced by G. A. Ilizarov of Kurgan, Siberia in 1951 [1]. The Ilizarov system produces miracles, which always cause awe, and elicits standing ovations in orthopaedic conferences, due to their apparently magical results [2].

This system gained popularity in 1990 and gradually rose to its peak until 2000, by when it had become popular all over the world, with surgeons producing similar reproducible results worldwide. It was followed by an era of wholesale modifications with respect to the design of the apparatus, and with an increasing tendency to replace the thin wires with thick Shanz pins. Around this time, a decline was observed in the popularity of this system. Surprisingly, by 2015, the popularity of the system had declined to such an extent that it was infrequently used and only in a few centres. Importantly, young orthopaedic surgeons were either unfamiliar, or afraid of, this system. However, it is regaining popularity these days, especially with complications arising with other procedures such as internal fixations, causing maladies worse than the problem they intended to solve.

Fracture dislocations around the wrist are managed either in a plaster or with internal fixation devices. The video below shows the third option. Closed ligamentotaxis with Ilizarov frame. This is an extremely simple, atraumatic and wonderful solution.

The benefits of using this technique is that only three K-wires and one and a half rings are used here. With ultralite rings, the assembly weighs below 265 grams.The procedure shows a progressive construction, where the frame is assembled in the Operation Theatre. Ligamentotaxis is the process of having rings proximal and distal to the joint around which the fracture has occurred [3]. By distracting the two units in the direction opposite to the deforming forces, a near anatomical reduction happens without touching the fracture haematoma [4]. The fracture healing time is dramatically reduced, and most fractures unite in four weeks, compared to six to eight weeks in a plaster, and even more with distal radial plates. All complications of plating and internal fixation are totally avoided.

The present video shows the procedure in a jiffy and easily understandable way (video 1). Since this technique was first described in my Delhi Ilizarov workshop, over 25 surgeons all over India are doing this procedure with excellent results.

Conclusion

Closed ligamentotaxis with ilizarov frame is a very simple procedure and in my opinion should be kept in mind before treating the radial fractures with some other techniques.

References

  1. Prakash L. The magic of Ilizarov; CBS publications New Delhi. 2016 first edition. .
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  2. Ilizarov GA. Transosseous osteosynthesis. 1st edition. Berlin Heidelberger New York: Springer Verlag; 1992. .
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  3. Ilizarov GA. The tension-stress effect on the genesis and growth of tissues (Part I): The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res. 1989; 238 (1) : 249-81 .
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  4. Ilizarov GA, Emilyanova HS, Lebedev BE. Some experimental studies. Mechanical characteristics of Kirsherner wires. In: Perosseus compression and distraction osteosynthesis in traumatology and orthopedics. Kurgan, pp 34–47. .
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