Component of Ilizarov Ring Fixator

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Components Of Ilizarov External Fixator
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Fracture first aid

• Presented by
• DR. Hany Al-Dakar

Consultant of prthopedic surgery
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2020 2021
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The Ilizarov

• It is an external fixator
• Consisting of parts which can be assembled in
  unlimited configurations
• Can overcome deformities by providing
• Compression
• Distraction
• Angulation
• Rotation
• At the same time limb is made stable enough to
  permit weight bearing

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Transfixing wires

• Available in two diameters
• 1.5 mm for upper extremity and pediatric
  applications
• 1.8 mm for lower extremity applications.
• Wire stiffness is proportionate to fourth power
  of its diameter
• wire tips
• - Trocar tip is used for metaphyseal bone
• - Bayonet tip is used for diaphyseal bone
• These wires have a special cutting tip so that
  predrilling is not required

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Olive wires

• It has several functions
• Stabilizing element preventing the bone from
  sliding along the wire during deformity
  correction
• Fulcrum or rotation point around which deformity
  correction occur
• Traction element to pull bone in a desired
  direction

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Transfixing wires

• Pin Attachment to Frame
• Never bend a pin to meet a frame, but instead,
  either remove and reinsert the pin, or use
  spacers to attach the pin to the Ring
• Wires are attached to ring using fixation bolts
  either cannulated or slotted.
• One wrench holding the fixation bolt stationary,
  the remaining wrench tightens the fixation nut.

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Rings
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Half Rings

• Multiple holes for attachments
• Multiple sizes from 80 to 240 mm
• 5 mm thick
• Offset ends that allow flat plane of a complete
  ring
• Solid rings are available

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Rings
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5/8 rings

• Used around distal humerus
• Prefabricated 5/8 circle rings are available
  120-130 150 mm
• May be made by two rings of the same size bolted
  together with the main portion of the ring is in
  contact with each other until incomplete ring is
  formed with the desired size

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Rings
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Omega rings

• Used around the shoulder where the 5/8-circle
  ring dig in the shoulder
• May be made by attachment of a 3-hole curved
  plats at each end of the 5/8-ring
• Prefabricated omega rings available 120 - 130
  140mm

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Rings

• Tensioning the wire across the ring distorts the
  ring which become oval in shape especially in
  large rings
• The second tensioned wire at 90 degrees will
  correct this distortion
• If the second wire is not at 90 degrees so use
  two rings together with a thickness of 10 mm to
  resist distortion

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Arches

• Large, heavy and curved plates.
• Available in 90 110 140 mm
• Used fixation of the upper femur.
• Available in two sets
• Small for pediatric
• Large for adults
• Each set has two different sizes
• 1/4-circle
• 1/3-circle.

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Bolts and Nuts
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Fixation Bolts

• Threads of bolts in Ilizarov system
• 6 mm in diameter
• 10 threads in 1 cm so one full turn moves a nut 1
  mm
• Diameter and threads of bolts are identical wit
  that of the connecting rods
• Available lengths 10- 16- 30 mm
• Bolts and nuts fit 10 mm wrench.

6mm
1
10
1cm
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Bolts and Nuts
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• Ilizarov fixator nut is used to fasten other
  compatible accessories on the Ilizarov external
  fixator rings with a nut
• Two Types
• Normal
• Nylon Insert

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Fixation bolts

• Used to secure wires
• Three varieties
• Cannulated used when a wire pass across the
  center of a fixation hole
• Grooved used when a wire is tangential to a
  fixation hole.
• Cannulated with a taped head used in crowded
  situation.

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Pin Holder
Ilizarov single pin fixation bolt is used to fix
the Schanz screw / half pin on the ring
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Schanz Screw

• Connecting Rings to bone
• Cortical Cancellous
• Multiple Sizes
• 3 mm
• 4mm
• 5mm
• 6mm

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Washers
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Washers

• Three categories
• 1.Plain washers
• Two thickness 1.5 2.0 mm
• Used to separate a peace of hard ware from anther
• Used with grooved washers for wire fixation

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Washers
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Washers

• 2- Grooved washers
• Used for wire fixation anywhere in the
  configuration
• The groove should rest against a flat piece of
  hard ware
• If the wire is far from the plane of the ring a
  multiple washers are stacked on a long bolt to
  secure the wire

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Washers
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Washers

• 3- Paired spheric washers
• Used to compensate for angulation between ring
  and threaded rod
• They allow for the threaded rod a 7.5 degree of
  angulation in a hole

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Rodes

• They are the basic connectors between supporting
  rings
• Lengths from 30 400 mm
• May bend if used to span a considerable distance

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Telescoping tubes

• Prevent deformity of the configuration when there
  is a long distance between the supporting rings
• They are secured to threaded rods in one of two
  ways
• Distraction tension against a nut
• Pressure from a bolt against the side of the
  threaded rod

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Graded telescoping rods

• It incorporates a mechanism to simplify
  distraction
• The rods are slotted and marked in millimeters so
  that the surgeon can assess the amount of
  elongation or shortening

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Posts

• One, two, three four hole varieties
• Two types
• Male post threaded rod coming out the end
• Female post taped hole at its end

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Posts

• Single hole post
• Also called hinge
• Asymmetrical with flat and rounded side
• When a pair of hole posts are bolted
  singletogether they form a hinge with the two
  arms at the same plane

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Posts

• Posts used for multiple functions
• Fixation points for wires off the plane of the
  ringe
• Attachment points for slotted threaded rods used
  for bone transport segment
• Single hole posts used as
• Swivels for ring rotation
• Points for pushing or pulling rings
• Three posts connected together at right angle to
  each other form a universal hinge

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Wire fixation buckle

• They were the Ilizarov original wire fixation
  device
• It is taped for attachment of a threaded rod
• It fits over an can slide along a ring or a plate
  so it can be used to secure a piece of hard ware
  any where along a ring or plate

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Plates
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Plates

• 1- Straight plats
• Available in a number of lengths ranging from 2
  to 14 holes
• Used as
• Wire attachment points e.g. lateral distraction
• Supporting elements in push configurations
  designed to simultaneous angulation and
  translation of ring clusters
• Short plates used to increase diameter of small
  rings

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Plates
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Plates

• 2- Paddles
• Plates with a treaded rod attached to one or both
  ends

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Plates
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Plates

• 3- Twisted plates
• Available in two, three and four hole lengths.
• Used when the surgeon wishes to rotate plane of
  fixation 90 degrees.
• Used with single hole posts to form a swivel for
  distraction on the convex side of the deformity
  so provide a fixed distance between rings while
  correction of the angle

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Sockets

• Available in two lengths 20 40 mm
• Used as interconnectors between threaded rods
• Used as spacers to raise point of fixation off
  the plane of the ring or plate
• Can function as a way to connect and disconnect a
  threaded rod to a ring to perform a cortectomy
• May help a surgeon to attach a hard ware to a
  ring in in such a crowded location
• Short socket can be used as an extra-long nut to
  get a wrench due to crowding of hard ware

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Bushings

• Available in two sizes
• The inner diameter of a bushing is larger than
  that of the outer diameter of a threaded rod
• used as a sliding assembly to move components
  along a threaded rod
• used as a fat washer to elevate a piece of hard
  ware off a ring or plate

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Wire Tensioners
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Wire Tensioners

• Spring-loaded tensioner
• has self-seating chuck and calibrated tension
  scale
• Its foot print is designed to rest against a ring
  during tensioning
• In a crowded location a socket can be slide on a
  wire to act as a spacer between fixation bolt and
  wire tensioner

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Wire Tensioners
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Wire Tensioners

• Manual threaded tensioner
• uses a large wing nut on a threaded rod bolted to
  a wire
• if no solid contact between jaws of the tensioner
  and the ring a plate and socket is used for
  counter traction
• NB manual tensioner should be always available
  as the spring loaded may fail to operate properly
  

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Wrenches
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Hinges
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