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The Ilizarov method of bone lengthening, reconstruction and osteosynthesis has developed immensely since its introduction by G.A. Ilizarov in the Soviet Union in the 1960s and in the Western countries in the early 1980s. It has become an integral part of the arsenal used by the orthopaedic community worldwide. The evolutionary development of the method and its current role has considerably improved the quality of life for millions of people around the whole world. Despite the great versatility of its possible applications for bone injuries and diseases, the Ilizarov method could not and cannot be the alternative to a range of other methods that are applied for some specific bone conditions, but rather is a method of choice. Its combination with the current methods of internal fixation or the means of internal fixation that use the biological principles that were laid down by G.A. Ilizarov have demonstrated the importance of tension stress, blood supply, functional loading, and fragment control during bone treatment. The objective of this study was to present an overview of the current state and concerns in the application of the Ilizarov method and define the prospective research trends aimed at regeneration stimulation, better control of treatment, infection barriers and patient comfort.

Methodological solutions of Prof. G.A. Ilizarov are the core stone of the contemporary bone lengthening and reconstruction surgery. They have been acknowledged in the orthopaedic world as one of the greatest contributions to treating bone pathologies. The Ilizarov method of transosseous compression–distraction osteosynthesis has been widely used for managing bone non-union and defects, bone infection, congenital and posttraumatic limb length discrepancies, hand and foot disorders. The optimal conditions for implementing distraction and compression osteogenesis were proven by numerous experimental studies that Prof. G.A. Ilizarov organized and supervised at a large orthopaedic research institute in Kurgan. The tension stress effect on regeneration and growth of tissues was thoroughly investigated with radiographic, histological and biochemical methods. The impact of the Ilizarov method on the progress of bone lengthening and reconstruction surgery could be called revolutionary.

Purpose The purpose of this study was to present a retrospective comparative overview of the Ilizarov non-free bone plasty techniques of one-stage multilevel fragment lengthening and gradual tibilisation of the fibula used for extensive tibial defect management. Methods Extensive tibial defects in 83 patients were managed either by multilevel fragment lengthening (group I, n=41, mean defect size 13.1±0.9 cm) or gradual tibilisation of the fibula (group II, n = 42, mean defect size 12.5 ± 1.2 cm) using the Ilizarov apparatus. The initial findings, treatment protocols and outcomes of those patients treated within the period 1972-2011 were studied retrospectively by medical records and radiographs, and statistically assessed with Microsoft Excel and Attestat software. Results Group I had multilevel fragment lengthening over one stage that averaged 288.0±14.4 days. The mean total period of gradual tibilisation of the fibula in group II was 316.0±29.7 days. The patient's age in the latter group had an effect on the completeness of leg-length equalisation. Conclusions The techniques can be used to manage extensive tibial defects as all the defects bridged, leg-length discrepancy and deformity were corrected and patients were able to load their limbs.

The Ilizarov method yields comparable results in the management of CPT associated with NF1 or tibial dysplasia of idiopathic origin in paediatric cases. Further research should focus on the ways to support the Ilizarov method in order to reduce the number of repetitive surgeries or eliminate them.

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The technical solutions used for mechanical effects on the ischaemic distraction regenerate resulted in its rescue and bone union in all the cases.

Lower and upper limb length discrepancy and deformity, congenital or acquired, are amongst the most common conditions in children for orthopaedic referral. Over the last twenty years, surgical techniques have evolved in an attempt to decrease Healing Index and minimise these complications. Areas covered: The flexible intramedullary nailing (FIN) is a minimally invasive intramedullary osteosynthesis. In combination with an external fixator, it is appropriated for pediatric bone lengthenings and lengthening of bones of small diameter in adults. In the study the Scopus and/or PubMed indexed publications about this combined technique were analyzed. Expert commentary: The use of titanium or stainless steel or hydroxyapatite-coated bent elastic nails is appropriate in limb lengthening for congenital and acquired limb length discrepancy. Hydroxyapatite-coated FIN should be applied for long-term reinforcement of lengthened bone in patients with metabolic bone disorders, skeletal dysplasias with compromised bone formation. Osteoinductive surface of nails is favorable for bone formation and as well as for stable position of nails without risks of migration in long-term follow-up. The FIN is an unique intramedullary fixation which respects the bone biology which is mandatory for a good bone consolidation.