The Ilizarov Method for the Management of Bone Tumors in the Lower Extremity: Techniques, Indications, and Outcomes

As the demand for limb-sparing surgeries after wide resection of bone lesions reaches an all-time high, so does the need for durable reconstruction. Recent advances in distraction osteogenesis within the field of orthopedic oncology have shown promising outcomes, offering the ability to restore near-normal function and reduce complications associated with non-biological constructs. The aim of this study is to identify, describe, and summarize the techniques, indications, and outcomes of the Ilizarov method for the management of bone tumors. The relevant literature describing the use of distraction osteogenesis in orthopedic oncology was identified from appropriate electronic databases (PubMed, MEDLINE, CINAHL, and EMBASE), and a narrative review was undertaken. Methods of distraction osteogenesis were classified into two groups: external and internal fixation. Within each group, we outline the indications and surgical techniques for several precise methods of distraction based on patient factors (age, psychological considerations) and tumor characteristics (proximity to the joint, location, type, and size of tumor, + / − radiation therapy/chemotherapy). We also report on various considerations and complications and highlight the pitfalls and benefits associated with each technique. Despite the potential of long duration of fixation, the frequency of pin-tract infections, and the technical expertise required, distraction osteogenesis allows for the regeneration of living bone with sufficient biologic affinity, biomedical strength, and resistance to infection. Given that the complications can be prevented or minimized, the use of distraction osteogenesis is likely to expand as the primary method of reconstruction in orthopedic oncology.