Evolution of the ilizarov technique: A scoping review of improvement

The Ilizarov technique is a cornerstone of orthopedic reconstruction, yet it faces persistent challenges such as prolonged external fixation and patient discomfort. This scoping review aims to synthesize recent advancements in the Ilizarov method, focusing on innovations in fixation devices, osteotomy techniques, bone transport protocols, and multimodal integrations. A literature search was conducted in PubMed/MEDLINE from inception to November 2024. Studies reporting innovations in device design, surgical technique, or adjunctive therapies related to the Ilizarov method were included. Key findings were synthesized narratively across four predefined domains. Recent improvements include: (1) lighter and smarter external fixators (e.g., hexapod systems, computer-aided design); (2) refined osteotomies (e.g., low-energy, bifocal/trifocal strategies) to preserve biology and reduce treatment time; (3) optimized transport protocols (e.g., acute shortening, cable-pulley systems); and (4) multimodal integration with technologies such as 3D printing, internal fixation, induced membrane technique, and biologics (e.g., BMSCs, growth factors), which have shown potential to enhance bone regeneration and reduce complications. The Ilizarov technique continues to evolve through device innovation, biological refinement, and technological integration. These advancements enhance its efficacy and patient outcomes, paving the way for broader clinical applications and further research.