Please click here to view the full Ilizarov Commissioning Statement.

Commissioning Position

This commissioning policy is needed to clarify under which circumstances the elective use of the Ilizarov technique is commissioned.

The use of the Ilizarov technique will NOT be commissioned where limb lengthening alone is the desired outcome as this would be deemed cosmetic and not medically necessary

(NB: NHS Vale of York CCG does NOT routinely commission an elective intervention on patients who have a BMI of 30 or above (classified as obese) or patients who are recorded as a current smoker – see commissioning statement 01. Optimising Outcomes from All Elective Surgery**)

NHS Vale of York CCG commissions the use of the Ilizarov technique/TSFs for elective use in orthopaedics in individual carefully selected cases which fulfill these criteria

• Complex mal-union or non-union of fractures (after at least 6 months duration or 9 months where the ‘Exogen’ ultrasound bone healing system has been tried and failed²).

• Bone deformity (affecting the leg/knee/ankle), including limb length discrepancy, that has resulted in chronic pain and/or difficulty walking and/or an increased risk of developing osteoarthritis^3.

• Where there is agreement by the regional orthopaedic MDT that, of all available treatments, Ilizarov/TSF is the best clinical option for the patient in terms of a favourable functional limb outcome (bone and functional outcomes are not always the same).
• The patient understands the long duration of external fixation, the likelihood of marked discomfort and possible complications
• The patient has been a non-smoker for at least 8 weeks* 
• The MDT should comprise at least two consultant orthopaedic surgeons, with input from specialist nursing, physiotherapy and musculoskeletal radiology.

* Smoking is a significant, potentially remediable risk factor for failure following Ilizarov reconstruction and cessation strategies are of paramount importance prior to initiating treatment¹⁴ Thus, careful patient selection is important for determining the likelihood of success with Ilizarov (see risk factors for further details)

Requests to use the Ilizarov technique outside these criteria must be submitted to the Vale of York CCG Individual Funding Request Panel (IFR) for consideration. Requests must include documented minutes from the MDT meeting at which the individual case was discussed.

To submit an application to the CCG's Individual Funding Request Panel, please click here for further information.

---