PROF. DR. J. J. PATWA Absract no.- 1172 Contact no.- +919824036131 Five stages of Ilizarov Technique 1. Latency period 4 to 7 days 2. Distraction – Compression 1 to 4 or 5 months 3. Stabilization period thrice as long as D.C. 4. Dynamization 15 to 20 days 5. Post protection Phase
1. LATENCY PERIOD ON LEAVING OPERATION THEATRE • Check pin – tract dressing • Pressure dressing over operative site
ON LEAVING OPERATION THEATRE • Cover the entire frame • Take check X-rays
POST OP. – DAY 1 • Evaluate pin site • Positioning : elevation, knee extension, ankle dorsiflexion • Isometric and ROM exercise
POST OP. – DAY 1 • Splints: Night splints, Dyna splint • Partial wt. Bearing, if tolerated with compensation & walker / support
LATENCY PHASE (CONT.) • Dressing S.O.S., antibiotics S.O.S. • Positioning : knee ext., ankle dorsiflex • Isometric and R.O.M. exercise / CPM
LATENCY PHASE • Splints : night splints, dyna splint • Partial wt. Bearing with bilateral support, level ground and stairs
LATENCY PERIOD – DURATION • Quality of corticotomy : more violent, more latency • Age & Quality of bone : young, healthy bone, less latency • Pathology : poliomyelitis, more latency achondroplasia, less latency
Latency period duration • Young child 3 days • Adolescents 5-7 days • Adult 7 days • Old 10 days • Minimally traumatic Early • corticotomy • More vascular damaging Late • corticotomy • Comminution Late
2.DISTRACTION PHASE • Recheck dressings • Recheck wire tension, skin around wires • Mark the direction and amount of turns • Teach distraction to the patient
DISTRACTION PHASE Accordian Method Hypo-plastic Well formed REGENRATE • Repeat X-rays – regenerate quality, deformity • Poor regenerate : slower rate / acute compression, wait for three weeks and then distraction at a half rate(0.25mm/12hrly).
DISTRACTION PHASE • Rate and rhythm adjusted to age, type of corticotomy, pathology • Pain relief generally required ice, heat, analgesics, TENS
DISTRACTION PHASE • Watch for insomnia, loss of appetite Do not allow patient to sleep in the morning hours / form Ilizarov physiotheraphy club, so they can guide each other
DISTRACTION PHASE (Deformity Correction) Elevation Cause Dyna Splint Contracture Prevention Foot Frame Foot Frame • Watch for developing contractures: - if straps or splints inadequate Consider EARLY TAL/ankle fixation (Foot Frame)
DISTRACTION PHASE Anticipated pre-construct Hinge Push Construct Olive • Watch for developing contractures: PT prone - if straps or splints inadequate Consider EARLY TAL/ankle fixation (Foot Frame)
DISTRACTION PHASE • Watch for nerve palsy • More aggressive physiotherapy: stretching active exercises, more wt. Bearing
DISTRACTION PHASE Accordian Method • X-ray : after giving a few days for slack, and a few days for distraction: about 10 days Hypo-plastic regenerate then go for Accordian Method Acute compression wait distraction at a half rate
3.STABILIZATION PHASE • Re-tension wires, watch for infection • Distract 0.5 – 1 mm / 4 – 7 days for tension of wire • Over – distract, then, compress to get a wider regenerate (training the regen.)
STABILIZATION PHASE (cont.) DYNAMIZATION • Encourage full wt. bearing without lateral supports / Dynamize the frame
FIXATOR REMOVAL When to remove ? • Clinically : loosen the nuts on the connecting rods one by one, if full weight bearing painless – remove • X-ray: at least three out of four cortices are formed
4.PROTECTION PHASE Calliper Coarset Brace Crepe support
5.POST – PROTECTION PHASE Out of cast or brace All four cortices formed Resistive physiotherapy No contact sports till medullary canal appear
PRE – OP. (NIRAV) 15 yrs. Old pt. With RPM of Rt. Lower limb with 4 cms. Shortening and fore foot adduction and mild equino varus deformity of foot following tendon transfer
Ilizarov Lengthening of leg as well as first meta-tarsal to correct deformity and leg length discrepancy
Leg Discrepancy as well as foot deformity fully corrected
NAHID – RPM Lt. Lower Limb with 5 cms. shortening Double level corticotomy weak regenerate at lower corticotomy
HEENA PRE – OP. 12 yrs. Old female had crush injury of foot & ankle with bone loss and damage lower epiphysis & foot was tagaling on damage fibula. After putting skin flap fortunately foot & limb was survived for which correction of deformity & ankle fusion done which was followed by limb lengthening via upper meta physeal corticotomy
FINAL FOLLOW-UP
PROF. DR. J. J. PATWA PROF. SHEVTSOV DIRECTOR OF KURGAN INSTITUTE RUSSIA CONGRATULATING PROF. J. J. PATWA FOR TALK AND RESEARCH ON”BURGER’S DISEASE”TRATED BY ILIZAROV AND SIGNING HIS BOOK ON”MASTER CASES OF ILIZAROV” AT GOA NATIONAL ILIZAROV CONFERECE 2013
Recommend
More recommend
