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Ilizarov Fixation for Correction of Bone Deformity  Limb Reconstructio Ilizarov Fixation for Correction of Bone Deformity  Limb Reconstructio

Ilizarov Fixation for Correction of Bone Deformity Limb Reconstructio - PDF document

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Ilizarov Fixation for Correction of Bone Deformity Limb Reconstructio - PPT Presentation

1 It is not a substitute for professional medical care and should only be used in association with treatment at the Nuffield Orthopaedic Centre Individual variations requiring specific instructions ID: 252290

1 It not substitute

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1 Ilizarov Fixation for Correction of Bone Deformity Limb Reconstruction and Limb Lengthening It is not a substitute for professional medical care and should only be used in association with treatment at the Nuffield Orthopaedic Centre. Individual variations requiring specific instructions not mentioned here may be Ilizarov Clinical Nurse Specialist Grateful thanks to the Ilizarov Multidiscipdevelopment of this booklet. Page 4 Your Ilizarov Team Page 5 Pre-operative Preparation Page 6 What causes a limb deformity?Page 8 Plastic Surgery Page 10 What is an External Fixator? Page 12 How do you lengthen a bone? Page 13 How does the frame correct a deformity? Page 14 Show me some examples Page 16 Risks of Surgery Page 17 Wound and Pin Care Page 18 Pain Control Page 20 Exercise and Physiotherapy Page 21 Managing at Home Page 22 Advice on Clothing Page 24 How long will the frame be on? Page 25 Problems you may encounter Page 28 Frequently Asked Questions Page 31 Tips from other patients Page 32 Contact Telephone Numbers Page 33 Web site addresses Mr Martin McNally Consultant Orthopaedic Surgeon Mr David Stubbs Consultant Orthopaedic Surgeon Mr Andy Wainwright Consultant Orthopaedic Surgeon M Orthopaedic Registrar Dr Senior House Officer Ilizarov Nursing Team Maz Sutherland Ilizarov Clinical Nurse Specialist Kim Stephenson Ilizarov LinkIlizarov Physiotherapy Team Laura Streeton Paediatric Physiotherapist Liz Ellis Adult Physiotherapist Jackie Halliday Ilizarov Aftercare Ilizarov Occupational Therapy Team Jackie Sherwood Paeds Alison Henderson Adults Occupational Therapist Mr Paul Critchley PlMr Henk Giele PlasM ………….. Plastic Surgery Registrar Dr…….. Plastic Surgery SHO Your treatment at the Nuffield involves a large multidisciplinary group of professionals your operation, usually ions or advice relevant to your admission, Information offered at the clinic appointment is supported with written information for Expect to be at the clinic for most of the day as at this clinic you get the opportunity to Ilizarov Office: 01865 737626 Ilizarov Mobile: 0782 5861951 Bony deformity may be the result of trauma. Fractures that heal at an odd angle are an example of this. These are called or a mal-united fracture. These do not necessarily cause you any pr“wear-and-tear” and stress on the joint is not equal across the joint. A mal-union can also give the appearance that the limb is shorter. A mal-union in the leg can therefore give you a limp and may cause problems with back pain due to the tilt when walking or standing. Hypophosphatemic Rickets can cause osteere “bowing” of the shin-bones. t stature and may cause problems with the surrounding joints long-term. condroplasia is a condition that causes shbones that make up the arm, leg, fingers and toes. The patient may have problems achieving their normal daily living activititheir lack of height or stature. deformity? tle given to a group of conditid Multiple Echondromatosis) the bone during childhood on same bone. This can cause deformities at the joint itself (on one or both sides of the Sometimes we are born missing digits, that is, fingers and toes or are missing complete bones. Surgery may be able to improvqualise the pressures across a joint. Surgery may involve using anotheruct a limb or a digit. The aim of this surgery would be to improve the function of the limb, (or digit, hand or nt, Mr Paul Critchley work closely with These types of operations involve a lot of pre-operative preparation. months before your operation. Our aim emotionally prepared for the surgery and have been provided with education about the t is impossible to predict and list every type of surgery as every individual case is slightly different. The examples given in explaining some of the common medical terminology and usua for example, “the nose job” Plastic surgery in limb reconstruction has various aims: To improve the function of a joint To reconstruct a limb or digit using b To reconstruct a limb or digit using so To transplant a digit (eg. to transplant a toe to the hand to improve the patients function of the hand) Moving a muscles tendon to another side offunction of a joint erring to skin, fat, muscle and the tendons Plastic Surgery may also involve using bone The bony chips are then used to fill small gaps in bone. ed to reconstruct a limb. This procedure is used in limb reconstructi What is Plastic Sur n example of this procedure is explained: the fibula, the smaller leg bone, below the knee) and transferred with its own blood need living bone. This is called live bone transport. It involves “plumbing” the leg bones arteries and A mal-union site is where your original fracture (sometimes held with metalwork) has a variety of reasons. If the mal-union site has metalwork present, your surgeon may need to remove this metalwork at the time limb or limbs affected. he external fixation device may be used founstable bone. It may be used for limb l The Ilizarov Fixator is a circular frame that surrounds the limb. What is an External Fixator? surgery may have a combination of wire pins and thicker pins called half pins. It can be used in a variety of ariety of functions. It may be used to correct a deformed limb. It may be usedlimb or correct a bony deformity. It may be used to increase the blood circulation to the ov Frame is that it can be used to do all of the above hese are narrow lengths of stainless sthigh tension and then secured. hese are stainless steel pins which are seThese pins are thicker than the wire pinsed on one side of the What are Wire Pin’s? What are Half Pin’s? gery, you may be left with have lost from surgery. 1. Your surgeon can use your old mal-union fracture site as the corticotomy after “freshening-up” the ends of the bones during surgery. 2. The second way, (more commonly) is that the gap at the corticotomy site and grow new bone. How do you What is a corticotomy? Corticotomy The adjustments to the frame are made at fos during the day using As a guide, most patients will aim to grow 1 mm of (immature) bone per day. he method is similar to leg lengthening. Usthe frame the angle of deformity decreasphysio will teach you (or your carer) how to make the adjustments to your frame. How does the frame correct a deformity? What is a Mono-lateral he Mono-lateral Fixator is a fixator device that is applied along the limb, not around the limb. It can be used for a variety of fractured limb or lengthen a limb. It is composed only of half pins. The principles Ilizarov Fixator, butWith the Mono-lateral fixator a tool called shows the usual appearer both legs at the same time or one leg at a time. (This decision is yours) usting the frame by tiny movements every X-ray showing frames on both legs Hypophosphatemic Rickets. Show me an (shin bone) orrection of Mal-Union or a mal-united fracture site. created. The frame is applied around the limb and the frame is adjusted by tiny ition of the fracture area or limb. Once the position has been achieved, we can amount of length lost by -union at the top of the tibi Showing the progression through limb lengthening. tibia) getting larger unhardened. We call this new bone the The yellow line is showing the bend at All operations involve an element of risk. Weyou should be aware of them. At the Nuffield, we do believe that our patients should be as fully informed as possible about their treatment, including the risks. t infection. Normally a short course of tablet antibiotics will treat this problem. However occasionally, patients may have to intravenous antibiotics or have a minor risks of infection Vary rarely due to the application of fixator or the operation you may experience some 4. Blood vessel problems: shown exercises to minimise the risk. ents who are undergoing ou perform exercises to help prevent these 6. Wire or Pin Breakage. casionally break during repaired, removed or replaced dependent on What are the Risks of Sur sites. leaves the skin. We teach you how to clean and support you, your family, to perform your own pin care routine. Even if you are physically incapable of actually performing the care, you can then safely advise your District Nurse or Relative on our protocol for care, reducing the incidence of complications leading from lack of knowledge. if clean and healthy, no other care is We usually encourage you to perform pin site inspection and care after you daily r in the shower, we ask you to direct the shower-head at the frame and ter off the pin sites and frame after you Who will look after my wounds and pin ltidisciplinary Team sometimes difficult to describe your pain it managing your pain following your operation. These include tablets, suppositories, cPain pumps allow you to control the amount of pain-killer you receive as you need it. Do not worry if you are lengthening or shortenwhen you first start the turning. ou may need extra pain relief, but this should How will my pain Will this operation be Take the painkillers given to you for as Take care to follow the Pharmacist’s advice printed on the container. As the pain decreases you eventually you can stop taking them altogether. It is very important to report to the ward nurses & doctors whilst in hospital or your GP when you go home. What about my pain relief when I go home? s part of the Ilizarov treatment, you ou can risk permanent joop the lengthening process to alengthening. t from you and your family. A large part of the success seen with the Ilizarov fixator is because the normal bodily circumstances ) continue ly holding yourlengthening your limb)using the IlizComplying with the physiotherapy will ensure many exercises? eet an OT (Occupational Therapist). possible. Getting on and off the toilet might cause yothigh. Raised toilet seating is available with a special “cut out” section to comfortably accommodate the fixator whilst sitting on the toilet. Some people find it difficult to get in and out make this easier and safer. available to help you regain as much independence as possible. Most of these devices are available on sh Will I be able to he clothes will have your framed arm to fit througideal. Shirts, blouses, sweatshirts or tops that you wish to adjust: of the arm. After tidying up these seams, more difficult, you may wish to talk to a dressmaker. There are track suits and jogg “poppers” or zips along the ed into clothing to accommodate the frames size. Long skirts are useful with leg frames. Some people find the appearance of their frame unpleasant or distressing. In this you have on are the zips Dotted line showing of material or ankle frames “plaster-boot” which is adjusted to fit your is boot has a pliable but solid sole with a material upper. of old jumpers or the legs of jogging and fitted over the frame (under clothes) to keep your limb warm. Socks can be adjusted to fit, allowing you to keep your foot warm. “Leg-warmer” to keep limb warm to keep toes warm frame. Centre held with ties or Velcro® f you are performing adjustments to your frame or if you needask you to come to clinic every week. Our clinics are on a Thursday and Friday ge your own transport for the clinic ent. For advice or questions, please contact k of this booklet. you a more accurate approximation of the u smoke as this is thought to delay bone ven below are approximate: Fixator for Non-union: hs to 12 months or more. Fixator for Limb LengtheninThis depends on the amount of lengtheniduring treatment that may delay the lengthening. Fixator for realigning a deformity: How long will the How often will I Infection at the pin site is a common problem. The pin site becomes sore. It may be slightly reddened or it may start to ooze. A pin site swab is taken to determine the type Staphylococcus Aureus. We ther is not left moist for too long. After 3 to 5 days on antibiotics the infe As your limb is being lengthened the bone gr the direction that you wish them to grow in. If you do not follow the instructions given by the physiotherapist, you risk permanent joint stiffness because the muscle is not being growing new bone. This can cause joint contthe joint and the degree of cprocedure, so you can perform exercises on“catch-up”. However, this does mean that the frame will be on for a longer period. 3. Wire or Pin Breakage. them from your limb. They can occasionally break during the treatment. In this case What type of with this treatment? During the first few weeks You are learning to adapt to the fixator andYou begin to see progress, whether it is a lessening deformity or leg lengthening being physio or exercises become tedious. time and life may have become pretty boring.! is a completely normal response to the treatment at this stage and please remember that these feelings will pass. t this stage it is extremely important to attend your clinic appointments. Take the time to talk to other patients. Try and think about activities or people that organise one activity or visit each week. Maybe tatime would help. Some examples are driving you mad, but you are able to see the light! We begin to neutralize the frame in clinic so that more weight is being put through the ill be discussed with you by your team of doctors at your clinic appointments. Soremoved at a clinic appointment. Remova day. Many patients rxator. (Some patients have light-weight splints) The length of time spent in this most patients spend 4 to 6 weeks in the plaster cast. ll patient’s experiences are different. Everyone had different coping mechanisms. down any information that you feel is important for us to know so that we can pass this information on to our future patients. How do people usually Frequently asked Questions orm them before you begin driving. es, swimming is known to be a beneficial exercise. After swimming, please shower your frame with clean water and dry the frame and pin sites. which will heat up extremely rapidly if exand soft tissues around your pin fixator limb protected from ex taking the pill up to 6 weeks following Am I allowed to drive my car with a fixator on? Am I allowed to go swimming? Am I allowed to Can I continue to take the myHRT? e hope that your external fixator will ontinuing your normal relationship with your partner. Fixator treatment can be stressful enough on its own, al life has to be put on hold untner from your protruding pins!! ndividual cases differ. When you return to you do, the extent of your injury, the type of fixator and type of treatment you are undertaking. There may be health and safereturn to work with the fixator, for example, in the food industry. Please talk to your (DEA) for advice. The DEA is usually based at your local Job Centre. obilise as much as possible and should contact the school or college to inform tand likely problems. us when discussing this with the teachers. (The OT can advise on this) assistant should be provided to supervise breaks and prefer to arrange home tuition for Health and Safety reasons. Wheelchairs may be loaned from your local wheelchair service or Red Cross, but do check with the OT. with my partner? work? When can my child go that we book hospital transport for you (either a car or ambulance). Please ask the IlAllowance if you are aged lehe disability has persisted Benefits Office, telephone number or doctor. You may neeif you are carrying a lot of drugs or medicines. ou can apply for a “certificate of Prepayment” which will support, you can pay for a 3 month discount prescription form, which for a one-off when having this treatment. Examples Mefenamic Acid, Ponstan, Aspirin. before the operation. What if I can’t afford Am I allowed to go on holiday? What if I can’t afford Are there any drugs I How to carry a your tea /coffee whilst on crutches Use a Thermos Flask carried in Put a Beach Towel in your baprevent your frame from scratching the enamel! Wrap a thin pillow around your frame at bedtime to Adidasusing a Haberdashery business located on Japlene Handmade Originals 6 Windmill Road Mon-Fri 0930-1730 Sat 0930-1400hrs or the quality or services provided by any business or service outside the Nuffield Hospital. haberdashery business nearer to Ilizarov Office Telephone: Ilizarov Clinical Nurse Specialist Mobile Bone Infection Unit Telephone: Mr Martin McNally & Mr David StubbsMedical Secretary Telephone: Mr Andy Wainwright Medical Secretary Telephone Mr Paul Critchley & Mr Henk Giele Medical Secretary: Telephone: Dr Berendt, Dr Byron & Dr Atkins Medical Secretary Telephone: Physiotherapy Department Occupational Therapy Department Community IV Team Social Services Benefits Help Line Community Legal Aid Line NHS Direct Tel (0845) 4647 (Free phone) NHS Direct: www.nhsdirect.nhs.uk www.groups.yahoo.com/group/ Advice on Medical Conditions: NOC Web Page: http://194.32.128.14/ STEPS Organization: This is where you can phone or email the parent of a child who are having similar treatment with an external fixator. Ilizarov Office Telephone: Maz Sutherland E-mail address: Marion.Sutherland@noc.anglox.nhs.uk Maz Sutherland Ilizarov Clinical Nurse Specialist Mobile Last Updated October 2007 Version Five ©