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

PROF. DR. J. J. PATWA Absract no.- 1172 Contact no.- +919824036131

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

•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).

Hypo-plastic Well formed

Accordian Method

REGENRATE

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)

• Watch for developing contractures:

- if straps or splints inadequate

Consider EARLY TAL/ankle fixation

(Foot Frame)

Foot

Frame

Contracture Prevention Dyna Splint

Elevation

Foot Frame

Cause

DISTRACTION PHASE

• Watch for developing contractures:

- if straps or splints inadequate

Consider EARLY TAL/ankle fixation

(Foot Frame)

Hinge Push Construct

Olive

PT prone

Anticipated pre-construct

DISTRACTION PHASE

• Watch for nerve palsy • More aggressive physiotherapy: stretching active exercises, more wt. Bearing

DISTRACTION PHASE

• X-ray : after giving a few days for slack, and a few

days for distraction: about 10 days

Accordian Method

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.)

• Encourage full wt. bearing without lateral

supports / Dynamize the frame

DYNAMIZATION

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. 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

PROF. DR. J. J. PATWA