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

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

Oct 20, 2023 446 likes •761 views

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

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SLIDE 1

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

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SLIDE 2
  • 1. LATENCY PERIOD

ON LEAVING OPERATION THEATRE

  • Check pin – tract dressing
  • Pressure dressing over operative site
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ON LEAVING OPERATION THEATRE

  • Cover the entire frame
  • Take check X-rays
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SLIDE 4

POST OP. – DAY 1

  • Evaluate pin site
  • Positioning : elevation,

knee extension, ankle dorsiflexion

  • Isometric and ROM exercise
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SLIDE 5

POST OP. – DAY 1

  • Splints: Night splints,

Dyna splint

  • Partial wt. Bearing, if tolerated

with compensation & walker / support

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SLIDE 6

LATENCY PHASE (CONT.)

  • Dressing S.O.S., antibiotics S.O.S.
  • Positioning : knee ext., ankle dorsiflex
  • Isometric and R.O.M. exercise / CPM
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SLIDE 7

LATENCY PHASE

  • Splints : night splints, dyna splint
  • Partial wt. Bearing with bilateral support,

level ground and stairs

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SLIDE 8

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

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SLIDE 9

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
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SLIDE 10

2.DISTRACTION PHASE

  • Recheck dressings
  • Recheck wire tension, skin around wires
  • Mark the direction and amount of turns
  • Teach distraction to the patient
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SLIDE 11

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

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SLIDE 12

DISTRACTION PHASE

  • Rate and rhythm adjusted to age, type of

corticotomy, pathology

  • Pain relief generally required ice, heat,

analgesics, TENS

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SLIDE 13

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

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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

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SLIDE 15

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

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SLIDE 16

DISTRACTION PHASE

  • Watch for nerve palsy
  • More aggressive physiotherapy:

stretching active exercises, more

  • wt. Bearing
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SLIDE 17

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

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SLIDE 18

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.)

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SLIDE 19

STABILIZATION PHASE (cont.)

  • Encourage full wt. bearing without lateral

supports / Dynamize the frame

DYNAMIZATION

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SLIDE 20

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

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SLIDE 21

4.PROTECTION PHASE Calliper Coarset Brace Crepe support

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SLIDE 22

5.POST – PROTECTION PHASE

Out of cast or brace

 All four cortices formed  Resistive physiotherapy  No contact sports till medullary canal appear

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SLIDE 23

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

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Ilizarov Lengthening of leg as well as first meta-tarsal to correct deformity and leg length discrepancy

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Leg Discrepancy as well as foot deformity fully corrected

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SLIDE 26

NAHID–RPM Lt. Lower Limb with 5 cms. shortening

Double level corticotomy weak regenerate at lower corticotomy

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SLIDE 27

HEENA

PRE – OP.

12 yrs. Old female had crush injury of foot & ankle with bone loss and damage lower epiphysis & foot was tagaling

  • n 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

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SLIDE 28

FINAL FOLLOW-UP

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SLIDE 29
  • 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
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