Doctors and scientists are constantly making discoveries to improve the quality of human life. In 1952, trauma surgeon Ilizarov created a device capable of maintaining performance and restoring lost health.
Advantages and disadvantages
The Ilizarov apparatus is a structure made of metal (carbon fiber), incorporating spokes that pass through parts of the bone at an angle of 90 degrees. The rods are attached to the rings by movable elements; as a result of their displacement, bone fragments can be formed as needed for therapy.
Initially, the device was massive and heavy, but thanks to modern alloys and metals, the design is lightweight, and the rings are replaced by half rings, plates and triangles.
The advantages of the device are:
- reduction of healing time for comminuted fractures and bone damage of varying complexity;
- there is no development of a false joint;
- You can lean lightly and load the damaged part of the body already on the third day after the procedure;
- when removing the device and bone supporting elements is not required additional operation and general anesthesia.
Disadvantages include aching pain at night in the puncture sites, unbearable itching and swelling in the places where the needles pass. This is due to the fact that during the process of drilling and applying the device, additional injury occurs. nerve ganglia, small and large vessels. Some patients complain of the inability to sit or lie normally or put on clothes.
Complications from wearing the structure can also include inflammation of the skin around the needles. At the initial stage, when prescribing antimicrobial therapy, this deficiency can be corrected.
To more severe consequences include osteomyelitis associated with infection through a wound during the use of a drill and the installation of knitting needles. This complication is avoided by using a low-speed drill that does not cause burns to bone tissue.
Application of the Ilizarov apparatus
The process of using the device is called osteosynthesis. The procedure allows you to compress and stretch bone fragments, forming a correct fusion.
The device is also used for:
- open and closed fracture varying degrees difficulties;
- complications after rickets;
- false joint;
- systemic diseases bones;
- pseudarthrosis;
- the need to correct growth, curvature of bones due to improperly healed fractures or genetic diseases;
- varus deformities of large joints or ankles.
Before installing the structure, you should evaluate general state the patient, check the skin (there should be no inflammation, since the use of knitting needles can aggravate the situation), the nature of the injury, the location of the fracture (the device works best on the fusion of tubular bones).
The main use of the device is to fuse bones and lengthen legs.
- For fusion of bones.
The main purpose of the structure is to fix bone fragments.
The Ilizarov apparatus is used for an open comminuted fracture, since improper fusion forms a false joint or the inability to fully move and maintain performance. Reliable fastening of bone fragments on the lower leg allows you to walk without waiting for complete recovery.
- To lengthen your legs.
To change the length of the limbs, it is necessary to disrupt the integrity of the skin and bones.
Basically, the tibia or femur is injured, and a pin is inserted into the fracture site. During the day, special mechanisms stretch the bone by 1 mm. In about 2 months, you can increase your height by 6 cm. The distraction process is long, sometimes the patient spends up to 12 months under the supervision of doctors. Traction causes pain and requires long rehabilitation. It is also necessary to remember about thinning bone tissue and increased vulnerability to injury.
Installation of the Ilizarov apparatus
To apply the device it is necessary surgery and general or local anesthesia.
Using a drill, two rods are installed into each bone fragment at right angles to each other. Afterwards, the knitting needles are attached to half rings, in which mechanisms for adjusting bone fragments are installed, using a special key. The number of rings may vary depending on the complexity of the fracture. As the rings come closer together, compression and bone formation occurs.
Treatment with the Ilizarov apparatus
The advantage of the installed device is the functional ability to move joints and muscles located nearby. Bone tissue regenerates faster and grows together correctly.
The Ilizarov apparatus is indicated for fractures of various etiologies:
- gunshot wounds to bone;
- open comminuted fractures;
- complications after purulent diseases;
- intra-articular fracture.
The design can be applied to any part of the body: spine, hands, feet, skull bones, pelvis, lower legs.
The Ilizarov apparatus on the arm is used for developmental disorders of bone tissue or for complex fractures. A structure is installed on the forearm for splinter injuries and displacements of the radius and ulna.
On the hip
Operations on femur made using:
- plates;
- pins;
- developed by Ilizarov.
Basically, the device is placed on the hip to correct the length of the legs or for the needs of plastic medicine (correction of bone curvature). Wearing the structure in these cases is long and can lead to complications:
- contracture and subluxation of the knee joint;
- disproportion;
- rough scars after removal of the needles and surgery;
- thinning of the femur.
On the shin
Due to the great complexity of the structure ankle joint The fusion of bone fragments after a fracture cannot be fixed with plaster.
The Ilizarov apparatus is used for shin fractures after car accidents, a strong blow and falls from towers or buildings.
The operation is performed for any complex fractures of the tibia and fibula, with open multi-fragmented injuries with associated fragmentation of joints.
Primary osteosynthesis should complete the surgical treatment of the wound. The patient is subjected to skeletal traction with a wire through the heel bone or talus joint to temporarily fix the fragments. A weight is placed on the splint and anesthesia is administered. The foot should have an angle of 90 degrees and occupy vertical position when applying the structure. The bone parts are fixed with knitting needles, which are attached to the rings. When the driving mechanism is shifted, the spoke is adjusted and proper bone formation occurs. Correction of the structure is carried out by a traumatologist in the department or during outpatient observation.
The Ilizarov apparatus on the lower leg accelerates the healing process and proper fusion, significantly reduces complications during the rehabilitation process and recurrent fractures.
Measures for recovery after a fracture
1) Physiotherapy.
Exercises have many advantages and are used for the following purposes:
- restore lost performance and movement in the joint;
- prevention of contractures;
- prevention of muscle atrophy;
- improvement of lymph flow;
- elimination of various complications (bedsores, stagnation of blood circulation)
Some movements are performed with the help of equipment or a physical therapy instructor. The main rule when performing exercises is the absence of pain and maintaining the integrity of the bone parts. The duration of the gymnastics is determined by the doctor.
2) Massage.
The timely start of massage sessions plays a role in:
- improving lymph and blood flow;
- strengthening ligaments and joints;
- reducing swelling;
- increasing muscle tone.
3) Physiotherapy.
- reduce pain;
- promote bone fusion;
- accelerate the period of recovery of working capacity of the upper and lower extremities.
For fractures, electrophoresis, UHF, paraffin baths, ozokerite treatment, magnetic therapy, and laser are used.
Contraindications to physiotherapy are:
- tumors;
- thyroid diseases;
- fever;
- dermatitis in the acute stage;
- mental illness;
- disruption of the heart.
4) Complete nutrition.
The diet should include foods rich in calcium, protein, minerals and vitamin complexes. It is recommended to eat more vegetables, fruits, and seafood. Additionally, you are allowed to take vitamin D.
also in recovery period Swimming helps a lot, giving up bad habits, frequent walks fresh air. Sometimes the doctor prescribes creams and various ointments against swelling, and for pain, decides which painkiller to give.
How long and how to wear the Ilizarov apparatus
Wearing the structure depends on the regeneration process and the injury itself.
When lengthening the legs, the device is used for 10 months, the minimum period of use is two months. The period of use of the structure is individual; the decision to remove it is made by doctors at a consultation.
During the treatment period after application of the Ilizarov apparatus, the patient should not give up his usual life. If desired, the device can be hidden by clothing with wide legs or sleeves. Already in the first week it is allowed to put a small load on the injured limb. If complications occur in the form of swelling or inflammation, compresses with a solution of dimexide or antibacterial therapy. A special cover made of natural material with elastic bands at the top and bottom will help reduce the likelihood of dust settling. Such a case protects the structure from injury when putting on clothes or while sleeping, and also saves from overheating in the sun or cold.
The price of the device depends on the fracture and its complexity, as well as the number of rings and spokes on the structure. Sometimes a design can cost up to 600 thousand.
How to remove the Ilizarov apparatus
Removal of the device occurs in the operating room, but is often done without anesthesia or pain relief. After removing the structure, small pinpoint wounds remain at the site of insertion of the rods, which should first be treated with dimexide or any other disinfectant and fast healing. After healing without associated infection, the wounds heal into almost invisible scars.
If the bone has not recovered sufficiently, the doctor may prescribe additional fixation using a plaster splint in preparation for future rehabilitation.
Caring for the device
Since parts of the structure pass through the skin and muscles on one side and come out on the other, in the absence of asepsis and antiseptics, inflammation is possible at the point where the needles enter. To prevent infection, a sterile cloth moistened is placed on each rod. alcohol solution. You can use vodka for disinfection. The napkins are changed every other day in the first two weeks of wearing the device, and after that – once every seven days.
In order to lengthen, shorten, correct curvature or fuse bones in the case of various pathologies, the Ilizarov apparatus is used. The simplicity of the design and reliability makes it possible to manipulate any bones. The device must be installed and removed experienced doctor. Wearing the device requires careful care from the patient.
Modern medicine considers the best device for surgical corrections bone tissue Ilizarov apparatus. Despite the fact that this product was invented back in the 50s of the last century, its design remains relevant to this day, constantly being improved. The therapeutic area of use of this device is quite wide. With its help, manipulations such as lengthening or compression of the bone, changing its curvature, healing fractures, treating articular contractures, and much more are possible.
Below we will tell you in more detail about what the Ilizarov apparatus is, why it is needed and for what pathologies its use is justified. We will also describe the principles of installation, removal, maintenance and point out the obvious disadvantages and advantages of the device.
Classic version of the Ilizarov apparatus
Important to remember! Surgical installation of the Ilizarov apparatus should only be performed by a physician experienced in performing such procedures. Before the operation, be sure to undergo full diagnostics body.
History of creation
Academician Ilizarov G. A.
Many scientists long time tried to create devices for transosseous osteosynthesis, which involves fusion of fragments of the bone structure. However, their attempts were unsuccessful. Only in 1952 Soviet surgeon and scientist G. A. Ilizarov created a device that creates all the conditions for effective implementation procedures of this kind. Initially, the device was called a “compression-distraction device” and consisted of two support rings connected by four adjustable rods. The device was mounted on the bone using two pairs of stainless steel knitting needles. The invention made it possible to solve many problems that arise during the treatment of various fractures and orthopedic diseases.
Device Description
In order to understand what the Ilizarov apparatus is, you need to know the constituent parts and elements of its design. The main purpose of the device is to provide rigid fixation of bone fragments in a certain place, eliminating any displacement. This effect is achieved using special knitting needles mounted on locking rings or semicircles, which in turn are connected by rigid rods. The needles are passed through bone tissue and are securely fastened with adjustable rods, which allows you to manipulate the course of therapy.
Early versions of the devices were very bulky and heavy, which caused a lot of inconvenience to patients. Modern modifications are made from lighter and more reliable materials, such as carbon fiber or titanium. Inconvenient rings are replaced with triangles, semicircles or plates. Also permanent medical research made it possible to adapt the device to almost any part of the body.
Design features allow a patient with a broken leg to move almost painlessly using crutches. This is achieved by distributing the weight of the human body over the entire area of the metal frame of the device.
Currently there are no analogues to this device.
Operating principle
Device installed on the patient's leg
Reposition or comparison of bone fragments with the Ilizarov apparatus is ensured by rigidly connecting the elements of the device with special fixing knitting needles. Management of fragments of bone structures is carried out by adjusting the position of frame supports.
Any manipulations with bones are carried out by changing the length of the regenerate. To do this, you need to twist the adjustable connections, thereby changing the distance between the locking rings.
A standard set of apparatus elements creates all conditions for the use of supports various types and configurations, as well as their connection with knitting needles on different levels and in any direction.
Remember! Only your doctor will tell you how long to wear the Ilizarov apparatus on your leg, arm or other part of the body. Under no circumstances should you make your own adjustments to the therapy process.
Indications for therapeutic use
Rickets is one of the main indications for the use of the Ilizarov apparatus
The main indications for the use of a compression-distraction device are such pathologies as:
- rickets;
- shortening of a limb, congenital or acquired;
- bone deformities;
- fractures of various origins;
- neoarthrosis (pseudoarthrosis).
This device also effectively copes with correcting bone curvatures and eliminating joint defects. The use of the Ilizarov apparatus ensures growth against the background of various skeletal diseases and aligns bones after infectious pathologies, tumors or injuries.
Using the transosseous osteosynthesis procedure, the following manipulations are performed:
- treatment of severe fractures of the thoracic, pelvic bones or spine;
- treatment of closed fractures;
- lengthening or compression of bones;
- corrective thickening and giving the bone the required shape;
- exclusion of skin grafting or grafting for open fractures;
- therapy for various dislocations with subsequent extension of ligaments;
- elimination of false joints;
- arthrodesis of large joints.
Modern medicine has created many modifications of the Ilizarov apparatus for the treatment of fractures and bone correction. There are models for the head, finger and hand, foot, thigh, lower leg, neck and the entire perimeter of the spine.
The device is also effectively used in orthopedic cosmetology to correct various curvatures and lengths of bones, clubfoot, articular defects, perform arthroplasty and correct the incorrect position of the body’s bones.
Important! Some types of fractures require mandatory application Ilizarov apparatus and cannot be treated with conventional plaster or orthosis. Assign The right way therapy can only be performed by a qualified physician.
Installation
Device mounted on the patient's arm
Installation of the device should be carried out exclusively by an experienced surgeon in the traumatology department. First of all, the surgical site is disinfected and anesthetized. Anesthesia can be either general or local, which directly depends on the severity of the injury and the extent of the surgical procedure.
At the beginning of the operation, the surgeon drills a pair of holes in each bone fragment and passes the wires through them at right angles, parallel to each other. Support rings (triangles, semicircles) are installed at the ends of the knitting needles and secured with special clamps. The rings, in turn, are fastened with adjustable rods. In the future, it is possible to change the distance between the rings by turning the rods with a key.
The compression effect is achieved by bringing the support frames closer together. Due to the constant change in the curvature of the knitting needles, it is necessary to tighten the barbells every day, as the compression force decreases.
Lengthening of the limb bones is carried out gradually. At the very beginning of the operation, the doctor performs a dissection (osteometry) of the bone, followed by installation of the device. A week after the procedure, the process of lengthening (distraction) begins. Stretching occurs due to an increase in the distance between the spokes due to the rotation of the nuts on the washers. The lengthening should not be more than one millimeter per day. Thus, to increase the bone by two centimeters, you need to rotate the device for an average of twenty days.
In case of cosmetic changes to the bone, identical manipulations are performed. An exception may be an immediate correction, when the curvature is corrected during surgery. Everyday curling is carried out mainly medical personnel or by the patient himself.
How long to wear the Ilizarov apparatus on the leg (or other part of the body) and total time treatment should be agreed with the surgeon.
After the patient's surgical procedures for a long time They suffer from pain, but this can be solved by constantly taking painkillers. Modern modifications of devices allow a person to move comfortably almost immediately after surgery.
Such manipulations can be performed not only on adult patients, but also on children. Often, a child’s fusion process occurs extremely quickly, which is important, given the specifics of the procedure. For this purpose, there are special children's sizes of devices.
Removal
The process of dismantling the device
The process of removing the Ilizarov apparatus should be carried out (if possible) by the same doctor who installed it. Anesthesia is often not required, since this process does not cause pain to the patient. However, some discomfort will still be present. First of all, the surgeon removes the rings and rods. Then he cuts off one end of the knitting needle and sticks it out of the bone. After this, the skin is treated disinfectants, and the doctor applies a plaster cast.
You need to start walking gradually. After removing the plaster, it is recommended to take several courses rehabilitation massage to restore normal blood circulation and accelerate regeneration.
Important! If the spokes themselves move, become dislodged, or become excessively deformed, seek medical attention immediately. If the device was placed askew or another error was made during installation, repeated procedures must be urgently performed. Ignoring it will lead to irreversible consequences.
Advantages and disadvantages
The obvious advantages of using this type of device include significant acceleration of the regeneration of damaged bone tissue and the possibility effective correction defects. Fusion of fractures using this device eliminates the development of the so-called “false joint.” An undoubted advantage is the fact that just a few days after the operation, a slight load on the injured limb is allowed.
Disadvantages include comparative inconvenience when dressing and wearing in general, strong painful sensations(especially at night) and the appearance of pinpoint scars at the site where the needles were installed.
Care measures
After the completion of the surgical operation, the doctor is obliged to teach the patient how to care for the device. First of all, it is necessary to wipe all parts of the structure with an antiseptic (preferably alcohol) without touching skin. This needs to be done daily.
In case of formation of inflammatory lesions and purulent discharge You must notify your doctor.
In order to reduce the risk of infection during wearing, you can resort to wearing a special antibacterial cover.
Price
Average device cost:
The cost of installing and removing the device varies from 2,000 to 10,000 rubles.
Conclusion
The Ilizarov apparatus is an effective device for the rapid fusion of damaged areas of bones and orthopedic correction bone defects. Following your doctor's instructions for caring for the device reduces the risk of developing purulent inflammatory processes. Numerous positive reviews indicate the high effectiveness of the device.
Instructions for use:
The Ilizarov apparatus was created in the early fifties of the twentieth century by the famous Soviet surgeon G. A. Ilizarov. The device, made by Ilizarov, consists of four metal skeletal traction spokes, fixed on two rings and interconnected by movable rods. Over the years, this device has been gradually improved. The modern Ilizarov apparatus is made of titanium with a high strength index. Modern designs use titanium or carbon fiber rods instead of spokes. The rigid rings in it are replaced with plates, semicircles and triangles. Quite light and small in size, modern medical device widely used in traumatology, in aesthetic medicine and orthopedics to correct body proportions, leg curvature, congenital deformities, clubfoot, abnormal development of the bones of the foot. This device used for rickets, pseudarthrosis, fractures various localizations and complexity, as well as to increase growth in systemic skeletal diseases, to treat joint contractures, to eliminate soft tissue and bone defects that occur after tumors, infections or injuries.
Installation of the Ilizarov apparatus
The Ilizarov compression-distraction apparatus is designed for distraction (stretching) or compression (squeezing), as well as for long-term fixation of individual bone fragments. With any fracture, the edges of the bone can become dislodged as the muscles pull them in different directions. The use of an Ilizarov apparatus on a leg or arm during a fracture prevents the displacement of bone fragments. It reliably fixes ununited fractures and false joints and does not require the use of additional plaster immobilization. Along with the treatment of false joints and non-united fractures, the device is successfully used to correct limb length.
The process of installing the Ilizarov apparatus on a leg or arm during a fracture occurs as follows. Two wires are passed through each bone fragment in the fracture area with a drill, crossing them at right angles. A couple of knitting needles each bone fragment fixed and secured in the ring (semi-ring) using a special key. When tightening the nuts on the moving rods, the distance between the rings changes. The bringing together of the rings provides compression between the edges of the fragments. Due to deformation of the spokes, the compression force gradually decreases. Therefore, the tension of the spokes must be monitored and adjusted daily. By skillfully manipulating the movable rods, it is possible to eliminate the displacement of fragments along the axis, angular deformations, and also perform closed reposition of bone fragments.
Leg lengthening using the Ilizarov apparatus is carried out in stages. First, the device is applied to the patient, then the bone is dissected (osteometry) and the fragments are fixed using an orthopedic device. Gradual lengthening of the legs (distraction) begins approximately one week after surgery. The rate of limb lengthening is one millimeter per day. The speed of distraction depends on the patient’s individual tolerance of this procedure. Thus, the duration of distraction when lengthening the limbs by five centimeters ranges from 50 to 75 days. The fixation period begins after the end of the leg lengthening period. Typically, the fixation period lasts twice as long as the distraction period.
Approximately a month later, surgery is performed on the second limb. Limb lengthening operations are performed under anesthesia. The patient can walk with the help of crutches already on the second day. During the rehabilitation period, the patient is recommended to swim and walk.
The Ilizarov apparatus is also used to correct the curvature of the limbs. During the operation, the bone is cut through the area of its deformation and then fixed in correct position using the device. Installation of the Ilizarov apparatus involves passing wires through the bones and inserting rods. Correction of the shape of the legs can be either gradual (the deformity is eliminated with daily correction) or one-step (correction is carried out directly during the operation). Daily adjustments are made by the patient themselves. The device is removed after the bones have fused in the correct position. Modern Ilizarov devices; They are relatively small in size, so the patient can fully move almost immediately after surgery.
Advantages and disadvantages of the Ilizarov apparatus
Installation of the Ilizarov apparatus can reduce the time required for fracture healing and reduce the likelihood of developing a pseudarthrosis to almost zero. Partial load on the injured limb is possible already on the second or third day after the procedure.
However, this device also has its drawbacks. Rings often interfere with sitting and lying down normally. After removal of the device, pinpoint scars remain at the puncture sites. Some reviews about the Ilizarov apparatus say that when using it, many patients experience swelling and It's a dull pain interfering with sleep.
Removal of the Ilizarov apparatus
Only a specialist can remove the device. As reviews say, the Ilizarov apparatus is most often removed without prior anesthesia.
After removing the Ilizarov apparatus, small wounds remain on the injured limb, which heal quite quickly. To speed up healing, wounds can be treated with disinfectants. Over time, almost invisible scars remain where the device was removed.
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Read more >>>Device Description
In order to understand what the Ilizarov apparatus is, you need to know the constituent parts and elements of its design. The main purpose of the device is to provide rigid fixation of bone fragments in a certain place, eliminating any displacement.
This effect is achieved using special knitting needles mounted on locking rings or semicircles, which in turn are connected by rigid rods. The needles are passed through the bone tissue and securely fastened with adjustable rods, which allows you to manipulate the course of therapy.
Symptoms
Basically, all victims who have received such an injury complain of:
- pain;
- swelling of the hand;
- hematomas on the skin;
- unusual hand mobility;
- crunch on examination;
- soreness - the patient does not know how to hold his hand because of the pain.
These are common manifestations in all types of fractures. The specific manifestations of a fracture are mainly related to its location. The table discusses the most common types of fractures.
Diagnostics
A traumatologist performs standard methods diagnostics:
- Patient interview. The doctor finds out the time and circumstances of the injury, and the symptoms bothering the patient.
- Inspection. The injured limb is examined. The intensity of pain, the presence of swelling, open wounds, forearm deformities. The condition of arteries and nerves, and limb functions are also assessed.
- X-ray. Radiography reveals the severity of the injury by the presence and number of bone fragments, the degree of their displacement, and the nature of the fracture.
An MRI or CT scan may be needed to diagnose complex injuries. According to the results of clinical and instrumental studies a final diagnosis is made and appropriate treatment is prescribed.
Treatment
Treatment is carried out in a hospital or outpatient setting, and depends on the severity of the injury. Treatment is divided into primary and auxiliary.
Basic treatment
The therapy is based on pain relief and immobilization of the affected limb. After eliminating the swelling, apply gypsum bandage or splint. It is necessary to give the physiological position of the hand - the hand is bent in elbow joint, the forearm is suspended on a scarf at chest level, with the palm facing inward.
In case of a fracture with displacement of a large number of fragments, surgery is performed. Under general or local anesthesia the surgeon performs reposition of fragments and osteosynthesis using metal plates or knitting needles.
Percutaneous fixation of fragments with wires has remained popular for many years. The knitting needles in the hand have both positive and negative sides.
Indications for therapeutic use
The main indications for the use of a compression-distraction device are such pathologies as:
- rickets;
- shortening of a limb, congenital or acquired;
- bone deformities;
- fractures of various origins;
- neoarthrosis (pseudoarthrosis).
This device also effectively copes with correcting bone curvatures and eliminating joint defects. The use of the Ilizarov apparatus ensures growth against the background of various skeletal diseases and aligns bones after infectious pathologies, tumors or injuries.
Where can I use the Ilizarov apparatus?
Ilizarov's DKA is successfully used in medical diversified orthopedic practice for the treatment of:
- complex fractures (displaced, comminuted, spiral, etc.)
- injuries and wounds in which fragmentation and crushing of bones occurs;
- reduction of dislocations;
- elimination of congenital and acquired bone deformations;
- chondrodysplasia;
- rickets;
- pseudarthrosis;
- post-traumatic and postoperative contractures.
The distraction device is also actively used in aesthetic medicine:
- straightening and lengthening the legs;
- changing the proportions of the leg (for example, lengthening the lower leg),
- correction of the shape of the foot, its length, etc.
Despite the modification of the form and materials, the essence of the treatment remains the same. On DA, if desired, you can carry out both one-stage and long-term reposition:
- with simultaneous traction, bone fragments are immediately set to a given distance using rods and fixed in this position;
- with prolonged stretching, the nuts are tightened several times every day, increasing the length of the rod by 0.75 - 1 mm per day
At the end of the period of distraction, the reverse process begins - compression, which usually lasts twice as long. At the same time, the length of the rods also decreases daily.
How long should you wear the device?
How long each stage lasts depends on the complexity of the fracture and individual characteristics the patient (his age, health, bone condition).
- Distraction stops when complete reduction is performed - bringing the fragments into an anatomical position corresponding to the state of the bone before the injury, and osteogenesis is completed.
- Compression is carried out as long as necessary for complete consolidation and hardening of the seam
- The device is removed when the attending physician establishes reliable stabilization (immobility) of all bone fragments.
The word “rapid” in relation to bone healing after complex fractures is a relative concept. The duration of installation of the device can be from 2 to 4 months, and sometimes more. But it is still better to wear the Ilizarov apparatus on your leg or arm for several months than to spend more than a year on repeated operations after unsuccessful reposition and plaster immobilization.
Ilizarov apparatus in cosmetic surgeries
The same scheme is used for so-called “cosmetic” operations to lengthen or straighten the legs (distraction osteogenesis), but there are important differences:
- Before lengthening or straightening surgery begins, the bone is subjected to an osteotomy, which means it is cut into two parts.
- The period of limb traction lasts longer than with a fracture: the duration depends on how many centimeters the leg is lengthened.
- The duration of the operation is also increased by the need to perform it on both legs: surgery on the second leg is performed in about a month (if there are no complications).
The duration of wearing the device is calculated based on a distraction of 1 mm/day. or 2.5 - 3 cm/month. This means that to increase height by 7 - 8 cm, it may take an average of 10 months (3 months - distraction, 6 - compression, 1 month - break between operations on the left and right leg).
How to install the Ilizarov apparatus
An X-ray of the broken arm or leg is taken in several projections.
- DKA is placed on a limb under local or general anesthesia, since transosseous osteosynthesis is quite painful procedure.
- In every bone fragment drill two holes located at an angle of 90˚ to each other.
- Titanium spokes are passed through the holes.
- Then the remaining structural elements are installed: rings in which the spokes are secured with a key, and supporting rods, the length of which is adjusted using nuts, depending on the mode.
- Every day the distance between the rings is changed by tightening the nut by the patient himself (the patient receives detailed instructions from the attending physician).
How to remove a distraction device
The device has been known in medicine since 1952, when it was invented by the famous surgeon Ilizarov. Using this design, it was possible to fix the bones for a long time, providing tension or compression of the bone tissue. An improved version of this device has survived to this day, which is recognized as the main means for bone restoration.
First aid for a fracture
First health care consists of simple events. Before the ambulance arrives you need to:
- give the victim a non-narcotic pain reliever (analgin, ibuprofen, baralgin);
- stop the bleeding;
- treat the wound with an antiseptic;
- If possible, apply ice to the fracture site;
- A hand bandage made from scrap materials in the form of a scarf will help immobilize the affected limb.
You cannot try to compare the fragments yourself. In this way, you can only harm the victim, causing displacement of fragments and rupture of arteries, blood vessels and nerves.
Price
The cost of installing and removing the device varies from 2,000 to 10,000 rubles.
I am a Muscovite, a retired officer. I served and taught at one of the military academies in Moscow. Now I’m 67. Physically developed, without bad habits.
Currently I live in a remote rural area 120 km from Moscow
The disaster happened at the end of January this year.
I had a heart attack at the moment when I was at a height of 7m from the ground (checking the amount of snow on the roof), and I unconscious fell like a sack onto the concrete path...
I woke up in the intensive care unit of a Moscow military hospital after surgery on the spine (damage to the 3rd and 4th vertebrae) and with a cast on both legs. (closed reposition of calcaneal bone fragments. correction of dislocation in the Chopart joint using a cutting machine and diafixation with knitting needles. immobilization with a plaster cast)
A week after the operation, deep ulcers developed on the right leg in a cast as a result of an incorrectly installed disc.
The plaster was removed, the ulcers were treated for a week, and on March 26, an Ilizarov app was installed for a 4mm stretch and sent home for a month.
I was recommended to tighten these nuts by 03mm every day for 12 days - which is what I did. But it didn’t work out every day, because the twisting procedure brought me unbearable pain. I was specifically afraid of getting a painful shock. Moreover, this is a post-infarction state......
There was no one to consult about the pain; it was almost impossible to reach the hospital by phone, and the local doctors were incompetent
The device was worn for 3 months, moving with the help wheelchair, and then a walker and finally, on June 25, the Ilizarov apparatus was removed. The doctors said that I was great, and so positive result they didn't expect it. They pulled out the needles without anesthesia, the pain was hellish, and then they said - everything is fine, get up and learn to walk slowly on your own. Pensioners are denied inpatient rehabilitation.
They didn’t give me any advice on how to properly recover. They say that we did the operation normally, and what happened next was none of our business.
The only thing they recommended was that I buy a detachable bandage at knee-joint, which is what I did.
Came home with severe pain, the next day the leg was very swollen..
What to do, where to get advice about edema and others possible consequences I don’t know what lies ahead of me...
Perhaps there are some printed materials on rehabilitation, and where can they be purchased?
There will probably be problems with the knee joint (it bends poorly)
state muscle mass(during this time I lost 20 kg.)
Possible problems with the spine and cardiac activity
Visit paid rehabilitation centers I have neither physical nor material opportunity - all my savings went to pay for the operation itself, expensive medications, the purchase of a special medical bed, wheelchair, and etc.
HOW SHOULD I BE IN A SIMILAR SITUATION, TELL ME
