Ilizarov frame assemblage

fixation of ilizarov.

1. ILIZAROV FRAME ASSEMBLAGE General considerations 1.Stability of frame fixation to bone. 2.Prevention of bone fragment motion. 3.Ability to manipulate.

2. FRAME CONSTRUCTION FIRST TYPE Advanced Preparation – Time saving but require adjustments.

3. SECOND TYPE Construction during surgery.

4. RING POSITION

5. RING LEVEL Determines distribution of the forces.

6. SPACE BETWEEN SKIN AND RING 3 cm minimum at the narrowest gap.

7. RING POSITIONING AT OSTEOTOMY/CORTICOTOMY, NONUNION AND/OR FRACTURE SITES S tability of this frame depends on the level and position of the pusher-puller ring. I t is placed no closer than 2 cm and no further than 4-5 cm from the tip of the fragment end. B one fragment end structure almost always is weakened by the microfractures during osteotomy or fracture, In non union it is weakened by regional osteoporosis. N eed for the free-fragment-end structure preservation in above all conditions.

8. RING ORIENTATION M ust be aligned for the connection , so half-rings are situated along the same straight line.

9. WIRES – TYPES AND UTILIZATION General considerations. Technique of k-wire introduction. Wire positioning on same ring. Offset wire positioning. Wires with stoppers. Proper distance of wire from joints. Wire tensioning. Affixing wire to ring. Reducing ( correcting ) wire. Wire re tensioning technique. Wire cutting and bending. Guide wire Pulling / Traction wire Bone fixation with half pin.

10. 1.General considerations K – wire when drilled destroys verylittle bone,tissue,marrow. If tensioned properly it decrease vibration and prevent soft tissue, bone destruction by its elasticity. Small penetration holes, so minimum contamination.

11. K-WIRE INTRODUCTION TECHNIQUE

12. WIRE POSITIONING ON SAME RING

13. DISTANCE FROM JOINTS,DIRECTION

14. WIRE TENSIONING

15. The range of the wire tensioning strength is 50 -130 kg . General recommendations 1 . Wire on half-ring: 50 to 70 kg. 2 . Offset (drop) wire, depend on supporting posts: 50 to 80. 3 . Single wire on a ring: up to 100 kg. 4 . Two to three wires on a ring in a young patient: 110 kg for each wire. 5 . Two to three wires on a ring in an adult patient: 120-130 kg for each wire. 6 . Wire with an olive stopper: 100 - 110 kg 7 . Wires with olive stoppers used for inter fragmentary compression 50 kg.

16. TENSIONING TECHNIQUE

17. AFFIXING WIRE TO RING

18. REDUCING (CORRECTING) WIRE

19. WIRE RETENSIONING TECHNIQUE In the long course of treatment, some of the wires will become slack as a result of metal fatigue and enlargement of the holes in the bone Slack wire produces pain , and inflammation Low-pitched tone when the wire is tapped confirms weakened tension and loss of stiffness . Re tensioning is performed by applying two wrenches simultaneously to the head of a fixation bolt and a nut and slowly turning both of them a quarter-turn or half turn

20. WIRE CUTTING AND BENDING

21. GUIDE WIRE Prevent 2 level distraction and fragment deviation . Provide axial stability.

22. PULLING OR TRACTION WIRE Connect between movable fragment and traction mechanism.

23. BONE FIXATION WITH HALFPINS 90 DEGREE ARCH 120 DEGREE ARCH