What is an Ilizarov external fixator?
An Ilizarov external fixator (Ilizarov frame) is a ring-like brace (see figure 1). The frame is applied to the outside of the limb and connected through the unbroken part of the bone inside the limb.
This is done by using a number of tensioned wires sometimes called pins. These wires/pins are attached to metal rods on the outside frame to provide bone stability.
Figure 1. Ilizarov frame on lower leg
This system helps provide a structural support to the limb and holds the broken bone fragments together so healing can take place over a period of time. It may be necessary to have this frame on your limb for a number of months.
An Ilizarov frame is used to:
- help heal complex fractures (complicated broken bones)
- help heal severe skin or tissue loss
- lengthen long bones if too much bone has been lost at the time of accident by allowing new bone to grow in between the two broken bone ends
- correct congenital or traumatic deformity of the bones.
What happens when you get to hospital?
On admission to hospital an orthopaedic doctor will see you and explain the Ilizarov procedure. This procedure needs to be done in an operating theatre and requires a general anaesthetic.
- You will be asked to sign a consent form to have this operation done.
- A staff member will complete your admission documentation, take your blood pressure, heart and breathing rate and check the nerve and blood supply of the limb that you will be having the Ilizarov frame applied to.
- You will also see an anaesthetist who will examine you and discuss pain relief medication and other important factors related to giving you an anaesthetic.
- You will be required not to eat or drink anything for several hours prior to your procedure.
- On the day of the operation, you will need to shower or be washed with an antiseptic wash and dressed in a theatre gown.
What happens after the operation?
- You will wake up in the recovery area of the operating theatres. Once you are awake and stable you will be transferred back to the ward area; you may still be feeling quite drowsy.
- You will have frequent checks of your limb, blood pressure, heart and breathing rate.
- Expect to see some blood or blood stained fluid draining from the pin sites, this is normal for the first 1 to 2 days.
- You may have an intravenous drip in your arm. This can be removed when you are drinking, eating and have urinated.
- If you are experiencing pain tell your nurse as they will be able to get pain medication for you.
A nurse will:
- clean your pin-sites for the first few days
- teach you and/or a nominated person how to care for your pin-sites when you are discharged home
- show you how to shower with the frame
- organise for the linen room to make a cover for your Ilizarov frame to prevent you causing damage to your other limbs, clothes and bed linen from the exposed pins.
A physiotherapist will teach you:
- exercises to keep your joints moving
- exercises to strengthen the muscles in your limb
- how to walk with crutches if required.
If you have a frame on your lower leg the physiotherapist may be required to make you a foot splint. This helps to stretch the Achilles tendon and prevents foot drop.
The doctor will:
- explain how much weight you can put on the limb that has the Ilizarov applied
- tell you when follow up care is required
- discuss when you can return to work
- provide any further medications, work certificates or letters required on discharge home. Please tell your doctor what certificates you will need on discharge.
What happens when you go home?
When you are back home you should take care to avoid:
- contamination of the pin sites, for example. keep your pets away from your frame
- dirt coming into contact with your pin sites and frame
- any high level activity, for example running, jumping or lifting
Do not drive a car or apply ointments or creams to the limb that has the frame on unless instructed by your doctor or nurse.
Taking care of your frame
- You can shower normally if your doctor has told you to do so
- Make sure that the limb that has the Ilizarov frame on is always dried well after showering.
- Continue to clean the pin sites in the shower at least daily or with sterile swab sticks and water that has been boiled, then cooled. Use the technique taught to you while in hospital. Please ask your nurse for sterile swab sticks before leaving hospital.
- Ensure that the skin moves freely up and down the pin.
- Leave any crusts that form around the pins. If left the crusts are a natural barrier from infection.
- Massage the pin sites, without touching the entry site with your fingers, to make sure the skin is moving freely.
- When sitting or lying down elevate your limb as this helps to reduce swelling.
- You may need to make changes to your clothing so that they accommodate the frame. Simple adjustments with velcro or buttons down the seam of pants helps overcome this problem.
Seek immediate medical advice if you notice:
- changes around the pin sites such as redness, swelling, discharge or increase in pain and fever. This may mean you have an infection and may need antibiotics.
- any changes such as pins and needles or numbness in your limb with the Ilizarov frame.
- loose wires or pins on your frame. Do not try any modifications yourself or let anyone else do this.
- You may have weekly outpatient appointments at first, followed by monthly appointments, to check on the progress of the bone healing. Please check with your doctor before leaving hospital when you are required to come back for outpatient appointments.
Where to get help
- Contact the hospital or health facility where you were given your Ilizarov frame.
- See your doctor.
- Visit a GP after hours.
- Ring healthdirect Australia on 1800 022 222.
Royal Perth Hospital
This publication is provided for education and information purposes only. It is not a substitute for professional medical care. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your healthcare professional. Readers should note that over time currency and completeness of the information may change. All users should seek advice from a qualified healthcare professional for a diagnosis and answers to their medical questions.