8

The IIizarov External Fixator

A Physiotherapist will visit your child at home to make sure your child is moving safely
and doing exercises properly. Depending on your child's needs, health care providers
from the Community Care Access Centre may also visit your child at home.

Your child will need to wear this device for many months. The hospital teacher and
the school principal can help you arrange for a home instruction teacher or plan for
your child's return to school.

Before you go home, the nurses will review your child's care. They will arrange
appointments for x-rays and visits with your child's surgeon at the clinic or the The Ilizarov External Fixator
surgeon's office.

What is the Ilizarov external fixator?

When should I call the surgeon?
The Ilizarov external fixator is the name of a device that is used to lengthen bones. It is a
Call the surgeon right away if you notice your child has any of these problems: very powerful tool that may also be used to stabilize fractures, regrow lost bone or correct
deformities in the length rotation or angles of bones.
• the pins, wires or rods come loose from the device
• your child feels ill or has a fever; a temperature higher than 38.5°C or 101.3°F This picture shows the Ilizarov device on the lower leg.
• continued redness, swelling, bleeding or discharge from the pin sites
• pain that does not go away or seems to be getting worse
• unable to eat or drink as usual
• nausea or vomiting

For Dr. Missiuna, call 905-527-3014 (office) or 905-540-0373 (pager).

If you cannot reach the surgeon bring your child to the emergency room at the
McMaster Children's Hospital (the McMaster University Medical Centre site of
Hamilton Health Sciences).

© Hamilton Health Sciences, 2003

PD 4850 – Reviewed: 01/2008
WPC\PtEd\CH\IlizarovExFixator-lw.doc
dt/January 2, 2008
____________________________________________________________________________
2 7
The IIizarov External Fixator The IIizarov External Fixator

How does this device work? The surgeon will direct the Physiotherapist as to what exercises need to be done
and whether weight bearing is allowed. Exercises stretch the muscles around the
The device is attached to two ends of the bone during surgery. When the device is area where the device is located. Your child will need to do exercises until the
adjusted several times a day, tension pulls the ends of the bone slightly apart. The body's device is removed.
natural healing process fills in this space with new bone. The bone can be lengthened by
about 1 mm each day. The device remains in place until the new bone becomes strong. As the device is heavy and cumbersome, your child may feel clumsy or unstable
This process may continue over several months. when walking. Your child may need help to move around at first. He or she needs
to take care that the device does not hit anything.

Exercises are very important. Weight bearing as instructed helps bone to form.

Your child should avoid:

What will it be like to wear this device? • any activity that would get dirt on or near the pin sites
You and your child need to prepare yourselves for what is involved with wearing • sports that would damage or create pressure on the device
this device. Your child can expect to wear the device for 6 months to one year.
This requires a big commitment of time and effort, for the parents and the child.
When can my child go home?
Each day that your child wears the device, you or your child must follow strict
instructions to: The usual hospital stay is 4 to 7 days. The surgeon will decide when your child can
go home. This will depend on whether:
• care for the many pin sites by cleaning the skin carefully at least 2 times a day
and after each shower • your child's pain is well controlled
• your child can eat and move about
• adjust the device using a technique called distraction 4 times a day
• the incisions are healing well
It takes time to adjust to wearing this large, heavy device. Your child may feel • all the teaching about the adjustment of the Ilizarov device is completed and
frustrated or overwhelmed at times. understood
• all the teaching about self-care is completed
• arrangements are made for any equipment or care needed at home

The health care team will help you prepare to take your child home. Before you can
go home, you or your child must be able to do the distraction and care for the pin sites.

The Physiotherapist will help you arrange for a wheelchair and possibly a walker to
use at home. An Occupational Therapist may talk with you to see if your child will be
able to manage comfortably at home.

please turn over Î

6 3
The IIizarov External Fixator The IIizarov External Fixator

What is "distraction"? How do I adjust the device

each day to lengthen the bone?
What happens before surgery?
The treatment process used to lengthen the bone is called distraction.
Distraction pulls the ends of the bone slightly apart. At first, the nurses will do Your child will have an appointment in the Pre-op Clinic in the Same Day Surgery
the distraction. Then the doctor and nurses will start to teach you or your child Unit. A Child Life Specialist and a nurse will help you and your child prepare for
(depending on his or her age and ability). You or your child can do the distraction surgery. Depending on your child's needs, your child may also see the anesthesiologist.
when you feel comfortable. You will be given a checklist of instructions to follow the day before surgery.

The distraction must be done 4 times a day, following strict instructions. On the day of surgery, come to the Same Day Surgery Unit. Your child will change
During treatment, you will be given specific instructions if a change to distraction into hospital clothes and go to the operating room with you.
is required. If the distraction is done too often or not often enough, the bone will not
lengthen properly. There can be serious complications, including having to have You may be asked to bring your child's shoes with you so they can be put on after the
surgery again. surgery to act as a splint for the foot.

The adjustment required for the distraction depends on the type of Ilizarov device.
Your doctor and nurse will show you how to do distraction with your device.
Some devices have a dial that you turn with a "click". Other devices are adjusted
by making a quarter turn with a wrench at specifically indicated nuts.
What happens during surgery?
If your child’s needs are complex, other distraction techniques such as compression
Your child will be given a general anesthetic so that he or she will be asleep during
and/or rotation are used. The doctor will give you specific instructions.
surgery and not feel any pain.

The Ilizarov device is attached to your child's bone. Small incisions are made in the
skin where the wires and pins go. The surgeon may need to make other incisions
What activity can my child do? depending on the type of surgery needed. Surgery may last from several hours to most
It may take time for your child to adjust to wearing this device. He or she may find of the day. At the end of the surgery, the operating room staff may put your child's
shoe on, to help keep the foot in the right position.
dressing is easier with pants or shorts that have Velcro™ at the sides. The nurse or
Child Life Specialist can provide suggestions for your child's clothing.

It is important that your child continue with his or her daily activities and get lots
of rest – 8 to 10 hours a day. The Physiotherapist will encourage your child to
gradually increase his or her activity in the first few days after surgery. Your child
will need to use a walker or crutches, depending on his or her age, weight bearing
instructions, balance and ability. This will be painful at first, so your child will be
given pain medication before activity.
4 5
The IIizarov External Fixator The IIizarov External Fixator

What happens after surgery? How do I take care of the pin sites?
Your child will go the Post Anaesthetic Care Unit (PACU) after surgery. In the Your child will have many pin sites from the device. For the first few days, there will
PACU, your child will be closely monitored until he or she is fully awake. As soon be bleeding and swelling around each site. During this time the nurse will clean away
as possible, the nurse will bring you to the PACU to be with your child. the blood around each site. For the next few weeks, clear fluid may drain from each
pin site.
When your child is fully awake, you and your child will go to the children's ward.
The nurses will continue to check: Clean and check all pin sites at least 2 times each day and after each shower.

• your child's vital signs - breathing, heart rate, blood pressure, and temperature Follow these steps to clean and care for the pin sites:
• the blood flow in the limb with the device 1. Wash your hands with warm water and soap. Rinse and dry hands.
• the wire and pin sites 2. Clean the skin around each pin site with a clean cotton tipped swab (such as
• your child's position and comfort a Q-tip™) and the solution prescribed by the doctor. Using a circular motion
starting at the pin, wipe around each pin once and throw the swab away. Repeat if
needed, wiping in circles, working outwards away from the pin. Remember to
clean all pin sites. Your child can help you keep count.

3. Any crusts of clear drainage should be removed from around the sites.
How can I help my child feel more comfortable?
4. If the skin is stuck to the pin, gently massage the skin.
After surgery, the amount and type of pain is different for each child.
5. Check each pin site and call the doctor if you notice:
Your child will feel a lot of pain for 3 to 4 days after surgery. During this time your
child will be given pain medication through the intravenous line, by epidural or by • swelling
mouth. When you go home, the surgeon will give you a prescription for pain • redness or heat
medication.
• change in the type, colour and odour of drainage
To learn more, ask your nurse for the information sheet called Learning about • tightness of the skin
relieving your child's pain. • change in the colour of the skin
• increased pain or tenderness
• pin movement
6. Use a clean cotton swab to put Polysporin® ointment around each pin site.
Use each swab only once, then throw it away. Do not wrap anything around
the sites.
While this device is in place, your child may have a shower, not a bath.
After the shower, dry the surrounding skin well with a clean towel. Then follow
the steps for pin site care.
4 5
The IIizarov External Fixator The IIizarov External Fixator

What happens after surgery? How do I take care of the pin sites?
Your child will go the Post Anaesthetic Care Unit (PACU) after surgery. In the Your child will have many pin sites from the device. For the first few days, there will
PACU, your child will be closely monitored until he or she is fully awake. As soon be bleeding and swelling around each site. During this time the nurse will clean away
as possible, the nurse will bring you to the PACU to be with your child. the blood around each site. For the next few weeks, clear fluid may drain from each
pin site.
When your child is fully awake, you and your child will go to the children's ward.
The nurses will continue to check: Clean and check all pin sites at least 2 times each day and after each shower.

• your child's vital signs - breathing, heart rate, blood pressure, and temperature Follow these steps to clean and care for the pin sites:
• the blood flow in the limb with the device 1. Wash your hands with warm water and soap. Rinse and dry hands.
• the wire and pin sites 2. Clean the skin around each pin site with a clean cotton tipped swab (such as
• your child's position and comfort a Q-tip™) and the solution prescribed by the doctor. Using a circular motion
starting at the pin, wipe around each pin once and throw the swab away. Repeat if
needed, wiping in circles, working outwards away from the pin. Remember to
clean all pin sites. Your child can help you keep count.

3. Any crusts of clear drainage should be removed from around the sites.
How can I help my child feel more comfortable?
4. If the skin is stuck to the pin, gently massage the skin.
After surgery, the amount and type of pain is different for each child.
5. Check each pin site and call the doctor if you notice:
Your child will feel a lot of pain for 3 to 4 days after surgery. During this time your
child will be given pain medication through the intravenous line, by epidural or by • swelling
mouth. When you go home, the surgeon will give you a prescription for pain • redness or heat
medication.
• change in the type, colour and odour of drainage
To learn more, ask your nurse for the information sheet called Learning about • tightness of the skin
relieving your child's pain. • change in the colour of the skin
• increased pain or tenderness
• pin movement
6. Use a clean cotton swab to put Polysporin® ointment around each pin site.
Use each swab only once, then throw it away. Do not wrap anything around
the sites.
While this device is in place, your child may have a shower, not a bath.
After the shower, dry the surrounding skin well with a clean towel. Then follow
the steps for pin site care.
6 3
The IIizarov External Fixator The IIizarov External Fixator

What is "distraction"? How do I adjust the device

each day to lengthen the bone?
What happens before surgery?
The treatment process used to lengthen the bone is called distraction.
Distraction pulls the ends of the bone slightly apart. At first, the nurses will do Your child will have an appointment in the Pre-op Clinic in the Same Day Surgery
the distraction. Then the doctor and nurses will start to teach you or your child Unit. A Child Life Specialist and a nurse will help you and your child prepare for
(depending on his or her age and ability). You or your child can do the distraction surgery. Depending on your child's needs, your child may also see the anesthesiologist.
when you feel comfortable. You will be given a checklist of instructions to follow the day before surgery.

The distraction must be done 4 times a day, following strict instructions. On the day of surgery, come to the Same Day Surgery Unit. Your child will change
During treatment, you will be given specific instructions if a change to distraction into hospital clothes and go to the operating room with you.
is required. If the distraction is done too often or not often enough, the bone will not
lengthen properly. There can be serious complications, including having to have You may be asked to bring your child's shoes with you so they can be put on after the
surgery again. surgery to act as a splint for the foot.

The adjustment required for the distraction depends on the type of Ilizarov device.
Your doctor and nurse will show you how to do distraction with your device.
Some devices have a dial that you turn with a "click". Other devices are adjusted
by making a quarter turn with a wrench at specifically indicated nuts.
What happens during surgery?
If your child’s needs are complex, other distraction techniques such as compression
Your child will be given a general anesthetic so that he or she will be asleep during
and/or rotation are used. The doctor will give you specific instructions.
surgery and not feel any pain.

The Ilizarov device is attached to your child's bone. Small incisions are made in the
skin where the wires and pins go. The surgeon may need to make other incisions
What activity can my child do? depending on the type of surgery needed. Surgery may last from several hours to most
It may take time for your child to adjust to wearing this device. He or she may find of the day. At the end of the surgery, the operating room staff may put your child's
shoe on, to help keep the foot in the right position.
dressing is easier with pants or shorts that have Velcro™ at the sides. The nurse or
Child Life Specialist can provide suggestions for your child's clothing.

It is important that your child continue with his or her daily activities and get lots
of rest – 8 to 10 hours a day. The Physiotherapist will encourage your child to
gradually increase his or her activity in the first few days after surgery. Your child
will need to use a walker or crutches, depending on his or her age, weight bearing
instructions, balance and ability. This will be painful at first, so your child will be
given pain medication before activity.
2 7
The IIizarov External Fixator The IIizarov External Fixator

How does this device work? The surgeon will direct the Physiotherapist as to what exercises need to be done
and whether weight bearing is allowed. Exercises stretch the muscles around the
The device is attached to two ends of the bone during surgery. When the device is area where the device is located. Your child will need to do exercises until the
adjusted several times a day, tension pulls the ends of the bone slightly apart. The body's device is removed.
natural healing process fills in this space with new bone. The bone can be lengthened by
about 1 mm each day. The device remains in place until the new bone becomes strong. As the device is heavy and cumbersome, your child may feel clumsy or unstable
This process may continue over several months. when walking. Your child may need help to move around at first. He or she needs
to take care that the device does not hit anything.

Exercises are very important. Weight bearing as instructed helps bone to form.

Your child should avoid:

What will it be like to wear this device? • any activity that would get dirt on or near the pin sites
You and your child need to prepare yourselves for what is involved with wearing • sports that would damage or create pressure on the device
this device. Your child can expect to wear the device for 6 months to one year.
This requires a big commitment of time and effort, for the parents and the child.
When can my child go home?
Each day that your child wears the device, you or your child must follow strict
instructions to: The usual hospital stay is 4 to 7 days. The surgeon will decide when your child can
go home. This will depend on whether:
• care for the many pin sites by cleaning the skin carefully at least 2 times a day
and after each shower • your child's pain is well controlled
• your child can eat and move about
• adjust the device using a technique called distraction 4 times a day
• the incisions are healing well
It takes time to adjust to wearing this large, heavy device. Your child may feel • all the teaching about the adjustment of the Ilizarov device is completed and
frustrated or overwhelmed at times. understood
• all the teaching about self-care is completed
• arrangements are made for any equipment or care needed at home

The health care team will help you prepare to take your child home. Before you can
go home, you or your child must be able to do the distraction and care for the pin sites.

The Physiotherapist will help you arrange for a wheelchair and possibly a walker to
use at home. An Occupational Therapist may talk with you to see if your child will be
able to manage comfortably at home.

please turn over Î

8
The IIizarov External Fixator

A Physiotherapist will visit your child at home to make sure your child is moving safely
and doing exercises properly. Depending on your child's needs, health care providers
from the Community Care Access Centre may also visit your child at home.

Your child will need to wear this device for many months. The hospital teacher and
the school principal can help you arrange for a home instruction teacher or plan for
your child's return to school.

Before you go home, the nurses will review your child's care. They will arrange
appointments for x-rays and visits with your child's surgeon at the clinic or the The Ilizarov External Fixator
surgeon's office.

What is the Ilizarov external fixator?

When should I call the surgeon?
The Ilizarov external fixator is the name of a device that is used to lengthen bones. It is a
Call the surgeon right away if you notice your child has any of these problems: very powerful tool that may also be used to stabilize fractures, regrow lost bone or correct
deformities in the length rotation or angles of bones.
• the pins, wires or rods come loose from the device
• your child feels ill or has a fever; a temperature higher than 38.5°C or 101.3°F This picture shows the Ilizarov device on the lower leg.
• continued redness, swelling, bleeding or discharge from the pin sites
• pain that does not go away or seems to be getting worse
• unable to eat or drink as usual
• nausea or vomiting

For Dr. Missiuna, call 905-527-3014 (office) or 905-540-0373 (pager).

If you cannot reach the surgeon bring your child to the emergency room at the
McMaster Children's Hospital (the McMaster University Medical Centre site of
Hamilton Health Sciences).

© Hamilton Health Sciences, 2003

PD 4850 – Reviewed: 01/2008
WPC\PtEd\CH\IlizarovExFixator-lw.doc
dt/January 2, 2008
____________________________________________________________________________