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Ilizarov Method: The Distraction Phase

Dr. Mangal Parihar 

- Discussion: It is during the distraction phase that most of the complications of the treatment will occur, and consequently the surgeon has to be constantly on the lookout for the known complications. Follow-up Frequency: During the distraction phase, the patient should be seen at least every two weeks. At these visits one should perform a detailed clinical examination covering the points noted below as well as X-ray studies. 

- Follow-up Checklist (Clinical): Distance moved on the threaded rods compared to previous visit. The threaded rods are marked with tape when distraction is begun. At every visit, the length of threaded rod visible beyond the tape is compared to the previous visit. This gives us a direct reading of the amount of distraction that the patient has performed during the intervening period. Normally, (at 1 mm per day) this should equal the number of days since the last visit. This is also used to keep a check that the distraction at bone (checked radiologically) is keeping up with the distraction at the distraction rods. 

- ROM of Adjacent Joints:
The amount of active and passive movements at the joints above and below the fixator is recorded at every visit. A decrease from previously recorded range of motion is the first sign of an evolving contracture, and calls for increased efforts on the part of the patient and the surgeon to intensify physiotherapy, hands-on stretching, and if needed the additional use of a splint. At times, in spite of all efforts the range of motion may deteriorate severely. In such cases a decision may have to be made to abandon the goal of treatment, and concentrate on regaining the lost range of motion, by intensive, inpatient physiotherapy. Occasionally the frame may need to be modified, into a contracture correcting configuration, and bony elongation postponed to a second stage of lengthening. Congenital shortening and deformities are especially prone to developing contractures in contrast to post traumatic problems. 

- Neurological Examination
- Pinsites for Signs of Inflammation / Infection
- Stability of Frame & Components

- Ilizarov Post Op Care 
- Menu:

 - The Early Post-op period (the Latent Phase) 
- Pain relief  
- Limb Positioning 
- The Distraction Phase 
- Neurological Examination 
- Pinsites for Signs of Inflammation / Infection 
- Stability of Frame & Components 
- Ambulation
  Follow-up Checklist (X-rays) 
- Quality of regenerate 
- Physiotherapy 
- The Consolidation Phase 
- Removal of the Fixator and Post Fixator Removal