Every frame is unique, and is made up from a wide choice of components which are connected to your bone with wires and pins. Sometimes the frame crosses the knee or foot. If you find this is difficult and your toes remain in a bent position try to gently straighten them out with your hands – hold this stretch for 30 seconds and repeat 3-5 times. Ed Vulliamy (13 December 2015). "How Comrade Ilizarov Saved My Leg". The Observer . Retrieved 13 December 2015.

The compression group had the poorest outcomes, with fewer patients achieving a rating of “excellent” or “good” in the bone and functional classifications (52.6% and 63.2%, respectively). This compares to 96.2% and 100% for the distraction group, 81.3% and 93.8% for the compression/distraction group, and 77.8% and 94.4% for the bone transport group. This difference was statistically significant in both the bone and functional domains ( P = 0.0017 and 0.00006).

Why do I need a frame?

Ilizarov Principles of Deformity Correction”, Annals of the Royal College of Surgeons of England 2010; 92: 102. The Limb Reconstruction Team consists of consultant orthopaedic surgeons, frame specialist nurse and specialist physiotherapist. What is a frame? Twenty-six cases were treated with monofocal distraction, 19 with monofocal compression, 16 with bifocal compression/distraction, and 18 with bone transport. Main Outcome Measurements: Try not to sit for long periods when at home, go for short walks regularly and keep using your walking aid(s) as instructed by your physiotherapist. Build up your walking distance gradually from short distances around the house to getting out and about. Vancomycin and meropenem were given intraoperatively, after sampling, and culture-specific antimicrobial therapy was continued for at least 6 weeks. Joint mobilization was commenced on day 2 and early full-weight-bearing encouraged. Outcome Measures

If you are having a frame because you have an “open” fracture (one with a skin wound and soft tissue injury) there is always a higher risk that bacteria has already entered your wound, increasing your risk of infection. Joint problems The algorithm was easy to apply, being dependent on simple questions that are always possible to answer. It was successful in cases of stiff nonunion and those with larger bone defects after resection of dead bone. The clinical and functional outcome of simple compression was disappointing, considering that these were often viable nonunions with small defects. All recurrences of infection and 71.4% of all refractures during follow-up occurred in this group. This may be due to residual biofilm, containing bacteria, present in the fluid and soft tissue in the “mobile” nonunion gap. The poor outcome implies that the algorithm is not correct in selecting compression as the preferred treatment of mobile, small-defect infected nonunions. We would suggest that these cases may be better treated with larger segmental resection (eradicating infection) and bifocal compression/distraction. In the presence of infection, caution is recommended in the use of both internal fixation and bone grafting. 18 Bose et al reported on 67 long-bone infected nonunions and noted that infection recurrence was significantly higher in the patients treated with internal fixation compared with those managed by external fixation. 2 Your physiotherapist will provide walking aids to allow you to mobilise from the first day after your operation, the aid used will vary depending how much support you require. It is advisable that you have pain relief prior to therapy input as this will allow you to get the most out of your time with the therapist. Seventy-nine patients were treated with 1 of 4 Ilizarov protocols. All patients had undergone at least one previous operation, 38 had associated limb deformity, and 49 had nonviable nonunions. Twenty-six had a new muscle flap at the time of Ilizarov surgery, and 25 had preexisting flaps reused. Intervention:In the case of lengthening a leg bone, an additional surgery will lengthen the Achilles tendon to accommodate the longer length of the treated bone. The therapeutic advantage of the Ilizarov treatment is that the patient can be physically active whilst awaiting the bone to repair. The Ilizarov apparatus also is used to treat and resolve a structural defect in a long bone, by transporting a segment of bone whilst simultaneously lengthening and regenerating the bone to reduce the defect, and so produce a single bone. Installing the Ilizarov apparatus requires minimally invasive surgery, and is not free of medical complications, such as inflammation, muscle transfixion, and contracture of the affected joint. Correct placement of pins/wires (see safe zones) avoiding ligaments and tendons, e.g. tibia anterior We present a treatment algorithm comprising 4 Ilizarov methods in managing infected tibial nonunion, using nonunion mobility and segmental defect size to govern treatment choice. Design: It will take you some time to adjust to the practicalities of living with the frame by making adjustments to clothing, your sleeping position and daily activities. Before you go home we will make sure you know how to look after your frame and signs of any complications that you need to look out for. How do I prepare for the frame?

Monofocal distraction: performed in cases with stiff nonunions with no major bone loss. A 4-ring frame was used, and a distal fibular osteotomy was made. Hinges were used to gradually correct angular deformity if present. Distraction was commenced at 1 mm per day for 2 weeks, or until deformity was corrected. Velazquez RJ, Bell DF, Armstrong PF, Babyn P, Tibshirani R. Complications of use of the Ilizarov technique in the correction of limb deformities in children. J Bone Joint Surg Am. 1993;75(8):1148–56. The mechanical functions of the Ilizarov apparatus are based upon the principles of tension (pulling force), wherein the controlled application of mechanical tension to the damaged limb immobilises the broken bones, and so facilitates the biological process of distraction osteogenesis (the regeneration of bone and soft tissue) in a reliable and reproducible manner. Moreover, external fixation with the apparatus allows the damaged limb to bear weight early in the medical treatment. [5]

Seek immediate medical advice if you notice:

Following extensive assessment and advice from their consultant and a team of specialists, a very small number of patients require an amputation after their frame treatment. This could be because of prolonged time in the frame, failure of the bone to heal, pain, infection or other reasons. This is can be a very difficult decision to make and will require careful consideration and discussion with many different specialists. Daily life

A frame is a special form of scaffolding (external frame) that can hold and control your bone to aid repair. Sometimes this is referred to as an Ilizarov frame, cage or a circular frame, because of the rings that go round the leg. After debridement, an assessment of the stability of the nonunion was made. The nonunion was regarded as “stiff” if it had angular bending of less than 7 degrees and axial movement of less than 5 mm on manual testing. 25,26 Stabilization and Realignment Ilizarov technique is paramount for the management of such non-unions and gives excellent results with gap non-union of the tibia. 10 , 11 It helps with segmental bone transport and distraction histogenesis, which is carried out slowly and under control, after corticotomy, to fill the bone gap. It has many advantages such as ease of correction of deformities, better stability, and early weight-bearing. There are disadvantages like it can be cumbersome, requires practice, and has difficulties such as wound dressing, patient compliance, and the length of time it requires for the complete union. Surgical excision and tissue sampling were performed according to a previously described protocol. 11,24 If an intramedullary nail was present, it was removed and the canal reamed. The excision was complete when only healthy bleeding bone remained.Tibiotalar arthrodesis serves as one of the most commonly performed arthrodesis around the ankle joint [ 7– 10]. Though we have made significant advances in the form of arthroscopy, arthroplasty, and arthrodiastasis, ankle arthrodesis still acts as the gold standard for end-stage disease [ 11]. There are various indications for arthrodesis, including post-traumatic degeneration, infection, rheumatoid arthritis, tumors, and neuromuscular conditions [ 11, 12]. Eight patients (10.1%) sustained a new fracture at a mean of 10.1 months after frame removal (median 7, range 1–48). Of these 8, 6 occurred in the compression group (representing a 31.6% fracture rate in that group) and 2 occurred in the compression/distraction group (12.5% fracture rate). It is important to restore a healthy soft tissue envelope for proper treatment of this complex problem. This could be done by major plastic surgery in the form of local myocutaneous flaps, or free flaps. But, in the presence of infection the chance for success of these plastic surgeries becomes very limited[ 5, 6]. During distraction osteogenesis all the tissues are lengthened including the bone, vessels, nerves, muscles and skin. This gradual lengthening may lead to spontaneous closure of the soft tissue defects without the need for plastic surgery[ 7- 9]. We present the largest series of infected tibial nonunions, treated using an algorithm, designed to help in decision making of Ilizarov strategy. 13,14,19 We have defined indications for each Ilizarov treatment protocol (monofocal distraction, monofocal compression, bifocal compression/distraction, and bone transport) based on the biologic and mechanical requirements of each infected nonunion. The primary outcome measure was the absence of recurrent infection. Secondary outcomes included bone union, complications, the Association for the Advancement of Methods of Ilizarov (ASAMI) bone and functional classification scores, and any need for further unplanned surgery. Results: