::Griffblog::

Medical professionals will tell you that infections are not ‘if’ but when with ilizarov and TSF frames. The bone/skin interface of the protruding pins is a haven for bugs and they can take hold very quickly as a result.

So with little pomp I presented myself at my GP’s Surgery last week. A pin site had become increasingly sore and inflamed over a few days and the skin surrounding it had begin to break down.

Sure enough my GP agreed that it is almost certainly infected. A swab was taken for testing but hard lumps under the skin are an indication that a possible abscess had already formed. The pin wire goes right through my leg from front to back and both ends are infected, one minor, one bad. And so I am now on a course of very strong antibiotics.

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Wearing a frame as bulky as this presents a number of problems not least of which is transport.

To get home from hospital I was lucky enough to have the assistance of my wife’s parents who own a large 4 door car.  As my leg is locked straight I managed to sit across the rear seats with my back against the door.  I did the same when I had to return for a check-up this time relying on my parents.

We own a 2-door Mercedes convertible and I thought it was time I investigate how or indeed ‘if’ I could get into our car.  I’ll be honest and say that I din’t hold up much chance of getting in.  I’d had a bad day but took some painkillers and off we went.

Being a convertible, albeit a large full 4 seater, the rear is much narrower because of the hood folding mechanisms.  So although I tried I could not fit across the rear seats and  the only way I could get in was with the hood down.  Fine now but not so practical with winter approaching!

Next up was the front passenger seat. With the seat moved as far back as possible and the squab tilted down (thankfully these are electric and almost everything moved, lifts and tilts!) I got in.   With assistance I can get my leg into the footwell and jam it high up on the bulkhead.  This is necessary because the frame is bulky and my leg will not bend so it has to be horizontal from the seat cushion.  Using a foam pillow to raise my bum a little was enough to sort that out.  It’s not easy but once in it is relatively comfortable so long as we avoid potholes and sleeping policemen!

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Yesterday I had my appointment with the Consultant to start the leg ‘distraction’ phase or leg ‘lengthening’ as we might better know it.

It’s very simple. The middle of the frame has two rings held together with four long threaded bolts and nuts. The nuts have a special four sided head marked with 1 to four dots. Four times a day I have to grab my two 10mm spanners, undo the lock nut, turn the special nut one quarter turn and then lock it off. Then repeat for the other three. This whole process is repeated every 4hrs.

In theory each full turn equates to 1mm of lengthening. The idea being that the bone ends are kept just far enough apart that they continue to grow towards each other but not so far apart that the bone gives up the battle and of course not so close that they actually knit. Over time new bone is grown and the femur is lengthened.

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Day1

I don’t think I’ve mentioned in any of my previous musings the great support and advice I have received from a Yahoo Group set up for those of us going through this procedure. These fixators are commonly used for complex fractures and not just leg lengthening.

The group allowed me to ask all those questions that you either never get time to ask or never occur to ask when you have the brief facetime with your surgeon and meant that I was far better prepared than I would otherwise have been, had suitable clothing at hand and knew exactly what to expect. As mine is a full length femoral frame the top ring is a half ring, I have seen pictures and know that. But on my last pre-op appointment a junior doctor showed me a femoral frame with the aforementioned half-ring and told me to ignore that, she passed it off as a carrying handle for the fixator as it was for demo purposes, you couldn’t make it up could you!

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My op last Friday went ahead as planned and 6 days later (yesterday) I was released home. I now sport a rather gruesome looking femoral ilizarov fixator frame worth a cool £6k!

It’s taking some major adjustments of course and it still very early days but I’m doing my very best to remain positive.  I had the Op 9am Friday morning which took 6hrs and arrived on the ward at 4.30pm.  Saturday was spent in bed but Sunday I was walking to the shower using a frame which is amazing progress given the operation.

The frame itself has 4 rings and stretches from high on my hip to my knee.  Mid-way is the adjustment section with 4 long threaded bolts that will be used for the lengthening procedure which begins next Tuesday. This is simple, each adjuster is turned a set number of times every day to achieve 1mm distraction per day. As I have 25mm of bone to grow it should take a month if the bone grows at the expected 1mm/day. We get shown what to do on Tuesday and then it is down to us to do at home each day!

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