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Ilizarov: An explantion 10

Posted by DarrenG on August 19, 2009

ilizarov-femurA few people have asked what brought all this about.  I’d forgot that the background and explanation to my leg issues had been lost when blog Mk1 went belly up without a backup so here is a quick summary:

Back in 1989 I had an accident whilst serving in HM Forces in Germany.  Long and short of that was I ended up with a fractured spine, punctured lung and a snapped femur,

The back was fixed with some metal scaffolding which I still sport, lung hole had a puncture repair and my leg was repaired with a full length internal nail down the shaft of the femur that was removed a few years later.

However, the leg repair, having been done in haste (I was understandably very ill at the time) left me with a loss of 2.5cm of bone from the femur and a severe rotation such that my foot points outwards about 30 degrees.  End result is hip, knee and back pain and a limp and an odd walking gait.

Fast forwards 20yrs and I resolved with increasing pain it was time I got it looked at properly rather than just treating the symptoms.  After a few referrals I saw a specialist and was told the solution is an ‘Ilizarov’ frame, named after the Russian Doctor who invented it. Designed for complex fracture repair and most importantly limb length discrepancy i.e. to ‘grow’ bone and lengthen limbs.

The process is simple.  The bone is broken, the ilizarov fixator  affixed with numerous pins going through the skin and into the bone and then the two halves of the frame, separated by threaded bolts are wound  apart at approximately 1mm a day.  Once the required length has been achieved the frame is locked off and the bone is allowed to catch up, knit and heal.  The frame is then removed and bob’s your uncle etc.

So Friday they will break the leg, point it in the right direction and affix frame.  After a week in hospital I will be allowed home and then MrsG or me will begin winding the bolts four times a day for one month or however long it takes for my femur to grow the required length of 2.5cm.  Then there is the healing and bone knitting phase and then finally it’s frame off, cast on for 6wks and I’ll be as good as new. Well that’s the plan.

It sounds nasty, is extremely painful and looks horrid but it’s not all bad.  The main issues are pain management and keeping all the many pin/skin/bone interfaces clean and infection free.  Many people actually continue to go to work with these things on and it will be worth it to sort the issue once and for all before arthritis sets in.

I’m not putting in my London Marathon application just yet though!

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  1. Iain (netean) Wed, 19 Aug 2009 12:02:44 UTC

    sounds like it’s going to bit shitty. Although originally injury sounds even worse.

    If you don’t mind me asking, why hasn’t this been addressed by NHS already, surely corrective surgery earlier would have resulted in less back pain, less limping and reduce the possibility of further problems in the future (hip, back, etc)?

    20 years sounds like a long time to limping and in pain without correction.

    Good luck with op, i’m SURE it will be so worth it in the end.

  2. DarrenG Wed, 19 Aug 2009 14:26:15 UTC

    To be fair the delay is no fault of the NHS. I managed to serve another 9 years in the Army after the accident and back then the prospect of corrective surgery never entered my mind. The limp just became the norm and most of the pain was blamed on my back which naturally will always be a little sensitive. But given what I did to it and the metalwork I have surrounding it I get remarkably little trouble, much less than many who suffer the more common back problems!

    It has only been in recent years with knee pains that I sought medical advice and was referred up the chain. Eventually I came to be laid out in front of a specialist in leg lengthening and was told that there was this solution, given the pros/cons and left to think about it. As it transpired, I was told the NHS may not have offered this option earlier because it is highly invasive and 2.5cm loss is borderline. But my age, the back pain and the likelihood of arthritis ticked enough boxes now that it gets the green light.

  3. Tracey Thu, 20 Aug 2009 20:25:06 UTC

    I saw you responded to my twitter post about my frame. I’ve had mine on a year (So NOT “the plan”) for congenital clubfoot (from a neuromuscular condition) & a 6 cm difference between my legs. Thanks to said neuromuscular condition my lengthening is taking a long time due to my bone not growing in at 1mm a day! I wish you the best of luck with your frame, its not as bad as it looks but the first week or so is not pleasant with new pin sites.

  4. DarrenG Thu, 20 Aug 2009 20:29:04 UTC

    Hope things progress well for your Tracey. Very nervous now so the sooner I get in and get it fitted the better.

  5. Panet Fri, 21 Aug 2009 08:16:55 UTC

    Good luck, hope it all goes well.

  6. markd Fri, 21 Aug 2009 19:59:24 UTC

    This will be posted a few hours after the op so hope all went well, and best wishes for a speedy recovery. You do a great job with the site so get well soon 😉

  7. RichardW Fri, 28 Aug 2009 09:16:35 UTC

    Hope it all goes well and the recovery is 100%.

    But please don’t assume because one or two people who’ve worn an Iilzarov frame had an easy time of it, you will. I obviously hope you do have an easy time of it, but some people go though hell.

    I gained 4.5cm of length back after a bike accident. The frame was doing two things, gaining length and compressing the original break trying to get that to heal so my case did have complications.

    The docs gave me the same stories before I had mine fitted. (I didn’t have a choice, it was frame on or leg off) Had the frame on for 9 months, one big infection, on high dosages of morphine for nearly all that 9 months.

    Would I have one put on again? Never. Ever. Again. Take the leg, take my life, nothing is worth going through that again.

    But if that picture is of you, then you’re obviously able to stand up so you’re about 1000% better than I was quite soon post op 🙂

    Good luck.

  8. DarrenG Fri, 28 Aug 2009 11:03:51 UTC

    Your experience sounds horrendous. I was released yesterday and will update the blog soon.
    I could walk with a frame day 2, on crutches day 4 and out day 6.
    Yes it hurts like a bitch at the moment but I’m only one week post op. I’m on low dose pain killers which may need a boost but we shall see so at the moment it’s all looking positive, fingers crossed.
    I’m guessing that mine was elective it was much more controlled than yours with the break being made in theatre?

  9. RichardW Fri, 28 Aug 2009 12:54:36 UTC

    Crikey, walking by day 4 is good.

    With me they added an artificial break further up my leg which was “stretched”, the original break was compressed so the frame was doing two things.

    After a month I found the golden rule is “keep moving”. If you try to avoid moving as much as possible the scabs have a chance to form around the pins and wires and stick to them. When they’ve done that its hurts like heck when you do try to move!

    Keep as mobile as you can (wander into kitchen to make cuppas, etc) and the scabs don’t form and its a lot less painful.

    And also to keep it clean. Very clean.

    Oh, and if you can get into a shower, god, it feels better than sex. Honestly, just feels sooooo good, but dry all the pin / wire sites off very thoroughly afterwards.

    (different doctors and nurses have different opinions on showers, some say avoid them or wear a bin bag over your leg, others say they’re good. I can see that a bath would be very bad, but a showers got running clean water, so as long as you dry off afterwards it’ll be fine. And thats what my Dr and nurses said too)

    Where did you have yours fitted? Mine was done at the Nuffield, Oxford, Dr McNally.

    I remember looking at the other people with frames on in the clinic and thinking “why are they in a lot less pain than me?” – heh, low pain threshold I guess.

    Morphines great to start with though 🙂 Horrible withdrawl symptoms though if your GP messes up and you totally run out at the start of a long bank holiday weekend…

  10. DarrenG Fri, 28 Aug 2009 14:53:04 UTC

    Yours does sound awful. I can and indeed have been told to shower daily and as you say, it makes everything feel a world better. Get up, shower then pin-site cleaning is the new routine.

    I had mine fitted at St Peters in Chertsey, they brought Ilizarov’s to the UK and are specialists so I’ve been told.

    Although I was on oral morphine in hospital I was discharged with only 10 Tramadol tablets at 2 per day which was worrying. I’ve since got my GP to prescribe more of them which she says I can take more frequently as necessary as well as oral morphine for any high pain occasions which has helped me relax knowing I now have a backup.

    I know what you mean about morphine dependence, been there before when I had original accident. I’m much more careful about it now and take it only when I have to.

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