Ilizarov hints, tips and advice.
Most of these have come about from my personal
experiences of a tibial frame. Also Ms Cindy Clute has offered her
advice for those of you unfortunate enough to have a femoral frame .
Bob from Houston offers advice about the Ilizarov
sponges widely used in the US and Lauren reminds us that exercise is important.
- Give up smoking.
By stopping smoking you improve your chance
of success by a massive 30%. And that means giving up and staying off
'em. This is because your blood will contain more oxygen if you don't
smoke and oxygen means better recovery. I have also seen it quoted in
differing sources that every single cigarette you smoke slows the
growth of new bone by 30 minutes. Take that over 20 cigarettes a day
and the results are frightening!
If you want to get really scared, check out
the link to Bone Healing & Smoking on the LINKS page!
- Get as healthy as possible (if possible).
- If you have prior warning that you will be having
an Ilizarov fixator then makes sure, as far as possible that you are
as fit as you can be. The fittter you are, as above, the better you
blood flow and the more oxygen that will be transferred to your
damaged limb, via the blood, and the better will be the healing process.
- Walk more, exercise more. Check with you GP first
as he may be able to recommend a suitable course of exercise. Some
councils in England run 'Fresh Start' groups for people suffering
from various disabilities, injuries or who are recovering from other
operations or similar trauma.
- Watch your weight.
- Get you weight down and keep it down! This is
especially important if your injury is to a leg. As there may be a
protracted period where your only mobility is via crutches or a
Zimmer frame, then you want your body to be as light as possible.[Believe
me, I speak from personal experience here!].
Remember that it becomes too easy to put weight on following any
operation possibly leading to a lesser degree of exercise than
previously so watch the food and booze intake.
Some general hints.
- Remember, the Ilizarov is a large lump of metalwork so don't
expect the designer clothes you wore on the way into hospital to fit
you after the operation. Assuming a leg fitting, underwear becomes
the first priority. It must be of wide leg diameter and preferably
made of one of the more 'elastic' materials. Believe me, even shorts
can be difficult enough to get up over the frame, so 'Y' fronts are
right out of the question.
- If you are female then a skirt will make life a lot easier. For
men, trousers can be a real problem. Shorts are usually OK but if
it's winter then that might not be an option. At the time of my
surgery (Late 1998) the current sports wear fad was for tracksuit
bottoms and shorts that have press-studs the complete length of the
leg. Some indeed actually go right to the waist band. These are a
God-send to the Ilizarov wearer. I recommend at least two pairs as
you will be spending an awful lot of time in them. (Note:
At late 2005 I have seen these are still available in some stores
and on the web, but you may need to hunt a bit)
- If you or an acquaintance are a dab hand with the sewing needle,
then you can replace one seam of a pair of jeans or any other
trousers with Velcro. This also works really well. [See Clothing
Modifications on this site for further ideas.]
- Still more clothing.
- Still on the subject of trousers. If you are modifying a pair as
mentioned above then may I suggest utilising a pair of ex-military
fatigues or camo's. These have myriads of pockets of differing sizes
and can make the carrying of magazines, bottles etc a complete doddle
whilst you're hopping about on your crutches.
- Cling film.
- Wonderful stuff!. Whilst you can get spill proof cups they really
aren't the same as drinking you tea or coffee from your favorite mug.
Enter Cling film!.
- Make your drink as usual, hot or cold.
- Tear off a length of cling film around a foot square and fold it double.
- Ensuring that the top of the cup is dry, place the folded film
over it, pull it tight around the mug and press it down firmly all round.
- And that's it. The cup can now be hung from one finger, grasped,
put in a carrier bag or transported in any number of other inventive
methods. And the contents will stay inside.
- This procedure can also be applied to plates, bowls etc with
equal success and certainly help free you from the situation where
you may have to eat or drink only in the kitchen because you can't
carry you refreshement anywhere else.
- Of course now there are many variations on the thermally
insulated mug and thermally insulated cup about that have a sealing
lid as an integral part of the design. A worthwhile investment!
- Cordless telephone
- If you haven't got one - get one. If not you can guarantee that
the moment you have put your crutches down, someone will ring. Also
they will ring off 0.1 seconds before , sweating buckets, you lift
the handset. Also should the worst happen and you take a fall, it's a
life line as long as you carry it with you and do not leave it on the
cradle ! Nowadays of course the mobile phone has largely surplanted
the domestic phone, but the same proviso - keep it with you at all
time, or very near to hand.
- A small shaving mirror on a stand may be worth while buying. If,
as I did, you have fixing pins through the foot and back of the
leg/ankle, you will find it difficult, nay - impossible to ensure
that you have satisfactorily cleaned the pin sites without a mirror.
Remember - it's your leg, and it's probably going to be down to you
to do the pin site cleaning, so any degree of help is worth considering.
- [PS as a point of interest I had 20 pin sites and could
reckon to spend at least an hour cleaning and drying them all. Don't
rush it, it isn't worth the risk. The mirror lets you be certain the
site and the pin are clean]
You're going to probably spend a fair amount of time moving around on
these things, so here are a few hints that might make things a bit easier.
- When you're shown how to use crutches, take damn good note of
your physiotherapist. This applies double if you've never used
crutches before. Even if you've spent some time on crutches, the
Ilizarov frame feels very different to moving in a plaster cast or no
cast atall. There appears to be a greater 'moment' of motion. Take
your time, get used to it.
- Stairs are probably the scariest things a crutch user can come
across (Other than escalators which you avoid like the plague!).
Take your time. Use the bannister or hand rail if there is one, and
for preference use one on the side of the injury. With respect to the
Ilizarov, if you have a foot frame on REMEMBER it probably overhangs
the back of the foot by 2.5 inches or more. So don't bring the
injured leg down too close and slam it into the stairs.
- Stairs (again)
- Get yourself some Bungee (luggage) straps. Choose a length that
will fit, slightly tensioned between the upper arm fitting and the
lower end of the crutch. When you want to go down stairs and aim to
use the hand rail, rather than trying to hold the unused crutch in
the same hand as is taking your body weight on the used crutch, just
hang it round your neck or over your shoulder. Sod it if anyone
stares, it's going to be the frame anyway (or your hairstyle) that
gets their (morbid) interest.
- After just a short time on crutches, your hands especially will
start to feel well beaten about. There are two things which can
really help limit the pain and callouses which can occur. Firstly,
bind the handles with tennis racquet grip or mountain bike handle bar
grip. The difference will be greatly appreciated by your hands and
arms. Secondly, try wearing a pair of padded weight lifting or
cycling gloves. This is also a great advantage. However be aware that
a prolonged use of crutches may cause you elbow and shoulder
problems. So again try to keep the body weight down. Also, ensure
that the crutches are adjusted to the most comfortable and
safe-feeling length for you. Don't have them so short that you have
to really lean into them, or so long that your elbows are permanently
heavily crooked. Experiment - you'll find the best position by trial
and error. Also it might be worth altering the crutch length
depending on your footwear. I have found that, when barefooted around
the house, I need my crutches adjusted about one notch (1 inch)
shorter than if I am wearing shoes. Try it out, you may find the
- This cannot be stressed enough, at all times be aware of the
surface of the ground on which you are walking. Don't trust to luck.
Just because a floor is supposed to be non-slip when wet, don't
believe it. Try the crutch on it first without body weight. You could
be in for a shock! Steer clear of freshly washed floors, especially
those in fast food outlets (McDonalds and the like). These floors are lethal!
- Marble, linoleum, quarry tiles, ceramic tiles, all of these and
similar can be dangerous when wet. So watch out!. Road surfaces and
pavements are normally fairly slip-free. But here the problems are
usually loose surfaces, rough surfaces and uneven levels. All of
these can catch you out.
- Basically you'll spend an awful lot of time looking at the ground
when you're on crutches. But there are advantages.
- You'd be surprised how much loose change and other goodies can be found.
- You can ignore people that you owe money to.
As an aside, may I also point out that when you move from crutches to
a walking stick many of the same points apply.
Don't assume you know how to walk with a stick. I did and was very
wrong. Ensure you're using it in the correct hand. The hand to use is
the one on the opposite side to the injury - I know that seems wrong
but I assure you it isn't.
Ensure that the stick is of the correct length for you. This should
be done by either your physical therapist or the walking aids
department of your hospital.
Ensure that the stick's rubber foot is kept in perfect condition.
Even though you're hopefully far more mobile by the time you've got a
stick, you still don't want to go taking any falls
Now some hints specifically aimed at those of you who
are wearing or expecting to get a Femural ilizarov frame. My thanks
to Cindy Clute for her help here.
Cindy mentions that the best item was the cutaway
toilet seat - apparently they are made for people with hip
replacements. So check with your hospital or local health centre for
these. She also makes a wise suggestion and would tell people who are
planning an Ilizarov to get their crutches before, and practice.
Whilst I found the tibial frame different to a straight cast, Cindy
observes that, with the femur frame,
It is so scary - a femoral cage does not so much
unbalance you as makes you wider/heavier than you are used to - I had
to angle my crutches away from my hips, as the top half-pins jutted
out quite a bit.
She also observes that whilst Tibial braces tend to
play havoc on ankles, femoral do the same to knees!! She states
Believe the Doctor when they tell you unless you bend
your knee from the start, you'll have problems with it. It gets hard
to get into cars, etc. when your knee won't bend.
As with the tibia frame, clothing is easy for females,
skirts - skirts - skirts. However she was in hospital with a fellow
who had one on his femur and snap-on sport pants are the only item.
Very stretchy underwear, as you can imagine, at the top of your
thigh, the cage is very wide, and underwear has to stretch. So no
boxers for guys.[Unless they're like the type I wear which are
very stretchy anyway because I'm a fat sod! - Slim]
Apparently there is also something called an ObusForme
pillow. It's a Canadian invention, essentially a curved pillow for
neck support. It was invaluable to put under the cage, and cradles
it. Because your sleep is limited to one position (compared to the
unilateral) you tend to wake up extremely sore.
Pin cleaning is easy because the sites are right in
your lap so to speak. None of them are under your thigh. As Cindy
rightly observed I have to stretch to clean mine.
And finally, usually, femoral lengthenings take longer
than tibials, So hang in there!
Bob, from Houston Texas, who's wife Bev can be seen in
Gallery Three of the Rogues gallery has
offered the following about the extremely expensive sponges widely
used in the US to cover the pinsites on Ilizarov frames.
My wife has had her ilizarov fixator for a little over
The hospital gave us a few packages of those little
sterile sponges to use, but we are running out of them and I have
been quoted anywhere from $60 to $90 for a package of 30 (my
insurance does not cover home care supplies).
There are 22 pin sites, so we're talking $300 -- $450
a week here!!! This is like outright robbery.
The doctor's office has advised us to instead use an
antiseptic lotion and foam cosmetic wedges. They are 120 for $5.99 at
Walgreen's and take only a minute or two longer to install (a slit
has to be snipped in each one with a scissors).
Bob the followed this up with the next e-mail
So far the foam cosmetic wedges have worked perfectly
-- we use the plastic clips that were intended for the Ilizarov
sponges to hold the wedges in place.
Even less expensive than using a drugstore, my
daughter found cosmetic wedges on sale at a beauty supply store for
US $3.99 per bag of 100.
Thus, our daily cost for 22 pinsites totals only 88
cents instead of as much as $66 for the real sponges.
The antiseptic/antimicrobial skin cleaner which has so
far worked quite well for the pinsites is called Hibiclens
-Bob (Houston, Texas, USA)
As always I would recommend checking out everything
with your doctor first before trying it out.
If your doctor doesn't advise the use of a skin
cleaner, then don't do it!
To paraphrase what seems to be on every packet these days;
Always read the labelling with your Doctor first!
I recently received an e-mail from 15 year Old Lauren
Sullivan. She wished to add her voice to the important topic of
exercise and Ilizarov fixation.
My name is Lauren Sullivan I'm 15 years old and for
the past 3 yrs. they've been trying to lengthen my left leg!
My left leg has always been 2 inchs shorter than my
right leg, it was just there from birth. However, since I was so
young they decided to lenghen my leg through bone grafts and a steel
rod .... well to make a long story short .. 3 yrs later and after 10
surgeries my body would'nt accept the cadaver's bone.
So, they put me in an ilizarov from my hip all the way
to my ankle for 7 months.
I had to be streched 2 inchs! The pins tore through my
skin and I experienced a pain that I did'nt know existed!
It was horrible! I was on many pain pills (Percacet,
Darvocet, Vicodin) and sometimes went days without eating and on top
of that I did not do my excercies!
PT was a big part of my life back then (exspecially
since I had to quit school)! My advice to all Ilizarov wearers is to
DO YOUR EXCERCISES!
Put weight down on your bad leg ... it
stimulates bone growth and I learned the hard way that if you don't
bend and straighten your knee when it's immobilized it will either
get stuck straight out or it will get stuck bent and they'll have to
do surgery to either bend or straighten it!
Oh and always keep your leg as clean as possible!!
I wish all Ilizarov wearers the best of luck and a
pain free recovery! Oh and now ... after all that .. I'm perfectly
And I'm now glad I did it ... no pain no gain!
The latest tip I've had comes from self-confessed 'Old
school' fixator wearer, Sean Pritchard.
He sent the following e-mail.
I won't bore you with stories about my frame(mk2)
other than to say that I've had one from hip to ankle for 14
months,and before that hip to knee for 2years 4 months so know a
little about them.
Maybe it's already been mentioned,but a product called
"Bactroban",a type of antiseptic vaseline is very good for
keeping pin sites moist and the skin supple.
As I'm sure you know if the skin around the pin site
becomes hard it doesn't "give" and the they really start to hurt.
Since my first frame was fitted at a time when pin
site care was different to as it is today I'm "old school"
and these sponges they use now may mean the above is of no use,but if
it helps anyone else out then I'm happy.
Best of luck to all fellow sufferers. Sean
The only thing I would add to Sean's tip is my normal
advice, check with your medical professional BEFORE
trying anything other than their prescribed activities, drugs, creams
etc whilst wearing fixation systems.
The following is a list of tips and suggestions from
Melinda Dillon. [See her story via the TALES page]
My thanks to Melinda for these useful snippets of advice.
After my accident - I was so weak when I got out of
the hospital I literally could not sit down or stand up off the
toilet by myself. The bathroom toilets and raisers are really
expensive from a medical supply company. However, walkers are really
cheap and can usually be rented. I had the smallest walker - turned
around backwards - over the toilet so I had handles to sit and stand
with. It was a great feeling of freedom to "go" alone after
having to have help for over 2 weeks.
- After surgery of applying a fixator, I took a Zinc
suppliment as it promotes cell regeneration and growth. My pinsites
were clean and healed within 4 days after both ilizarovs were put on.
Take no more than 30mg / day - I was actually taking 50mg / 2 days.
- Crutches - I highly recommend what we call the
Canadian Crutches. These are the metal crutches that wrap around your
forearm rather than the wooden crutches that come up under your
armpit. These are much more comfortable as well as being more
manageable, more stable, and more manuverable.
- Final advise - don't be too afraid of the
ilizarov. It is a medical apparatus therefore you must be careful
with it. But don't let it stop you from life while you have it on. I
banged it into doorways, against chairs, etc when going to a
restaraunt for dinner or something. (Not all public buildings are set
up for walkways wide enough for crutches). It only stings for a
second and then your back to the "normal" everyday pain you
experience while wearing a fixator. Other activities I enjoyed
include: Movies have handicapped seats available, football games have
handicapped seats, dancing clubs (usually sat in back at a table with
leg propped up), and of course visits to and from family and friends.
I even went to work with both of my fixators. AND to attract even
more attention, I decorated it with battery operated Christmas lights
and little 1 inch decorations both Christmas' I had the thing on! HA!
I'm awaiting pictures of Melinda's christmas
decorations as I hope to get a selection up on the site for this
Christmas. So anyone out there with suitable decorated framework,
please send me a copy at the usual e-mail address of firstname.lastname@example.org. Ta!
And now yet another suggestion from Melinda and it's
certainly going to make things easier if you've got lots of pins and
wires on your frame
I had the doctor cut off the bigger pins just outside
the frame so you didn't have this 3 - 6 inch long pin sticking out to
cause more difficulties with clothing etc.
You can also have the smaller wires cut off just
outside their frame attachment.
I then went to the automotive store and bought a foot
section of vaccuum hose (I then cut into 3/4 inch sections and placed
over the big pins to prevent scratching/cutting myself or clothes and
sheets) and some 1/16 inch hose to put over the smaller wires.
This was a life saver and MUCH more convenient than
having those long pins sticking out for months. And it doesn't touch
anything inside the frame so you don't have to worry about causing
My doctors thought this was great!