The use of the Ilizarov apparatus for various bone surgical procedures. Ilizarov apparatus: scope and features of application Leg lengthening with the Ilizarov apparatus

The Ilizarov apparatus is used for fixing bone tissue, its compression or stretching.

In 1952 G.A. Ilizarov developed a design that is still used for fixing bone tissue, its compression or stretching. Since that time, it has undergone numerous changes. The modern Ilizarov compression-distraction apparatus is made of high-strength titanium. Instead of the spokes that were used before, titanium and carbon fiber rods are used, rigid rings are replaced with plates, triangles and semicircles.

This medical device is small and weighs little. It is widely used in various medical fields, for example, in traumatology, to correct the proportions, curvature of the legs, and anomalies in the development of the bones of the foot. The device is widely used for fractures of the legs, lower leg, thigh, heel, hand.

Its use on the leg or arm in case of fractures does not allow the bone fragments to move. It fixes well ununited fractures, false joints. There is no need to apply additional immobilization with gypsum. In addition, the device is used for limb lengthening.

The progress of the operation

All parts of the device, plates, spokes and others are made simply and with high quality, however, it is important to pay attention to its assembly. The mounted compression-distraction apparatus is sterilized on the day of the operation along with other instruments. Each plate and every other part must be sterilized. All devices are placed on a separate table for tools. If an intervention is planned at the focus of the disease, another table is laid for the appropriate instruments.

The patient is positioned so that the part to be corrected, the thigh, lower leg, hand, and any other area of the arm or leg, is completely free. If the device is placed on the thigh, a pillow is placed under the intact buttock so that the diseased buttock hangs down. When working with the lower leg, you can use the Beler splint with one femoral hammock. If an operation is being performed on a hand, for example, a hand, upper limb placed on a side table.

During surgery, general, intraosseous or local anesthesia is used.

The assembled apparatus is applied to the desired zone of the limb in order to mark the location of the rings with green paint. Then, using a drill, two needles are passed through the bone in directions that mutually intersect.

When the doctor performs the introduction, he must hold the needle with a dry and unused napkin.

It is important to avoid burns to the skin and bones, so frequent stops must be made while using the drill. If burns are allowed to occur, they may develop dangerous complications in the form of purulent processes, osteomyelitis. During the introduction of the needles, it is necessary to ensure that they do not touch the napkins and linen, otherwise the sterility will be violated.

Balls are put on the knitting needles, which are pre-treated with alcohol. The balls are attached to the skin with rubber stoppers. After all the spokes have been drawn, on each ring one lock is removed, the other is loosened. Thanks to this, the Ilizarov apparatus becomes open and can be safely put on the limb, after which the rings are connected, the spokes are not strongly fixed in special holders.

Why can't the knitting needles be securely fastened immediately? Because before the final fixing it is necessary to check how the locks are fixed on the rings, only after that you can start to tighten the knitting needles. This is also done according to a certain scheme, which is followed when using the apparatus in case of fractures of the legs, hands, lower leg, thigh, limb lengthening, etc.

To firmly fix each knitting needle, it is necessary to fasten one end of it tightly, bend and bite off with the help of wire cutters. At the other end, you need to put on a spoke tensioner, the emphasis of which is behind the ring of the apparatus. In the second spoke tensioner, the spoke is tensioned and secured, then it is removed.

After these actions, the compression or stretching of the fragments of the bones of the leg, thigh, heel, and hand is performed with the barbells. In this way, optimization of the length and shape of the bone is achieved. This is done by rotating the nuts. It is better to put on a sterile cover on the Ilizarov apparatus, which protects the needles from infection.

Bone lengthening occurs in several stages:

The device is installed first.
Then osteometry is performed, that is, the bone is dissected;
Fragments are fixed using a special apparatus for orthopedics.

Leg lengthening is performed gradually seven days after the operation. It is important to observe a certain rate of leg lengthening - 1 mm per day. Distraction speed is determined depending on the individual tolerance of the person. Distraction with an elongation of five centimeters lasts from 50 to 75 days. The fixation period begins after the lengthening of the legs has ended. After 30 days, work begins with the second limb. Two days later, patients are already walking on crutches. IN rehabilitation period better to swim and walk.

Eat different ways device overlay. The general principles are the same. It is very important to properly care for the structure.

Rules for care and withdrawal

The Ilizarov apparatus requires careful maintenance. If you do not comply with sanitary measures, inflammation may begin in an adult, and even more so in a child. Disinfection is carried out using a fifty percent solution of medical alcohol, using distilled water. You can use vodka, but only the one that was made according to all technical requirements. The composition is needed in order to impregnate napkins before applying them to the borders of the skin and fragments of the spokes. Napkins in the care process should be changed once every 2 days for 14 days, then once a week.

Subsequently, some difficulties may arise with the use of the device, since after some time it is necessary to gradually load the arm or leg. For example, you may see:

increased pain in the thigh, lower leg, hand, heel or other area of application of the device;
redness;
swelling;
pus may be released.

In order to eliminate inflamed foci and the associated pain during care, you need to use wipes with a solution of dimexide, which is diluted with purified water, a one-to-one ratio is observed.

In addition, the doctor prescribed antibiotics. It is necessary to observe the entire dosage, without increasing or decreasing it. If within a few days the condition does not improve, it is necessary to contact a medical facility, otherwise inflammation of the bone and other dangerous complications may begin.

As already mentioned, in order to facilitate care, eliminating the possibility of dirt getting on the device, it is better to use a case. It covers the apparatus from the top to the bottom of the apparatus. To properly care for the patient and the device, you should follow all the doctor's prescriptions.

The Ilizarov apparatus is removed only in a medical facility. How long to wear it depends on the nature of the bone correction, the type of fracture (thigh, hand, heel, etc.) individual features patient. Usually the minimum period is one month. Sometimes the device is removed only after three months or more. Removal is performed by an experienced doctor. Most often, when removing anesthesia, anesthesia is not used due to minor pain.

First, the external parts are dismantled, then the spokes are shortened. After removing the apparatus, a plaster bandage is applied, which limits the movement of a person, allowing the process of restoration of the bones of the hand, lower leg and other parts to be successfully completed in order to minimize the risk of a second fracture. How long to wear this bandage, the doctor determines.

Rehabilitation

Rehabilitation after removal of the Ilizarov apparatus includes massage and physiotherapy exercises

The Ilizarov apparatus will bring more benefit if you continue to care for your hand or foot after it has been removed. Rehabilitation is based on massage. Physiotherapy exercises are also prescribed. All these measures are aimed at restoring blood flow due to prolonged inactivity. Flexibility returns to the hands and other joints, and strength to the muscles. If such measures are not taken, a permanent limitation of mobility may occur, it will also be difficult to overcome the pain, since it may be, albeit insignificant.

After removing the device, there are scars that gradually disappear. The Ilizarov apparatus is effective method fracture treatment. This is an excellent method of skeletal traction. All its parts are made of reliable metal, all plates, knitting needles and other parts are correct use and care for them and the patient, both during wearing and after removal, give a good result.

The Ilizarov apparatus was invented in 1951 by orthopedic surgeon Gavriil Abramovich Ilizarov for the treatment of complex and bone deformities.

It has been experimentally proven that transosseous compression osteosynthesis creates conditions for rapid bone union without mixing. The Ilizarov apparatus on the leg is used for fractures of the lower leg, intra-articular fractures of the knee, femur.

The original version of the device consisted of two rings, sliding rods and provided for four knitting needles.

First, the pins were inserted into drilled holes above and below the fracture at a ninety degree angle. Then they were fixed to the rings, and the width and distance were fixed with sliding rods on the nuts. The diameter of the rings changed in steps of a millimeter.

The stainless steel structure was completely disassembled and could serve universally.

The number of elements increased as needed to fix the limbs after multi-comminuted fractures.

What is the Ilizarov apparatus today? Modern models include titanium rings and half rings, spokes, fixing rods and screws.

The rings are distinguished by grooves that increase the accuracy of the placement of the device. Instead, in some modifications, frames and springs are used so that the fixation is flexible.

The main advantages of the Ilizarov apparatus:

structural rigidity;
fixation of the bone in any direction;
strong fixation of fragments.

The design of the device does not affect the performance of muscles and some joints, preventing contractures and maintaining tissue trophism compared to gypsum.

The patient can load the limb to maintain blood supply and function.

The photo shows how the apparatus looks on the lower leg and thigh.

Depending on the location on the leg, the device will interfere with the flexion of the limb in the joints.

Operating principle

Treatment is based on two methods:

Compression or compression - allows you to combine and fix fragments. Splicing speed and accuracy are improved. Compression is maintained until consolidation and hardening of the seams.
Distraction or stretching is necessary to increase the length of the bone. The fragments are pulled away from each other with needles, and between them a bone regenerate is formed, from which bone. Distraction is carried out by 1-2 mm per day. The goal is to bring the fragments into anatomical position and complete osteogenesis.

The device controls the position of the fragments throughout the treatment, timely eliminates the displacement in length, width, angular and rotational.

Indications for use

With the Ilizarov apparatus, traumatology and orthopedics solves a number of complex problems:

Lengthening of the legs with the Ilizarov apparatus is carried out in restorative, reconstructive surgery, sometimes in cosmetic surgery. More often, the procedure is required after complicated fractures as a result of an accident.

Installation

Before applying transosseous distraction-compression, radiography in several projections is needed.

They put the Ilizarov apparatus after fractures, most often under general anesthesia, as holes are drilled in bone fragments through which titanium spokes are passed.

They are fixed on the rings with keys. The bearing rods are fixed by adjusting the length with nuts with a certain mode. Installation takes about 30-40 minutes.

Each patient is individually made a plan to change the settings of the device:

by tightening the nuts, they change the distance between the rings installed on the mobile rods. Their convergence provides compression of the edges of bone breaks;
Deformation of the pins makes it possible to reduce the compression force, their tension is constantly monitored in order to eliminate the displacement of fragments, and to carry out the reposition in time.

Reference. Barbells are a visual tool for monitoring bone growth and the healing process. The doctor prescribes repeated examinations to adjust the settings and the tension of the spokes in the apparatus.

Removing the device

The device is removed only after the control image, when the fragments are confirmed.

The dismantling is carried out by the same surgeon who installed the structure. First, the doctor unwinds the rods, clamps and rings. Then he cuts the needles and takes them out.

Removal is carried out under local anesthesia , and small wounds remain in the areas where the metal elements are located. They are treated with a disinfectant solution.

In case of insufficient strengthening of the bone tissue, a plaster or a fixing bandage is applied.

After the Ilizarov apparatus is removed, patients need rehabilitation:

massage to improve trophism;
physiotherapy for muscle stimulation;
gymnastics to reduce contracture and restore limb strength.

Physical rehabilitation should begin immediately after removal of the bone fusion device to avoid weakening the limb and developing muscle imbalances.

The duration of the course is 2-3 months. At the same time, external agents are used for the speedy healing and pain relief of wounds.

Advantages

Treatment of orthopedic problems with the Ilizarov apparatus depends on the competence of the doctor and the characteristics of the patient's body.

Transosseous osteosynthesis provides clear advantages over other techniques:

rapid healing after a fracture;
low risk of false joints formation;
no need to buy expensive plates;
lack of implants in the bones;
no need for surgery.

Patients with the Ilizarov apparatus can move on crutches a week after the installation of the spokes. Emphasis on the limb can be done when they disappear pain under axial load.

The main advantage of the technology is that even with multi-comminuted fractures, patients do not need to stay in the hospital. Fragments are fixed with knitting needles, their displacement is prevented. Muscle atrophy is not observed while maintaining the mode of mobility.

Flaws

The device has drawbacks: it is difficult to sleep with it, the design is heavy (especially for children and women), independence in everyday matters remains low. For example, you can swim with a design if you place it in a plastic bag.

The risk of inflammation of soft tissues in the places where the wires pass remains high. Wounds remain open, which increases the risk of bacterial entry. With suppuration and inflammation, the doctor prescribes antibiotics.

It is not uncommon for patients to experience aching pain in the bones that have been drilled. Injury to blood vessels and nerve endings with a metal component can make itself felt discomfort for a long time.

Care activities

The device has to be worn for more than 3-4 months. Ilizarov spokes, installed in rings, penetrate soft tissues and bones. Remain at the installation site open wounds which increases the risk of infection.

After installing the device, the surgeon tells the patient about the rules for caring for the injured limb.

The needles are disinfected daily with an alcohol solution (dilution with water 1:1). Wipe areas of the skin that come into contact with the metal. Napkins are changed every 2 days for the first two weeks, and after that - every week.

The first week after installation, the limb will be swollen and reddened, hot to the touch. The adjustment step also causes discomfort and pain.

However, with general malaise, fever and fever - symptoms of intoxication - you need to see a doctor. Isolation from wounds of ichor, pus is a sign of infection. The doctor prescribes antibiotic therapy, anti-inflammatory drugs.

With gain inflammatory process the surgeon decides to remove the device to prevent infection of the bone tissue.

To prevent infection, the first days after the installation of the spokes, the wounds are covered with bandages, and a special cover is worn over the device.

Alternatives to the Ilizarov apparatus

In orthopedic traumatology, fixation and correction of bones are used using plates or intramedullary pins.

Important! The Ilizarov apparatus has the main feature of its application: the clinic must have experience in transosseous osteosynthesis in order to exclude miscalculations with limb traction and displacement of fragments (disconnection of the pins).

Which is better: Ilizarov apparatus or plate

Osteosynthesis is necessary if the fragments do not grow together without surgical intervention.

These are fractures of the olecranon, patella, some injuries, the neck of the femur, intra-articular fractures of the condyles of the bones.

Intramedullary screws allow loading limbs in a short time after surgery. They are often used for transverse fractures of the femur, tibia and humerus due to the large diameter of the medullary canal.

Many variants have been developed for long bones with various mounting options.

Plates, unlike pins, are attached on top of the bone and must conform to its curves. They are chosen if the operation is possible, the risk of rejection of a foreign body is minimal.

Plates are used when a large fragment can be fixed in several places.

With fractures of tubular bones and complex fractures, transosseous osteosynthesis is more often preferred.

The choice of treatment method is always in the competence of the surgeon, who knows better what to apply in your case - the Ilizarov Apparatus or the plate. Plates are suitable for fractures without reposition.

They also take into account how much to wear the apparatus on the leg. Plates and screws accelerate rehabilitation in some cases.

Price

You can find out how much the Ilizarov apparatus costs only after the traumatologist evaluates the images.

The configuration and complexity of the device depends on the nature and complexity of the fracture and affects the final cost. The price is determined by the installation location of the apparatus, the material of manufacture, the number of rings and spokes.

The cost starts from 30 thousand and ends at 500 thousand, while the surgeon needs to pay about 150 thousand.

Conclusion

The Ilizarov apparatus refers to the means of transosseous osteosynthesis without surgery and a long stay in the hospital.

The treatment time for the problem is usually 3-4 months, except in cases of limb lengthening. The device is recommended for use in complex closed fractures, while the effectiveness of the installation depends entirely on the competence of the surgeon.

In contact with

If a patient is diagnosed with a dangerous bone fracture, in which separate pieces of hard tissue have formed, he needs to undergo osteosynthesis. This procedure allows you to correctly match the fragments with the help of special devices and devices, which will ensure that the pieces do not move on long time. All types of surgical reposition retain the functionality of the movement of the axis of the segment. Manipulation stabilizes and fixes the damaged area until the moment of fusion.

Most often, osteosynthesis is used for fractures inside the joints, if the integrity of the surface has been violated, or if long tubular bones are damaged, mandible. Before proceeding with such a complex operation, the patient must be carefully examined using a tomograph. This will allow doctors to draw up an accurate treatment plan, choose the best method, a set of tools and fixators.

Varieties of the procedure

Since it is very complicated operation, which requires high accuracy of execution, it is best to carry out the manipulation on the first day after the injury. But this is not always possible, so osteosynthesis can be divided into 2 types, taking into account the execution time: primary and delayed. The latter variety requires a more accurate diagnosis, because there are cases of the formation of a false joint or improper bone fusion. In any case, the operation will be carried out only after diagnosis and examination. For this, ultrasound, X-ray and computed tomography are used.

The next way to classify the types of this operation depends on the method of introducing fixing elements. There are only 2 options: submersible and external.

The first is also called internal osteosynthesis. For its implementation, the following fixators are used:

knitting needles;
pins;
plates;
screws.

Intraosseous osteosynthesis is a type of submersible method in which a fixator (nails or pins) is injected under x-ray control into the bone. Doctors perform closed and open surgery using this technique, which depends on the area and nature of the fracture. Another technique is bone osteosynthesis. This variation makes it possible to connect the bone. Main fasteners:

rings;
screws;
screws;
wire;
metal tape.

Transosseous osteosynthesis is prescribed if the fixator needs to be inserted through the wall of the bone tube in the transverse or oblique direction. For this, the traumatologist-orthopedist uses knitting needles or screws. The external transosseous method of fragment reposition is performed after the fracture zone is exposed.

For this operation, doctors use special distraction-compression devices that stably fix the affected area. The fusion option allows the patient to recover faster after surgery and dispense with plaster immobilization. It is worth mentioning separately ultrasound procedure. This is a new technique for osteosynthesis, which is not yet used so often.

Indications and contraindications

The main indications for this method of treatment are not so extensive. Osteosynthesis is prescribed to a patient if, along with a bone fracture, he is diagnosed with an infringement of soft tissue, which is clamped by fragments, or a large nerve is damaged.

Besides, surgically treat complex fractures that are beyond the power of a traumatologist. Usually these are damage to the femoral neck, olecranon or patella with displacement. separate view consider a closed fracture, which can turn into an open one due to perforation of the skin.

Osteosynthesis is also indicated for pseudoarthrosis, as well as if the patient's bone fragments have dispersed after a previous operation or they have not fused (slow recovery). A procedure is prescribed if the patient cannot undergo a closed operation. Surgical intervention is performed with damage to the collarbone, joints, lower leg, thigh, spine.

Contraindications for such manipulation consist of several points.
For example, do not use this procedure when an infection is introduced into the affected area.
If a person has an open fracture, but the area is too large, osteosynthesis is not prescribed.
You should not resort to such an operation if the general condition of the patient is unsatisfactory.

venous insufficiency of the extremities;
systemic disease of hard tissues;
dangerous pathologies of internal organs.

Briefly about innovative methods

Modern medicine differs significantly from earlier methods due to minimally invasive osteosynthesis. This technique allows splicing fragments using small skin incisions, and physicians are able to perform both bone surgery and intraosseous surgery. This treatment option favorably affects the fusion process, after which the patient does not need to carry out cosmetic operations.

A variation of this method is BIOS - intramedullary blocking osteosynthesis. It is used in the treatment of fractures of the tubular bones of the extremities. All operations are controlled by X-ray machine. The doctor makes a small incision 5 cm long. A special rod is inserted into the medullary canal, which is made of titanium alloy or medical steel. It is fixed with screws, for which a specialist makes several punctures (about 1 cm) on the surface of the skin.

The essence of this method is to transfer part of the load from the damaged bone to the rod inside it. Since during the procedure there is no need to open the fracture zone, fusion occurs much faster, because doctors manage to maintain the integrity of the blood supply system. After the operation, the patient is not put in plaster, so the rehabilitation time is minimal.

There are extramedullary and intramedullary osteosynthesis. The first option involves the use of external devices of a pin design, as well as the combination of fragments with the help of screws and plates. The second allows you to fix the affected area with the help of rods that are inserted into the medullary canal.

Femur

Such fractures are considered extremely serious, and most often they are diagnosed in older people. There are 3 types of hip fractures:

at the top;
in the lower part;
femoral diaphysis.

In the first case, the operation is performed if the general condition of the patient is satisfactory and he does not have impacted injuries of the femoral neck. Usually surgical intervention carried out on the third day after injury. Osteosynthesis of the femur requires the use of such tools:

three-bladed nail;
cannulated screw;
l-shaped plate.

Before the operation, the patient will necessarily undergo skeletal traction, an X-ray will be taken. During the reposition, doctors will accurately match the bone fragments, after which they will fix them essential tool. The technique for treating a median fracture of this bone requires the use of a three-blade nail.

In fractures of the second type, the operation is prescribed on the 6th day after the injury, but before that, the patient must be stretched out of the skeleton. Doctors use rods and plates for splicing, devices that will fix the affected area in an external way. Features of the procedure: it is strictly forbidden to carry out patients in serious condition. If fragments of hard tissues can injure the thigh, they should be urgently immobilized. This usually occurs with combined or comminuted injuries.

After such a procedure, the patient is faced with the question of whether it is necessary to remove the plate, because this is another stress for the body. Such an operation is urgently needed if fusion has not occurred, its conflict with any structure of the joint is diagnosed, which causes contracture of the latter.

Removal of metal structures is indicated if a fixator was installed in the patient during the surgical intervention, in which metallosis (corrosion) occurred over time.

Other factors for the operation to remove the plate:

infectious process;
migration or fracture of a metal structure;
planned step-by-step removal as part of the recovery (the stage is included in the course of the entire course of treatment);
sports;
cosmetic procedure to remove the scar;
osteoporosis.

Options for operations on the upper extremities

The operation is performed for fractures of the bones of the limbs, therefore, the procedure is often prescribed for fusion of hard tissues of the arm, leg, and thigh. Osteosynthesis humerus can be carried out according to the Demyanov method, using compression plates, or Tkachenko, Kaplan-Antonov fixators, but with removable contractors. Manipulation is prescribed for fractures on the diaphysis of the humerus, if conservative therapy does not bring success.

Another variant of the operation involves treatment with a pin, which must be inserted through the proximal fragment. To do this, the physician will have to expose the broken bone in the area of damage, find the tubercle and cut the skin over it. After that, a hole is made with an awl, through which the rod is driven into the bone marrow cavity. Fragments will need to be accurately matched and advanced to the full length of the entered element. The same manipulation can be carried out through the distal piece of bone.

If a patient is diagnosed with an intra-articular fracture of the olecranon, it is best to perform an operation to install metal structures. The procedure is performed immediately after the injury. Osteosynthesis of the olecranon requires fixation of fragments, but before this manipulation, the physician will need to completely eliminate the displacement. The patient wears a cast for 4 or more weeks, as this place is difficult to treat.

One of the most popular osteosynthesis techniques is Weber fusion. For this, the specialist uses a titanium knitting needle (2 pcs.) And a wire from which a special loop is made. But in most cases, the mobility of the limb will be permanently limited.

lower limb

Separately, it is necessary to consider various fractures of the diphyses of the bones of the lower leg. Most often, patients come to the traumatologist with problems of the tibia. It is the largest and most important for the normal functioning lower limb. In the past, physicians long-term treatment with the help of plaster and skeletal hood, but this technology ineffective, so more stable methods are now used.

Tibial osteosynthesis is a procedure that allows to reduce the rehabilitation time and is a minimally invasive option. In the event of a fracture of the diphysis, a specialist will install a lockable rod, and intra-articular injuries will be cured by inserting a plate. External fixation devices are used to heal open fractures.

Ankle osteosynthesis is indicated in the presence of a large number crushed, helical, rotational, avulsion or comminuted fractures. The operation requires a mandatory preliminary x-ray, and sometimes a tomography and an MRI are needed. closed type damage is spliced using the Ilizarov apparatus and needles are inserted into the damaged area. For foot fractures (usually metatarsal bones) fixation of fragments occurs by the intramedullary method with the introduction of thin pins. In addition, the doctor will apply a plaster cast to the damaged area, which should be worn for 2 months.

Patient rehabilitation

After the operation, you need to carefully monitor your well-being and contact a specialist at the slightest negative symptoms ( sharp pain, swelling or fever). In the first few days, such symptoms are normal, but they should not appear a few weeks after the procedure.

Other complications after surgery that require urgent medical advice:

arthritis;
fat embolism;
osteomyelitis;
gas gangrene;
suppuration.

Rehabilitation is a significant stage of the entire course of therapy. So that the muscles do not atrophy, and blood enters the damaged area, you should start exercising in time, which is prescribed a day after surgery.

After a week, the patient will need to begin to actively move, but in the event of a fracture of the lower limb, he must use crutches.

Treatment of osteomyelitis: basic principles and features of the methods used

Osteomyelitis is a serious purulent-necrotic bone disease. All components are involved in the inflammatory process: bone marrow, bone tissue itself, periosteum, as well as surrounding tissues. The main task in the treatment of osteomyelitis is to prevent the development of a chronic purulent process in the bone, so it must be timely and complete.

Most often, the disease develops after damage to the bones as a result of trauma or surgery, less often - as an infection screening from another focus with blood flow. This variant usually occurs in children under one year old and adults with a weakened immune system.

At acute course disease symptoms are divided into general (fever up to 38-40 C, weakness, chills, muscle aches, palpitations) and local (pain, swelling and redness of the skin in the area of the affected bone). For chronic osteomyelitis general symptoms are usually expressed much less and appear only during periods of exacerbation. The appearance of fistulas (moves) from a purulent focus to the skin is added to the local signs of the disease, and the pain syndrome becomes weaker. During periods of remission, the well-being of patients improves, pain does not bother, and fistulous passages can be delayed.

Basic principles of osteomyelitis treatment

The choice of which methods will be used for treatment depends on many factors:

Treatment can be conservative (i.e. without the use of surgery) and surgical, and a combination of these methods is also possible - this is the most common option for managing such patients.

In any case, the patient is subject to mandatory hospitalization in the trauma or surgical department. The ideal option is a comprehensive approach to treatment with the participation of specialists in the field of traumatology, purulent surgery, clinical pharmacology, restorative medicine and other specialties as needed.

The first step is the use of antibacterial drugs. These medicines must be:

effective against the most common pathogens and
have the ability to penetrate into the bone tissue.

When chronic process with the development of fistulous passages and poor discharge, the use of antibacterial drugs without surgical treatment impractical. Surgical treatment consists in the removal of necrotic tissues, foreign bodies and sequesters; in some cases, excision of fistulous tracts and skin around chronic wound defects is required.

Conservative treatment

Conservative treatment usually supplements surgical treatment, however, if there is no purulent infection (serous osteomyelitis), it can be used independently.

Antibacterial therapy

Antibiotic treatment should be based on identification of the pathogen isolated from the osteomyelitis site during biopsy or surgical debridement. Before starting the use of antibiotics, doctors receive discharge from the source of infection and send it for bacteriological culture. Then, without waiting for the results of the study, start antibiotic therapy with the drug a wide range, depending on the most likely pathogen. This method is called empiric antibiotic therapy.

Empiric therapy is also used in cases where it is not possible to isolate the pathogen from the site of infection, for example, when negative results sowing. In such situations, doctors take into account the nature of the infection: nosocomial infection is usually caused by methicillin-resistant Staphylococcus aureus (MRSA), community-acquired infections are usually polymicrobial, with the presence of gram-negative flora.

After identifying the microorganism that caused the infection, the treatment regimen can be modified. Both oral (i.e., tablets and capsules) and parenteral (i.e., injections) antibiotics can be used alone or in combination, depending on which susceptibility spectrum has been determined for the microorganism and how patient the patient is tolerant of the treatment. . The last factor is very important, because when prescribing drugs in tablets, it is necessary to strictly observe the prescribed scheme and frequency of administration. Missing tablets can lead to the development of resistance by microorganisms and reduce the effectiveness of treatment.

Usually, antibiotic therapy for osteomyelitis takes 4-6 weeks. Studies have shown that the restoration of blood supply to the bone after surgical treatment takes about 4 weeks, so the course cannot last less than this period.

Antibiotics that have proven their effectiveness in research and clinical practice:

clindamycin;
rifamiptsin;
cephalosporins;
linezolid;
trimethoprim-sulfamethoxazole (co-trimoxazole);
fluoroquinolones.

Clindamycin is given by mouth after initial intravenous therapy for 1-2 weeks and has excellent bioavailability. It is effective against most gram-positive bacteria, including staphylococci.

Linezolid is active against MRSA and vancomycin-resistant enterococci. It inhibits the synthesis of bacterial proteins, penetrates perfectly into the bones to the site of infection, and can be administered both intravenously and orally. Its effectiveness against resistant strains makes it indispensable in the treatment of nosocomial infection.

Fluoroquinolones are used to treat adult patients with gram-negative micrognathisms. They are well absorbed when taken orally, and also show a good concentration of the drug in the bones and soft tissues. Their other advantage is the availability of both injectable and tablet forms, which allows for stepwise therapy with the transition from one form to another.

Among cephalosporins, preference is usually given to the 3rd generation drug - ceftriaxone. It is active against most common pathogens, and a long half-life allows injections of only 1 time per day, which is undoubtedly convenient for the patient, given the long course of treatment.

Rifampicin gives optimal intracellular concentration and a good sensitivity profile in methicillin-resistant Staphylococcus aureus. It makes sense to use it in combination with drugs that act on the cell wall to achieve a synergistic effect and to avoid the rapid development of resistant strains. Often used in combination with co-trimoxazole.

Physiotherapy for osteomyelitis

Physiotherapy treatment is usually applied after the completion of surgical treatment and a course of general antibiotic therapy, however, in some cases, it can be prescribed in parallel with general treatment. From physical methods for osteomyelitis use:

electrophoresis of drugs;
mud and paraffin treatment;
ultraviolet irradiation;
hyperbaric oxygen therapy, etc.

Medicinal electrophoresis is performed using antibacterial drugs and calcium. It not only allows active ingredient penetrate to the site of infection, but also improves blood and lymph circulation in the focus and promotes rapid healing.

Mud and paraffin applications are used to treat closed forms of chronic osteomyelitis without fistulas and lead to a decrease in inflammation and even resorption of small sequesters.

UV therapy is applied topically and has a good analgesic and anti-inflammatory effect.

HBO is usually included in complex treatment, helps to increase the body's resistance, and also prevents chronic osteomyelitis.

Physiotherapy

Exercise therapy is indicated at the recovery stage of the treatment of osteomyelitis. The affected bone can be loaded no earlier than 20 days after the operation. However, during hospitalization, physical exercise for healthy parts of the body - even lying in bed for 15-20 minutes a day, you need to do simple exercises.

Treatment of osteomyelitis with folk remedies

Application folk methods and phytotherapy (herbal treatment) is possible as part of an integrated approach to the management of patients with osteomyelitis. It is unacceptable to use folk remedies without adequate medical supervision, without surgical treatment of the focus of infection and a course of antibacterial drugs.

Treatment with folk remedies can be both local and general. In both cases, it is aimed at stimulating the immune response and the overall resistance of the body.

As a general strengthening treatment, you can recommend:

Local treatment should be aimed at reducing inflammation and improving microcirculation. For these purposes, you can use semi-alcohol compresses, aloe juice, compresses with cabbage leaf and onions. Such methods of treatment are suitable only for closed forms of osteomyelitis, otherwise it is possible to intensify purulent processes in the focus of infection.

In any case, before using folk remedies, you need to check with your doctor if there are any contraindications to a particular method.

Surgery

Surgical treatment is used in patients with osteomyelitis in the case of:

failure to respond to specific antibiotic therapy,
in the presence of a soft tissue abscess,
accumulations of discharge under the periosteum,
if there is a suspicion of involvement in the process of adjacent joints.

Complete and timely surgical treatment is the key to a speedy recovery of the patient and prevents the development of chronic infection.

Operations for osteomyelitis

Depending on the form and stage of the course of the disease, it is possible to perform various interventions:

At the preoperative stage, antibacterial, detoxification therapy is carried out, it is necessary to prepare the patient's body for intervention. After the operation is completed, immobilization (immobilization) and an elevated position of the limb, as well as drainage of the wound, are necessary. At the same time, antimicrobial therapy and measures to improve blood supply continue.

An important factor is the prevention of re-infection with resistant nosocomial strains. For this use local treatment solutions of antiseptics and regular dressings.

External osteosynthesis

At difficult cases when there is a significant bone defect and a chronic inflammatory process, restoration of one's own bone is required after the operation. Most often, external osteosynthesis with the Ilizarov apparatus is used for this. This method, with an uncomplicated course, allows you to restore your own bone in about 95% of cases. At the same time, blood supply, innervation, structure and function of the bone are restored.

Laser treatment

IN last years appeared new method treatment - osteoperforation of the bone affected by osteomyelitis with a laser. In this case, the surrounding soft tissues are less damaged than with traditional surgical treatment. However, like any other method, it has its own indications and contraindications. The choice of the optimal treatment tactics is a joint work of the doctor and the patient, it should always be individual.

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Evminov's profilaktor is a design that is a wide board with a crossbar and an emphasis for the possibility of adjusting the angle of inclination. The device is used to strengthen the muscular frame of the back and stretch the spine. It is effective in the treatment of osteochondrosis, scoliosis and other diseases of the spinal column.

Evminov's technique, which is used when exercising on this simulator, involves performing low-amplitude movements at an angle of inclination to the floor of about 20 degrees. This position contributes to the unloading of the muscles of the body, which expands the size of the intervertebral spaces where the discs are located. In the future, the exercise therapy instructor determines the list of exercises depending on the individual characteristics of the pathology.

Evminov's prophylactor is also used to distract the spine in order to prevent attacks of pain syndrome. For this, it is selected physiotherapy(exercise therapy) in combination with the principles correct breathing by Katarina Schroth.

The simulator can be installed both in medical institutions and in a one-room apartment. He does not take large areas, and when folded has a minimum size.

Medicinal properties of the product

Evminov's profilator is based on the patterns of development of the spinal column, which were studied by the famous orthopedist Ilizarov. The scientist noticed that excessive stretching of muscle fibers leads to the launch of the processes of restoration of bones, tissues and blood vessels.

Evminov's method modulates this effect by combining the unloading of the spine with the simultaneous strengthening of the skeletal muscles of the back. Most of exercises on the simulator are performed in a half-hanging position, lying down or head down. This position allows you to relax the muscular frame of the back as much as possible. At the same time, with the help of smooth exercises, stretching of the skeletal muscles is achieved.

To improve the effect, the Evminov simulator is made individually in a special center for the characteristics of the human spinal column. It is even better if its installation is carried out by trained engineers. However, such a board can be made independently, but the following features must be taken into account:

board stiffness;
Slip coefficient;
Friction force level;
Resistance to deformation.

In confirmation of the high efficiency of Evminov's simulator, readers' attention should be drawn to the fact that the invention is patented not only in the CIS countries, but also in Europe.

Evminov's classic board is a surface consisting of 8 fragments. They are made up of wood. different breeds. For convenient fixation of a person, the device is equipped with handles and loops for attaching to the wall.

Features of the technique

Evminov's technique is based on facilitating the work of the spine in a horizontal position. It is known that intervertebral discs do not have their own blood supply. Nutrients come to them from adjacent vertebrae. With deformities of the spinal column, compression of the discs and damage to the vertebrae are observed. This stops the blood supply. To restore it, it is necessary to "stretch" the intervertebral discs. Pathological changes disrupt this process, therefore, against the background of any displacements of the spinal column, osteochondrosis is observed.

Being engaged on a medical board, it is possible to modulate the above described process. As a result of daily training on the board, cartilage begins to receive nutrients and water. This leads to an increase in the size of the spinal column, which can be checked by measuring the height of the body before and after classes at the dispensary.

Evminov's profilator allows you to perform a set of strength exercises with minimal application of "bone" strength. At the same time, physical exercises do not damage the vertebrae and minimally load the muscles.

True, it should be remembered that there are dangerous exercises that lead to stretching of the paravertebral zone:

Tilts to the right and left with weight lifting;
Twisting with an angle of more than 20 degrees;
Squats with weights.

In professional rehabilitation centers, gymnastics complexes on an inclined board are divided into groups depending on the characteristics of the patient's pathology:

Treatment programs - in case of exacerbation and treatment of diseases of the spinal column;
Wellness programs - for prevention;
Sports programs - with the aim of building endurance and muscle strength;
Special programs for body shaping and height increase.

Evminov's technique in the treatment of diseases of the spine:

Gentle motor mode;
2 complexes exercise recommended by a doctor;
The duration of the training is not more than 30 minutes;
The frequency of repetitions - from 3 to 6 times a day;
The nature and pace of execution is smooth and slow;
The duration of the course is from 2 to 12 months.

Indications for the treatment program:

Pain in the back;
Different stages of osteochondrosis;
Intervertebral hernia;
Chronic sciatica in the acute stage;
Lumbishialgia (pain in the lower back and limbs due to compression of the nerve roots);
Bechterew's disease (calcification of the ligaments along the spine);
Scoliotic disease.

Evminov's board prophylactic for pain in the lower back caused by pinching of the spinal nerves can increase pain, so it is recommended to consult a doctor before starting strength exercises.

Evminov's method in the treatment of diseases of the spine is not approved by all doctors. Distraction (traction, traction) is a method of passive relaxation, which contributes to the expansion of the intervertebral spaces, but the therapeutic effect of it is questionable by many doctors.

Usually, as soon as a person from an inclined position on the board returns to a vertical position, the pain syndrome intensifies. As a result, the prophylactic in the treatment of spinal curvature by instructors of specialized rehabilitation centers is used in combination with the method of physiotherapy. The basis of the treatment of pathology is classical physiotherapy exercises (LFK).

There are also contraindications to the exercises according to the above method:

Oncological education;
Mental disorders;
Tuberculosis;
severe arrhythmia;
Purulent inflammation of the bone tissue;
Traumatic injuries of the spine with spinal cord injury.

Since the Evminov board requires significant physical effort and takes a lot of time from a person, it is better to use it as an additional method of treating the pathology of the spinal column.

However, with perseverance and patience, the preventer will help get rid of the disease. We recommend several exercises that you can perform at home on this simulator:

Position your back on the board at a 20 degree angle. Hang from the bar and concentrate on stretching your spine. To do this, stretch your legs down. Number of repetitions 2-3;
Half hanging with feet on the floor does this: hang your hands on the crossbar. At the same time, lower your legs down along the edges from the bench. Relax and feel the spine stretch;
The next exercise is aimed at eliminating curvature of the spinal column. Rest on the board with the palms of your hands in a position on your stomach. Tighten your calf muscles and try to touch your chin to your chest. Repeat the procedure 2-3 times;
Grasp the crossbar of the prophylactic with your hands and slowly begin to sway your legs to one and the other side. Then twist the spine, but carefully (at an angle of no more than 20 degrees).

In conclusion, I would like to note that the Evminov method is not used as an individual and the only way to treat diseases of the spine. It is better to use it in combination with classical exercise therapy, but only after consulting a doctor.

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It consists of 4 metal knitting needles connected in a special way, which are attached to 2 rings and are equipped with moving rods.

Today, the device is made from titanium alloys.

In the article, you will learn what the Ilizarov apparatus is used for, how much it needs to be worn, and how the hand is developed after removal.

Indications for use

The Ilizarov apparatus has found application in various fields of medicine. It is used to treat:

Correction of developmental anomalies;
Bone curvature;
Correction of an incorrectly fused bone after;
Diseases of the musculoskeletal system;
Joint diseases;
Pathology of the musculoskeletal system;
Rakhita etc.

On the hand, the Ilizarov apparatus is most often installed to lengthen or shorten bones, change their shape, and splice fragments.

It is indispensable in cases where parts of the bone during injury have diverged into different sides , and the muscles fixed them in this state.

You can not do without the Ilizarov apparatus and with a complex fracture of the arm with displacement. It also helps in correcting the formation of false joints.

Installation of the Ilizarov apparatus on the arm

Usually the device is installed for a sufficiently long period (more about the terms below), the duration of which is determined by the attending physician. The device is attached to the arm using pins that are passed through drilled holes in the bone.. The patient is under general or local anesthesia.

The spokes are crossed at an angle of 90 degrees and fixed on the ring. Nuts indicate the required length. Subsequently, the doctor checks and re-adjusts the desired length every day.

The rods, which are located between the rings of the apparatus, are designed to control the development of growth and restoration of the bone, its position and the accuracy of matching fragments.

With the help of the Ilizarov apparatus, bone fragments fit snugly to each other. The device does not allow them to disperse, as it fixes the fragments.

The number of rings in the fixture varies. This is a complex apparatus, so treatment should be carried out only under the supervision of a specialized specialist.

Patient Care Requirements

When installing the Ilizarov apparatus, constant monitoring of the patient's condition and his regular examination are required.

When wearing the device, the development of an infectious process is possible. Therefore, it is necessary to disinfect its surfaces and observe aseptic conditions. The needles are disinfected using alcohol solution. It is necessary to wipe them not only along the entire length, but also to treat the skin in places of contact with them. To prevent bacterial infection from above, the device is covered with a bandage, which is tightly fastened.

It should also be borne in mind that the process of changing bones can be quite painful, so support for the patient's treatment with antibiotics, anti-inflammatory and pain medications is required.

The hand during fixation in the first days swells strongly, turns red, at this time there may also be an increase in local temperature.

If there is a general rise in temperature, it is noted headache, severe malaise, dizziness, increased bleeding at the attachment points, then urgent measures should be taken.

Then it is necessary to remove the apparatus and conduct rehabilitation treatment, after which the doctor decides on a new fixation of the device. In this case, we can talk about the occurrence of an abscess or the addition of an infection.

An important measure is the prevention of the development of osteomyelitis of the upper limb. It may result from:

Infection;
Bone damage during installation;
Fixing errors;
inflammation;
Improper care, etc.

It is required not only to control the patient's well-being while wearing the device, but also to regulate the process of its installation by an experienced specialist to prevent complications.

In addition, discomfort, malaise and discomfort at the location of the device. Even with medical correction, it can be difficult to completely get rid of them. Therefore, the patient may experience a decrease in mood, irritability and insomnia. In these cases, the use of sedatives, tranquilizers, herbal medicine, and sleeping pills is indicated.

Advantages and disadvantages of using the Ilizarov apparatus

The main advantages of this treatment method include:

Reliability;
The possibility of correcting severe injuries with displacement of bones and the presence of comminuted injuries;
Prevention of improper fusion of bones;
Correction of disproportions of the upper limbs;
Restoration of the function of the joints and the position of the hand in relation to the shoulder;
Reduction of terms of rehabilitation after injuries;
The ability to correct defects that cannot be cured by other means.

Flaws:

The need for anesthesia;
stay in a hospital;
Inconvenience and discomfort for the patient;
The need for constant care;
Regular x-ray examination;
The possibility of infection;
Remaining traces after removal.

Terms of wearing and removal

In the treatment of injuries and diseases of the upper limb, the period of mandatory wearing of the Ilizarov apparatus is about 30 days.

In case of significant damage or repair congenital anomalies it can be extended up to 90 days.

Removal of the Ilizarov apparatus from the hand is carried out under local anesthesia in case of pain.

If the patient feels well and the doctor decides accordingly, the removal of the device can be carried out without anesthesia.

In this case, the needles are removed from the places of fixation, the wound is treated with disinfectants, and a sterile bandage is applied to it.

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After removing the device, the arm is placed in a cast and completely immobilized. The bandage is removed only after full recovery condition and function of the hand.

Consequences and rehabilitation after the Ilizarov apparatus

After the device is removed, the patient needs a mandatory period of rehabilitation for a complete recovery. At this time you need:

Massage;
Physiotherapy;
Physiotherapy;
Dosed loads;
Swimming, etc.

Such measures allow you to develop muscles, strengthen ligaments and activate the blood supply to tissues. This is very important for the full restoration of the functions and motor skills of the hand.

It is desirable that the limb get used to constant loads in order to fully restore the range of motion and eliminate pain.

Complications may occur if the doctor's instructions are not followed.. In cases where the swelling does not subside or the upper limb is swollen even more, you should immediately consult a doctor. Complications may be the result of a vascular reaction, an inflammatory process, or infection.

How to relieve swelling of the hand after a fracture of the radius can be read.

There are severe injuries in which the natural fusion of bones in a cast can take up to six months. In order to reduce the time and increase the chances of healing after a fracture, the famous surgeon G. A. Ilizarov invented his own technique in 1950. He designed a structure that is implanted into a damaged limb with the ability to adjust the joint of bone fragments. Due to this, surgical intervention was excluded, and the patient's chances of restoring motor function were significantly increased.

How the device works

Imagine a wide bracelet consisting of several rings fastened together with rods that can be adjusted in width. The spokes come from the rings. Their purpose is to gain a foothold in bone fragments and, with the help of adjustment, control the fusion process. The device is unique in that it allows you to speed up the healing process of severe fractures, as well as treat false joints.

The design is made of titanium alloy, which allows patients to bypass metal detectors and undergo magnetic resonance imaging, because the device will always be with the patient for the next few months. Titanium alloy is less susceptible oxidizing properties, does not cause allergic reactions and other intolerances.

The patient who has been put on spends the first week in the hospital, where they monitor how the body reacts to the foreign structure, the patient is taught how to care for the device. You will need daily treatment of the skin surface with antiseptic agents to prevent infection from entering the wound. Then the patient is discharged home, where the process of bone fusion will take place for several months. Several times a month, he needs to visit a doctor who will adjust the tension of the spokes.

How to remove the device

The period of wearing the structure depends on the severity of the fracture or bone anomaly. Usually, the Ilizarov apparatus is removed after a month, but in case of severe pathology, the period can increase up to 90 days. Do not try to remove the device yourself, only a specialist can competently and under local anesthesia carry out this procedure. The surgeon will have to disassemble the device into parts or loosen the device enough to remove the tension on the spokes. To do this, he will need ordinary wrenches, pliers and wire cutters. The spokes bite off the structure and are removed last.

Before removing them, the skin should be treated with alcohol. Pliers clamp the knitting needle, twist it slightly and pull it towards you. Do not make sudden movements. After it comes out, bleeding is possible, which must be clamped with a cotton swab for several minutes. The wound is treated with an antiseptic, and only after that they begin to dismantle the next knitting needle.

After removing the Ilizarov apparatus, the entire surface of the skin is treated with hydrogen peroxide, iodine, and a gauze bandage is put on. If necessary, in the future, the damaged limb is placed in plaster for the subsequent restoration of full functionality, after which the patient is waiting for rehabilitation.