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Ilizarov Method: Removal of the Fixator and Post fixator removal

Dr. Mangal Parihar 

- Discussion: A month too late is better than a day too early. This is a useful thing to remember at a time when even the most cooperative patient is usually becoming impatient for the frame to be removed. The ability of the regenerate for unprotected weight bearing must be ensured prior to taking off the frame. The x-rays must show at least three cortices; i.e. out of four cortices (anterior, posterior, medial and lateral) in AP & lateral projections, at least three should be fully ossified, with a sharp outline of the cortical bone. Finally before actually removing the frame the patient may be administered a 'stress test'. in which all the uprights connecting the proximal and distal segments of bone are disconnected and the patient asked to use the limb in a functional manner ( weight bearing for the lower limb and functional activities for the upper limb). If the patient is able to do this the frame can then be removed with confidence. Actual removal of the fixator is usually done under anesthesia. In adults, though it is possible to do without it, it is not recommended as the removal of half pins is quite painful. In case a removal is done without anesthesia, one must remember to loosen the wire fixation bolts thus releasing wire tension prior to cutting the wire. Ensure that the limb does not drop suddenly when the last wires are cut. Remember to inject local anesthetic at the side of the olive when removing olive wires. 

- Post Fixator Removal:
If Schanz pins had been used, the patient should be protected weight bearing for a period of six weeks to allow for some repair of the pin tracts in the bone. Use of braces or casts is usually not necessary if the plan outlined above has been followed, but when in doubt it is always safer to put the patient in a snugly fitting cast or brace as required. In certain cases, namely congenital pseudarthrosis of the tibia, residual significant deformity, and a small cross sectional area of regenerate the limb needs long term protection in the form of a plastic brace. Strenuous activity and contact sports should be avoided till such time as all four cortices are seen clearly and the medullary cavity has recanalised. 

- Ilizarov Menu:
 
- The Early Post-op period (the Latent Phase) 
- Pain relief: 
- Limb Positioning 
- The Distraction Phase 
- Neurological Examination 
- Pinsites for Signs of Inflammation / Infection 
 Stability of Frame & Components 
- Ambulation 
- Follow-up Checklist (X-rays) 
- Quality of regenerate. 
 Physiotherapy 
- The Consolidation Phase 
- Removal of the Fixator and Post Fixator Removal