Shah, Harshad M.; Koirala, Shreel
April 2018
Genij Ortopedii;2018, Vol. 24 Issue 2, p174
Academic Journal
Introduction: Ilizarov technique for limb lengthening involves distractive and compressive forces. Many complications arise during the long course of treatment, most however are preventable/correctable and will not interfere with the successful results of treatment. The common preventable complications due to distraction is equinus deformity of the foot. With the tibial lengthening of more then 6 cms the tension generated in the muscle specially the triceps surae against the distractive force produces muscle contracture gradually leading to equinus of foot. Prophylaxis against muscle contracture is an essential part of treatment for limb lengthening. It can be achieved by passive stretching of muscle by physiotherapy or active stretching of muscle by weight bearing on the limb for a minimum period of 6 hrs/day. Weight bearing with increased muscular activity stimulate osteogenesis whereas the converse retards it. Physiotherapy is not patient compliant and does not provide adequate axial loading. Active stretching by weight bearing provides both axial loading and muscular activity. But within a significant amount of shortening weight bearing is not possible. Therefore, an orthosis was made by Arora for the correction of equinus. This was modified which could be attached to the Ilizarov fixator and allows the patient to weight bear on the limb. In our hospital we use this double decker foot orthosis in 6 patients with more then 6 cm shortening and we obtained excellent results without contracture or equinus deformity. Material and methods: In six patients who underwent limb lengthening 4 tibial and 2 femoral we used the double decker foot orthosis we came out with good results. Each of them are evaluated for equinus, consolidation, growth of bone, ambulation and patient satisfaction The procedure: - The various devices like ordinary bandages elastic bandages, ordinary foot sole attached to Ilizarov did prevent equinus to some extent but with the limbs being unequal the weight bearing was absolutely not possible. So we came out with an orthosis which could make the patient ambulant and prevent from equinus deformity. It consists of the aerial piece made of alkathene material which will be in contact with the patient’s foot. It is of 0.5 cm in breadth. - The ground piece is also made up of alkathene material attached to a rubber sole comes in contact with the ground. It is of 1.5 cm in breadth. - Connecting rods 4 in number attached to the aerial piece and ground piece. The distance between them will be the amount of lengthening to be achieved. - The scale attached to the ground piece will be fixed and sliding over the aerial piece. The amount of distraction achieved or to be achieved will be measured through the scale. It will also be easier for the patient. - After achieving the required lengthening aerial and the ground piece comes together and measures about 2 cm. Which is used for ground clearance. Discussion: Equinus of foot during lengthening is one major complication. To maintain normal tibio-talar relationship which will be altered due various muscles acting across the ankle joint leading to deformities. ambulating the patient with shortening is very difficult so weight bearing is not possible which in turn hampers bone growth and consolidation. Flexion contracture in knee due muscle contracture and non-usage of the limb during the entire process of limb lengthening. The psychological effect of patient is much stressful and painful due to his morbidity. Patient not understanding the process of limb lengthening thoroughly and reporting poor regeneration, sometimes increased lengthening leading to shortening of normal limb. All the complications are prevented to maximum extent with our modified double decker foot orthosis with a measuring scale. Results: - No equinus deformity in all 6 patients; - No clawing toes; - No limb length discrepancy; - Good regeneration and remodeling; - Excellent patient satisfaction & Social acceptance. Conclusion: - The complications of limb lengthening can be prevented. - This simple DOUBLE DECKER foot orthosis can be used in all the patients who are undergoing limb lengthening process.


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