Fixator Adjustments

The Ilizarov fixator has nuts marked with nail polish and/or clicker rods that need to be adjusted with a metric wrench. The wrench will be supplied by the team, along with specific procedural instructions. The regular size Ilizarov device uses 10-mm metric wrenches. The small mini-Ilizarov uses 8-mm metric wrenches.

The Orthofix fixator needs to be adjusted with a special Allen wrench, which will be provided by the team, along with specific procedural instructions. Automators are electric motors attached to some Ilizarov fixators to perform automatic adjustments. They will be programmed by the team.

The Heidelberg fixator has components that can lengthen or correct angular deformities. It uses two special wrenches for lengthening and a different Allen wrench for deformity correction. Each fixator is clearly marked, and instructions are provided by the team.

It is important that the adjustments be performed correctly, because they affect the correction process. If you are unsure of the instructions, experience sudden pain associated with adjustments, or have any other questions, please contact the team at 410-601-8700.

Ilizarov fixator	Orthofix fixator	Heidelberg fixator

Fixator care

You should not get the fixator wet until your incisions are healed and staples removed. Tub baths are not permitted because of the hazard of dirty bath water entering the pin sites. It is helpful to use a shower chair and hand-held shower hose for safety. A liquid antibacterial soap should be used. Be sure to rinse the fixator well. After showering, dry the fixator with a towel and use a hair dryer on cool setting to dry the remaining areas.

Splints/Shoes

There may be a special splint attached to your fixator. This is a resting splint, which helps prevent muscle contracture at a joint. This resting splint should be worn all night and for periods during the day, according to instruction.

Pin care and sponges

Sponge dressings may be placed around your pins. This allows the skin to heal after surgery and decreases the motion of the skin at the pin site. The sponges will be changed within a day or so after surgery. The sponges will then be changed every day for the first week. Once the surgical sites are dry, the use of sponges may be discontinued. The sponges that we use at the Center are not available in stores or at pharmacies.

Sponge changes should occur daily and are as follows:

1. Gather supplies and wash hands.
2. Pull up the stack of sponges.
3. Remove and discard the old sponge that is next to the skin.
4. Wash hands.
5. Inspect sites for redness, swelling, drainage, and foul odor.
6. Clean pin sites with cotton swabs and normal saline solution. Use one or more new swabs with each pin. Gently press down on the skin while rolling the swab away from the pin site.
7. Until instructed to discontinue (usually 1 week), use the following as a guidline. Place a new sponge around the pin, and replace the stack of sponges. The stack of sponges should give slight compression against the skin.

In the past, daily pin cleaning with a swab using saline or peroxide was recommended. We no longer recommend daily pin cleaning. This simply irritates the pin site. Instead, we recommend cleaning only those pin sites that are draining or have crust around them. All crust should be removed from the pin site if possible. Crust is a non-living material and is a great host to bacteria. The body cannot remove crust itself. It may be difficult to remove the crust with a cotton swab. You may need to use tweezers. We recommend cleaning the tweezers in water and then soaking them in alcohol after each cleaning. Dead areas of skin may develop and will need to be removed by the ICLL team during a clinic appointment. This is usually painless but is often frightening to children. This is mostly needed for some upper thigh pins where the soft tissues are abundant. Minimizing pin skin motion by tight wraps will help prevent this minor problem. Daily washing of the pin sites with a shower head is the best pin care possible. Swimming also helps clean the pin sites.

Some fixators have larger pins called half-pins. These half-pins require the same care as do the smaller pins, and those that are applied to the femur or humerus should be compression wrapped instead of surrounded by sponges. The procedure is to wrap the half-pins with 3-inch Kerlix gauze after cleaning. If there are several pins close together, they may be wrapped as a cluster. These dressings should be changed daily. You should use the entire roll of Kerlix (see compression wrap handout). If the wrap does not indent the skin in the fleshy thigh or upper arm, it is not doing anything. The purpose of the wrap is to minimize pin skin motion, which helps prevent irritation and infection.

Pin care should be performed once daily until showers are allowed. Pin care is then needed only if a pin site infection or heavy crusting develops. The best time for pin care is after a shower or bath when the skin is damp and crusts can be removed easily by cleaning each site with a cotton-tipped applicator and normal saline solution.

Be sure to inspect all pin sites every day for signs of infection.

The International Center for Limb Lengthening
Sinai Hospital of Baltimore
2401 West Belvedere Avenue
Baltimore, Maryland 21215, USA
phone: 410-601-8700
toll-free: 800-221-8425
fax: 410-601-9576