Transcript Document

Reza Shahryar KAMRANI MD.
TUMS Shariati Hospital
20/2/91
Tehran Iran
36th annual congress of IAS
Exterla fixation in
Burned Limb
• External fixation in burned limb
– 1; Acute phase
– Positioning
– Concomitant bone and joint trauma
– 2; Recovery phase
– Against contraction
– 3; Reconstruction phase
– Release of the contractions
– Lengthening
• External fixation in burned limb
– 1; Acute phase
– Positioning
– Concomitant bone and joint trauma
– 2; Recovery phase
– Against contraction
– 3; Reconstruction phase
– Release of the contractions
– Lengthening
– Acute phase
– Positioning
– Concomitant bone and joint trauma
– 4 patient
• 1 tibio-fibula
• 3 distal femur
– Healed in all cases
– 8 patient
– 8-63 years old
– 14 days Ex.Fix aplication
• External fixation in burned limb
– 1; Acute phase
– Positioning
– Concomitant bone and joint trauma
– 2; Recovery phase
– Against contraction
– 3; Reconstruction phase
– Release of the contractions
– Lengthening
Benjamin Franklin :
‘‘An ounce of prevention is better than a pound
of cure’’
burns 3 5 (2 0 0 9) 2 7 4– 2 7 9
– 18 cases
• 7 prevention
• 7primary treatment (mild and mod cases)
• 4 adjustment treatment
• Preventive in 7 cases
• External fixation in burned limb
– 1; Acute phase
– Positioning
– Concomitant bone and joint trauma
– 2; Recovery phase
– Against contraction
– 3; Reconstruction phase
– Release of the contractions
– Lengthening
burns 3 5 (2 0 0 9) 2 7 4– 2 7 9
– 18 cases
• 7 prevention
• 7 primary treatment (mild and mod cases)
• 4 adjustment treatment
• Primary treatment 7 cases
– Over weeks
– Maintain two times of distraction time
• Adjustment treatment in 4 cases
• 4 case 5 knee
• Circumferential scar of burn
• Recurrence of the flexion contraction
• Scarectomy + Free Flap + Hinge Ilizarov
• Full ROM + 1 drop foot
• Herzenburg 1994
– Ilizarov gradual correction of the knee contraction
• 6-8weeks
– Rebound phenomenin 13of 14 cases
– A case report of 43 years long flexion contraction
of the wrist
• Hinge Ilizarov
• 1mm/d * 6 weeks + 2 m in site
– 6 hands in 5patients
– Mean age of burn = 7y
– Mean age of treatment = 16.6 y
– Mean previous failed surgery = 5
– Distraction begins after subside of pain
– 1 mm/d
– Several z lengthening meaning while of distraction
left unsutured + split SG at the end of correction
– Remove after correction + 4w splint + PT
• External fixation in burned limb
– 1; Acute phase
– Positioning
– Concomitant bone and joint trauma
– 2; Recovery phase
– Against contraction
– 3; Reconstruction phase
– Release of the contractions
– Lengthening
(J Burn Care Rehabil 2004;25: 416–420)
• 20 years of experience in hand burn
contracture correction with external fixator
– 218 case
– 4 m to 20 y duration
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Remove of the hypertrophic scars and contractions
Correct the contraction
Apply the fixator
Skin graft
One week interval
Arthrodiastasis in 5-7 days
Joint repositioning gradually
2-3 w static phase
2-3 w dynamization
splint and rehabilitation
– Conservative surgical release
– Application JESS frame for residual correction
– 6 weeks
– Hand therapy
What have I picked up?
• Acute and sub acute phase
– Pin fixators are superior to shanz fixators
• Reconstruction phase
– Gradual correction is a well accepted technique in
intractable burn deformities
– Concurrent soft tissue release and coverage (graft
or flap) is advised
Thank you for your attention