B Lrs Advice Physio
B Lrs Advice Physio
B Lrs Advice Physio
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Taylor Spatial
Frame (TSF)
Limb
Reconstruction
System (LRS)
Other fixators are used and may include the Sheffield Ring
fixator (previously called the Sheffield Hybrid frame) or the
Hoffman fixator (a rail fixator).
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Half pins
Wires / olive wires - wires that fix the frame to the bone,
going all the way across the bone
Distraction
Dynamisation
Exogen
Physiostim
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Elective
Congenital
- Deformity correction
- Short stature
- Limb abnormalities
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Post operatively
Patients should commence an active exercise regime
as soon as possible post operatively. This will be
dictated by the site and type of fixator.
Patients should be mobilised as soon as possible
post operatively. The weight bearing status will be
dictated by the operating surgeon depending on each
units regimes and the patients condition.
Prior to discharge patients should be able to self
manage exercise regimes (or with carer assistance).
Wherever possible, patients should be independently
mobile, with walking aids as appropriate. Some
patients may continue to require supervision whilst
walking (for example children).
Prior to discharge, patients should be provided with
an out patient physiotherapy appointment or an
urgent referral should have been made to local
physiotherapy services.
Out Patient Physiotherapy
All patients should attend for out patient physiotherapy as
soon as possible following their discharge home, ideally
within a week of discharge.
Patients should be seen regularly throughout the whole
time the external fixator is in situ and after its removal until
they achieve full potential function and joint range.
Patients should be continuously assessed and exercise
regimes and mobility should be progressed regularly.
However, it is acknowledged that clinical caseloads may
determine how often it is possible to treat the patient.
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Physiotherapy considerations
Joint range of movement should be monitored closely.
Those patients who are undergoing deformity correction /
lengthening have a limb that is constantly changing due to
the surgical process and therefore need regular review.
Specific attention should be paid to the joints above and
below the fixator site looking at range of movement and
power.
Caution should be paid during soft tissue stretches where
joint range is compromised, particularly following removal
of the external fixator due to the potential vulnerability of
the bone.
Mobility and function should be reviewed regularly and
progressed as the patient is able and permitted. Many
patients can fully weightbear at some point whilst the
fixator is in situ.
Rehabilitation activities could include things such as
wobble board work, step ups, balance pad work, treadmill,
exercise bikes and cross trainers along with basic
physiotherapy activities such as core stability, muscle
strengthening exercises and patella mobilisations etc. All
activities will be dependant on weightbearing status or any
restrictions placed by the patients surgeon.
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Complications / problems
Pin site infections- (usually treated with flucloxacillin)
can cause a dramatic loss of range of movement,
pain and decreased mobility. These symptoms may
present prior to any visible signs of infection
(redness, swelling, discharge). These symptoms will
generally settle with the treatment of the pin site
infection.
Pain some patients may experience problems
controlling pain. It may be helpful to get the patient
reviewed as soon as possible. Some analgesics may
be inadvisable for patients with external fixators (for
example, Non-Steroidal Anti-Inflammatory drugs).
Non-compliance there may be lots of reasons for
these
patients
to
be
non-compliant
with
physiotherapy, such as pain control, travel issues,
taking time off work or school. These issues may
often be resolved by involving other agencies. Every
effort should be made to keep the patient engaged
whilst undergoing this treatment.
Joint contractures if not monitored closely patients
may develop joint contractures, this can be a result of
limb lengthening +/- poor positioning. At the first sign
of a joint contracture physiotherapy should be
increased, positioning should be addressed and the
patient should be referred back to their consultant.
Muscle shortening patients may have a reduction in
joint ranges during their time in the external fixator
especially if they are having their limb lengthened.
However every effort should be made to maintain as
much range as possible.
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Amanda Trees
Clinical Specialist Physiotherapist
James Cook University Hospital
Middlesbrough
Tracy Johnston
Clinical Specialist Physiotherapist
Sheffield Childrens NHS Foundation Trust
Sheffield
December 2008
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