1. A day in the life of an Ilizarov Occupational Therapist
Occupational therapy in the Limb Reconstruction s Service in the Belfast HSC Trust
Occupational Therapy the Limb Reconstruction Service in the Belfast HSC Trust
A day in the life of an Ilizarov Occupational Therapist
Jillian Black
Clinical Specialist Occupational Therapist
Trauma
Poly trauma
Bone loss
Specialist nurse
Surgeon
Occupational therapy in the Limb Reconstruction s Service in the Belfast HSC Trust OT
Adult
Child
Physio ad
Elective
Deformity correction
4 months – 2+ years

2. Background
1WTE since 1998
Patient group – average age 45.5 (19-91)
Ratio 2.6 males to 1 female
MDT working – patients active engage in rehab
Ilizarov philosophy – loading limb = good bone healing
Contents
Splinting: rationale, types and audit
Functional skills: FIM/FAM audit
Extended ADLs

3. Static progressive until achieve correct position, then static.
Splinting
Joint stiffness due to trauma, frame position, pain, difficulty weight bearing, frame adjustments
Static progressive until achieve correct position, then static.
Velcro foot splint Rodded foot splint
Rodded foot splint audit
20 made Jan Sept 2017
16 achieved neutral in 1 week to 15 week
More than half achieved neutral ankle in 4 weeks

4. Knee Splints
Correct knee flexion deformities
Thermoplastic and Ilizarov
components
Hinge set at passive end range
Toe Splints /slings
Maintain forefoot/ toe extension
Foot within frame, e.g. foot correction, ankle arthrodesis

5. Functional skills - living with a frame
Maximising independence – through functional assessment, rehab and equipment provision
FIM/FAM completed at admission and discharge.
FIM/FAM Audit 81 files reviewed (June June 2017)
Type of frame
70 tibia
9 tibia and cross knee
1 bilateral tibia
1 precise nail
Reason for frame
74 fractures
7 elective
Mechanism of injury
Number
Fall 38
RTC 21
Sport/ activity 10
Stress fracture 2
Crush injury
Assault 3
Deformity correction 5
Mechanism of injury
Number
Fall 38
RTC 21
Sport/ activity 10
Stress fracture 2
Crush injury
Assault 3
Reason for frame
Average admission score
Average discharge score
Percentage increase
Elective
150.5
157.5 5
Trauma unspecified #
163
178
12.1
Schatzker#
135.4
164.8 34
-Pilon/distal tibia#
148
161.2
35.2
Segmental /compound#
160
171.2 9
Spiral# 30
198.6
5.6

6. FIMFIM/FAM results Areas of improvement Number of patients
Bath transfer 33
Bed chair toilet transfer 20
Bathing
Dressing lower 19
Community mobility 14
Car transfer 12
Walking
Dressing upper 9
Stairs
Grooming 8
Reason for frame
Average admission score
Average discharge score
% increase
Elective
150.5
157.5 5
Unspecified fracture
163
178
12.1
Schatzker fracture
135.4
164.8 34
Pilon fracture
148
161.2
35.2
Segmental fracture
160
171.2 9
Spiral fracture
188
198.6
5.6

7. Forewarned is forearmed
Extended ADL – work, school, leisure, coping skill
Maintain ‘normal’ routine and roles
Find alternatives to maintain activity levels and achievement
Structure, planning, goal setting, pacing
“Managing the frame was easy, keeping my head right was more difficult”
Forewarned is forearmed
Patients views
100% were satisfied or very satisfied with
all aspects of OT

8. and finally …!
Ilizarov philosophy – load limb = good bone healing
In a typical day an Ilizarov Occupational Therapist will
splint to improve joint position
functional skills and equipment increase independence and use of the limb
good coping skills allow patient to take control of their own recovery
Future plans
formalise psychological screening
scar management