Use of cable ties in ilizarov frame assembly: A simple method to prevent wire-related injuries during postoperative care

Abstract

Introduction Ilizarov ring fixators are usually applied for ailments such as open fractures, infected nonunions, malunions, growth disturbances, and angular deformities. Moreover, such conditions are often complicated by factors such as concomitant infection, compromised soft tissue cover, compromised vascularity, and disturbed metabolic milieu.[12] Treatment of such conditions often requires prolonged external fixations and pin site care plays a vital role in the prevention of infection, increasing longevity of fixation, keeping soft tissues supple, and increasing compliance to weight-bearing regimen.[3] Compliance to pin site care has prudent correlation with surgical outcome. Due to prolonged external fixation periods, usually home-based self-care of pin sites and frame assembly is prescribed to the patient rather than hospital-based care.[4] Problems with Conventional Methods Conventionally, tensioned Ilizarov wires outside wire fixation boltsare bent in loop shape and cut end is pushed under ring towards nearby empty hole.[5] We found such bending to be counterproductive for pin site care, frame maneuvers, and overall compliance of the patient. Multiple bending of wires in adjacent rings decreases available space for any pin site dressing and any correction maneuver. Their loose, sharp ends may potentially prick or scratch hands during any care maneuver. Such bends even impede any possible retensioning of wires in postoperative phase by grossly reducing stress endurance of wires and making them breakage prone [Figure 1a and b].Figure 1: (a) Conventional method of wire management with 2 bends and positioning under Ilizarov ring. (b) Conventional method critically decreases maneuverable space between Ilizarov rings and predisposes to wire-related injuries during frame careImprovisation and its Benefits After learning about practical difficulties being faced by patients in Ilizarov frame care and comprehending multiple feedbacks from patients, we started using nylon cable ties for fastening loose wire ends of Ilizarov wires with adjacent rings [Figure 2a and b].Figure 2: (a) Nylon cable ties – 4-inch length. (b) Clinical use of nylon cable ties with sharp ends of wires fastened to ring and allowing safe assess to pin sitesSuch wire fastenings neatly arrange all wires' ends parallel to ring either to its sides or its undersurface. It frees up maneuverable space between two rings and facilitates better pin site care. It gives practical benefit of saving hands from scratching protruding wire ends and decreasing wire-related injuries during pin site care. Since only one soft bend is given to any Ilizarov wire, it can be easily retensioned without risk of wire breakage during any possible retensioning. Better pin site care prevents local infections and increases comfort of patient. Nylon cable ties are easily available, cheap, and can be easily applied. Such fastening of ilizarov wires does not infringe on any biomechanical principle of Ilizarov methodology and positively contributes to important aspect of postoperative frame care in Ilizarov surgeries. Conclusion Nylon cable ties are easily available, cost-effective, simpler way to organize loose ends of Ilizarov wires which gives more maneuverable space, facilitates better pin site care, and prevents wire-related injuries. Use of cable ties positively influences follow-up care and overall surgical outcome. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.