CHAPTER ONE (1)

INTRODUCTION
1.1. ABOUT SIWES
In the discussion of the value and standard of higher education to national development, the
prevalence of occupational mismatch among Nigerian graduates has assumed center stage.
Studies typically evaluate work-based study programs’ progress in skill acquisition and
utilization.

The theoretical lectures that students were subjected to in universities and polytechnics
during the early years of science and technology development in Nigeria have since been
shown to be a poor teaching strategy, leaving students with little or no technical experience in
their field of study even after graduation. In the same way, our nation’s growth and progress
are hampered by students’ failure to contribute to society. This viewpoint is how SIWES was
first introduced to the industrial and educational sectors.

1.2. HISTORY OF SIWES

The term ‘SIWES’ is an acronym for “Student Industrial Work Experience Scheme.” To
address the issue of Nigerian graduates of higher schools without the practical skills needed
for employment in industries, the Industrial Training Fund (ITF) developed SIWES in 1973.
The Industrial Training Fund was established in 1971 and has operated consistently and
painstakingly within its enabling laws, Decree 47 of 1971, as Amended in the 2011 ITF ACT.
The Scheme exposes students to industry-based skills required for a seamless transfer from
the classroom to the workplace. It gives tertiary students a chance to become familiar with
and gain exposure to the necessary handling experience with machinery and equipment
typically unavailable in educational institutions.

Before the creation of the program, there was an increasing worry among our industrialists
that graduates from our institutions of higher learning lacked the necessary practical
background education to be ready for employment in the industries. The employers
concluded that the theoretical education imparted in our higher education institutions was not
suited to their demands.

Therefore, the Industrial Training Funds (ITF) had a good reason for starting and creating the
program in 1973. The Scheme started in 1974 in 11 institutions of higher learning with 784

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participants. By 1978, it has widened in scope to about 5,000 participants from 32 different
institutions in the country (Ojokuku et al., 2015).

Additionally, it is a planned and structured program with clearly stated and precise
professional objectives designed to help participants advance their occupational
competencies. The Students Industrial Work Experience Scheme (SIWES) is a recognized
training program included in the various degree programs offered by all Nigerian Universities
that meet the approved Minimum Academic Standard. The program aims to close the gap
between theory and practice in professional education programs offered by Nigerian tertiary
institutions in science, agriculture, medicine (including nursing), engineering, management,
and ICT. Its purpose is to introduce students to machinery, tools, and professional work.

The ITF initially provided all of the Scheme’s funding, but in 1978 it withdrew because the
fund found the financial commitment too much to handle. The federal government handed
over program command in 1979 to the National Universities Commission (NUC) and the
National Board for Technical Education (NBTE). In November 1984, the federal government
delegated ITF the responsibility of overseeing and carrying out the plan. In July 1985, the
Industrial Training Fund (ITF) took over, with all funding coming from the federal
government.

SIWES is a twelve to twenty-four-week-long (3 -6 months) program. It is to be completed

after the first year of polytechnics (ND1) and the second, third, and/or fourth year of
university, depending on the institution. For colleges of education, it holds for four months at
the end of the second year of the NCE program.

1.2.1. VISION STATEMENT

To Be the Leading Skills Training Organization in Nigeria And One of The Best in The
World.
To Be the Leading Human Capital Development Organization in Nigeria And One of The
Best in The World.

1.2.2. MISSION STATEMENT

To Set, Regulate Training Standards and Provide Need-Based Human Capital Development
Interventions Using A Corps of Highly Competent Professionals in Line with Global Best
Practices.

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1.2.3. CORE VALUES
 Commitment
 Loyalty
 Integrity
 Professionalism & Creativity
 Efficiency & Effectiveness
 Team Work

1.3. AIMS AND OBJECTIVES OF SIWES

The Industrial Training Fund’s Policy Document No.1 of 1973 (ITF, 1973), which
established SIWES, outlined the Scheme’s objectives. The objectives are to:

 Provide an avenue for students in Institutions of higher learning to acquire industrial

skills and experience in their respective courses of study.

 Prepare students for the Industrial Work situation they will likely experience after
graduation.

 Expose students to work methods and techniques of handling equipment and

machinery that may not be available in their Institutions.

 Make the transition from school to the world of work easier, and enhance students’
networks for later job placements.

 Provide students with an opportunity to apply their knowledge to real work situations,
thereby bridging the gap between theory and practice; and

 Enlist and strengthen Employers’ involvement in the entire educational process,

thereby preparing the students for employment in Industry and Commerce.

1.4. BODIES INVOLVED IN THE MANAGEMENT OF SIWES AND THEIR

ROLES

The Federal Government, the Industrial Training Fund (ITF), the Supervising Agency, the
National Universities Commission, NUC, labor employers, and institutions all have specific
roles to play in the management of SIWES. They all work together to ensure an effective and
efficient administration of the industrial training program in Nigeria. These roles are outlined
below:
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1.4.1. The Federal Government of Nigeria
 Provision of adequate funds to the ITF for the Scheme through the Federal Ministry of
Industry.
 Making it mandatory for all ministries, companies, and parastatals to offer
placements to students in accordance with the provisions of Decree No. 47 of 1971, as
amended in 1990.
 Formulating policies to guide the Scheme’s national implementation.
1.4.2. The Industrial Training Fund (ITF)
 Creating SIWES policies and guidelines for distribution to all SIWES participating
bodies.
 Providing logistical support for the Scheme’s administration.
 Disburse supervisory and student allowance by e-payment.
 Organizing pre-attachment orientation programs for students.
 Providing information on companies for attachment and assisting students with
industrial placements.
 Supervising industrial attachment students.
 Accepting and processing placement lists from educational institutions and regulatory
agencies.
 Examining and processing student logbooks as well as ITF Form 8.
1.4.3. The Supervising Agencies

The three recognized supervising agencies are;

 The National Universities Commission (NUC).

 The National Board for Technical Education (NBTE).
 The National Commission for Colleges of Education (NCCE).

They are responsible for the following;

 Establishing and accrediting SIWES units/Directorates in institutions under their

jurisdiction.
 Vetting and approving Master and Placement lists of students from participating
institutions and forwarding same to ITF.

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  Adequately funding the SIWES Directorate in participating institutions; directing the
appointment of a full-time SIWES Coordinator/Director; reviewing SIWES-qualified
programs regularly.
 Participating in the ITF-sponsored biennial SIWES conferences and seminars.
1.4.4. The Institutions. (Universities, Polytechnics, and Colleges of Education,
Technology, or Agriculture)
 Identify placement opportunities for students to work with employers.
 Return all completed ITF forms to the nearest ITF Area office.
 Register students and collect their bank information at the time of registration.
1.4.5. The Employers of Labor
 Carry out relevant setups and profiling tasks for his employers, who are Industry
Based Supervisors.
 Find SIWES students to be engaged online.
 Fill/update SCAF online (optional).
 Assign Students to Industry-Based Supervisors.
 Approve Students’ Log Book.
 Fill Employer portion of Form 8.
 Upload relevant files, such as videos, for students.

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Fig. 1.1. SIWES Stakeholder Relationship. (SIWES, 2022).

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1.5. BENEFITS OF THE SIWES PROGRAM

Students taking part in industrial training may also receive several additional benefits. They
include the following:

 Students get the chance to combine their in-class learning of theory with real-world
application of that knowledge to complete workplace tasks.
 Introducing students to the workplace setting they will eventually occupy will allow
them to see how their future professions are structured.
 Making it easier for trainees to connect with possible employers.
 Minimization of the perplexity felt by students pursuing courses in science,
engineering, and technology, especially those from non-technological backgrounds,
with reference to various machinery, procedures, instruments, etc., accessible in the
industry.
 Preparing students to contribute to national development and their companies’
productivity as soon as they graduate.
 Providing a supportive environment where students can grow and improve their
personal qualities, including leadership, creativity, initiative, resourcefulness, critical
thinking, time management, presenting, and interpersonal skills, among others.

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 CHAPTER TWO (2)

COMPANY PROFILE

2.1. BRIEF HISTORY OF THE ESTABLISHMENT

Albina Mejeel Specialist Hospital, Center for Ilizarov Orthopedic Technology, is a

private secondary hospital serving local and international patients and clients. It offers
comprehensive treatment that goes above and beyond what is expected in the industry and
anticipates and satisfies the needs of the patients, their families, and the communities.

Founded in January 1998 by a group of 5 staff, including the Chief Medical Doctor, Albina
Mejeel Specialist Hospital’s history is intricately entwined into the development of its
neighborhood, and having the patronage and confidence of the community it serves has
allowed them to thrive over the years and establish itself as an influential member and
contributor to the healthcare sector in Nigeria.

Dr. Leonard Mbamara is the Chief Medical Director of Albina Mejeel Specialist Hospital in
Lagos. He is a former USSR-trained medical practitioner with over 30 years in active practice
spanning from Lagos University Teaching Hospital LUTH, Idi-Araba, Falomo Police
Hospital, Lagos, Bonny Camp Medical Centre, and others before delving into private
practice. His vast experience in general practice, armed with a doctorate in orthopedic medics
and obstetrics, positioned him in a state to build an establishment relying solely on
professionalism and expertise.

In 2010, the hospital became a fully-fledged establishment with a number of staffs ranging
from 10-20 staff. More departments were also formed, including the Ultrasound and
radiography, laboratory, pharmacy, gynecology and obstetrics, pediatrics, optometry,
physiotherapy and majorly orthopedic medics. It was also relocated from the previous
location to a new two-story building with improved facilities and equipment.

The relocation indicates its expansion by increasing the number of hospital beds and rooms
and the number of specialists who may now practice their specialties. Additionally, there are
more medical and diagnostic services available. Currently, the hospital has about 35-50 staff,
licensed by the Nigeria Ministry of Health, with facility code 24/17/1/2/2/0003, and
registered as a Secondary Health Care Centre.
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2.2. ADDRESS AND LOCATION OF THE ESTABLISHMENT

Albina Mejeel Specialist Hospital, Center for Ilizarov Orthopedic Technology, is located at
13 Asani Akinbon Street, Victory Estate, Iba, Ojo, Lagos.

Fig. 2.1. Building of Albina Mejeel Specialist Hospital

2.3. VISION, MISSION, AND CORE VALUES OF THE ESTABLISHMENT

2.3.1. Vision

The go-to location for multispecialty patient care, top-notch customer service, medical
education, training, and research.

2.3.2. Mission
 With the best customer service and clinical results, we provide complete care that is
safe, high-quality, and exceptional.

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  Through cutting-edge facilities and professionally run training programs, we develop
healthcare professionals.
 We are a company with a strong sense of values.
 We collaborate with local communities to deliver healthcare services and programs
tailored to their requirements.
2.3.3. Core Values
 Accountability
 Innovativeness
 Service with compassion
 Excellence
 Integrity
 Teamwork
2.4. CORPORATE OBJECTIVES AND QUALITY POLICY
2.4.1. Corporate objectives
 To provide a safe and therapeutic environment for all patients, staff, and visitors.
 To implement training initiatives that would continuously enhance services.
 To carry out studies that will help to enhance services continuously.
 To always have qualified staff available.
 To continuously enhance our method for managing risk and quality.
 To offer corporate social responsibility services to the community’s impoverished and
unmet needs.
 To maintain medical indicators below the aggregate rate for peer hospitals.

2.4.2. Quality Policy

At Albina Mejeel Specialist Hospital, we pledge to fulfill the expectations of our patients and
stakeholders by offering;

 Excellence in all services and approved functions

 Effective and efficient training, research, and health services
 Employees who put patients first
 Services must be continually improved to provide the highest level of excellent, safe
patient care.
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2.5. ORGANIZATIONAL STRUCTURE OF THE ESTABLISHMENT

Fig 2.2. Organogram of Albina Mejeel Specialist Hospital.

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2.6. DEPARTMENTS AND SECTIONS IN THE ESTABLISHMENT

Albina Mejeel Specialist Hospital has different sections and departments, each performing
distinct duties and headed by trained professionals. They work together to ensure the smooth
running of the establishment. The departments within the walls of AMSH include;

 Nursing department: It is headed by a Chief Matron. This department regulates,

conducts research, and supervises clinical nursing practice in the hospital. The staff
and student nurses all report to this department.
 Department of Physical Medicine and Rehabilitation: Clients with functional
limitations brought on by diseases or injuries are served by this section. This division
includes Physiotherapy/ Prosthetics and Orthotics and is headed by a CPO-
Certified Prosthetist and Orthotist.
 Operation Theater (OT) consists of one or more operation theatres and other
facilities. These are four zones – outer zone, clean zone, sterile zone, and disposal
zone.

Fig 2.3. Operation theater (OT)

 Pharmacy Department: All pharmaceuticals and medications are chosen, purchased,

compounded, stored, and dispensed by the pharmacy department. A licensed
pharmacist is in charge of the pharmacy.

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  Radiology and Ultrasonography Department (X-ray Department)

Fig. 2.4. Radiology and Ultrasonography Room

 Obstetrics and Gynecology department

 Pediatrics department
 Laboratory department
 Ophthalmology department

Non-Medical Departments are;

 Admissions Division: The patients must be admitted to the hospital by the admitting
department.

Fig. 2.5. Admission and Hospital Card Room

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 Accounts and Finance (Business Office): This department is responsible for
collecting money owing to the hospital, purchasing supplies and equipment, managing
all hospital financial records, keeping track of assets and liabilities, and assisting with
budgeting.
 Housekeeping and laundry
 Hospital Waste Management division
 General supply division: Syringes, needles, and treatment trays are a few examples
of the equipment and supplies that this department prepares and provides to other
departments for use in client care.
 Mechanical and maintenance department: They manually operate equipment,
make adjustments, and regularly check the clinical devices and equipment. They are
responsible for ensuring that all of these systems are running correctly, efficiently,
and safely.

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 CHAPTER THREE (3)

WORK CARRIED OUT DURING SIWES

3.1. CORRECTION OF DEFORMITIES USING SERIAL MANIPULATION AND

CASTING

Serial casting is a less invasive method of correcting deformities that gradually stretches tight
muscles over time. Serial casting maintains the joint’s position, putting a small amount of
tension on the muscle. The muscle will grow progressively longer and more flexibly due to
this strain. Although it can also be applied to the knees, elbows, wrists, or fingers, the ankle
region receives most of its application.

Through gradual, persistent stretching, serial casting aims to increase the range of motion and
extend constricted muscles. Even when the patient isn’t moving, it ensures the muscle is
always stretched. The cast will gently stretch the muscles, so it should not be painful. As you
maintain a stretch, the tension decreases, which allows the muscle fibers to lengthen. Each
time the cast is replaced, the muscle can be stretched further.

Serial casting is ideal for children because it is non-invasive. It’s a lengthy process and could
take weeks or months to produce improvements. The cast is typically changed every seven
days for up to 12 weeks. However, the severity of the person’s spasticity will determine
whether the cast should be changed slightly sooner or later.

During my IT placement, I understood that this method of correction of deformity is effective

for many cases involving joints and muscle spasticity, rather than only club feet. We used this
method to manage and correct Clubfoot, cerebral palsy-induced spasticity, hyperextension of
the knee, crossover toe, and many others. Below is a detailed report on each case.

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3.1.1. CORRECTION OF CLUBFOOT DEFORMITY (IDIOPATHIC AND NON-
ISOLATED) USING THE PONSETTI METHOD

Clubfoot, also called talipes equinovarus, is a congenital disability that affects the foot and
ankle. It’s a congenital condition, meaning a baby is born with it. It won’t go away on its
own, but children get good results from early treatment. The Ponseti method, a non-surgical
procedure to realign the foot, is a very effective and relatively inexpensive clubfoot treatment
that offers long-lasting results. Clubfoot is one of the most common congenital deformities;
about 1 in every 1000 children is born with Clubfoot worldwide. It is also more common in
boys than in girls. It could be bilateral or unilateral.

The Ponsetti method of Clubfoot correction is often preferred because surgeons report that
Clubfoot treated by surgical techniques becomes weak, stiff, and sometimes painful in adult
life. This procedure aims to reduce, if not eliminate, all elements of the deformity to obtain a
functional, flexible, pain-free, strong, normal-looking, plantigrade and shoeable foot.

The treatment result depends on

 The severity of the Clubfoot

 Involvement of other health issues
 Age and physical developmental stage of the child at treatment start.
 Experience of the doctor/health care worker
 Cooperation of parents and guardians
 Brace compliance

Minor differences may be noticed in successfully treated Clubfoot.

 The Clubfoot is slightly smaller (shorter, narrower) than the other foot
 A smaller circumference of the lower leg
 Shorter calf muscles.

Clubfoot is best corrected soon after birth (7 to 10 days), when the child is not walking or
before the child turns five years old.

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3.1.1.1. ASSESSMENT AND EXAMINATION OF CLUBFOOT DEFORMITY

Initial Assessment of the Deformity

a) Check the feet for signs of Clubfoot. The abbreviation “CAVE” stands for Cavus,
Adductus, Varus, and Equinus, and it makes it simple to remember the four parts of
the deformity that make up a clubfoot. Firstly clarify that the child really has
Clubfoot. Postural equino-varus and metatarsus adductus are two conditions that must
be distinguished from Clubfoot. The baby’s position in the womb puts pressure on the
foot, molding it into an unnatural position that leads to postural equino-varus.
b) Begin the assessment with general information and history.
c) Evaluate the severity of the condition by checking the Pirani scoring signs. The foot
examination may be done on the mother’s lap where the child feels safe and
comfortable.
d) Examine the whole body of the child for other deformities or problems. The initial
assessment should include the entire body (spine, hips, hands). Fully undress the child
and lay them on the examination table.

The Pirani Scoring Signs are;

 Posterior Crease of the ankle (PC)

The PC is a measure of the posterior contracture. Hold the foot in a gently corrected position.
Examine the back of the heel.

Score 0: When multiple fine creases are visible that do not change the contour of the heel.
These creases allow the skin to adjust and stretch as the ankle dorsiflexes.

Score 0.5: When one or two deep creases are visible, that does not appreciably change the
contour of the heel.

Score 1: When one or two deep creases are visible that appreciably change the contour of the
heel.

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 0 0.5 1

Fig 3.1. Illustration of Posterior Crease of the ankle (PC)

 Empty Heel (EH)

. If the Talus is fully plantar flexed, the Calcaneus is also in Equinus so that the posterior
aspect of the Calcaneus is drawn up and out of the heel pad. As the Plantar flexion of the
Talus corrects, the Calcaneus fills the heel pad. Hold the foot in a gently corrected position.
Place the examining finger on the corner of the heel and bisect the angle between the sole of
the foot and the back of the calf. Apply gentle pressure with the finger.

Score 0: The Calcaneus is immediately palpable (comparable with the feeling of gentle
pressure on the temple).

Score 0.5: The heel pad feels soft, but the Calcaneus is palpable deep within the heel pad
(comparable with the feeling of gentle pressure on the tip of the nose).

Score 1: The heel pad feels empty. No bony prominences can be felt (comparable with the
feeling of gentle pressure on the ball of the thumb).

0 0.5 1

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Fig. 3.2. Illustration of Empty Heel (EH)

 Rigid Equinus (RE)

The RE is a measure of the posterior contracture. Hold the knee in full Extension and
supinate the foot slightly. Then gently dorsiflex the foot much as possible. View the leg
and foot from the lateral side and measure the movement from the neutral position (0°-
line).

Score 0: Clear Dorsiflexion.

Score 0.5: Around neutral position can be achieved.

Score 1: Clearly, no neutral position can be achieved. The Pirani Scoring sign is
beneficial for writing down the measured angle.

0 0.5 1

Fig 3.3. Illustration of Rigid Equinus (RE)

 Medial Crease of the sole of the foot (MC)

The MC is a measure of the medial contracture. Hold the foot in a gently corrected position.
Examine the medial arch of the foot.

Score 0: Multiple fine creases are seen, which do not change the contour of the arch.

Score 0.5: One or two deep creases are seen, which don’t appreciably change the contour of
the arch.
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Score 1: One or two deep creases are seen, which appreciably change the contour of the arch.

0 0.5 1

Fig 3.4. Illustration of Medial Crease of the sole of the foot (MC)

 The lateral part of the Head of the Talus (LHT)

The LHT is a measurement of how far the Navicular reduces onto the head of the Talus. In
the Congenital Clubfoot, the lateral part of the head of the Talus is uncovered. As the
deformity corrects because of the treatment, the Navicular reduces onto the head of the Talus
and covers it. Hold the foot in a deformed position. Palpate the lateral part of the head of the
Talus with the pulp of the thumb. Abduct the foot with the other hand gently. Note if the
Navicular reduces onto the head of the Talus.

Score 0: Loss of the ability to palpate the lateral edge of the head of the Talus (because of the
complete reduction of the Navicular onto the head of the Talus).

Score 0.5: Reduction of the ability to palpate the lateral edge of the head of the Talus
(because of partial reduction of the Navicular onto the head of the Talus).

Score 1: Still easily palpable head of the Talus even with the forefoot in as much correction
as is allowed by the deformity (because of fixed medial subluxation of the Navicular).

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 0 0.5 1

Fig. 3.5. Illustration of the lateral part of the Head of the Talus (LHT)

 The curvature of the Lateral Border of the foot (CLB)

The CLB is a measure of the medial contracture. The amount of curvature can indicate the
amount of medial contracture. Examine the plantar surface of the foot and gauge the lateral
border of the foot by placing a straight edge (pencil) along the lateral border of the
Calcaneus.

Score 0: The lateral border of the foot is straight from the heel to the head of the Metatarsal
V.

Score 0.5: The lateral border of the foot is mildly curved. The curvature appears to be in the

distal part of the foot in the area of the Metatarsals.

Score 1: A pronounced curvature of the lateral border of the foot is seen. The curvature
appears to be at the level of the Calcaneo-cuboid joint.

0.5 1

Fig. 3.6. Illustration of the curvature of the Lateral Border of the foot (CLB)

3.1.1.2. MANIPULATION OF CLUBFOOT BEFORE CASTING

The manipulation technique is based on understanding the described coupling of movements

(the foot follows the track).

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To correct the hindfoot, we need to manipulate the midfoot. The initiator for the correction of
the whole foot is the abduction of the midfoot. The steps in manipulation are;

1. Precise identification of the head of the Talus and Talo-calcaneo-navicular joint. It is

essential to localize the head of the Talus very well to prevent a wrong manipulation and
failure of the treatment.

 Grasp the (right) forefoot with the (right) hand.

 With (left) thumb and index finger, feel the Malleoli from the front.
 Move the (left) thumb and index finger forward to clasp the head of the Talus.

In this position:

a. Feel the Navicular with the tip of your index finger.

b. Feel the anterior tuberosity of the Calcaneus with the tip of your thumb.

2. Slowly and gently abduct the forefoot and feel the motion in the Talo-calcaneo-navicular
joint

The easy summarization of this technique involves the following steps;

 Stabilize the Talus by placing the thumb over the head of the Talus. This provides a
pivot point around which the foot is abducted.
 Manipulate the foot with supination followed by abduction with the other hand. This
should not cause any discomfort to the child. In the beginning, much supination is
required. But supination will automatically decrease with more achieved abduction.
 Hold the correction with gentle pressure, then release and repeat.
Younger child (= not walked at treatment start): Hold the correction for 30-40 seconds,
then release and repeat 1-2 times. It will take around 2 minutes per Clubfoot.

Older child (= already walked at treatment start). Hold the correction for 1-2 minutes,
then release and repeat 3-4 times. It will take 5-10 minutes per Clubfoot.

3.1.1.3. CASTING OF CLUBFOOT AFTER MANIPULATION

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 The cast is applied after the manipulation and immobilizes the foot to stretch the tight
ligaments, joint capsules, and tendons. Important points to note during casting are;

1. Using long leg casts up to the groin is mandatory to keep the foot under the Talus in
Abduction and prevent Rotation in the ankle.

2. In the “younger child” (= not walked before treatment started), cast the knees in 90°
flexion and change the cast every 5-7 days. In the “older child” (walked before treatment
starts), cast the knees in 70° flexion so they can stand up and change the casts every 7- 14
days.

3. The last cast, if tenotomy of the Achilles tendon is done, will stay for 3 weeks in the
“younger child” and 4 weeks in the “older child.”

4. While casting, change hand positions to avoid prolonged pressure over the Talus and
other spots to prevent pressure sores.

5. Always mould well at pressure-sensitive areas (heel, malleoli, and sole of the foot).

First cast: Correction of the Cavus (main focus) + Correction of Midfoot Inversion and
Heel Varus

Aim for the forefoot and midfoot alignment by supinating the forefoot and some Abduction.

1. Stabilize the Talus by placing the thumb over the lateral part of the head of the Talus.

2. Elevate the first ray and achieve supination of the forefoot in line with the midfoot.
Then abduct the foot gently.

3. Hold the corrected position while an assistant applies padding and plaster. Change
hand positions and mould well at the heel, Malleoli, and sole of the foot. In small babies,
correction of the cavus usually occurs with the first cast. A severe Cavus in a stiff foot
will need 2 or 3 cast changes for correction.

Following casts: Correction of Midfoot Inversion and Heel Varus + Continue

Correction of Cavus (if needed)

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In each cast, aim for more Abduction while Supination automatically decreases. In a severe
Clubfoot with still strong cavus after the first cast, make the correction of the cavus your
priority.

1. Stabilize the Talus by placing the thumb over the lateral part of the head of the Talus.

2. Hold the foot in abduction. Remember that supination decreases with the increase of
abduction. The correction of the Calcaneus will be achieved because of coupling. Plaster
as often as you need to get enough abduction.

3. Hold the corrected position while an assistant applies padding and molds the POP
bandage.

Last cast(s): Correction of Rigid Equinus in the ankle + Improvement of Midfoot

Abduction and Heel Valgus

1. Stabilize the Talus by placing the thumb over the lateral part of the head of the Talus.

2. Move the foot in maximal possible abduction without any Pronation and then into
Dorsiflexion in the ankle with the lower hand.

3. Hold the corrected position while an assistant applies padding and POP bandage.
Change hand positions and mould well at the heel, malleoli, and sole of the foot.

3.1.1.4. BRACING AFTER CORRECTION OF CLUBFOOT

The Bracing is an essential and critical part of the Ponsetti treatment. After the Clubfoot is
corrected, it has to be held in position for some time with the brace to prevent a recurrence.
The brace must be put on immediately after the last casts are removed. The child is required
to wear the abduction brace for a period of 3-4 months for 18-23 hours a day. An Ankle-Foot
Orthosis should not be used in place of the abduction brace. The child is also advised not to
stand or walk in the brace as it is not designed for this purpose.

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3.1.1.5. CASE STUDY OF A PATIENT WITH NON-ISOLATED CLUBFOOT
DEFORMITY AT ALBINA MEJEEL SPECIALIST HOSPITAL

Below is a report of a case we handled during my IT placement. This 7-year-old child

presented non-isolated clubfoot deformity (associated with Cerebral Palsy), and we managed
it with the Ponsetti treatment to attain at least 75% mobility functionality in the patient.

Fig 3.7. Assessment and examination Sheet of Clubfoot patient

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Fig 3.8. First Serial Cast on Clubfoot Patient

Fig 3.9. Third Serial Cast on Clubfoot patient

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Fig 3.10. Treatment graph recording during Ponsetti Treatment of Clubfoot Patient

From the graph, we can deduce that the right leg improved significantly faster than the left
leg. At the end of casting, we recommend a custom orthopedic shoe (designed with the exact
mechanism as the abduction brace) because the patient experienced severe muscle spasticity
associated with cerebral palsy.

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3.1.2. CORRECTION OF CONGENITAL GENU RECURVATUM USING CASTING
TECHNIQUES

Genu recurvatum is a knee joint abnormality that causes the knee to bend inward. Excessive
extension of the tibiofemoral joint results in this malformation. It is often referred to as Knee
hyperextension or Back Knee. This deformity is more common in women and people with
familial laxity to the knee joint. Women are at greater risk of experiencing a hyperextended
knee injury as their ligaments tend to be laxer than men’s which results in an increased
likelihood of joint instability.

Congenital genu recurvatum is present at birth and may cause the family and medical
professionals some concern. It may exist alone, be related to other musculoskeletal
abnormalities, or be a symptom of a condition. Hip dysplasia, talipes equinovarus, and an
absent patella are further potentially related musculoskeletal defects. Larsen syndrome and
arthrogryposis multiplex congenita are syndromes that include genu recurvatum.

Observation, flexion exercises, splinting, casting, or surgery may all be used as treatments,
depending on how severe the deformity is. With conservative treatment, results are better
when hyperextension is less severe and the knee joint is more aligned.

3.1.2.1. CASE PRESENTATION OF CONGENITAL GENU RECURVATUM IN

AMSH

A 2-year-old girl presented to the medical rehabilitation department with congenital

hyperextension of both knees. She displayed notable signs of imbalance and bilateral medial
deviation of the knee. The patient was walking without support; however, her gait was
markedly affected due to bilateral talipes equinovalgus and weakness of the knees. In the
upright position, the patient presented the typical GR posture. This posture consists of
hyperextension of both knees, with that of the right knee being significantly more severe.
Slight valgus of both knees when standing, corrected significantly on passive hyperextension
of the knee with the patient supine and was rather a component of the GR posture and not a
major part of the GR deformity. This is shown in Figure 3.11

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Fig 3.11. A 2-year-old girl with Bilateral GR and talipes equinovalgus.

3.1.2.2. THE PROCEDURE OF CONVENTIONAL CORRECTION OF

CONGENITAL GR USING CASTING AND MANIPULATION

The aim of the procedure is to correct the GR and bilateral talipes equinovalgus by restoring
the RT angle. Gradual correction using serial casting and manipulation (with subsequent use
of an AFO) was chosen. A long-leg cast was used in the initial procedure (for two weeks) and
then subsequently replaced with Sarmiento or Patella Tendon-Bearing (PTB) cast. This was
done so that weight is born on the patellar tendon region anteriorly. the patient is encouraged
to bear weight on the plaster cast.

The details of the improvement after two weeks of bearing the initial cast are presented in
figure 3.12.

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Fig. 3.12. Clinical documentation of GR-defromity’s progress after removal of first
serial cast

Fig. 3.13. Picture of GR-deformity's progress after removal of the first serial cast

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3.1.3. OTHER CONDITIONS MANAGED WITH THE CONSERVATIONAL SERIAL
CASTING AND MANIPULATION TECHNIQUE

During the course of my industrial training at Albina Mejeel Specialist Clinic, we were able
to successfully correct various deformities using the principle of serial casting and
manipulation. It offered tremendous and effective results. It is also a cost-efficient method,
compared to its counterpart -the surgical method.

Some other significant deformities we were able to successfully manage with this
conservational technique include the following;

3.1.3.1. CONGENITAL VERTICAL TALUS DEFORMITY

A rare congenital foot deformity known as congenital vertical talus causes the child's foot's
sole to flex unnaturally in a convex position, giving the foot the impression of having a
rocker's bottom. This ailment is frequently referred to as rocker-bottom foot for this reason.

A newborn's feet typically appear flat due to the extra-fat pads on the bottom. A concave arch
typically forms in the child's foot as they grow. A child's foot that has a rocker's bottom
flexes in the opposite way, causing the heel and toes to touch the shin while the middle of the
foot touches the floor.

The most noticeable sign of congenital vertical talus is a rocker-bottomed foot, which is
typically noticeable at birth or as a child learns to walk.

Other signs and symptoms include;

 a forefoot and midfoot flex that is upward

 Atypical ankle flex causes the hindfoot to be raised.
 Inability to properly line the midfoot with the backfoot
 Unusual foot posture; the child may walk on the inside of their foot while the outer
edge is elevated, which affects their balance and how they distribute their weight.

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 Conservational methods of treating this deformity to prevent the condition from getting worse
include:

 Stretching exercises for the forefoot and hindfoot

 Serial manipulation and casting of the midfoot and forefoot in a flexed position to reduce
the upward curve of the foot

3.1.3.2. CONGENITAL FLEXION DEFORMITY OF THE THUMB (TRIGGER

THUMB)

Congenital trigger thumb is a trigger thumb in infants and young children. Triggering,
clicking, or snapping is observed by flexion or extension of the interphalangeal joint (IPJ). In
the furthest stage, no extension is possible and there is a fixed flexion deformity of the thumb
in the IPJ. Cause, natural history, prognosis, and recommended treatment are controversial.

A clinical diagnosis is determined when there is flexion deformity at the thumb IP joint. For
flexible deformities, nonoperative management and splinting are the recommended
treatments. If a fixed deformity persists after the age of a year, surgery to release the A1
pulley is recommended.

The occurrence of bilateral incidence and trigger thumbs in both children of twins is an
indication of a congenital cause (Fahey and Bollinger, 1954). Trigger thumb in children is
also associated with trisomy of chromosomes (Neu and Murray, 1983).

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Fig. 3.14. Before casting (left) and after two weeks of casting (right) of the Congenital
Trigger Finger.

3.1.3.3. TOE WALKING DEFORMITY

Toe walking is a gait abnormality characterized by an absence of normal heel-to-floor contact

(heel strike) by both feet during gait. Gait begins to stabilize around age 3–4 years and
matures by 7 years of age (Wu et al., 2015). Among children with CP who are not walking by
age 2 years, only 10% walk independently by age 7 (Wu et al., 2004), underscoring the
importance of early identification and intervention.

The lack of complete foot contact with the ground throughout the majority of the gait cycle
and the inability to make heel contact with the floor during the first stance phase of the gait
cycle are the two characteristics that are used to describe it. Throughout the gait cycle, most
of the floor contact is made by the forefoot.

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There are several causes of toe walking, ranging from erratic habits to severe neuromuscular
disorders. Idiopathic toe walking (ITW), a diagnosis of exclusion, is the kind of toe walking
that is most frequently reported. Non-idiopathic toe walking is the general term for toe
walking that has a specific etiology (most frequently a neurologic or musculoskeletal
disorder).

Forms of treatment for toe-walking deformity include;

 Rehabilitation Therapy

To reduce the amount of toe walking, several sessions of stretching the tight muscles may be
effective. Children will benefit from home stretching activities as well.

 Bracing

Some children may benefit from an ankle-foot orthosis (AFO) to help encourage a flat
foot with walking. The AFO is a custom brace used during the daytime to help stretch and
encourage a flat foot position. If worn at night, the AFO can help stretch the tight muscles
while a child is sleeping.

 Serial casting and manipulation

Short leg casts can be worn for one to two weeks at a time to gradually focus on
loosening tight muscles and improving foot and ankle posture. These casts allow children
to walk in them. In certain children, the inclusion of Botox injections to assist loosen the
stiff muscles in casts may be more beneficial.

 Gastrocnemius or Achilles Tendon Lengthening

When physical therapy and serial casting fail to improve the tight ankle, surgery may be
required to establish a flat foot posture when walking. Lengthening is a surgical treatment
that allows for a broader range of motion and function of the foot and ankle by
lengthening the tight Achilles tendon or gastrocnemius muscle. The lengthening also
allows children to better tolerate AFOs and achieve a flat foot position with walking.

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 Fig. 3.15. A little boy diagnosed with toe walking deformity.

3.2. FRACTURE AND FRACTURE MANAGEMENT

A bone fracture (sometimes abbreviated FRX or FX or #) is a medical condition with a partial

or complete break in the continuity of the bone. It is a break in the bone that occurs when
more force is applied to the bone than the bone can withstand. It can also result due to certain
medical conditions that weaken the bone, such as osteoporosis, osteopenia, bone cancer, or
osteogenesis imperfect. The fracture is then properly termed a pathologic fracture.

3.2.1. GENERAL CLASSIFICATION OF FRACTURE.

a) Closed (Simple Fracture): a fracture of the bone only, without damage to the
surrounding tissues or a break in the skin.
b) Open (Compound Fracture): a fracture in which there is an open wound or break in
the skin, that is the broken bone pierces the skin causing a risk of infection.

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 c) Transverse Fracture: the break is in a straight line across the bone.

d) Spiral Fracture: also known as torsion fracture. A fracture occurs when a torque
(rotating Force) is applied along the axis of a bone, hence causing it to be twisted)
Comminuted Fracture is a break or splinter of the bone into more than two fragments
e) Impacted Fracture: the bones are driven together, and one fragment goes into
another.
f) Greenstick Fracture: here, the bone partly fractures on one side, but does not break
entirely because the rest of the bone can bend. This is more common among children;
whose bones are softer and more elastic.
g) Oblique Fracture: A fracture that is diagonal to a bone's long axis.

In orthopedic medicine, fractures are classified in various ways. Historically they are named
after the physician who first described the fracture condition; however, there are more
systematic classification which includes;
1. Classification based on displacement.
This is based on the alignment of the end of the fractured bones (fragment).
• Non-displaced
• Displaced
• Translated, with sideways displacement
• Angulated
• Rotated
• Shortened
2. Classification by fracture pattern.
• Linear Fracture: Fracture that is parallel to the bone's long axis
• Transverse Fracture: fracture at a right angle to the bone's long axis
• Oblique Fracture: a fracture that is diagonal to a bone's long axis (more than
30°)
• Spiral Fracture: fracture where at least one part of the bone has been twisted.
• Compression /Wedge fracture: usually occurs in the vertebrae (spine). Bone
becomes brittle and is crushed and flattened in appearance, with or without
trauma.
• Impacted Fracture
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 • Avulsion Fracture: A fracture in which a fragment of bone is separated from
the main mass.

3. Classification based on fragments.

• Incomplete fracture: a fracture in which the bone fragments are still partially
joined.
• Complete Fracture: a fracture in which bone fracture separates completely
• Comminuted Fracture: a fracture in which bone has broken into several pieces.

3.2.2. DIAGNOSIS OF FRACTURE.

a) X-RAY:
b) X-ray imaging produces a picture of internal tissues, bones, and organs. Most
fractures are diagnosed by using an x-ray. This is done in 3 conditions: 2 views (AP-
Anteroposterior joints (if limb fracture) and 2 times (pre-reduction and post-
reduction).
c) Magnetic resonance imaging (MRI)
d) Bone scan
e) Computed tomography scan (CT scan). Three-dimensional imaging procedure
f) Swab; for an open fracture.

3.2.3. SIGNS AND SYMPTOMS OF FRACTURE

Although bone tissues contain no nociceptors (pain receptors), bone fracture is painful for
several reasons;
a) Edema and hematoma of nearby soft tissue caused by ruptured bone marrow evoke
pressure pains.
b) Involuntary muscle spasm trying to hold bone fragments in place.

3.2.4. TREATMENT OF FRACTURE

Treatment of bone fractures is basically classified into 2;

 Surgical (operative)
 Conservative (Non-operative)

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3.2.4.1. SURGICAL PROCEDURE
The four AO (Association for osteosynthesis) principles, in their basic form, have governed
the approach to the surgical procedure of fracture management. They are as follows.
• Anatomical reduction of the fracture fragments by making incisions to realign
bone fragments or in cases where there are other tissue damages
• Stable fixation
• Preservation of blood supply to the injured area of the extremity
• Early range of motion and rehabilitation.

There are 3 classes of surgical management of fracture;

I. Open reduction and internal fixation (ORIF)
II. External fixation
III. Bone graft-bone transplants.

I. Open reduction and internal fixation (ORIF)

During this operation, the bone fragments are first repositioned and aligned and then held
together with internal fixators which are plates and screws, intramedullary nails,
extramedullary nails, etc.

Indications for ORIF;

 Intra articular fractures
 Repair of blood vessels and nerves
 Elderly patients; to allow early mobilization
 Multiple injuries
 Long bone fracture; tibia, femur, and humerus.
 Failure of the conservative method of treatment

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 II. External Fixation
In 1907, Belgian physician Albin-Lambotte developed the technique of external fixation for
the management of fractures. External fixation provides fracture stabilization at a distance
from the fracture site without interfering with the soft tissue structures near the fracture site.
This technique not only provides stability for the extremity and maintains bone length,
alignment and rotation without requiring casting but also allows inspection of the soft tissue
structures that are vital for fracture healing, as well as subsequent wound care.

EFs have been successfully used in fractures involving the humerus, forearm, pelvis, femur,
tibia, and fibula (Vincenti et al., 2019; Rigal et al., 2018). It is also used for deformity
correction, limb lengthening and treatment of bone defects (Simpson et al., 2019; Bliven et
al., 2019). Therefore, from a purely orthopaedic point of view, previous studies support the
use of EFs in treating bone fractures.

THE ILIZAROV FIXATOR

The Ilizarov apparatus is a type of external fixator used in orthopedics surgery to lengthen or
reshape limb bones; as limb-sparing techniques to treat complex and/or open bone fracture;
and in cases of infected non-unions of bones that are not amenable to other techniques. It is
named after the orthopedic surgeon Gavril Abramovich Ilizarov from the Soviet Union, who
pioneered the technique. Through controlled and mechanically applied tension stress, Gavril
Ilizarov showed that bone and soft tissue can be made to regenerate in a reliable and
reproducible manner.

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Fig.3.16. The Ilizarov Apparatus
MECHANICS AND PHYSICS
The device is a circular fixator, modular in structure. Stainless steel (or titanium) rings are
fixed to the bone via a stainless heavy gauge worn called phis (or Kirschner wires). The rings
are connected to each other with threaded rods attached through adjustable nuts. The circular
construction and tensioned wire of the Ilizarov apparatus provide far more structural support
than the traditional monolateral fixator system. This allows early weight bearing.

The apparatus is based on the principles which Ilizarov called "the theory of tensions". The
top rings of Ilizarov (fixed to the healthy bone by the k-wires) allow force to be transferred
through the external frame (the vertical metal rods), bypassing the fracture site. Force is then
transferred back to act as a sort of bridge, both immobilizing the fracture site and relieving it
of stress while allowing for the movement of the entire limb and partial weight bearing.
Middle rings (and tensional wires) act to hold the bone fragments in place and to give greater
structural support to the apparatus and limb. However, the critical load-bearing rings are the

P a g e 40 | 55
top and bottom rings which transfer the force from the healthy bone down to the healthy
bone, bypassing the fracture site.

The total time for correction is approximately 10 weeks (varying from 8 to 14 weeks),
depending on the severity and stiffness of the deformities. After this corrective period,
patients are discharged from the hospital (if inpatient) and the device is kept in place, with no
further adjustments, for an additional 4 weeks, to achieve stabilization of the correction.
Patients are allowed to bear weight on the foot using a customized rocker bottom sandal
attached to the foot and the external fixator with self-adhesive straps. When midfoot
osteotomies are made necessary, the device is kept in place for an additional approximately 8
weeks to ensure consolidation of the regenerated bone. After removal of the device under
general anesthesia, patients are kept in a short leg-walking cast for another 4 to 6 weeks and
encouraged to walk bearing full weight on the operated limb. After this period, an ankle-foot
orthosis is used for 6 months.

Despite the many advantages of using Ilizarov EFs, its drawbacks during the application and
healing stages are well documented, which include longer learning curve with a greater
requirement for technical expertise, need for image intensification intraoperatively and
potentially inappropriate in emergencies such as in vascular injury or compartment syndrome
(Lacobelis et al., 2010).

PARTS OF AN ILIZAROV APPARATUS

 Primary components
 Secondary components

Primary components
 rings - supports transfixation
 arches
 Ilizarov/ Kirshner wires
 olive wires
 buckles - allow mechanical derotation
 bolts - for holding the wires

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Secondary components
 rods
 plates - to reinforce ring fixator
 Support post
 Male post-threaded projection fixed with nuts
 Female post-threaded hole fixed with the bolt.
 Hinge post
 Telescopic rod - provide stability when long-distance spanning is required between
rings
 Nuts - tighten the connecting bolts and stabilize connecting rods
 Tensioners - used to tension wire to an exact force, thus improving stability for the
entire bone frame construct.

ADVANTAGES OF THE ILIZAROV APPARATUS

 Minimally invasive
 Bone grafting if necessary
 Simple hardware removal
 Relatively easy application.

COMPLICATIONS OF USING THE ILIZAROV APPARATUS

Early complication
 Vascular complication (Avascular necrosis)
 Neurological complications
 Comminuted fracture of the osteotomized bone.
 Local skin tightness
 Edema
Late complication
 Compartment syndrome
 Pin site infection
 Osteoporosis
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  Non-union
 Mal union

3.2.4.2. CONSERVATIVE PROCEDURE:

In non-operative therapy for the treatment of fracture, it involves;
• Pain management
• Reduction (closed)
• Immobilization and in some cases
• Traction, when necessary.

Pain management
These methods include medications such as ibuprofen, acetaminophen with codeine, and
Vicodin application of splints, casts, braces after reduction, etc.

Reduction (closed)
Closed reduction is the manipulation of bone fragments without surgical exposure of the
fragments. The broken are made aligned without cutting the skin open. It may be done right
after the injury or several days later.

Immobilization
Immobilization refers to the process of holding a fractured body part in place/keeping it in
position while healing takes place using a cast, splint, or brace. It is a form of pain
management.
Immobilization restricts motion to allow the injured area to heal. It can help reduce pain
swelling and muscle spasms. When an arm, hand, leg, or foot requires immobilization, the
cast splint or brace will generally extend from the joint above the injury to the joint below the
injury. For example; injury to the mid-calf or tibia requires immobilization from the knee to
the ankle a foot.

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Fig. 3.17. Application of a Leg Cylinder Cast on a patient with a ruptured patella
tendon

3.3. AMPUTATION
Amputation is the removal of a limb by trauma, medical illnesses, or surgery. As a surgical
measure, it is used to control pain or a disease process in the affected limb, such as gangrene
malignancy.

3.3.1. TYPES OF AMPUTATION.

1. Lower extremity amputation
 Partial foot (amputation distal to the ankle)
 Ankle disarticulation.
 Transfemoral amputation.
 Knee disarticulation.
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  Transtibial amputation.
 Hip disarticulation.
 Transpelvic disarticulation.
 Trans metatarsal disarticulation.

2. Upper extremity amputation.

 Partial hand amputation.
 Wrist disarticulation.
 Trans radial amputation
 Transhumeral amputation.
 Elbow disarticulation.
 Shoulder disarticulation.
 Forequarter amputation.

Other include;
 Rhinotomy (amputation of the nose).
 Amputation of the ears.
 Glossectomy (of the tongue).
 Mastectomy (of the breasts).

3.3.2 CAUSES OF AMPUTATION

 Sepsis.
 Trauma e.g. fracture
 Congenital
 Infection (osteomyelitis or diabetic foot infection).

3.3.3. SURGICAL PROCEDURE FOR AMPUTATION

3. Ligation of the supplying artery and draining vein to prevent bleeding.
4. Transection of the muscles.
5. Sawing off the bone using a Golgi saw or an oscillating saw.
6. Removal of the diseased tissue and bone.
7. Smoothening uneven areas or bones.
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 8. Sealing off blood vessels and nerves by suturing.
9. Cutting and shaping of the muscles.
10. Sealing of the stump by suturing.
11. Use of Rigid Removable Dressings (RRDs) for trans tibia amputation, or soft
bandaging to improve the healing time, prevent edema and give shape to the stump in
preparation for a prosthesis.

3.3.4 POST-AMPUTATION AND PRE-PROSTHESIS CARE

Most operative nursing care priorities are the same as for any surgical patient: assessing and
maintaining the patient's airway, breathing, and circulation, monitoring vital signs, managing
pain, and watching for signs and symptoms of hemorrhage.

 After surgery, the patient will have a soft or rigid dressing made of fiberglass or
plaster.
 Assess the surgical dressing for integrity and drainage. Elevate the stump for the first
24 to 48 hours.

 Move and turn the patient gently and slowly to prevent severe muscle spasms
reposition the patient every two hours. Lying prone helps reduce hip flexion
contractions. Avoid placing pillows between the patient's leg or under the back.

 Unwrap the stump dressing every 4 to 6 hours for the first two days postoperatively as
prescribed and then at least once daily. Assess the stump for signs and symptoms of
infection and skin irritation or breakdown (suture breakdown).

 Before rewrapping the stump, change the dressings but avoid lotion. Wrap the stump
with a crepe bandage (or after 4 to 8 weeks with a plaster bandage) to give shape and
rigidity to the stump before the prosthesis is prescribed.

3.4. INFRARED MASSAGE THERAPY

Infrared massage therapy is the therapeutic combination of various deep muscular and
lymphatic techniques specifically used with infrared light placed over the area, that is simple

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and painless to provide; massage, acupressure, therapeutic heat, far infrared rays, and has an
incredible deep healing effect.

Infrared massage is with the intention of improving and strengthening the whole body on a
cellular level and the well-being of a person. The effects of the treatment relax the muscles
while improving blood circulation, stimulating blood flow and tissue repair, and relieving
pain.

The infrared light penetrates the skin and is absorbed by the deep tissues. Combined with
muscular techniques, it helps to firm, repair, rebuild, and push out more toxins on a deeper
level, opens up muscle and tissue fibers, and increases circulation and healing time, allowing
for even deeper healing in the areas being worked.

A light massage using lotion, cream, and/or essential oils and the infrared light, after just
about 8-30 minutes of treatment, depending on the area being worked, the blood flow is
enhanced by 400 percent. The most dramatic benefits of infrared are achieved with multiple
treatment sessions, about 5 times a week for more effective results.

3.4.1. INDICATIONS FOR INFRARED MASSAGE THERAPY

 Arthritis
 Lumbago (low back pain)
 Bursitis
 Central nervous system injuries
 Diabetes
 Diabetic neuropathy
 Neck pain
 Muscle spasms and strains
 Osteoarthritis
 Rheumatoid arthritis
 Parkinson's disease
 Sciatica
 Stroke

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  Temporomandibular joint pain (TMJ)
 Tendonitis
 Surgical incisions

3.4.2 CONTRAINDICATIONS OF INFRARED LIGHT THERAPY

 Areas with poor or deficit skin sensation
 Sensitive areas e.g. the eyes, thyroid, etc.
 Epileptic seizures
 Severe osteoporosis
 Scar tissue
 Cardiovascular disease

3.5. EXPERIENCE GAINED

Working at Albina Mejeel Specialist Clinic, Center for Ilizarov Orthopedic technique, as a
student trainee has given me the opportunity to apply some of the theoretical knowledge
gained during my study at the university and also acquire more practical knowledge there.

I also gained experience in other fields like Gynecology, Radiography, Orthopaedic

Medicine, Obstetrics, and also Nursing science. During the course of my work, I had to
interact with many professionals which were very beneficial to me.
Below is a summary of my general experience gained;
1. I learnt how to diagnose, reduce and manage fractures using the Ilizarov external
fixator.
2. I learnt and practiced the different techniques involved in casting and cast removal.
3. I learnt how to successfully correct different kinds of the deformity using the serial
casting and manipulation technique.
4. I learnt documentation and follow-up on patients’ medical records.
5. I learned a major aspect of physiotherapy which is massage therapy using infrared
light.
6. I learnt how to communicate with patients and professionals effectively.

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 CHAPTER FOUR
EQUIPMENT, MATERIALS, AND TOOLS USED IN WORK
CARRIED OUT
4.1. CORRECTION OF DEFORMITIES USING SERIAL CASTING AND
MANIPULATION

Tools, materials, and equipment Uses

Plaster of Paris (POP) bandage and When a bone was out of position and is
Fiberglass manipulated back into position, plaster may
be used to help hold the bone in the proper
position.
Stockinette and soft paddings used as a general-purpose protective skin
covering that protects the skin underneath
the hard cast.
Manual and electric cast cutter used in the removal of the cast after a period
of time.
Cast spreader spreading apart and removing hard plaster
or fiberglass casting materials.
Bowl and basin of water Used to soak the POP bandage before
application.
Table 4.1. Tools, materials, and equipment used in the correction of deformities using
serial casting and manipulation.

4.2. FRACTURE AND FRACTURE MANAGEMENT

Tools, materials, and equipment Uses
Illizarov apparatus Helps to heal complex fractures
(complicated broken bones) help heal severe
skin or tissue loss. lengthen long bones if
too much bone has been lost at the time of
accident by allowing new bone to grow in
between the two broken bone ends.
Internal fixators (Kirchner wires, nails, used to repair severely displaced or open

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 screws, and plates) bone fractures where the fracture has
pierced the skin
Casting materials to protect and support fractured or injured
bones and joints
Cast removal tools Used to remove cast after fracture healing is
ascertained
Table 4.2. Tools, materials, and equipment used in fracture management

Fig 4.1. An Illizarov External Fixator

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4.3. AMPUTATION
Tools, materials, and equipment Uses
Dissection and cutting scissors used to cut thick tissues or sutures, either
straight or curved
Retractors and handheld clamps. Used in keeping in keeping wounds and
incisions open
Needle holders, suture material (absorbable Used in stitching the ends of the stump after
and nonabsorbable), and forceps (fine and amputation.
toothed)

Bone instruments (e.g., saw, bone nibblers, Used in shaping and cutting the bones during
amputation surgery
osteotomes, mallet, and curettes)

Diathermy device. Uses high frequency alternate polarity

radio-wave electrical current to cut or
coagulate tissue during amputation surgery.
Irrigation reduce the microbial burden by removing
tissue debris, metabolic waste, and tissue
exudate from the surgical field before site
closure.
Table 4.3. Tools, materials, and equipment used in amputation

4.4. INFRARED HEAT THERAPY

Tools, materials, and equipment Uses
Infrared heat massage lamp Introduces the infrared light that penetrates
deep into your body (2-7 mm) all the way to
the inner layers of your skin, to your
muscles, nerves, and bones for pain relief,
reduction of muscle tension, relaxation,
improved circulation, weight loss, skin
purification, lowered side effects of
diabetes, boosting of the immune system
and lowering of blood pressure.
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 Essential oils and ointments (olive oil, To maintain suppleness and offers pain
diclomol, methyl salicylate) relief during the therapy

Table 4.4. Tools, materials, and equipment used in Infrared heat therapy

Fig. 4.2. An infrared heat massage lamp.

CHAPTER FIVE (5)

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CHALLENGES OF SIWES, CONCLUSION, AND RECOMMENDATION
5.1. CHALLENGES OF SIWES
 Finding a good establishment willing to accept IT students was a hassle.
 During my first few days, I had difficulties understanding a lot of terms and
terminologies used at the hospital.
 Distance from my place of residence to my place of attachment.

5.2 CONCLUSION
This report has been able to x-ray the amount of the entire work experience gained by me
during my SIWES program at Albina Mejeel Specialist Clinic, Center for Ilizarov Orthopedic
Technique, which is a core scheme in ITF and which is an active movement in the
responsibility of strengthening the effective learning and teaching skill-based course.

During my training, I have improved greatly my interpersonal skills, through interaction with
a diverse group of people in the hospital, from my supervisor and co-students to other
professionals and workers. I have also gained communication skills to be used when working
with both professionals and non-professionals. Since the purpose of the attachment, the
scheme was to expose students to an industrial environment and enable them to develop
occupational competencies; to some extent, I am confident to say that the scheme has
broadened my knowledge and I have improved a lot.
5.3 RECOMMENDATION
In view, of the relevance of the SIWES program, it is important that it is sustained by the
government through the Industrial Training Fund (ITF) as it exposes the student to work
facilities and equipment that may not be available in their respective institutions in relation to
their course of study. To this end, I recommend that the following should be implemented;
 Regular monthly allowances for students on attachment should be paid promptly.
 Organizations should always accept students for SIWES and subsequently assign
them to relevant jobs.
 The organization should put in place the necessary equipment and facilities for the
training of students.

REFERENCES
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extremities: biomechanical perspective and recent innovations Injury. pp. S10-S17

Fahey, J.J, Bollinger, J.A (1954). "Trigger-finger in adults and children". Journal of Bone
and Joint Surgery. 36B (6): 1200–1218.

ITF (1973). Policy document No.1 Industrial training fund, Jos Nigeria.

Iacobellis, C., Berizzi, A., & Aldegheri. (2010). R. Bone transport using the Ilizarov method:
a review of complications in 100 consecutive cases. Strategies in trauma and limb
reconstruction, pp. 17-22.
Neu, B. R.; Murray, J. F. (1983). "Congenital bilateral trigger digits in twins." The Journal of
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Ojokuku, B. Y., Emeahara, E. N., Aboyade, M. A. & Chris-Israel, H. O. (2015). Influence of

Students' Industrial Work Experience Scheme on Professional Development of
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Rigal, S., Mathieu, L., & de l'Escalopier, N. (2018). Temporary fixation of limbs and pelvis
Orthopaedics & Traumatol: Surgery Res, pp. S81-S88

Simpson, A., Robiati, M., & Tsang L. (2019). Non-union: indications for external fixation
Injury.pp. S73- S78.

Vicenti, G., Antonella, A., Filipponi, M., Conserva, V., Solarino, G., Carrozzo, M., &
Moretti, B. (2019). A comparative retrospective study of locking plate fixation versus
a dedicated external fixator of 3- and 4-part proximal humerus fractures: results after
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Wu, Y. W., Day, S. M., Strauss, D. J., & Shavelle, R. M. (2004). Prognosis for ambulation in
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Ojokuku, B. Y., Emeahara, E. N.,
Aboyade, M. A. and Chris-Israel,
H. O., “Influence Of Students’
Industrial
Work Experience Scheme On
Professional Development Of
Library And Information
Science
Students In SouthWest, Nigeria”
(2015). Library Philosophy and
Practice (e-journal). 1330

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