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Both children and adults with limb length discrepancies
(LLDs) typically come to The Center for Limb Lengthening
and Reconstruction at University Hospital to see if they
are appropriate candidates for any form of limb reconstruction
and lengthening. Our physicians will discuss different
treatment options and patients will be provided with educational
tools such as an informative video and shown a model of
a limb with an external fixator. This helps the patient
and family to better appreciate what is involved in undergoing
this type of procedure. The need to follow a schedule
of turning struts/screws daily is reinforced and the simple
technique is demonstrated on the model. Post-operative
rehabilitation is also discussed with the patient.
The patient is encouraged to discuss the surgery with
family, get a second opinion and to return to the physician’s
office within a few weeks. At that time, the patient’s
readiness for surgery is re-evaluated. If the patient
is prepared for surgery, a date is set for the procedure.
The parents of pediatric patients are advised to alert
the school regarding possible absence and given a medical
clearance note as required by the school.
The Hospital Stay
Day 1
The patient and family (for pediatric patients) arrive
at The University Hospital the morning of surgery. Following
surgery, the patient is taken to the recovery room and
later to the floor for nursing care and pain control.
The medical team performs a post-op check.
Days 2 and 3
The patient is visited by a member of the medical team
to check on recovery. Physical therapy has the patient
begin to mobilize. A device called a Dynasplint TM may
be provided to keep the knee and/or ankle in proper
position. The physician explains to the patient and
family how to do strut turns and provides a schedule.
The first post-op appointment is scheduled. The patient
is then discharged to home or to a specialized hospital
for further rehabilitation.
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(A) A young girl undergoing tibial
lengthening. Note the brace (“Dynasplint”) connected
to the external fixator that helps keep the ankle
in a satisfactory position. (B)
This patient is undergoing a forearm lengthening.
In order to maintain finger mobility and prevent
contractures, customized slings can be suspended
off the external fixator. |
After Discharge
On the first post-op visit (approximately one week
after surgery) in the physician’s office, the
patient gets x-rays, the dressing is removed from the
limb and pin sites are cleaned. The patient is instructed
on how to clean and care for pin sites. The patient
receives prescriptions for supplies such as hydrogen
peroxide, two inch kling and antibiotics with refills.
The importance of daily cleaning and physical therapy
are emphasized.
The patient continues with physical therapy 3-5 times
a week and daily pin cleaning. Patients are seen by
the physician in the office approximately every 2-3
weeks. During these visits, x-rays will be taken and
reviewed, pin sites checked. The strut schedule will
be checked and the Range of Motion (ROM) will be checked.
The daily strut turns, physical therapy and visits
with the physician every 2-3 weeks continue until the
desired length is achieved and x-rays reveal enough
bone consolidation to remove fixator.
Once it is determined through x-rays and exam that
the external fixator is ready to be removed, an Operating
Room date is scheduled. It is discussed whether the
patient will be placed in a cast or brace following
the operation and arrangements are made for the patient
to be measured with an orthotist. The patient returns
for a pre-operative visit approximately 2 weeks prior
to surgery. Paperwork is completed and x-rays are taken.
Information regarding the day of surgery is reviewed.
The patient’s family is encouraged to bring crutches/walker/wheelchair
with them on the day the removal of external fixation
is scheduled.
Surgery Day
The patient arrives at the designated Operating Room
and is prepared for the same day procedure. Patient
wakes up from surgery with either cast or brace in place
and is sent home the same day.
Post-op Visit #1
Within a week of surgery, patient is
seen in the physician’s office. X-rays are taken.
If the patient is in a brace, the dressings are removed
and the surgical site is examined. The next visit is
scheduled, at which time the cast or brace may be removed
or gradually weaned off.
Post-op Visit #2-3
X-rays are taken and if bone is deemed
to be healing, cast or brace is removed. Patient is
given a prescription for physical therapy. An appointment
is scheduled for 4-5 weeks to check ROM and incision
site. At that point, x-rays and photographs may be taken.
Once ROM goals are reached, physical therapy is discontinued.
Office visits are now less frequent as correction has
been satisfactory.
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Patient
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