LEG LENGTHENING SHORTENING AFTERCARE
Category: Orthopedic Surgery
Abstract : Aftercare After the operation, nursing staff teach patients how to clean and care for the skin around the pins that attach the external fixator to the limb (pinsite care). Patients are also shown how to recognize and treat early signs of infection and not to neglect pinsite care, which takes about 30 minutes every day until the apparatus is removed. It is very important in preventing infection
Aftercare
After the operation, nursing staff teach patients how to clean and care for the skin around the pins that attach the external fixator to the limb (pinsite care). Patients are also shown how to recognize and treat early signs of infection and not to neglect pinsite care, which takes about 30 minutes every day until the apparatus is removed. It is very important in preventing infection from developing.
After an epiphysiodesis procedure, hospitalization is required for about a week. Occasionally, a cast is placed on the operated leg for some three to four weeks. Healing usually requires from eight to 12 weeks, at which time full activities can be resumed.
In the case of leg shortening surgery, two to three weeks of hospitalization is common. Occasionally, a cast is placed on the leg for three to four weeks. Muscle weakness is common, and muscle-strengthening therapy is started as soon as tolerated after surgery. Crutches are required for six to eight weeks. Some patients may require from six to 12 months to regain normal knee control and function. The intramedullary rod is usually removed after a year.
In the case of leg lengthening surgery, hospitalization may require a week or longer. Intensive physical therapy is required to maintain a normal range of leg motion. Frequent visits to the treating physician are also required to adjust the external fixator and attentive care of the pins holding the device is essential to prevent infection. Healing time depends on the extent of lengthening. A rule of thumb is that each 0.4 in (1 cm) of lengthening requires some 36 days of healing. A large variety of external fixators are now available for use. Today’s fixators are very durable, and are generally capable of holding full weight. Most patients can continue many normal activities during the three to six months the device is worn.
Metal pins, screws, staples, rods, or plates are used in leg lengthening/shortening surgery to stabilize bone during healing. Most orthopedic surgeons prefer to plan to remove any large metal implants after several months to a year. Removal of implanted metal devices requires another surgical procedure under general anesthesia.
During the recovery period, physical therapy plays a very important role in keeping the patient’s joints flexible and in maintaining muscle strength. Patients are advised to eat a nutritious diet and to take calcium supplements. To speed up the bone healing process, gradual weight-bearing is encouraged. Patients are usually provided with an external system that stimulates bone growth at the site, either an ultrasound device or one that creates a painless electromagnetic field.
Risks
All the risks associated with surgery and the administration of anesthesia exist, including adverse reactions to medications, bleeding and breathing problems.
Specific risks associated with LLD surgery include:
• osteomyelitis (bone infection)
• nerve injury that can cause loss of feeling in the operated leg
• injury to blood vessels
• poor bone healing (non-union)
• avascular necrosis (AVN) of the femoral head as a result of vascular damage during surgery
• chondrolysis (destruction of cartilage) following insertion of rods and pins
• hardware failure, failure of epiphysiodesis, failure of slip progression
• unequal limb lengths if one leg fails to heal properly (The physician may need to reverse the direction of the external fixator device to strengthen it, causing a slight discrepancy between the two legs.)
• joint stiffness (contractures) may occur during lengthening, especially significant lengthenings
• pin loosening in the anchor sites
Another serious specific risk associated with leg lengthening / shortening surgery is infection of the pins or wires going through the bone and/or resting on the skin that may result in further bone or skin infections (osteomyelitis, cellulitis, staph infections).
Normal results
Epiphysiodesis usually has good outcomes when performed at the correct time in the growth period, though it may result in an undesirable short stature. Bone shortening may achieve better correction than epiphysiodesis, but requires a much longer convalescence. Bone lengthening is completely successful only 40% of the time and has a much higher rate of complications. Recovery time from leg lengthening surgery varies among patients, with the consolidation phase sometimes lasting a long period, especially in adults. Generally speaking, children heal in half the time as it takes an adult patient. For example, when the desired goal is 1.5 in (3.8 cm) of new bone growth, a child will wear the fixation device for some three months while an adult will need to wear it for six months.
Alternatives
A LLD of 0.8 in (2 cm) or less is usually not a functional problem and non-surgical treatment options are preferred.
The simplest forms do not involve surgery:
• Orthotics.
Often leg length can be equalized with a sole or heel lift attached to or inserted inside the shoe. This measure can effectively level a difference of 0.4–2.0 in (1.0–5.0 cm) and correct about two thirds of the LLD. Up to 0.4 in (1 cm) can be inserted in a shoe. Beyond this, the lift gets heavy, awkward, and can cause problems such as ankle sprains and falls. The shoes look unsightly and patients complain of gait instability with such a large lift. A foot-in-foot prosthesis can be used for larger LLDs but they tend to be bulky and used as a temporary measure.
• Physical therapy.
LLD results in the pelvis tilting sideways since one side of the body is higher than the other side. In turn, this causes a kink in the spine known as a scoliosis. Thus, leg length discrepancies can alter the mechanics of the pelvis so that the normal stabilizing and controlling action of specific muscles is altered. A common approach is to use exercises designed to modify the mechanics through specific strengthening of muscles that are weak and stretching of muscles that are restricting movement.
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