Deformity correction. A patient's guide. Information for patients Sheffield Teaching Hospitals

Transcription

1 Deformity correction A patient's guide Information for patients Sheffield Teaching Hospitals

2 This leaflet applies to any deformity correction and it will set out the general principles and complications. The specialist limb reconstruction team will discuss your care plan with you at length and personalise it to your specific deformity before any treatment. It is important that you have a realistic picture of what the treatment you are about to undergo involves and the likely impact it will have upon yourself and your family. We advise that you take things one step at a time. Do not build up hope that everything will run smoothly and be problem free; this may not always be the case. Complications can occur despite the measures we take to prevent them. It is important that you try to maintain a normal life wherever possible for you and your family. We appreciate this can be difficult but not impossible. Help and advice is always on hand from your limb reconstruction team so please let them know of any problems or worries you may have. The deformity that you are correcting is... page 2 of 12

3 Corticotomy When it is necessary to do so, the limb reconstruction surgeon will perform a corticotomy in the operating theatre. A corticotomy is a surgical cut in the bone; when pulled apart slowly new bone will form between the two bone ends. The anaesthetic used during this procedure will be discussed with you by the anaethetist. After the corticotomy there will be a resting phase which is usually for around 10 days which means that you do not start your corrections until after day 10. This is to allow for the bone to start healing prior to correcting. Bone forms better if it is lengthened slowly so your corrections will be done 4 times a day unless otherwise stated by the limb reconstruction team. Your plan will be marked out in the back of this booklet by one of the limb reconstruction team. During your treatment, the corrections you are making will be followed up by x-rays and by the limb reconstruction team on a regular basis. This will involve attending the out-patient department at the Northern General Hospital, Sheffield. When you have completed the corrections and your consultant is happy for you to stop correcting, the frame will stay in place until your new bone joins solidly with the rest of your bone. This may take months. Your frame will only be removed when your consultant is happy that the new bone has healed. page 3 of 12

4 Physiotherapy Physiotherapy is very important at all times of your treatment, but even more so during your correction / lengthening phase. As you change the position and shape of your bone, the nearby muscles and tendons can become tight. This tightness can lead to a loss of movement at your knee and your ankle, which will affect your everyday lifestyle tasks. Your physiotherapist will show you exercises and stretches to do to prevent the muscles from becoming too tight and to try to maintain your range of movement at your joints. It is important that you take your pain relief regularly to be able to perform these exercises. It is recommended that you do your corrections and your stretches around 30 minutes after you have carried out each of your corrections. Here are a few recommended exercises for your knee and ankle. Rest your operated leg onto a step or raised block. Keeping your knee straight lean forwards until you can feel a stretch behind your knee and hold for 5 seconds. Repeat 10 times page 4 of 12

5 In a sitting position, rest your operated leg out in front of you onto another chair with your knee straight and hold for 5 minutes. You should feel a stretch at the back of your knee. Hold onto the back of a chair. Place your operated leg behind you keeping your heel on the floor, bend your front leg and lean forwards. You should feel a stretch in the calf muscle of the operated leg. Hold for 5 seconds and repeat 10 times. page 5 of 12

6 Place your operated leg on a step, lean forwards bending the knee and keeping your heel down. You should feel a stretch in your ankle. Repeat 20 times. Using your elastic theraband, place around your foot and pull the foot up towards you. Hold for 5 seconds and repeat 10 times. This may mean that you are exercising more frequently than normal, but this is necessary to prevent complications. If the muscles don t keep adequately stretched out then the corrections may have to be stopped or slowed down. This may have a big effect on the overall result and you may not reach the desired outcome. You must attend out-patient physiotherapy regularly during this stage of your treatment. Further advice can be sought by speaking to Nicola Glossop, Clinical Specialist Physiotherapist in Limb Reconstruction at the Northern General Hospital: page 6 of 12

7 Pain control The pain experienced is different for everybody. For some, the pain can be quite intense which requires strong pain killers from your GP. You may also need extra pain relief in order to do your physiotherapy exercises. Nerve pain Whilst doing your corrections you may experience nerve pain. You must discuss this as soon as possible with the limb reconstruction team. Tension blistering As you correct your deformity you may notice blistering or drag marks near your wires. This is common and is known as tension blistering or cheese wiring. It can be painful and you may need some extra pain killers during this period. You are more at risk of developing a pin site infection if this occurs. If you are unsure, please contact the limb reconstruction team who will discuss this with you. Premature consolidation It has been known for the bone ends of the corticotomy to unite before the corrections have finished. This is known as premature consolidation. The signs of this can be the wires bending, sudden extreme pain on correcting and finding it difficult to turn the nuts on the rod. If you experience this, please contact the limb reconstruction team immediately. page 7 of 12

8 Length of treatment The length of treatment depends on the deformity you are correcting. This will be discussed with you by the limb reconstruction team before you consent to treatment. The length of hospital stay is different for everybody. To be able to go home from hospital you need to: be safe (you will need to have passed all assessments from Physiotherapy and Occupational therapy), be comfortable (your pain will be under control), and know how to look after your frame (you will have been taught dressings and corrections by the limb reconstruction nurses). Treatment can be long and tiresome. You need to be 100% committed before you engage in treatment. This will be discussed with you at length by the limb reconstruction team who will counsel you prior to consenting to treatment. If you have a history of depression or mental illness, please discuss this with the limb reconstruction team who can refer you to the appropriate services. For your information You will need a pair of 10mm open ended spanners. If you have the LRS rail, an Allen key will be loaned to you. If you have a Hexapod system, a ruler will be loaned to you. page 8 of 12

9 Instructions for corrections Date/time page 9 of 12

10 Frequently asked questions What happens if I miss a turn or forget to do a turn? Don t panic! Just carry on as normal and let one of the limb reconstruction team know. What if I go too far or not far enough? Ring the limb reconstruction team straight away and they will discuss the options with you. What happens if I run out of length? Ring the limb reconstruction team who will plan to bring you in to the next available clinic to change the length of rod. Do not continue to correct on the other rods if you run out of length on one of them. page 10 of 12

11 Questions you have for the limb reconstruction team: page 11 of 12

12 If you have any problems or you feel you need advice, please contact the Limb Reconstruction Nurses, Maria Vincent or Katy Cooke, by telephone on: Produced with support from Sheffield Hospitals Charity Working together we can help local patients feel even better To donate visit Registered Charity No Alternative formats can be available on request. Please Sheffield Teaching Hospitals NHS Foundation Trust 2018 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. PD8626-PIL3646 v2 Issue Date: February Review Date: February 2021