Limb lengthening and reconstruction. Children s Hospital Information for Patients, Parents and Carers

Transcription

1 Limb lengthening and reconstruction Children s Hospital Information for Patients, Parents and Carers

2 Advice for leg lengthening and reconstruction Introduction This booklet has been designed to provide information prior to the application of a circular frame or external fixator. The Taylor Spatial frame and the Ilizarov Frame are external devices that are used for limb correction, straightening and lengthening of a limb. The frames consist of rings usually 4-6 made of carbon fibre or stainless steel. Thin wires and thicker pins that are called half pins are fixed to the rings of the frame and pass through the skin and in to the bone. The surgeon will divide the bone in a procedure called an osteotomy. The osteotomy lies in a section of bone between the two rings. The half pins are attached to one side of the frame and the wires go through the bone to the other side of the frame where they are attached and held under pressure. There are also rods/struts between the rings to make the frame stable; these are used to make any adjustments that might be required. The rings, struts and rods of the frames come in many sizes and made to fit each individual. 2

3 Treatment There are also rods/struts between the rings to make the frame stable; these are used to make any adjustments that might be required. The rings, struts and rods of the frames come in many sizes and made to fit each individual. The 6 struts of a Taylor Spatial frame allow for the different directions of movement which means that the bones can be can be lengthened, shortened, angled or rotated all at the same time. The struts also come in differing sizes and are changed at times to allow the above to take place. A computer programme will work out a detailed prescription for adjusting the frame. 3

4 Adjustments When adjusting the spatial frame you will follow the chart above. You will be taught how to follow the chart and how to make the adjustments. Each strut has its own colour, number, markings and adjustment knob. The surgeon will set these markers initially and 5-7 days after surgery you will start to turn the adjustment knob. 4

5 At home Adjustments Struts have a locking bolt that sit above the coloured marker, you will need to loosen this before you make any turns and lock it back into place after you have done this. Each knob has a plus sign and an arrow, turning the knob toward the plus sign which is in the direction of the arrow will make the strut longer, turning away from the plus sign will make the strut shorter. Please note that depending on the type of correction planned you may not need to adjust all the struts. Always check each morning before you start any turns that the numbers on each strut are where they were meant to be ensuring that you starting from exactly where you finished the day before. The above is known as the Correction/Lengthening phase. You will have your frame on for a minimum of 4 months, each case is individual and therefore your time in a frame may be longer. 5

6 Consolidation phase When your consultant is satisfied that the correction/lengthening the Consolidation phase begins. This is when your bone strengthens and becomes more solid, you will still need to wear your fixator but you will need no further adjustments. When an Ilizarov frame is applied in Order to correct or lengthen, the frame/rings that support the ends of the bone following an osteotomy can be adjusted slowly every day to gradually increase the space between the bone ends. The new bone will grow in the desired position. You will be taught how to make these adjustments. This is achieved by turning a nut which has 4 sides and numbers on these that look like a dice, these turns are made with a pair of spanners the nuts are turned 4 times a day, one quarter turn lengthens the frame one quarter this is known as distraction this creates 1 millimetre of bone a day. There is a chance that you may experience some failure of the mechanics of the external fixator for example bent or broken wires/ pins or you maybe having difficulty turning the strut. If this happens please call in promptly. 6

7 Pain management Following surgery your child may return with a Patient controlled analgesia pump which contains Morphine. This is a strong pain killer which is controlled by the patient. Alternatively an epidural infusion may be used this delivers a continuous dose of pain relief via a narrow plastic tube that is inserted into the spinal canal. These options will be discussed with you by the anaesthetist. Your nurse will use a pain scoring tool to assess the level of pain or discomfort felt. Other types of pain relief can be given with an Epidural and Patient controlled analgesia. Analgesia will be given to you to take home on discharge. 7

8 Diet Diet is important before and after surgery, it is important that you have a diet that is sufficient in vitamin D and Calcium. Calcium affects how strong bone is and also helps with healing. Foods rich in calcium are milk, cheese yogurts and eggs. Vitamin D is important as it controls how much calcium is absorbed into the intestines. Vitamin D can be found in milk, cereal fish and egg yolks. It is also sensible to limit the amount of fizzy drinks. Caffeine in fizzy drinks increases the amount of calcium that we excrete in urine, so swapping to milk or water is a good idea. 8

9 Pin site care Before you are discharged from hospital you will be shown how to care for your pin sites. The pins will be cleaned whilst you are on the ward and then will be cleaned weekly unless you are advised otherwise. Pin site care is important as the wires/pins pass through the skin and muscle and into the bone. This increases the risk of infection on the skin spreading to the bone. Pin sites should always be checked for signs of infection when they are cleaned, or more often if you have concerns. Sites fall into three categories normal, irritated or infected. This usually occurs in the first few weeks after the frame is applied and when the adjustments to the frame commence. This is due to the wire being pulled through the skin. You may find that the wires that are the nearest to the joints such as the knee, ankle and elbow can also become irritated and ooze after increased activity or exercise. An irritated pin site is not an infected pin site but may require more frequent dressing changes. If you have any concerns contact the team. Signs of an infected pin site Increase in pain to that area Spreading redness of the skin Increased discharge or pus Increased swelling Increased pain or difficulty mobilising Temperature Feeling unwell 9

10 Pin site care Normal pin sites No discharge, pain, tenderness, changes in colour or swelling around the site where the pin enters the skin. Irritated pin site Pin sites can become irritated or inflamed this will appear red around the pin site. There may be some oozing of a clear straw coloured fluid. This usually occurs in the first few weeks after the frame is applied and when the adjustments to the frame commence. This is due to the wire being pulled through the skin. You may find that the wires that are the nearest to the joints such as the knee, ankle and elbow can also become irritated and ooze after increased activity or exercise. An irritated pin site is not an infected pin site but may require more frequent dressing changes. If you have any concerns contact the team. 10

11 Pin site care Infected pin sites Signs of an infected pin site Increase in pain to that area Spreading redness of the skin Increased discharge or pus Increased swelling Increased pain or difficulty mobilising Temperature Feeling unwell 11

12 Pre assessment You will be asked to attend a Pre-assessment clinic approximately 2 weeks before the operation date. You will see the consultant; discuss the procedure and consent for the surgery. Any blood test that is required will be obtained and also a medical history taken. The Pre-assessment clinic also gives you the opportunity for you to ask any further questions that you may have. Listed below are some questions to ask How long will the frame be on for? Can I walk with the frame on? Can I go back to school? Can I bath or shower? Will I have physiotherapy? Can we go on holiday? What clothes are suitable to wear with a frame? 12

13 The Team Mr Abraham Consultant Orthopaedic Consultant Mr Furlong Consultant Orthopaedic Consultant Jo Shaw Paediatric Orthopaedic Nurse Specialist Useful contact numbers Jo Shaw / Ward / Team secretary Julie Keeley

14 Your Questions / Notes If you have any questions, write them down here to remind you what to ask when you speak to your child s consultant/nurse. 14

15 Your Questions / Notes If you have any questions, write them down here to remind you what to ask when you speak to your child s consultant/nurse. 15

16 Leaflet Produced : September 2016 Next Review: September 2018 (Shaw) - Childrens - CHI Today s research is tomorrow s care We all benefit from research. Leicester s Hospitals is a research active Trust so you may find that research is happening when you visit the hospital or your clinic. If you are interested in finding out how you can become involved in a clinical trial or to find out more about taking part in research, please speak to your clinician or GP. If you would like this information in another language or format, please contact the service equality manager on