Limb lengthening and reconstruction: Living with a fixator

Once your child is fitted with a fixator, they will need to adjust to changes in their routine and their ability to do everyday tasks.

Follow-up appointments

Once your child goes home with the fixator after surgery, they will return to clinic:

• once a week during the correction or lengthening phase
• once a month during the consolidation (healing) phase.

At home with a fixator

Most children will be allowed to put weight on the operated limb right after limb reconstruction surgery. This may be sore or scary at first, but it is quite safe. Your child may need to use crutches, a walker or a wheelchair while they heal.

You will need to think about how your child’s limited movement will affect how they can get in and around your home, including going up and down stairs and using the washroom. You may also need to plan extra time for getting in and out of the car or using public transport.

At school with a fixator

Children with internal and external fixators are expected to return to school once they recover from their surgery. You and your child’s school should support your child’s return as soon as possible.

If you think your child will be unable to attend school for several weeks after their limb lengthening or correction surgery, you may be able to arrange home tutoring with the help of the school and a letter from your child’s surgeon. Keep in mind, however, that children are usually happier to be back at school with their friends instead of at home during the day.

How to prepare for your child’s return to school after surgery

Your child’s school will need to make plans to help your child when they return. Telling your child’s school about your child’s surgery as far in advance as possible will make it easier for them to put these plans in place. Here are some points to talk about with your child’s school.

How your child will get to and from school

• Your child may need to use an accessible bus or taxi.

Moving between classes

• Your child may need extra time, or time when other students are not in the hallways, to move from one class to the next.

Going up and down stairs

• Your child will need extra time for stairs. If available, an elevator may be the best choice.

Using the washroom

• A washroom that is designed for wheelchairs is the safest option.

Taking part in physical education class

• If your child is moving easily without a walker or crutches, their school may allow them to take part in physical education with their classmates.
• If your child cannot move easily without support, they would ideally spend the time scheduled for physical education working on their exercises from their physiotherapist.
• After the surgeon removes the fixator, your child will be guided back to all activities. In general, they will not do any contact or impact activities for one year after their fixator is removed.

Managing medications

• Ask your child’s school about their policy on managing prescription medications in the classroom. Policies can differ from school to school.

Missing school for surgery and follow-up appointments

• Tell your child’s school that your child will be away for one to two weeks around the time of surgery, for a full day once a week during the lengthening or correction phase and one day a month during the healing phase.
  

Changes to your child’s clothing

If your child is due to have an external fixator, such as a Taylor Spatial Frame or monolateral rail, be aware that they are bulky and can catch on clothing. They can also damage bedding, soft furnishings, floors and car seats. Consider making the following changes so your child’s clothing can fit over the fixator.

Clothing options

• Snap-on track pants, tear-away track pants or shorts
• Loose fitting skirts or dresses

Clothing alterations

• You can widen clothing by cutting down one seam and stitching in extra material. You can also secure extra fabric with hooks and loops, Velcro or buttons.
• You can widen snug-fitting underwear with snaps, ties or Velcro down the side.

Protection for bedding and soft furnishings

• You may choose to make a custom fabric bag and place it over the external fixator to protect furniture and bedding. Some patients use old sheets.

Managing pain

There are several options for managing pain at home. Always discuss the options for your child with their surgeon.

Important: Do not give your child any anti-inflammatory medications such as ibuprofen during treatment. These drugs may slow down or even prevent bone healing in situations such as limb reconstruction.

Showering, bathing and swimming

Your child’s surgeon will tell you when your child can begin showering. This is usually allowed two weeks after limb lengthening and reconstruction surgery, once the pin and wire sites are clean and dry.

Talk to your child’s surgeon about when your child can use private and public swimming pools or swim in the ocean. To reduce the risk of infection, your child will not be able to take baths or swim in lakes until the fixator is removed.

Smoking

Smoke and second-hand smoke can delay and sometimes even stop bone healing. Slower healing means your child will need to use the fixator for longer. It will also increase the risk of other complications such as infection. As a result, it is essential for your child to avoid smoke-filled environments inside and outside the home.

Nutrition

During treatment, your child must eat a healthy, balanced diet to give their bone the nutrients it needs to grow and heal and to allow their immune system to fight any infections.

The surgeon may recommend that your child:

• eat more calories, to give them more energy to recover
• take calcium and vitamin D supplements, to help grow new bone and to keep their bones strong and healthy.

Supplements are recommended even if your child has a diet rich in calcium and vitamin D. They will help make sure that your child gets enough of these nutrients every day.