Care After Surgery
Understanding Limb Correction
The bone deformity must be corrected, and/or the bone lengthened. The new bone that grows is then allowed to strengthen and harden in the new shape/length. This second step is called “consolidation.” Your surgeon will be able to give you an estimate of how long these two stages will take, depending on your specific health situation, but external fixation is usually in place for 4 to 12 months.
While the deformity is being corrected, the external fixator will need gradual adjustments, to help new bone tissue grow into place over time. When your surgeon is happy with the length, shape and alignment of the bones, adjustments will no longer be needed. However, you will still wear the external fixator, which will support your limb while the new bone tissue hardens and the limb becomes stronger. A good rule of thumb to remember is that consolidation takes twice as long as lengthening/reshaping.
Before having surgery, it’s important to do more than simply read information. Use patient education materials and websites such as this one to help you and your family come up with questions that you will ask your surgeon, nurses, physical therapist and other medical professionals. You may also want to speak to patients who have had external fixation.
In addition, you can read some Patient Stories, to get an idea of what the experience and recovery process is like.
Care After Surgery
Adjustments to the external fixator will begin between 5 and 14 days after your/your loved one’s surgery, starting sooner in younger patients. Your surgeon will explain the schedule for adjustments, and how many visits will be needed. Your surgeon will give you information on potential post-operative complications (such as pin-site infection, joint stiffness or muscle contractures, and wire or pin breakage), and the signs that you should seek treatment, as well as the appropriate healthcare professional to contact.
You/your loved one may experience some discomfort after leaving the hospital. This is normal, and likely due to being more active at home than in the hospital. Pain will decrease over a few weeks. In the meantime, you/your loved one can take the painkillers that have been prescribed, according to need and instructions. If pain increases acutely or does not go away as expected, contact your surgeon or family doctor. As the pain decreases, you can eventually stop taking the painkillers.
You/your loved one will be taught how to clean the pin sites — that is, the area of skin around the pin or wire, where it passes through the skin. Follow exactly the instructions for pin site care in the brochure and/or video provided by your surgeon or hospital staff after surgery.
You can clean the fixator frame with a damp cloth or cotton swabs to keep the whole fixator free of dust, grease or dirt. If you are able to shower, you may clean the fixator gently with soap and water, drying it afterwards with a clean towel. If you/your loved one have taken a bath, rinse the frame and pin sites with the shower head afterwards, then using cleansing solution if instructed to do so.
All pin sites need to be checked every day, according to the instructions for pin site care in the brochure and/or video provided by your surgeon or hospital staff after surgery. If the pin site becomes “clogged” from leakage that has dried, the site will need to be cleaned.
Exercises and Physical therapy
Exercises will be taught to you/your loved one by a physical therapist. If you do not do these exercises, you could have permanent joint stiffness, or it may be necessary for your surgeon to stop the deformity-correction process, to let the limb recover. This could mean you have to wear the external fixator for a longer time. Your family, friends or a caregiver can also be taught the exercises, to help you/your loved one in doing them.
Physical therapy exercises should be performed according to the instructions of hospital staff or a physical therapist. Doing them will help strengthen your/your loved one’s muscles, joints and bones, and prevent stiffness and shortening. One of the reasons external fixation works well is that the normal body stresses on the skeleton continue to be applied through the skeleton and muscles, while the fixator device safely holds the limb. Following physical therapy instructions is extremely important to making sure you/your loved one gain the maximum benefits of surgery and external fixation. Bear in mind that excessive exercise may also be harmful. Always follow the physical therapist’s instructions.
Adjustments to the Fixator
Soon after your surgery, you will be shown how to adjust the length of your fixator frame. The number of times a day you need to do this will be decided by your surgeon. This lengthens your bone at a comfortable rate set by the surgeon, letting your new bone cells grow. Lengthening too fast may mean that new bone cannot grow fast enough and this will cause problems with bone healing. Lengthening too slowly may result in the bone growing together before lengthening is done. By taking regular X-ray or ultrasound pictures of your bones, your doctor will make sure that the adjustments aren’t happening either too fast or too slowly, and may ask you to change the rate of adjustments as a result. Even when your leg reaches the right length and angle, you/your loved one will still wear the fixator while the bone grows strong. You/your loved one may need to wear a cast for a short while after the fixator frame has been removed.