Preparing for Surgery

Introduction

In order to make the limb correction process work, you must prepare for the journey. Staying physically active will be important — you should try to maintain as many daily routines as possible and continue attending school, work and social activities. Here are some considerations to work through with your surgeon and family as part of planning for your surgery.

Finding a surgeon

Before you schedule surgery or any treatment, you need to feel confident that your specialist or surgeon is right for you. It is important that your surgeon listen to and fully answer your questions, so that you can understand why surgery has been recommended and what will be involved in each step of preparation and recovery.

Your surgeon should want your questions. Your health and the correction of your limb deformity relies on good communication, which builds trust and leads to better results, quality, safety and satisfaction. It also helps your doctor and care team get to know you better, by understanding your most important concerns. The right surgeon will be committed to this two-way relationship.

You may also wish to speak to other patients or medical professionals about any surgeon or specialist you are considering.

Consulting with your surgeon

Before deciding on surgery, your surgeon will explain your treatment options. There are a variety of non-surgical and surgical treatment options that may be appropriate, depending on the type and extent of your limb deformity.

If external fixation is medically a good option for the correction of your limb deformity, your surgeon will explain the reason external fixation has been recommended, the full details of the surgery, and the benefits and risks of surgery. It is important to remember that all surgeries, including surgery to apply external fixation, have some risks.

Some risks to be aware of and ask questions about if you have any concerns include:

  • Anesthetic complications — most common are nausea and vomiting
  • Infection — most common is pin-site infection, which can typically be treated with antibiotics (although more intensive treatments may be necessary in some cases).
  • Nerve problems — may occur, but are rare.
  • Blood vessel problems — may occur, but are rare and more often due to immobility rather than the fixator or procedure themselves.
  • Joint or muscle problems — muscle stiffness is common, and can be managed by walking and doing exercises according to your surgeon’s instructions.
  • Wire or pin breakage — in the occasional event of breakage, the wire or pin may be repaired, removed and replaced.

Blood clots in the leg, which may result in thromboembolic disease (blood clots in the lungs) — this can be a complication of any operation. The surgeon and the hospital should have a protocol for avoiding this problem and this should be explained to you.

The bone may break if it is not healed properly (fracture), or it may be slow to heal or fail to heal (delayed or nonunion). Any operation involving a bone osteotomy may develop these problems, and your surgeon can explain how much the risk is in your case.

At the end of treatment, the deformity or the original problem may not be completely cured and you may still have some symptoms. Again discuss with your surgeon.

Communicating with your insurer

Because medical insurance may be key to receiving the treatment you need, it is important to communicate with your insurer, to confirm whether or not your surgery and potential after-care situations will be covered.

Check your policy, to see what services are and are not covered. You can request this information from your insurance company. Alternately, you and your surgeon can submit paperwork to the insurance company for “pre-certification,” to ensure there are no surprise bills after surgery. If you are pre-approved, your insurance company will let you and your doctor know. At the time of surgery, you pay the co-pay or deductible and your insurance should pay the rest.

However, sometimes your insurance company may deny coverage, even after pre-certification. This can be for reasons other than what is covered by the insurance policy, such as exceeding your benefit allowance. If pre-certification is denied for other reasons, such as restrictions on treatment (for example, the procedure is covered, but for a different diagnosis) or a determination that the treatment isn’t “medically necessary,” you may still be able to get insurance coverage. You can start by appealing the decision with the insurance company, which must provide you with all information about the process. By getting this information and following the process, you may be able to have a denial overturned.

Planning ahead

The surgery will result in some degree of pain, but your care team will work to keep you/your loved one as comfortable as possible. Your pain will be assessed regularly. Pain levels will improve over the course of recovery — remember, the goal of surgery is not only to correct the limb deformity, but also to cure the symptoms (such as pain).

The amount of time the external fixator will be in place depends on the severity of the deformity, and how much correction is needed, as well as your/your loved one’s general health and medical history. Factors such as age, smoking status, nutrition status and mobility levels can influence healing. Your surgeon will provide expected time frames according to your/your loved one’s specific situation.

You should prepare your home in advance of the surgery. For example, getting on and off the toilet might cause you problems if your fixator extends on to the thigh, so it’s a good idea to get raised toilet seating that accommodates the fixator. You may also need aids to make getting in and out of the bath safer and easier. Other devices that may come in handy include long-handled sponges and shoe-horns, long-handled graspers (for items on high shelves), and long-handled sock aids. Because standing ability may be reduced during recovery, a high stool to sit on may be helpful to have in both the kitchen and bathroom, for carrying out daily activities.