Last updated date: 27-Apr-2023
Originally Written in English
Serious limb injuries are uncommon, but they can have devastating implications. Injuries acquired as a consequence of an accident, sport, or violence need extensive competence from the start in order to optimize function and hasten recovery.
Limb lengthening and reconstruction treatments are utilized in children and adults to restore missing bone and extend and/or straighten malformed bone segments of the legs and arms. This is an orthopedic surgery specialist that deals with the treatment of post-injury sequelae and the repair of limb deformities, including limb lengthening.
What is Limb Reconstruction?
"Limb Reconstruction" is an orthopedic surgery that deals with situations when a limb has the improper form or length and function is compromised. Limb Reconstruction (LR) surgeons employ a range of procedures to restore a limb's length, form, and function, including re-aligning bones, appropriately placing or stabilizing joints, and occasionally lengthening bones.
A 'deformity' occurs when a limb has a different shape owing to an issue with a bone or joint. A malformation can be of any of the following types: angulation, rotation, translation, or length. Working out the exact nature of the abnormality and its influence on function is one of the complexities of Limb Reconstruction. A deformity might be "congenital," meaning it is present at birth, or it can develop later, hence "acquired."
Limb Reconstruction techniques are used to treat patients with a variety of conditions, including those born with fibula hemimelia, congenital short femur, and congenital tibial pseudarthrosis, patients with bone dysplasias such as achondroplasia or fibrous dysplasia, and patients who have suffered trauma (broken bones) or bone infections that may have affected bone growth. Clubfoot and joint stiffness ("contractures") caused by spina bifida or arthrogryposis are also treatable conditions.
Some defects can be rectified rapidly, such as by cutting the bone, accurately aligning it, and securing it with a plate and screws. Some malformations need progressive correction, which may necessitate the use of an external fixator. An external fixator is a metal frame that is affixed to the limb by screws or wires that travel through the skin. Small changes to the fixator can be performed to gradually move the bones below.
- Effects of Radiation and Excision Surgery
Radiation and surgical removal of muscle, bone, nerves, or soft tissue may be used to treat sarcoma and sarcoid tumors. This can lead to significant bone and soft tissue abnormalities. There is also the chance of nerve injury.
Cancer therapies of this type are a typical reason for limb function therapy at the Center. This is especially true for individuals undergoing radiation and excision surgery for sarcoma and sarcoid tumors.
To treat the considerable tissue loss associated with sarcoma surgery, soft tissue covering and bone repair are required. However, before reconstruction can begin, a brief healing interval and the prompt use of adjuvant radiation at the operation site are required.
What is Functional Reconstruction?
Functional reconstruction is a subspecialty that focuses on restoring range of motion, weight-bearing capability, sensibility, and organic strength in the limbs and appendages. Many patients who require functional reconstruction have lost range of motion, strength, and/or feeling in their limbs or appendages as a result of abnormal healing processes such as scarring, nonunions and malunions caused by trauma, or cancer and its treatment.
Limb Reconstruction Techniques
Limb reconstruction doctors are well-versed in orthopedic trauma surgery bone fixing procedures such as intramedullary nailing and plating. Fine wire fixation is also used by surgeons. Fine wire circular fixing is used for the following applications:
- Acute trauma, including peri-articular fractures
- Amputee evaluations
- Deformity correction
- Limb lengthening
- Treating bone defects or loss secondary to tumor, trauma or infection through distraction osteogenesis
- Treatment of malunions and nonunions
- Treatment of osteomyelitis
Services offered include:
- Open fractures of the lower limb, foot and ankle
- Open fractures of the upper limb, wrist and hand
- Closed fractures of the lower limb, foot and ankle
- Closed fractures of the upper limb and hand
- Nerve injuries and nerve reconstruction
- Tendon injuries and tendon reconstruction
- Limb length adjustment surgery
- Amputation surgery
- Residual limb adjustments
- Treatment of neuroma
- Flap reconstruction
- Skin grafting
- Complex wound management
What is Limb Lengthening?
If one of your child's legs is shorter than the other, limb equalizing techniques such as limb lengthening or shortening may be beneficial. Limb lengthening procedures differ depending on the child's age, size, and underlying problems. To extend a limb (extremity), the bone is sliced during surgery and then gradually separated with the help of an external fixator or internal hardware over time. Multiple operations may be required throughout the course of a child's life, depending on the magnitude of the limb length difference.
You will be welcomed to the hospital before beginning treatment to learn more about what is involved. Your initial evaluation session may take place prior to the fitting of a frame.
During your appointment, a nurse will explain how long the treatment will take, the frame, pin site care, and a turns routine. They will also do a medical examination, including measuring your child's height and weight and taking their blood pressure, as well as fill out the relevant paperwork.
You will also meet with a physiotherapist or occupational therapist before the therapy begins to assess your child's requirements and provide advise on what you can do to make the treatment as successful as possible.
- Preparing for your assessment
There are a few things you can do to help your assessment go smoothly:
- Think about / write down any questions you want to ask
- Bring some information about what medications or treatments your child currently has
- Bring swimwear or shorts for your child to wear during medical photography and examinations
- Be prepared to wait – Although we always try to meet families on schedule, visits can occasionally run late depending on how complicated a child's requirements are, and it's critical that we're thorough (your visit may take up to six hours)
- Be prepared to visit different departments – your child may need blood tests, x-rays, medical photography and/or a scanogram during their pre-op visit
- Before having a frame fitted
Before your frame is fitted, a consultant will explain the operation to you, discuss the risks and advantages, and obtain your approval for the therapy to proceed.
You may also see other clinical staff including:
- An anesthetist may be involved if your child has particularly complex needs
- A junior doctor will take a full medical history of your child
- A specialist pain team nurse will discuss different ways of keeping any pain under control
- A clinical psychologist may be involved if we feel this would help with the treatment
- Patients with skin grafts and temporary external fixators
If the patient has recently had a traumatic injury and received skin grafts from the Plastic Surgical team, they will either have internal fixation with steel or a temporary external fixator for their bone damage. This is then removed when the grafts have healed, which usually takes around 4 weeks. If they have considerable bone loss or significant deformity that cannot be treated with internal fixation, this will be done in the operating room and a fine wire frame will be used.
Admissions for scheduled surgery
Patients are usually admitted on the day of operation; the Trauma Coordinators or Bookers call them a few days in advance to make sure they know where to go and when to be nil by mouth.
It is best to carry loose garments, and if they have a fine wire frame or external cabling, trousers with side holes are the best option. To facilitate mobility, choose sensible walking shoes and solid, well-supported slippers.
- Day of Surgery
The anesthetist evaluates patients once they are hospitalized. Pre-operative check lists are completed, and patients are given wrist bands that are checked often by teams, and they are requested to put on theatrical gowns.
These are all-day operating lists, and every attempt is made to adhere to scheduled schedules; but, because Addenbrooke's is a major trauma center, this may vary if there is an emergency life-threatening case.
- Post- operative instructions
These are sometimes patient-specific, although mobilization usually begins the next day, and it is critical that it begins as soon as possible to minimize joint stiffness. An X-ray is frequently obtained, although patients can often move around before this, and the doctors will advise whether or not weight can be put through the operated limb.
Patients are typically started on pain-controlled analgesia pumps, and as they progress and their pain is controlled, this is checked on a regular basis and stepped down to tablets when appropriate, and patients are sent home with pain relievers.
Anti-coagulation injections are also provided to patients to lower the chance of blood clots; they or a family member are trained how to administer them, or a district nurse can be appointed if they are unable to do so.
- Fine wire frames
If the patient has a good frame, a post-operative X-ray is taken, and the Specialist Nurse gives the patient a frame prescription and teaches them how to follow it, make frame changes, and care for the pin sites. If bone transfer is necessary, patients are told how to spin clickers or dice, how frequently (usually one quarter turn four times a day), and given a clicker chart to keep track of this. Family and friends/caregivers can also be trained how to care for the frame and make any necessary changes.
We will release patients after they can manage their fames safely and independently. If movement is delayed or extra assistance is necessary, we will transport patients to area hospitals.
- Cables for limb lengthening
Patients who have cables for limb lengthening are taught how to use the system by the Specialist Nurse, and they are released home after they can safely manage all cable modifications, pin-site care, and are ambulatory. These individuals are seen in clinic on a regular basis and are given x-rays upon arrival.
- Precice nails
The Specialist Nurse will review, explain how this system works, and how to utilize the magnets for patients who are receiving limb lengthening with Precice Nails. During the procedure, a mark will be placed on the patient's leg to indicate where the magnet should be put. The patient typically does this practice four times per day and is routinely evaluated in clinic with x-rays upon arrival. For more assistance, contact numbers for the firm and textual instructions on the application are provided.
Patients with Precice nails may usually go home the next day after surgery, as long as they are comfortable utilizing their magnets for limb lengthening and securely moving independently.
While in the hospital, the physiotherapists will do frequent assessments and provide an activity regimen. It is critical that this is followed during the hospitalization and after discharge to decrease the risk of possible consequences.
- Occupational therapy
If any modifications or specialized equipment are necessary, the patient will be evaluated by the occupational therapy team and suitable equipment will be supplied.
Wheelchairs can be obtained through local Red Cross services if needed.
- Outpatient follow-up
The patient will have regular out-patient appointments that will be mailed to them, and clinics will be held on Tuesday mornings and Friday afternoons. Before meeting the team, X-rays are frequently required, and if they have fine wire frames, a new frame prescription will be prepared and supplied in clinic, with frame modifications made as needed. As a result, it is best to come at least half an hour before your scheduled appointment time to allow for x-rays and minimize delays.
Limb Reconstruction Surgery is concerned with repairing a severely injured arm or leg. Treatment is frequently protracted and may include numerous trips to the operating room. Furthermore, plastic surgery may be involved in some aspects of the procedure.