Friday, March 15, 2013

Day 16- What's a Strut?

Boppa and Maddie joined Em and I at PT today. It was Pajama day! Emma had Fran today- she is The Director and a great woman. She had Em walking on the treadmill- frontwards, backwards and side steps and also doing leg presses. Nice work Em!
We have our first Dr. Appt scheduled for Wednesday of next week which I'm excited for. They will take X-rays and determine how everything is going. I'm putting together an informational post that includes my notes and a better understanding of everything that is going on but let me explain the lengthening process and give a little history to help answer some questions or confuse you that much more.
Em's fibular and tibia are estimated to be a total of 10 cm shorter in her right leg at maturity (this equals 4 inches of actual height). This lengthening is to make up half of that discrepancy (5 cm which is the max for a Paley lengthening). This will get her 2 inches of length in her right leg to make both legs equal at this time. The remaining 5cm discrepancy (or 2 inches- confusing I know) will happen over the next 12 years- meaning when she is fully developed (age 15ish) she will again be 2 inches shorter on the right side. This means another surgery will need to take place at around 10-12 years old. There are a few different options at that point which I won't get into now but I can say it most likely will not be with a fixator.
I've had a number of questions in regards to the struts, turning process and schedule. To start, the surgery consisted of the doctors breaking both her tibia and fibular. Then a pin was inserted through her leg connecting both bones and out the other side of her leg. That pin is then attached to both sides of the fixator. This was done on the top and bottom of her leg. A pin was also inserted between her toes and out her heel, as well as through just below her ankle and out the other side- both being attached to the fixator. Those pins are to hold the foot in a 90 degree position for her benefit as when the lengthening happens the foot is going to want to point down as all the muscles, tendons, etc... are stretched by physical therapy. Then come the screws which were placed into the tibia and attached to the fixator above (3 screws) and below (2 screws) the break. The 6 struts are attached to the fixator and are what do the actual lengthening. I've attached a picture of strut #2 (you can also see strut #1 and #3 and one of the top screws as well as two of the bottom screws that go into her tibia- these have the orange caps). There is a dial at the top of the strut, just above the number, which has an arrow on it and that is what is turned until the silver pin in the strut reaches the desired number. The turns are done by following a schedule (1st page of schedule attached), to lengthen her leg. Each day a strut is turned, we are lengthening 1mm. These struts will need to be changed out for longer ones during this lengthening process (anytime during the shaded boxes within the schedule). The lengthening process is for a total of 72 days. After that, we return home for the healing process with continued PT for roughly another 72 days. Then back down here to have the fixator removed and a cast or splint put on for another 2-4 weeks. Now that I've completely confused you, I'm off to turn some struts.
Update- great night. Kevin, Mandy and Grace came over for dinner with the Riso's and Boppa handled the grill. Good grub and a few beers to get us warmed up for the Irish festival tomorrow!

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