Phase 2: final plan and info, waiting on surgery date

We had our appt. with Dr. Scott on Tuesday. It was very similar to the last appt. in December other than we took x-rays to verify what Phase 2 will consist of.

Mary's (FH) left leg is knocked knee'd so Dr. Scott will put in an "8 Plate". This is a very common procedure with FH kids. A professional explanation can be found at:
http://us.orthofix.com/ftp/assets/Product/Product_Files/eight-plate/8P-PE.pdf 
My explanation is it stops the bone it is attached to from growing so the whole leg straightens as the leg grows then the 8 plate is removed. If we were doing this alone it would be a 1 hour outpatient surgery, with a 3 week recovery. There is a minor 2nd surgery to remove the 8 plate when the leg is straight which is usually months later. 

Knock-Knee

But...Dr. Scott will be doing a 2nd procedure at the same time. Mary's metatarsals are crooked in her left foot. He will add a bone wedge to her (FH) left foot with a pin to help straighten it. The good thing is this should make her foot larger which is the big benefit for Mary. Her feet are currently 4 sizes different.When examining the foot x-ray he had an idea for the base of the metatarsals but he kept it a secret. I am pretty sure that means he didn't want to freak Mary out with it. This is the procedure that requires non-weight bearing and makes recovery time 2-3 months.

Once again he offered to work on any scars but Mary is hesitant. He wants to make them "more like a line than a moon." I need to ask her if she doesn't want to because she likes them or if she is concerned about the procedure to "fix" them. She has no concern showing them to the world still which I love. 
  
I did verify other than not having an ACL and having a shorter fibula (80% of normal) she does seem to have all other bones, etc. The last 2 metatarsals in her left foot are fused together. The bones in the back of the foot are aligned well but they are also fused together. Her arch is flatter than normal so he wouldn't do anything to it.

Dr. Scott took a hand x-ray to determine her "bone age" meaning how much more growing she has left in her. She is older than her birth age, but the growth centers are still open, so she appears to be "12" not 11. This means since we are only trying to get 1 more cm. to make her legs more even we are still fine on time but he wouldn't go beyond next summer.

x-ray of hand determined "bone" age of 12

Dr. Scott talked about either doing an 8 plate on the "regular" right leg now with the other two procedures on her left leg, or the operation where you stop the growth in the regular leg next summer (it's too early to do this procedure now based on her bone age). He offered to do both legs at once which sounds appealing to get it all behind you but Mary had a great question, "How will I walk if we do both legs at once?" To which he responded "You can walk on right leg but you won't want to." 

Stopping the growth is a quicker process but there is a chance of over correcting. The con to the 8 plate is it takes longer and requires 2 procedures to put it in and to remove it. Oh yeah, and the problem of mobility. 

He wants to "fix" the left leg sooner rather than later because if the 8 plate on the left (FH) leg doesn't work now then we can do another fixator next year.

Dr. Scott predicts that as an adult the current callus near her left pinky toe will be a problem. It is caused by her bones not being at the same level. Its an "easy" fix, essentially you break the bone and it will heal at the "normal" level.

Dr. Scott, Mom, Dad, and Mary are all leaning towards only doing the procedures on the left now, not both legs at once. My main reason is although it sounds great to get it all behind her, there is no promise it will be all behind her. This is more art than exact science. It sounds like it would be miserable doing both legs at once and if the left 8 plate doesn't work, it wouldn't be the last procedure anyway. We need to try it then go from there.

When we do the left leg only the process is:

• Inpatient for one night for pain control,
• Out of school for 10 days (it would be a month if we did both legs at once)
• Short cast initially with a brace on her knee for a week or two,
• Then get her knee moving for a week or 2,
• Take out the pin in the foot after 4 weeks, (in his office which freaked Mary out),
• Then she would move into a walking cast for 2-4 weeks 
• So by 8 weeks, she is completely free -out of casts and would start regaining mobility.
• he said to plan for 3 months to be conservative. 
• Office visits are less frequent than with a fixator: after 1-2 weeks, then another 2 weeks, then a month
• There is a much lower chance of infection than with a fixator
• She would have a wheelchair initially and to use with long distance but could mainly use crutches. 

So we have all reacted to the news of these additional procedures that we didn't know were coming in a much calmer way than with the fixator- especially Mary! However, we have been waiting for a surgery date since Tuesday and I have to admit I am starting to lose my Zen attitude and my obsessed planning gear is kicking in. 

When I called to schedule the surgery on Tuesday he was already booked into July. Mary's only request is that she is ready for the beginning of the next school year or at least for when volleyball starts at the beginning of October. The last week of June would be ideal. The 2nd week of May would be my 2nd choice. However, it is looking like it will be a random day in April...he is trying to find more OR time.