Epiphysiodesis Procedure

On Thursday morning Mary had a "distal femoral epiphysiodesis using the phemister technique" aka a procedure to stop the growth in her growth plate in her longer leg in hopes to allow her shorter leg to grow and catch up to minimize her leg length discrepancy. The current discrepancy is approximately 3 cm.

This was procedure was number 7 for her fibular hemimelia. The first 5 were all associated with the external fixator in 2012 at age 9, then at age 11, she had an 8 plate put in her left knee and work on her left foot to help straighten it out. Mary is now almost 13.

• We had the first surgery time at 7:30, 
• Mary was more nervous for this procedure than I anticipated (older and wiser I guess),
• Dr. Scott's portion was only 37 minutes and we were called to recovery right before 9:00. 
• Other than shaking from the anesthesia initially (reminded me of me after by my deliveries of the girls), 
• recovery was fast and we headed home at 10. 

• We bought a machine that allows cold water to constantly "ice" the area for the first 48 hours (you do check the skin periodically and there shouldn't be direct contact with the skin). Insurance didn't cover it but we assume she will have more procedures, plus her parents aren't getting any younger and anyone can use it. We think it helped recovery a lot.

Mary has a strong pain tolerance. Although they prescribed a stronger pain med because the procure involves bone pain she only took over the counter ibuprofen at home. It is always nerve wracking going into the first night after a procedure because of concerns of pain management but Mary slept all night. Her first real discomfort after the procedure wasn't until 5:45 the following morning. Even then she said it was sore not painful. 

She really wanted to go to school the next day but the hardest part of the procedure has been using crutches. Her shorter, weaker left leg has to support her body since the procedure was on her stronger, longer right leg. She was unsteady as a result. 

She is very mature about the medical stuff and she realized it's better not to push too hard too fast so she can have a shorter recovery in the long run. If she went to school she also couldn't use the ice machine that seemed to be helping so much. 

It is day 3 and Mary hasn't had any medicine, she has iced a little bit and even practiced walking without crutches. 

So this procedure has proven to be "easy" as the medical world says it is. Medical easy isn't always easy in reality :-)

The procedure is a gamble because there isn't anything to precisely determine the best timing. You don't want to do it too early so that the short leg turns out to be longer than the longer leg that had the growth stopped, and doing it too late means its kind of wasted because the shorter leg doesn't get to catch up very much. Dr. Scott says it appears we have gotten pretty lucky, the growth plate looked like it still has some growth in it but not a ton. We have to wait and see the true success in 18-24 months when she should reach her adult height. She is almost 5'1".

Pre-Op for Epiphysiodesis

We had Mary's pre-op for the Epiphysiodesis on Wed., Dec 12. 

• On the longer leg Dr. Scott will make a small incision on each side of the knee,
• He will cut less than a cm. square piece of the bone (distal femur), twist it 90 degrees, and reinsert it. 
• He will also scrape the growth plate really well because he wants to make sure that growth plate stops growing.
• They explained by just doing the two sides it confuses the bone enough to stop growing in that area.

• He did take another standing x-ray with a 3 cm block and confirmed he wants to keep the 8 plate in her left knee for longer, he says sometime it rebounds a little when you take it out

Other surgery info:

• No liquids after midnight the night before
• Surgery would be cancelled if she had a fever of 100.5 and/or had a very productive cold or hacking cough
• We currently have the first time slot (because they know we will be on time :-) ), unless a small baby needs the slot.
• The actual procedure is only 45 minutes so she should only be away for 2 hours.
• They will give her local pain medicine (Novocain) before they close her up, and bandage the knee.
• She should have loose sweats to wear home, no yoga pants
• She will be weight bearing as much as tolerated, use crutches if need to originally
• We said we would pass on the wheelchair offer
• As she knows from before the more you move the better
• PT is optional, sometimes the knee loses range of motion
• We have a pain medicine for at home, advises to stay ahead of the pain initially (as usual)
• He is going to order "the ice man" for us which wraps the knee and surrounds it with cool water to help reduce pain and swelling.
• Her dad was good to think about the orthodontic forsus (a metal version of rubber bands) Mary has right now for her braces. We were given the chief anesthesiologists contact information and was advised to have it removed for surgery because it limits the mouth opening. SO she is off to the orthodontist to have it removed.