Consolidation Is Going Well

Mary had a doctors appointment yesterday and had two x-rays. 

The first one shows the bone is consolidating really well on the left side. 

• Her doctor explained that the bone opposite of the incision site grows back faster which is what the x-ray shows. 
• Her Physical Therapist explained that the bone grows with a bulge then thru time the body absorbs the extra amount.

The second x-ray is a lateral view and it does show the bone is growing on both sides.

Since the consolidation is going well, he cleared her to full weight bearing with crutches and to move to one crutch once she can do it without leaning. 

We will see him again in 3 weeks.

He stated she may be all done by the Fall or Christmas. I was originally told 4 months which would be October.  

3 cm!!!

We went to the doctor on Day 30 and confirmed Mary was at 3 cm. - the goal!

June 11: Before lengthening

July 9: 30 mm/3cm

The Physical Therapist spent a lot of time working on her to help her stand as straight as possible to get a standing x-ray. 

Standing x-ray

Then her doctor decided:

• she should take 3 days off of lengthening and 
• then continue lengthening if she could tolerate it. 

He said the additional 3 cm she had gained will have huge benefits the rest of her life because that should leave her with a 0.5 cm difference but he wanted to see if she could get more length because she will likely lose some length she has gained when she has a foot surgery later.

We had to get a new RX for the lengthening device and the medical device company contact stated it was common to take a break at 2.5 cm then begin lengthening again.

The other good news is that Mary appears to be producing a lot of good bone!

Taking 3 days off did help Mary's comfort level and she was able to lengthen another 3 days.

We went to the doctor a week later and officially decided to stop lengthening. That meant she could also lose the knee immobilizer!!! 

So the hardest part should be behind us. Now we expect 3 months:

• of bone consolidation, 
• getting weight bearing privileges back, 
• regaining range of motion in her knee, and 
• learning to walk with a more even body.

Pain Started

Day 18 of 30 Mary started getting uncomfortable. We were surprised because other than the rash to the skin glue the internal leg lengthening has been going smoothly and usually things start getting uncomfortable around 5 cm. and she was at 2 cm.

On Days 21 and 23 Mary was so uncomfortable she had to stay home versus do  activities that she did the week before. One day she described it as it "felt like her quad had done a million squats."

She had to keep moving positions to try to get comfortable and had trouble sleeping a couple of nights. 

The good news is after seeing her Physical Therapist on day 24 and learning she was really tight and needed lots of massaging we backed off some PT and we focused more on massaging and it seemed to help.

We go to her doctor in 2 days and we are hoping he confirms we are at 3 cm. and she can stop lengthening and begin the consolidation phase and weight bearing.

2/3 done!

Mary had an x-ray on Friday and she has lengthened 19 mm so she is still tracking the 1 mm a day! 11 more to go!

June 28: 19 mm

June 11: 1 mm

She also had a lateral x-ray of her knee to make sure there is no slipping and there is none.

The lower metal is an 8 plate from 5th grade

We will go back in a week and a half. She will get a standing x-ray and she should be done lengthening.

Rash to Dermabond skin glue

The magnetic internal leg lengthening has been going very well except 2 weeks after surgery Mary developed a rash to the skin glue. She was prescribed a topical to apply twice daily, Triamcinolone but the rash spread away from the incision sites so 3 weeks after surgery she went on a 5 day dose of Prednisone.

rash near incision

rash away from incision

The itching is disappointing.

One Week of Lengthening = 2.9 mm

Mary had an x-ray today and she is on track. In one week the space between the broken bone has lengthened 7.9 mm. The goal is 22.1 mm more. If she stays on track she will be done lengthening around July 10, then she can become weight bearing and the bone consolidates. 

June 11
(paperclip was taped to outside of leg for x-ray)

June 17

First Internal PRECICE Nail Leg Lengthening session (post-op)

Mary had her post-op appointment today. 

• We learned the CT before surgery shows a 35 mm discrepancy. So the goal is to lengthen 30 mm. (Her foot is fused and she toes down so we can't go for the full amount.)

• They removed the gauze from the incision sites and we saw the mark that indicates where the PRECICE device is in her leg (The mark stays on the whole time of lengthening (approx. 37 days) so you know where to put the machine to lengthen and where to take the weekly x-rays to monitor bone growth.)
• The happy face is her surgeons traditional mark to indicate the correct leg for surgery.

There are 3 incisions: 1. top to insert rod and 2 screws, 2. middle is where the bone was broken and the device was inserted, 3. lower one is where 2 more screws are to stabilize the rod.

PRECICE Nail Lengthening Device

PRECICE device in suitcase

Device positioned on leg for 1st lengthening session. It is loud so you know the magnets are spinning.

Yes, that's a paperclip taped to her quad for reference for x-rays

Mary will lengthen .5 mm two times a day. You shouldn't have any metal close to the device when lengthening, and it needs to be within 7 cm. to work.

Mary needs to work on hip and ankle range of motion during lengthening but she should not bend her knee more than 30 degrees. She will work on her knee range of motion once the lengthen is done.