In the last blog, I discussed the use of external fixation for pediatric trauma. Now let us look at more “elective” applications of ex-fix in the pediatric population.
The most common use of mini-rail type systems in the pediatric population is most likely for the lengthening of metatarsals for patients with painful brachymetatarsia. Another less common (if not more effective) application is for lateral column lengthening in severe pes valgo planus feet with lateral deviations at the calcaneocuboid joint.
Probably the most infrequent use of ex-fix is for the staged correction of the severe talipes equinovarus. This involves a more extensive frame and a firm knowledge of the staging required. However, this approach has received much more press in Europe so I will not go into much detail with this in this series.
As I have mentioned in the past, the most important aspects of this particular type of surgical procedure employing external fixation is ensuring proper patient selection and having a solid understanding of the Ilizarov technique of callus distraction. Education of patients and their families is crucial for the use of ex-fix in this population and requires much more of a team approach than almost any other type of technique in our arsenal.
It is absolutely imperative that all members of the family are on board and understand completely what they must do on a daily basis to ensure the success of the procedure and the long-term goals of the surgery. (A detailed outline of the specific technique itself will be discussed in next month’s blog.) Any small deviation in this could lead to failure, much more so in this population than in older patients.
Several of the key issues in dealing with post-op care for this technique involve the method of callus distraction and its intricacies. The family must be well aware that they will need to adjust the device several times a day, only adjust it a certain amount and make sure the patient is comfortable throughout the post-op period.
This raises several questions. How comfortable are you with dealing with the intricacies of the procedure? How comfortable will the family be with the daily routine required? How effectively can you convey the post-op protocol, the need for strict adherence and attendance at follow-up visits? Also, how likely is it that your patient and the family are going to adhere to the protocol? The answers to the aforementioned questions may lead to either a disaster or a very good outcome.
Next month, this blog will focus more on the callus distraction technique and some pearls on how to prevent certain postoperative issues. As always, please feel free to send me questions, films or any ideas you would like me to address in future blogs. I can be reached at firstname.lastname@example.org