Femoral Derotational Osteotomy with Internal Fixation using Pediatric Femoral Nail

Why does my child need this surgery?

The common indication for this procedure is for the child who walks with his/her feet severely turned in. Children normally go through a stage of walking with the feet turned in from the hip (femoral anteversion). However, with normal muscle pull this corrects in the overwhelming majority of children.

Because children with cerebral palsy have abnormal muscle pull, this may not correct. This certainly can make walking very difficult for the child.

There are no braces that can prevent or correct these problems and there is no scientific evidence that sitting in the W position causes or worsens the situation.

What does the surgery involve?

This involves an inpatient admission for surgery. Surgery is typically 2 to 3 hours for one side to be completed. Patients typically stay in the hospital for 3 days.

What are the incisions like?

There are three small incisions that are covered with steri strips, 2x2s and Tegaderm.

Will my child have pain?

Yes. However, the pain will be controlled with pain relievers and muscle relaxants.

If, after your child returns home, you feel that he/she is having inappropriate pain or side effects from the medications, please call the office.

What happens immediately after surgery?

Patients are taken to the Post Anesthesia Care Unit after surgery for a brief period of time. The patients are then typically transferred to the 10th Floor (Home to Orthopedics) depending on hospital availability.

Will my child need physical therapy?

Yes, the therapists will work with your child at the bedside at first, and then with assisted walking, if the child was previously a walker. There will also be a prescription for physical therapy after discharge. We can send that to the therapist prior to surgery in order for you to secure appointment times.

We typically order for therapy 2 to 3 times a week for at least the first 6 weeks after therapy begins.

Individual insurance coverage will often dictate what therapy is possible. It is very helpful for families to inquire about their coverage prior to surgery in order to facilitate the process of obtaining what is needed for their child.

When will my child have to return to see the doctor?

1st post operative appointment = 7-14 days AND WILL REQUIRE AN X-RAY AT THAT TIME.

 

When will my child return to school?

This can be quite variable. The child’s comfort level is the determining factor. A good deal of the variability is dependent upon the child’s comfort in the school setting, the length of the bus ride and the ability of the school to accommodate the child’s needs. These are the limiting factors in the return to school. From a surgical standpoint, the child may return to school when comfortable.

 

Will my child be able to walk?

If your child was an independent walker before the surgery, he will most likely need a walker or crutches for a while. However, the goal will be to have him up on his feet before four to six weeks after surgery. Children who used walking aids prior to the surgery will require more support in the beginning.

Each child’s need for extra support will be very individual as will the length of time for which the support will be necessary.

 

Will my child be able to ride in the car?

There should be no difficulty with positioning the child for car rides.

 

Will the nail(s) need to be removed?

In some children who are very slim, the nails prominence can become bothersome. The removal of the nail is a very minor procedure compared to putting it in. It is typically an outpatient surgery and done through the same incision.

 

Will this surgery ever need to be repeated?

Times if physician, child and parent decide they would like to have changes in alignment this can be done in the Operating Room for a minor procedure.

 

What are the possible complications associated with this surgery?

The possible complications associated with this surgery include infection and fractures. These complications are not common and respond well to treatment, although fractures can extend recovery

time.

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