Orthopedic Surgery

By Novacheck, Tom F.; Nicolaus, Deborah | The Exceptional Parent, September 1997 | Go to article overview

Orthopedic Surgery


Novacheck, Tom F., Nicolaus, Deborah, The Exceptional Parent


Orthopedic surgery corrects the muscle and bone deformaties caused by spasticity, but does not directly change the spasticity itself. The more severely malaligned a child's muscles and bones, the more likely orthopedic surgery will be needed.

For best outcomes, the child undergoing othopedic surgery should be between five years old and adolescence and have had appropriate spasticity management. By age five, a child with spasticity probably has been treated with orthotics (braces), physical therapy and oral or injectable medications. If these treatments to decrease spasticity no longer seem effective, orthopedic surgery may be timely.

Patient evaluation for surgery

Usually, a physician must rely on the physical exam, x-rays and videotape to determine if orthopedic surgery is needed. A videotape of both the front and side views of the child walking can be viewed repetitively and in slow motion to help diagnosis. For a child with spasticity, several problems are common: a child's shin bone (tibia) or thigh bone (femur) may be twisted, one or more tendons may be too short (contracted), or the feet may be turned out because of a complex combination of bone and joint deformities within the feet.

Types of orthopedic surgeries

Three fairly common orthopedic procedures illustrate the range of problems that can be addressed by a skilled orthopedic surgeon. All are done under general anesthesia and usually require a hospital stay of one to five days.

Tendon lengthening: Tendon lengthening involves exposing the tendon and dividing it lengthwise into two halves. The two ends of the cut tendon are then rejoined to create a longer, single tendon. The lengthened tendon reduces the tension on the muscle, thus reducing muscle tightness. This procedure takes about one half hour. It is usually done at the same time as other orthopedic procedures.

Tendon transfer: In this procedure, the tendon is removed from its point of attachment to the bone and is secured to a new site with a suture (stitches). Duration is about 45 minutes. Casting or bracing is necessary for three weeks after surgery.

Osteotomy: This procedure, which is performed on the femur (thigh bone) to correct alignment, takes about one hour. A metal plate and screws are inserted to hold the realigned bone in its new position until it heals. Casting after surgery may or may not be necessary. Once the bone is fully healed -- usually nine to 12 months later -- the metal plate and screws are removed through the original incision, usually as an outpatient operation. Children are able to walk within two days after plate removal and return to their regular activity level.

Multiple lower-extremity procedures: Today, multiple lower extremity procedures (multiple surgeries during a single trip to the operating room) are done. Typically four to seven procedures are performed at one or more locations in the legs (hips, knees, ankles and feet) and may include any of the above procedures.

Postoperative management

Following surgery, immobility is encouraged to prevent the development of excessive weakness and stiffness. …

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