Follow-up
Scoliosis Surgery
Caring For Yourself After Surgery To Correct Scoliosis
Halo Thoracic Brace
C-Spine Clearance Guidelines
\There are many questions you might have about what will happen after your child has surgery. Below you can find information on some of the most common questions and concerns. If you have any other questions please discuss them with the Orthopaedic CP team.
How Long Will My Child Be in the Hospital?
For a VDRO and/or pelvic osteotomy most children will stay at BC Children’s Hospital (BCCH) for 5 to 7 days.
Pain Management Following Orthopaedic SurgeryPain after surgery is normal. During your child’s hospitalization at Children’s Hospital, the Acute Pain Service team will provide expert pain service to manage your child’s pain problems. Their mission is to “STOP PAIN HURTING”. The Acute Pain Service anaesthetist and nurse clinician are experts in managing pain and will see your child daily while in the hospital.
This team will work together with your child’s orthopaedic surgeon and the nursing staff to create and optimize a pain management plan to provide as much comfort with minimum risk or side effects.
The pain-relief medications used are those that are appropriate for the severity of pain your child is experiencing. The Acute Pain Service team will follow your child until your child is comfortable enough to manage with oral medication alone or via a Gastrostomy Tube for those children who receive medications that route.
Resources:
Assessing Your Child’s Pain After Surgery:
Managing your child’s pain is important. Since pain from surgery can be very intense in the beginning, your child will be given stronger pain medicines immediately after the surgery. There will then be a step-down to weaker medicine as recovery and pain relief progress.
Your child’s nurse will regularly ask and assess your child’s pain to find out how well the medicine is working. Parents & caregivers are a critical part in helping the health care team to recognize when your child is in pain.
Depending on your child’s age and ability, he/she may be able to tell the nurse how much pain he/she is feeling. The nurses in the hospital will use a pain scale asking your child if he hurts a little or a lot.
If your child cannot speak or does not understand about their pain, there are other ways to check pain. To assess pain, your child’s nurse will also watch your child for signs such as crying, moaning, fussing, frowning, playing or sleeping. Watch your child carefully and see what you think. Parents often know if their child has pain or is uncomfortable in any way. It is very important for parents to let their child’s nurse know what their child’s behaviour is like when they are in pain and any other comfort measures that help.
Speak to your child’s nurse if you think your child is in pain!
Muscle Spasms After Orthopedic Surgery:
What is a spasm? It is an uncontrolled, usually fast, muscle jerk that might or might not be visible to others. Spasms are often related to increased pain your child is experiencing.
Muscle spasms can be common after your child’s orthopedic surgery. When muscles are cut or stretched during the surgery, they can react by going into spasm. It is important to know that your child may also receive a medication to help control muscle spasms.
If your child has been taking medicines to manage his/her muscle spasms already before having surgery, the amount (dosage) of the medicine might be increased for a period of time post operatively and when they go home from the hospital.
After the Surgery: Taking Care of Your Child’s Pain at Home
Some things you should know about your child’s post-operative pain:
- Children do not all feel pain the same way
- Your child will likely have pain after his/her surgery.
- In the days after the surgery, the pain should get better, not worse
- Pain medicines will help your child hurt less. Always follow the directions given to you by the nurse, doctor, nurse practitioner or pharmacist.
- Comforting your child will help him/her relax & relieve pain.
- Distracting your child can also help relieve pain.
- Comfort & distractions can be as important as giving medicine to your child.
- Check how much pain your child has 1 hour after you give pain medicine.
The day you go home from the Hospital:
Before you leave the hospital, your child’s nurse, surgeon, doctor or nurse practitioner will tell you how you can help your child when he/she hurts. You may be given a prescription for pain-relief medications and be advised about giving medicines that are available without a prescription for pain relief.
The day he/she goes home, if your child is in pain, you can give him/her some pain relief medicine regularly during the rest of the day, and the next few days too, if needed.
You will help your child to hurt less, by giving pain-relief medicine regularly in the first few days after your child is home.
Tips:
- Follow the directions of the prescription medication bottle and the non-prescription pain-relief medication bottle/package.
- Pain after surgery is normal.
- Do not wait to give pain relief medicine until your child is in a lot of pain.
- For many children it is good to give pain-relief medicine in the morning to get their day started and at bedtime to help with sleep.
- Taking pain relief medicine regularly (even at night) is important.
- Prevention of pain is better than treatment. It is important to give pain medicines regularly.
- Pain relief medicine works better if your child takes the medicine before the pain gets strong.
- After the first few days, when your child hurts less, give the medicine only when he needs it. You will know when he/she says it hurts. The way he/she acts may also show you that your child is in pain. Some pain-relief medicines can cause stomach upset. Avoid giving these medicines on an empty stomach.
- Parents can help make the best pain relief decisions for their own child because they know their children best.
Note: If your child was given medicine to manage “muscle spasms”, continue to give the medicine as prescribed by the Orthopedic Surgeon/Doctor.
If your child is still in pain or muscle spasms are getting worse or if you have questions/concerns:
Please call your Doctor, Orthopaedic Surgeon’s office or the Orthopedic Nurse Clinician for advice.
Resources:
There is a Pain Diary: Pain after Orthopedic Surgery available to you for your use.
What to expect in the following weeks of recovery:
You can expect ups and downs with pain relief. It is common to have times when your child’s pain increases – especially when their activity, home exercise program and physiotherapy increases.
Tips:
- Some children have discomfort when their casts are removed in the weeks following surgery. It is important to give your child some pain-relief medicine before this procedure.
- Some children experience anxiety or pain when their position is moved or during any range of motion/home exercise/physiotherapy sessions, especially the first time their legs are moved.
- Consider giving your child pain-relief medicine 30 minutes to 1 hour before a therapy/exercise session is planned to improve comfort.
Will My Child Have A Cast?
Yes, most children will return from the operating room in a cast. The type of cast will depend on the surgery.
Petrie (or Broomstick) Cast
Most children who have a VDRO and adductor muscle lengthening will have this type of cast. This cast starts up at the groin and goes all the way to the ankles. The legs are positioned out straight and are spread wide apart. They are kept apart by putting a wooden bar between the two casted legs.
Sometimes this type of cast is used for children who have had both a VDRO and pelvic osteotomy. If this is true, the doctor may limit the amount your child is allowed to flex their hip for a few weeks after the surgery. This means that your child may not be able to sit up all the way. This will be reviewed with you once your child is on the hospital unit after surgery.
Hip Spica Cast
If you child has both a VDRO and pelvic osteotomy, he or she may have a hip spica cast. This is a body cast that starts around the nipple line and covers all or part of your child’s legs. It does not allow the body to flex at the hips and your child will not be able to sit upright in this cast. Your child will be lying nearly flat. . The surgeon will choose this type of cast because it is more stable and provides more protection by limiting all movements at the hip.
Detailed information on caring for your child in this type of cast is available in the information pamphlet “Hip Spica Body Cast: Introduction to the Hip Spica Body Cast”.
If a cast is not required, your child may need alternative positioning devices such as an Abduction Splint or Abduction Pillow.
If your child uses ankle foot orthotics (AFOs), the occupational therapist may mold resting foot splints that fit over top of the cast to keep your child’s feet in a good position.
How Can We Prevent Pressure Sores?
While your child is in a cast or splint it is very important to watch their skin. Children in casts and splints are at risk for pressure sores.
For detailed information about what a pressure sore is, why and where they happen, and how to prevent them please read the The Added Pressure of Surgery: Preventing Pressure Sores After Your Child’s Surgery
How Long Will the Cast be on?
The Petrie or Hip Spica cast will be left on for 3 to 6 weeks. The length of time in the cast will depend on the type of operation and the amount of healing seen on x-ray.
What Happens After the Cast Comes Off?
Once the cast is taken off, positioning is important as the bones and muscles continue to heal. The occupational therapist may make an Abduction Splint. This is a splint that is custom made for your child. It holds the legs wide apart, similar to the Petrie cast. The splint may be required all the time for a few more weeks or just at night time. Or your child may be given a special pillow, called an Abduction Wedge, which straps to their legs and keeps the legs wide apart, to use at night time
Abduction Splint
When the cast comes off, your child will be able to move more and sometimes this will hurt. This is not unusual and should decrease within a few weeks. In order to help minimize discomfort you should bring some pain medication to the clinic on the day the cast is being removed.
Do not force any movements when moving your child’s hip. This may damage the plate and screw fixation in your child’s hip. This is especially true in children who are not able to walk because their bones are not as strong.
After the cast comes off, your child can typically return to their usual wheelchair seating. It is recommended that the wheelchair have a wide pommel or another method of keeping the legs separated.
After the surgery, you may notice that the leg on the side of your child’s surgery is shorter. This happens because the head of the femur (ball) was tipped down into the socket. This leg length will not get worse over time and the growth of the leg will not be affected.
When Can My Child Stand or Walk?
If your child is having a VDRO or PO, he or she will not be allowed to stand or put any weight on their legs for several weeks. When your child can begin to stand will depend on how quickly their bones heal. This is different for each child. Your child will usually allowed to begin putting some weight on their legs at 6 weeks. The pool is a great place to gradually begin weight bearing. Full weight bearing may not be allowed until up to 3 months after surgery. X-rays will be used to determine when your child is ready to stand. If your child’s surgery is a soft tissue procedures, such as an adductor lengthening, there are no weight bearing restrictions.
What Will It Be Like at Home?
Your child’s physiotherapist and occupational therapist on the hospital unit will review what your child can and cannot do after surgery. They will show you how to move your child in the cast and teach you how to position your child so they are comfortable. The nursing staff will review how to perform personal care while your child is in the cast and how to care for the cast.
How Long Is the Recovery Period?
Each child has different abilities and, therefore, recovery will also differ for each child. We expect it will take your child at least 6 months to return to the same level of functioning as before the surgery. It may take up to a year to regain full strength and mobility. Physiotherapy is important during this time period.
What Follow Up is Required?
Your child requires continued monitoring of their hip development after the surgery. As your child grows, there is a risk that the problem will occur again. Therefore, it is very important that you return to the Orthopaedic Clinic for follow up visits.
If you child had plates or screws placed in their hips these may be taken out 1 year after their first surgery. This will be done during another surgery. Your child will stay in the hospital for 1-2 nights and they may not be able to stand or put weight through their legs for 2 weeks. There is no casting or splinting required when plates and screws are removed.
