Will my child’s growth be limited by this surgery? Dr. Ahmad and his colleagues are recognized specialists in ACL reconstruction, managing a high volume of complicated cases of all ages and levels of athletic ability. They have particular expertise in managing ACL injuries in patients who are still growing, using techniques that minimize or avoid injury to the growth plate.
When can I remove the bandages? On Post-operative day 1 (POD 1), you can remove the dressings, allthough you cannot remove the butterfly strips (“steri-strips”) from the skin.
After my surgery, when will I be able to shower, and what should I do with the bandages?
You can shower on POD 1, and you should replace the dressing only as needed, with gauze dressing or band-aids.
Will I be able to use my knee right after the surgery?
Most of the procedures we do in our Sports Medicine Clinic allow for weight bearing when tolerated. However, ask your doctor before you leave the Hospital.
What can I do to relieve the pain, after surgery?
Although your doctor will prescribe any specific pain medication that your child will need, usually Motrin will be enough to calm the discomfort from this type of surgery. You can also place a bag of ice wrapped in a towel directly over the wound, and it is useful to sleep with a pillow under the heel.
For how long will I have to use the brace and the crutches?
Usually, the crutches are used for 2-3 weeks, while the brace is worn for around 4 weeks. In any case, consult directly with your doctor if you have any doubts.
Is physical therapy necessary?
Yes. This helps in the proper recovery from a surgery of this type. Your doctor will prescribe the specific type your child will need for his or her case.
What does my doctor mean by Shoulder Instability?
It means that the joint in the shoulder is loose and able to slide around too much in the socket. Sometimes, the shoulder actually slips out of the socket. This is called a dislocation. If not treated, instability can lead to arthritis of the shoulder, with impaired movement and pain.
What parts of the shoulder are affected?
The shoulder is made up of the bones of the shoulder blade (scapula), the upper arm (humerus) and the collarbone (clavicle). They are surrounded by a bundle of muscle tendons called the rotator cuff. This cuff connects the humerus to the scapula allowing movement of the arm at the shoulder joint and keeping the humerus tightly hold in the socket of the shoulder (glenoid). As this glenoid is very shallow and flat, there is a rim of soft tissue (labrum) surrounding its edge, and making the socket more like a cup. This way, the socket fits the head of the humerus better. All these structures are covered by a joint capsule made of ligaments, which holds fluids to lubricate the joint. This capsule is somewhat loose so that the shoulder can move freely. If the shoulder moves too far from the original position, though, the ligaments in the capsule become tight and stop it from going to far.
When a force –either external, like running into a fielder; or internal, like pitching an extremely fast curve ball- overcomes the strength of the muscles in the rotator cuff and/or the ligaments of the shoulder, a dislocation of the shoulder joint can happen. Nearly all of them are anterior dislocations, meaning that the humerus slips out of the front of the glenoid socket. Only a very small percentage (around 3%) of dislocations are posterior dislocations, or out the back.
Sometimes though, the shoulder does not come completely out of place. It does only partially, but then goes back to its normal position. This is what we call a subluxation.
I had a shoulder dislocation in the past, and now my doctor says I have shoulder instability. Are they related in any way?
Instability, although not always, often follows an injury that caused the shoulder to dislocate. This initial injury is usually fairly significant, and the shoulder must be positioned (reduced) back in its place by the doctor. This procedure might make it look as it the shoulder was normal again, but quiet often the ligaments and tendons in the joint remain unstable. They, along with the cartilage rim around socket, may have become stretched or torn. This makes them unable to keep the shoulder in place when it moves in certain positions. An unstable shoulder can result in repeated dislocations, even during normal activities.
I’ve never had any problems in my shoulder, but now I have pain although I haven’t done anything different to what I usually do. Why is this?
In some cases, the instability can happen without a previous apparent injury. People who do repeated shoulder motions may gradually stretch out the joint capsule. This is especially common in baseball pitchers, volleyball players, and swimmers. If the joint capsule gets stretched out and the shoulder muscles become weak, the ball of the humerus (the upper arm bone) begins to slip around too much within the shoulder. Eventually this can cause irritation and pain in the shoulder.
Is there a genetic condition associated with this instability?
Some people show a genetic problem with the connective tissues of their body (such as ligaments, tendons, cartilages, epidermis…) that can lead to ligaments that are too elastic. When these stretch too easily, they may not be able to hold the joints in place. All the joints of the body may be too loose. Some joints, such as the shoulder, may be easily dislocated.
Is it a problem to have shoulder instability?
Chronic instability causes several symptoms, like frequent subluxations of the shoulder. In this case, the shoulder may slip out of place (sublux) in certain positions or with certain movements. This commonly happens when the hand is raised above the head, for example while throwing a ball. It usually causes a quick feeling of pain, like something is slipping or pinching in the shoulder. Over time, people suffering from this stop using the shoulder in ways that cause subluxation.
What are the consequences of having frequent dislocations of the shoulder?
If the shoulder becomes so loose that it starts dislocating frequently, it can become a real problem, especially if you can't get it back in place and must go to the emergency room every time. A dislocation is usually very obvious: it is very painful, and the shoulder looks abnormal. Trying to move the shoulder in any way causes extreme pain. But the biggest problem is that a dislocated shoulder can damage the nerves around the joint.
If the nerves have been stretched, a numb spot may develop on the outside of the arm, just below the top point of the shoulder. Several of the shoulder muscles may become slightly weak until the nerve recovers. But the weakness is usually temporary.
Can my doctor diagnose this condition even when the shoulder is not dislocated and looks normal?
The diagnosis is done mainly through your medical history and physical exam. The doctor will ask you many questions about past shoulder injuries, pain, and how this is affecting your daily activities.
During the physical exam, the doctor will feel and move your shoulder, checking it for strength and mobility. Your doctor will stress the shoulder to test the ligaments. When the shoulder is stretched in certain directions, you may get the feeling that the shoulder is going to dislocate. This is a very important sign of instability. It is called an “apprehension sign”. It will be uncomfortable, because you will think it’s going to dislocate, but it won’t: the doctor is not here to cause injuries, but to try to fix them!
When you go to the doctor with a dislocated shoulder, X-rays are necessary to make sure therre is no fracture. They are usually done after the shoulder is put back into joint, allowing your doctor to make sure the joint is back in place. They can also help confirm that your shoulder was dislocated or injured in the past.
Other test that might be used to diagnose this instability is an arthroscopy of the joint, done with general anesthesia.
What treatment options are available?
The initial goal of treatment is to reduce or control the pain, and this is usually done with rest and anti-inflammatory medication, such as aspirin or ibuprofen. Sometimes, if you are having trouble controlling your pain, the doctor may suggest a cortisone injection –a strong anti-inflammatory medication- directly into the joint.
A physical or occupational therapist will direct your rehabilitation. At first, they will show you ways to avoid positions and activities that put the shoulder at further risk of injury or dislocation.
The therapist may use heat or ice treatments to alleviate the pain and inflammation. Massages and active and passive exercises are used to improve the range of motion in your shoulder and nearby joints and muscles. Later on, strengthening exercises improve the strength and control of the shoulder. This, together with specific training of the shoulder, will improve its stability and help it move smoothly.
Therapy lasts usually 6-8 weeks, time enough for most patients to get back to their activities with full use of their arm.
Sometimes therapy may not be enough to resolve the instability, and you may need surgery. Almost all the different types of shoulder operations attempt to tighten the loose ligaments. These ligaments are usually along the front or bottom part of the shoulder capsule.
It’s the most common method for shoulders prone to anterior dislocations. It involves sewing or stapling ligaments, along with the labrum, on the front side of the joint back into their original position, drilling holes into the scapula in which these sutures will afterwards be anchored.
This procedure can be done through an incision on the front of the shoulder or using an arthroscope, which requires smaller incisions, meaning less time in the hospital and less time to heal.
An incision is made on the front of the joint capsule creating a flap, which is later pulled over the front of the capsule and sewn together, making it tighter.
Thermal Capsular Shrinkage:
Through an arthroscope, an electrode probe is slid inside the unstable shoulder. The electrode heats up, causing the capsule to shrink and tighten. One of the risks is that the capsule may get too tight, leading to restricted shoulder motion.
What should I expect after treatment?
It usually requires a rehabilitation program, where the goal will be to strengthen the rotator cuff and shoulder blade muscles to make the shoulder more stable. At first the exercises are done with a therapist, eventually getting on a home program of exercise to keep the muscles strong and flexible. This should help avoid future problems.
The rehabilitation program here is more complex. Usually, a sling is worn to support and protect the shoulder for 1-4 weeks. Depending on the type of surgery, therapy goes on for 2-4 months, generally achieving full recovery after 6 months.
Initially, therapy focus on control of pain and swelling. The therapist might use ice and/or electrical stimulation, together with massage and other types of hands-on treatments to relieve the muscle spasm and pain.
Therapy after open surgery has to be done with caution. Although exercises are started soon after the surgery is done, all the movements that stretch the front part of the capsule are done with great caution for the first 6-8 weeks. Gradually, therapy works into active stretching and strengthening of the muscles and other structuers of the shoulder.
If the front shoulder muscles have been cut, therapy goes even. First we begin with passive movements, where the shoulder joint is moved, but the muscles stay relaxed. Gentle movement of the joint and gradual stretches are done by the therapist, who may eventually teach you how to do these passive exercises at home.
Active therapy starts 3-4 weeks after surgery. You use your own muscle power, beginning with light strengthening exercises that work the muscles without straining the healing tissues.
At about 6 weeks you start doing more active strengthening, focusing on improving the strength and control of the rotator cuff muscles and the muscles around the shoulder blade. This helps your shoulder move smoothly during all your activities.
By about the 10th week, you will start even more active strengthening exercises of the rotator cuff muscles. These muscles will help hold the humerus tightly in the glenoid to improve shoulder stability.
Some athletes, especially pitchers and quarterbacks start gradually in their sport activity about three months after surgery. They can usually return to competition within four to six months.
What is patellar subluxation? The patella, or kneecap slides up and down a groove called the trochlea on the end of the thigh bone as the knee bends. The patella is designed to fit in the center of this trochlea, and slide evenly within it. In some people, the patella is pulled towards the outside of the knee. As this happens, the patella does not slide centrally within its groove. This improper tracking may not cause the patient any problems, or it may lead to dislocation of the patella (where the kneecap fully dislocates out of the groove). Most commonly, the tracking problem causes discomfort with activity, and pain around the sides of the kneecap. Patellar subluxation is a condition that usually affects adolescent, and sometimes younger children.
What causes patellar subluxation?
There are dozens of factors implicated in the cause of patellar subluxation. The bottom line is that it is probably the contribution of several factors that lead to instablitiy of the kneecap. Possible factors include:
A wider pelvis
A shallow groove for the kneecap
Abnormalities in gait
What else may be causing kneecap pain? The most common cause of kneecap pain is chondromalacia, or an irritation of the cartilage on the undersurface of the kneecap. Patellar subluxation and chondromalacia can go hand in hand, but they should be considered separate entities. That said, if chondromalacia is being caused by subluxation, then the instability of the kneecap must be addressed for treatment to be successful. Other causes of kneecap pain include osteoarthritis, patellar tendonitis (Jumper's knee), and plica syndrome.
Is there any treatment for patellar subluxation?
Treatment of the unstable patella is first to ensure that the patella is not dislocated. Your doctor can determine by examining your knee and obtaining x-rays, to see if the kneecap is outside of its groove. In patients with a kneecap dislocation, the kneecap may need to be repositioned, or "reduced."
Treatment of patellar subluxation includes:
Physical Therapy: traditionally, patients were sent to physical therapy to strengthen their VMO (part of the quadriceps muscle) to realign the pull on the kneecap. More recent research has shown that this is probably not the critical factor in eliminating kneecap problems. Focusing instead on strengthening of the hip abductors and hip flexors (so-called pelvic stabilization exercises) offers better control of the kneecap
Bracing and Taping: bracing and taping of the kneecap are also a conroversial topic in the rehabilitation of kneecap problems. These often provide symptomatic relief, but are certainly not a long-term solution. Caertianly if symptomatic relief is found with a brace or tape, it is certainly appropriate to continue with this as a treatment.
Better Footwear: it contributes to the gait cycle. Motion control running shoes may help control your gait while running and decrease the pressure on the kneecap.
Is surgery ever needed for patellar subluxation or dislocation?
Some patients are not cured by conservative therapy, and it may be determined that surgery is needed, especially in patients who have significant pain or recurrent dislocation. By looking into the knee with an arthroscope, the surgeon can assess the mechanics of the knee joint to ascertain if there is an anatomic malalignment that could be corrected. One common malalignment is the result of too much lateral tension that pulls the kneecap out from its groove; this can place increased pressure on cartilage and lead to dislocation. For this problem, a procedure known as a lateral release can be performed. This procedure involves cutting the tight lateral ligaments to allow the patella to resume its normal position.
What is a patellar dislocation?
A dislocation of the patella occurs when the kneecap comes completely out of its groove, and rests on the outside of the knee joint. Kneecap dislocations usually occur as a significant injury the first time the injury occurs, but the kneecap may dislocate much more easily after the first injury.
Why do kneecap dislocations become a recurrent problem?
When the kneecap comes out of joint the first time, ligaments that were holding the kneecap in position are torn. The most commonly torn structure is called the medial patellofemoral ligament, or MPFL. This ligament secures the patella to the inside (medial) of the knee. When a kneecap dislocation occurs, something must fail to allow the kneecap out of the groove, and usually it is the MPFL.
Once the MPFL is torn, it often does not heal with proper tension, and the kneecap can subsequently dislocate more easily.
That is why recurrent dislocation of the kneecap occurs in a high percentage of patients who have this injury.
What can be done to treat a kneecap dislocation?
Traditionally, kneecap dislocations were treated by bracing a patient, and allowing the MPFL to heal. Unfortunately, bracing does not seem to be terribly effective, and no matter how long a brace is worn after a kneecap dislocation, the redislocation rate is still quite high.
In patients who have recurrent (repeat) dislocations, there are surgical options. The usual treatment is to loosen the lateral (outside) ligaments that pull the kneecap; a so-called lateral release. At the same time, the muscle of the medial side of the knee (the VMO) is advanced to pull the kneecap more centrally.
What about surgery after a first-time kneecap dislocation?
Recent interest has developed in preventing these recurrent dislocations. Each time the kneecap dislocates, the cartilage can be injured, and the ligaments can become more stretched out. Some surgeons are trying to restore the normal anatomy by repairing the MPFL after a first-time dislocation. This surgery is controversial, because not all patients who dislocate their kneecap will have another dislocation. However, some patients would rather have the ligament repaired in an effort to lower the chance of having this become a repeat problem.
Trauma (coming soon)
Percutaneous Tendo Achilles Lengthening (TAL's) Surgery
How long will my child stay in the Hospital?
The procedure is done as an ambulatory surgery. This means that you will come into the hospital on the day of surgery and go home later that afternoon or evening. All the children receive general anesthesia during surgery and go to the recovery room until fully awake.
Is my child going to have scars because of this surgery?
The lengthening procedure is done by making small incisions into the muscle and tendon, through small puncture wounds on the back of the calves/heels, the muscle/tendon is continuously stretched until the appropriate length is achieved. There are no "scars", the puncture sites heal well and are almost invisible by the time the casts are removed in six weeks.
How long will my child take to recover from his surgery?
The children are placed in short leg casts at the time of surgery; these casts will be on for up to six weeks. The children should keep their feet elevated for the first 48 hours and/or up to one week after surgery to decrease swelling and pain. They may walk on these casts and most children feel well enough to be up on their feet in three of four days.
How do I take care of the cast, after the TAL procedure?
Cast care includes checking the toes for swelling, color, warmth and sensitivity. Call the doctor if the toes become very swollen, change color (blue, purple), are cool to the touch or if the child complains of numbness or decreased feeling in the toes.
Try to keep the heels of the casts from resting continueously on the bed. This can lead to increased pressure on the heels and skin breakdown under the cast. Placing a pillow under the ankles and calves can help.
Casts must be kept dry (that may mean doing sponge baths for a few weeks). Nothing should be put down the cast to relieve itching. Using a hand held dryer on a COOL setting may help, as well as medications such as Benedryl.
Cast shoes/boots should be worn when walking on the casts. This helps protect the casts from cracking or breaking. If the casts crack or break call the doctor so the cast can be repaired or replaced.
Try to keep the heels of the casts from resting continuously on the bed. This may mean putting a pillow under the ankles to decrease pressure on the heels when the child lays down or reclines.
What can I do to alleviate my child’s pain?
There is some discomfort after surgery, therefore, you will be given a prescription for pain medicine before you leave the hospital. Most children can switch to Motrin or plain Tylenol within 4 to 7 days after surgery.
My child just came off his casts, and he walks “funny”. Is there anything wrong?
When the casts come off, the children will initially have a "funny" gait (there may be external rotation and a flat foot appearance). It will take 6-12 weeks for the gait to improve. The parents and doctor will decide together when the child may return to sports/activities.
What do you mean, by limb-lengthening?
Leg length discrepancy is an orthopaedic problem that usually appears in childhood, in which one's legs are of unequal lengths. Often abbreviated as “LLD”, leg length discrepancy may be caused by or associated with a number of other orthopaedic or medical conditions, but is generally treated in a similar fashion, regardless of cause and depending on severity. Leg lengthening is a treatment option for severe cases of LLD, whose results have improved somewhat with the emergence of a technique known as callotasis, in which only the outer portion of the bone (the cortex) is cut, (i.e. a corticotomy). This allows the bone to be more easily lengthened by an external fixation device that is attached to either side of the cut bone with pins through the skin. The “ex-fix”, as it is sometimes called, is gradually adjusted by an orthopaedic surgeon, and healing can occur at the same time that the leg is being distracted, or lengthened over time.
What types of instruments do you use to do this?
Depending on the specific case, we use devices such as the Taylor spatial Frame, or multi-pin external fixators.
My child has an EBI Fixator. What do I need to do the lengthening, and how do I do it?
You will need an Allen wrench for fixator and, 4 times a day, you will need to loosen the joints with the wrench at the bottom and top of the fixator, place it in the lengthening joint and turn one quarter (1/4) turn following the arrow on fixator for direction, often counterclockwise. When you’re done, retighten the joints that were loosened. Call your doctor if lengthening joint is too difficult to turn or if fixator frame becomes loose.
My child has a Multiplane Fixator. What do I need to do the lengthening, and how do I do it?
The doctor will give you a computer color-coded printout of the lengthening schedule, which you will need to follow for each numbered strut, turning each of them accordingly.
Scoliosis/Spine Fusion Surgery
Does my child need any medications before scoliosis surgery?
Most of our patients having spine surgery are treated preoperatively with an iron supplement and Procrit/Epogen (Erythropoietin). The iron supplement starts 6 weeks prior to surgery. The Procrit is an injectable medication that is administered by your pediatrician once a week for 4 weeks prior to the surgery (see Erythopoietin preoperative treatment for orthopedic surgery). We need to coordinate this treatment with your pediatrician, which is why it is imperative that you contact us as early as possible.
How do we prepare for my child’s scoliosis surgery?
Between 4pm and 9pm, on the evening prior to surgery, a nurse from the Ambulatory Surgical Unit will call and let you know when you need to stop eating food and all liquids, and at what time to arrive at the hospital. Please remember to bring with you the questionnaire and the physical exam report filled out by your pediatrician, and the signed surgical consent form to the hospital. On the day of surgery, report to the security desk on the first floor of Children's Hospital. You will be directed to the ambulatory surgical unit on the fourth floor. There, a nurse will prepare you for surgery and the anesthesiologist will speak to you. Parents may accompany children into the operating room.
How will my child be treated for pain after scoliosis surgery?
Pain medication is administered through a special pump. When your child has pain, he or she will be able to give him or herself medication to relieve the pain.
How long will it take for my child to “get back to normal life”?
After the operation, you will be transferred to the Pediatric Intensive Care Unit (ICU). You will be there for one to two days. There are cots available and one parent may stay overnight in the ICU and on the general pediatric unit. About two days after surgery, the nurses and physical therapists will begin getting you up and out of bed. Soon you will be walking all around the pediatric unit. The bandage on your back will be changed before you leave the hospital usually you'll be able to take the bandage off 7-10 days after the operation. Often self-absorbing sutures are used so there is no need for "the sutures to be removed". Sometimes staples are used and these need to be removed in a couple of weeks. Most patients are able to take a shower (no baths) 7-10 days after the surgery check with your doctor. Once home you will need to take it easy in terms of activities for 4-6 weeks. Home tutoring will be needed during this time; please contact your school district early regarding this need. The doctor's office will provide you with a letter for the home tutoring. A follow up appointment with x-rays needs to be scheduled for 6 weeks after surgery. If everything is well, the next follow up appointment will be scheduled for 6 months after surgery.
Should I worry about fever, after the surgery?
If you develop a fever, that is, temperature higher than 101°F, call the doctor.
My child’s scar is very sensitive. What should I do?
Call the doctor if your suture line becomes red, swollen, warm to touch, or if there is drainage from the wound.
What can I do if my child keeps complaining about pain?
Call the doctor if you have significant pain that is not being controlled by pain medication.
My child feels weakness, tingling or numbness in his legs after the surgery. What should I do?
Call the doctor immediately.
What types of activities, and when, can my child do after surgery?
Activities that twist or rotate the spine need to be avoided during the first 6 months.
No gym or team sports for up to 6 months after surgery. At the 6 month check up (after surgery) you can discuss with the doctor about increasing your activities.
Light workout - you may walk on a treadmill or use an exercise bike and participate in a light workout to maintain physical fitness.
Swimming in a pool or the ocean is allowed, but swimming laps for the first 6 weeks should be avoided.
Knee Epiphyseodesis Surgery
How long should I wear the knee immobilizer?
Use the knee immobilizer until you are comfortable, approximately one-week. You may remove it as needed for showering, changing clothes and comfort.
When can I start walking, after surgery?
Use your crutches until you are comfortable: you may be partial weight bearing immediately. You may be full weight bearing when comfortable.
Can I go back to sports after the operation?
Do not participate in gym or sports for at least 6 weeks after the operation. School notes are available at the office.
Pelvic Osteotomy Surgery
How long will my child be in the Hospital?
You can expect to be in the hospital for 2 or 3 nights after surgery.
How can I get a wheelchair, walker or crutches?
A reclining pediatric wheelchair with leg extensions will be needed at home. Early in the hospitalization please speak to the hospital workers. They will help make arrangements for discharge. We will provide you with a prescription for the wheelchair, walker, or crutches. In some cases, a hospital bed will be ordered. We work closely with the hospital social workers to coordinate discharge planning and arranging for a nurse and physical therapist to make home visits.
What type of activities will my child be able to do after the surgery?
A hospital and/or home physical therapist will teach you how to transfer from (bed to chair) after surgery.
Non-weight bearing - toe touch only on the affected side for transfers from bed to chair for 4 weeks after surgery.
After 4 weeks, the physical therapist will teach you progressive weight bearing with crutches or a walker.
No ambulation without an aid (i.e. walker, crutches) is allowed for 6 weeks after surgery.
How do I take care of the surgical bandaging?
The dressing/bandage will be changed in the hospital before discharge. It may be left on for 7-10 days after the surgery date and only needs to be changed if it is soiled. You may shower after 7-10 days and now no longer need a bandage. The small steri-strips across the suture line will fall off on their own.
How will my child be treated for pain?
Your child will likely require an intravenous analgesia system. This special pump will allow the child to self medicate or receive a continuous controlled amount of medication for the first 24-48 hours post-operatively. On discharge, a prescription will be provided for oral pain medication. If your child requires a liquid solution for pain medication because they are unable to swallow pills, please have the discharge prescription filled at a pharmacy hear the hospital, as the solution form of the medicine may not be readily avaliable in your local pharmacy.
General Discharge Instructions
My child is being discharged. What should I do?
After your child's surgery and hospital stay, the doctor will write discharge orders. They are completed early in the morning the day of discharge. Sometimes they are completed the evening before. Plan to be ready to go home by 10am the day of discharge.
Prior to this day please discuss with the social worker and the nursing staff if you need any equipment, school notes, visiting nurse or physical therapy referrals or an ambulance for transport. They can plan to have these in place before you leave the hospital.
At discharge you will receive a prescription for pain medicine. This should be taken as needed and after a couple of days you should be able to alternate the prescription medicine with Tylenol or Ibuprofen. If your child requires a liquid solution for pain medicine because they are unable to swallow pills, the liquid form of pain medicine may not be readily available at your local pharmacy, therefore, please have the prescription filled at a pharmacy near the hospital. Contact the doctor if after a few days the pain is not improving.
Soiled bandages/dressings will be changed prior to discharge. Often the new bandage may be left in place for 7-10 days after the surgery and then removed. Notify the doctor if there is a large amount of new drainage in the dressing or if the suture line is actively oozing after you are home. Showers, not baths, may begin in 7 to 10 days after surgery if the suture line is intact and not oozing.
Most sutures (stitches) are dissolvable and do not need to be removed. If your child has staples in place, plan to come back in two weeks to have them removed. Once the bandage is removed, check the suture line for any redness, swelling or drainage.
Also check that your child does not have a fever (>101°F). Notify the doctor if a fever persists for longer than 24 hours.
General Cast Care
What is a cast?
A cast is a rigid casing wrapped around a broken bone to keep it from moving while it heals. The cast must remain in place until the doctor removes it. If the cast is broken or damaged, the bone might not heal properly. Swelling sometimes occurs when a bone is broken; it can be helped by elevating the affected limb.
How do I take care of the cast?
Ask the doctor how active your child can be while the cast is on.
Keep the cast dry and clean.
Keep the casted limb (leg or arm) elevated on pillows higher than your chest to prevent swelling.
Have your child move their fingers or toes to reduce swelling and prevent joints from getting stiff.
If any of the following problems occur, return to the doctor, clinic, or emergency room:
The cast breaks.
The cast is too tight.
Your child's fingers or toes turn blue or pale or become cold.
Your child's fingers or toes get numb (can't feel).
Your child has a high fever.
Your child is in increasing pain.
DO NOT get any water on or near the cast.
DO NOT pull the padding out of the cast.
Make certain your child DOES NOT put any objects down the cast. If your child experiences itching, tell your doctor.
DO NOT cut the cast.
Make sure your child DOES NOT walk on the cast unless your doctor tells you this is appropriate.
Spica Cast Care
What is a Spica cast?
A cast which includes the trunk of the body and one or more limbs is called a Spica cast, just as a cast which includes the "trunk" of the arm and one or more fingers or the thumb is. For example, a shoulder spica includes the trunk of the body and one arm, usually to the wrist or hand. Shoulder spicas are almost never seen today, having been replaced with specialized splints and slings which allow early mobility of the injury so as to avoid joint stiffness after healing. A hip spica includes the trunk of the body and one or more legs. A hip spica which covers only one leg to the ankle or foot may be referred to as a single hip spica, while one which covers both legs is called a double hip spica. A one-and-a-half hip spica encases one leg to the ankle or foot and the other to just above the knee. The extent to which the hip spica covers the trunk depends greatly on the injury and the surgeon; the spica may extend only to the navel, allowing mobility of the spine and the possibility of walking with the aid of crutches, or may extend to the rib cage or even to the armpits in some rare cases. Hip spicas were formerly common in reducing femoral fractures, but today are rarely used except for congenital hip dislocations, and then mostly while the child is still an infant
In some cases, a hip spica may only extend down one or more legs to above the knee. Such casts, called pantaloon casts, are occasionally seen to immobilize an injured lumbar spine or pelvis, in which case the trunk portion of the cast usually extends to the armpits.
How do I take care of the spica cast?
Keeping the cast dry is very important. It prevents skin irritation and breakdown. It also prevents cast odors.
Gortex lined casts may be wiped with a damp washcloth to clean.
Check the baby's toes/feet to make sure they are warm, have good color and are not swollen.
Do not pull the padding out of the cast.
Make sure that the child does not put any objects down the cast.
How do I prevent urine and stool from staining the cast?
These steps and supplies have proven to be effective in preventing urine and stool from staining the cast:
Place a POISE Bladder control pad front to back around the baby's bottom and up under the cast. In the young infant who is less than 1 year, it should just reach the top of the cast.
Next, fit a small diaper (in young infants the newborn size fits well) under the cast and tucked around the sides.
Finally a larger size diaper fits over the cast and keeps everything in place.
It is important to check/change the diaper frequently. It may be necessary to only change the POISE pad with each diaper change.
If urine or stool leak out of the diaper and up under the cast, clean the skin well with a damp washcloth or diaper wipe. Examine the skin every day.
My child has some skin irritation. Can I use babypowder?
For skin beakdown, a thin layer of Desitin may be used on diaper rash. Do not use babypowder under the cast.
Clubfoot Cast Care
My child has clubfeet. Why does he/she get casted?
When casting is used as an initial treatment, the infant's foot/feet will be placed in a short or long leg cast for a total of approximately 12 weeks.
How often does the Clubfoot cast get changed?
An appointment will be made every one to two weeks to check the correction of the foot/feet's position, and to apply a new cast(s). The parents need to remove the cast(s) before each appointment. Do this the morning of the appointment. Soak the cast(s) in warm water and vinegar. You'll often need two people to do this. It will take about an hour before the cast starts to unravel. Inspect the skin for any signs of redness or irritation. Tell the doctor if the skin is irritated. We may need to wait to put on the next cast.
How do I make sure the Clubfoot cast is correctly applied?
Check that all the toes are warm, with good color, and they move easily. If the infant can pull their foot/feet back up into the cast so that you cannot see the toes, soak the cast off, call the doctor and make an appointment. If the cast cracks or becomes soft, call the doctor, make an appointment and soak the cast off before the appointment.
Preparing for Your Child's Surgery
My child is going to have surgery. How do I schedule it?
Once the physician completes the surgery-scheduling sheet he will send it to our precertification office. You may contact the surgery scheduler at 212-305-0622 to set up a date for the surgery and give our scheduler any information that may be needed by your insurance company.
Why does my child need to go to the pediatrician before surgery?
Once the surgery date is obtained you will need to make an appointment with your pediatrician. Please try to make this appointment for the week before surgery. The purpose of this visit is to ensure that your child is ready for surgery and does not have any colds, viruses, ear infections, strep throat, etc.
A few weeks prior to the surgery you will receive a conformation letter with the date of the surgery, a Surgery Consent form and a "Pediatric Medical Questionnaire"; please fill this out and bring it with you on the day of surgery. On the last page of this questionnaire is the Physician History which is filled out by the pediatrician. Ordinarily we do not require blood work or a urine sample to be done prior to surgery. Please have your pediatrician fill out the history and physical and fax it to the surgical scheduling office at 212-305-7314.
This is a big Hospital. Is there a way to get to know it before the surgery?
Preparing your child for surgery and hospitalization can be difficult. The Child Life Program at Children's Hospital offers tours of the hospital geared towards the child's developmental level. They can also provide guidance on how to prepare your child at home and what to bring with you for the hospital visit. They may be reached at 212-305-2607. The Children's Hospital of New York-Presbyterian website also offers a virtual preoperative tour. Go to www.childrensnyp.org/mschony/ and click on "A Pre-Surgical Tour: Just For Kids!".
At what time do I have to take my child to the Hospital for the surgery?
The night before surgery the Ambulatory Surgical Unit will call you between 4 PM and 9 PM to tell you what time you should come to the hospital. If surgery is scheduled for a Monday they will call you the Friday evening before the surgery. The Children's Hospital entrance is at 3959 Broadway between 166th street and 167th street. There is valet parking in front of this entrance. Stop at the security desk and they will direct you to the 4th floor for admission. Self-parking is available at the hospital parking lot on the corner of Ft. Washington Ave. and 165th street.
Can I go with my child into the Operating Room?
You may walk with your child into the OR and once the operation is complete and your child has been transferred to the recovery room you may stay with them in the recovery room. The surgeon will speak with you after the surgery, therefore, please let the surgery unit staff know where you will be.
Can I stay during the night with my child, after the surgery?
One parent may stay over night at the child's bedside. There are parent beds available. Please speak to the nurse on the unit. If your child goes to the intensive care unit (ICU) one parent may stay overnight at the child's bedside.
Where can the rest of the visitors stay?
Guest accommodations are available in the Milstein Hospital building. Please call them in advance to make arrangements at 212-305-4820. These accomodations need to be reserved early. They cost about $200.00 a night. The Radison Hotel in Fort Lee, New Jersey is also avaliable and they provide shuttle service to the hospital. Their number is 201-871-2020.
I think my child is going to need special equipment, such as a wheelchair or a hospital bed. How do I get it?
If you think your child will need special equipment, i.e. wheelchair, hospital bed, etc, or placement in a rehabilitation hospital postoperatively, please contact the physician's office a few weeks before surgery to make these arrangements.
Parents Helping Parents
Are there other parents I could talk to?
Yes. Parents Helping Parents is one our Quality of Life programs, matching families who have faced a similar experience. Learn from other parents how they handled what you are dealing with… casting or bracing, surgery, or missed school days. If you are seeking advice, or willing to share your experience, let one of our staff know you would like to participate in the Parents Helping Parents program.
Parents Hosting Parents
Do you offer housing for out-of-town families?
Yes. At the Morgan Stanley Children’s Hospital of New York-Presbyterian, we believe family participation is part of the healing process. See "Preparing for your Child’s Surgery" regarding accommodations in the medical center or neighboring hotels.
For families traveling to the area for an outpatient procedure or appointment, we may be able to match you with a host family. Parents Housing Parents is one of our Quality of Life programs matching host and visiting families in their time of need. If you are seeking a place to stay, or are willing to open your home to a family for one night prior to their appointment, let one of our staff know you would like to participate in our Parents Housing Parents program.
Patient Success Stories
We would love to share success stories with you. We know that success stories help parents visualize the best outcomes for their child.
If you would like to share your story, let one of our staff know. By sharing your story, other parents will find hope.
Fundraising and Help
If you would like to make a donation, your gift to the Pediatric Orthopaedic Research Fund will help us sustain our work advancing pediatric research and care internationally ~ to improve every child’s quality of life. Donate On-line.
Our patients are so happy with the quality of care they receive, we are often asked how they can say “Thank You.” Please tell your friends, family and neighbors. We know that your good word is the strongest recommendation we can receive. (Besides being ranked the top Children’s Hospital in New York by US News and World Report).