Limb Realignment

There are several surgical techniques available for limb realignment. The choice of procedure depends on your condition and individual needs. The most common of these are: 

• Closing wedge osteotomy: wherein a small wedge is removed from one side of the bone to correct angular deformity.
• Opening wedge osteotomy: wherein a small wedge of bone is added to the bone to correct deformity.
• Joint surface elevation: wherein osteotomy inside a deformed joint is used to realign the joint and increase its stability.
• Lengthening or shortening osteotomy: wherein the bone is cut and fixed in a lengthened or shortened position.
• Derotation osteotomy: wherein the bone is cut transversely, rotated and fixed in its new position.
• Gradual correction: wherein the bone is cut and an external frame is fitted which will be used to position over the course of weeks.
• Guided growth: for children with open growth plates, wherein deformity around the large joints is corrected by modulation of growth plate using temporary staples, screws or plates.

Preparation prior to surgery

• You will receive a thorough health assessment: including medical history. You may be advised to modify certain lifestyle factors and you may be referred to another specialist. You may be asked to stop taking certain medications as your surgery date approaches. X-rays, CT scans, and MRIs will be used to evaluate your condition and plan your surgery.  
• Skin and bowel preparation: On the evening before your surgery, you will be asked to wash your leg using the sponge provided at your pre-admission clinic. A skin test may be administered if an iodine allergy is suspected. You will also be provided medicine to help you evacuate your bowels prior to surgery.
• Patient education: if neccessary, you may speak with a physiotherapist who can advise you on post-operative mobility. 

On the day of the surgery

• You will be asked to complete your surgical paperwork and will meet with the anaesthetist.
• The surgical site will be prepared.
• You will be administered general or spinal anaesthesia.
• Your osteotomy procedure will be completed.
• The new position will be secured using an external fixator, an intramedullary nail, or by using plates and screws. 
• The wound will be sutured and dressed.

After your surgery

• In-patient care: you will remain in hospital for several days for monitoring and early-stage rehabilition. 
• Pain and swelling: You may experience mild to moderate pain. You will be prescribed painkillers to manage these symptoms. Inflammation can be controlled by icing (15 minutes per hour maximum) and elevation.
• Mobilising: If necessary, you will not weightbear for a period of time. Thereafter you may being to weightbear gradually, with crutches, under clinical supervision. 
• Aftercare: at one week post-surgery, you will be required to attend a wound check and at two weeks your sutures will be removed. You may receive a correction program for your frame during this appointment: if so, you will require fortnightly x-rays thereafter. At 6 weeks, you will undergo further X-rays to assess healing, and at three months after your surgery for the same reason. You may be prescribed blood thinners to reduce the risk of a clot developing. 
• Physical Therapy: A tailored rehabilitation program will help regain strength, flexibility, and mobility and prevent joint contractures, which are common during limb lengthening.