Complication of lengthening and the role of post-operative care, physical and psychological rehabilitation among fibula hemimelia

Abstract

There is a clear clinical need for efficient physiotherapy and rehabilitation programs during and after bone lengthening and reconstruction for gaining the optimal effect and also prevention or treatment of lengthening side effects. Pin tract infection is the most prevalent side effect during lengthening which could be prevented and treated initially via proper wound care. Muscle contractures are typically a consequence of the generated tension on the distracted muscle. It can be managed by physiotherapy initially and surgically in later severe stages. Furthermore, it is essential to avoid muscle contracture development, which is the demonstration of the imbalanced muscle appeals on the joint to inhibit the following subluxation. The knee is the furthermost affected joint by the aforementioned problem due to the inherent lack of ligamentous and bony stability. Joint stiffness is the other possible unfavorable effect of lengthening. It happens because of extensive muscle contractures or may possibly be attributed to rigidity of the joint following the amplified pressure on the joint surface during the process of lengthening. Physiotherapy and occupational therapy including endurance and strength exercise as well as stretching play an important role during the rehabilitation periods for the prevention and also the treatment of muscle contracture and the following deformity and also joint stiffness. Likewise, the effect of mental and physical rehabilitation programs should not be overlooked.

Keywords: Fibular hemimelia; Rehabilitation; Reconstruction; Lengthening

Core Tip: Difficulties that occur during limb lengthening are not avoidable. Pin tract infections are considered the most common adverse effect of lengthening which should be prevented through prophylaxis and treated as soon as possible when occurred. Muscle contractures are usually a result of the tension generated on the muscle due to distraction. It can be managed by physiotherapy initially and surgically in later severe stages. Subluxation or dislocation during lengthening may have been attributed to the preexisting joint instability or imbalanced muscle tension that developed during lengthening. It often happens in the knee joint posteriorly.