Procedure

During inpatient treatment

– Regarding medicines:

+ Antibiotics: The patient is given prophylactic antibiotics. Therefore, there will be 1 antibiotic injection 30 minutes before the surgery, followed by the use of injectable antibiotics in the next 24 hours after surgery. From day 2, switch to oral antibiotics for 5 days.

+ Analgesics: Perform multimodal analgesia. Before spinal anesthesia, the anesthesiologist placed an epidural analgesia line for continuous pain relief for the first 3 days after surgery. After 03 days, remove the analgesia line and switch to oral analgesics, combining 2-3 types of pain relievers. The oral doses will be gradually reduced until the patient is discharged.

+ Edema and hematoma medications: Will be used in oral form, or sublingual administration, for 05 – 07 days.

+ Venous thromboembolism medications: 01 tablet per day, use continuously until discharge.

– The nurse will change the wound dressing on the first day after surgery, then repeat it every 48 hours, wrappring sterile gauze to protect the nail.

– Apply cold compression, elevate the surgical legs: Cold compression has vasoconstrictive properties, therefore reduces swelling, edema, and pain; elevating the legs to reduce edema should also produce good pain reliever effect, the duration of cold compression and leg elevation should be 03 – 05 days. During this period, in order for blood to be circulated and avoid occlusion, it is recommended to do passive exercises or active movements gently for the knee and ankle joints; always place the leg fixators perpendicularly while at rest or sleeping to prevent future shortening of the Achilles tendons.

– After 5 days since the surgery, when the pain and edema are no more, the patient should do more active exercises, especially of the joints of the lower limbs, and stretch the heel tendons. When going to bed, always keep the pillow straight and do not sleep in a bent position.

– After 7 days since the surgery, the doctor will stretch the frames and instruct the patient to self-operate the external fixator frames to stretch the cavities at the rate of 1mm per day, divided equally into 3 times (the stakes on each extensor frame are already divided into 6 faces, turn a different face every 8 hours at the time marks of 6 am, 2 pm and 10 pm), turn clockwise, from left to right looking down from above.

– After 10 days since the surgery, remove stitches and take an X-ray of the legs for assessment, if the cavities are well stretched, the patient can be discharged from the hospital and receive outpatient treatment.

During outpatient treatment

– Change the bandages around the nails, wipe the dried scabs around the nails with physiological saline, then sterilize with 70-degree white alcohol or Betadine and wrap sterile gauzes around the nails once a day. If the nails cause inflammation or are oozing pus, take a picture and notify the doctor to decide if antibiotics should be given.

– Following the doctor’s instruction, the patient needs to stretch on his/her own. Note that even if the stretching process does not cause any pain, it is recommended that the patient should not turn the stakes more than 3 times a day to ensure the regeneration of bones, tendons, muscles, blood vessels and nerves. During the stretching process, if there is a lot of pain, the patient can adjust the stretching rate to twice a day, at 6-7am and 6-7pm. Do not turn the stakes more than 3 times a day just to remove the fixation more quickly, because that will not give the cavities enough time to develop, leading to poor development of the cavities and even the growth of the bones.

– Rehabilitation exercises during the process of stretching: Focus on exercises to stretch the knees, reduce hypertonia of the quadriceps, practice flexing the insteps into the shins to stretch the Achilles tendons, and practice rotation of the ankle joints. It is recommended to practice compressing part of your body weight when standing or walking with two crutches, or in a walker 3-4 times a day, 10-15 minutes each time. Note that while standing or walking, the body weight must be evenly distributed on 2 legs. Avoid putting the whole body weight on 1 leg.

– During the outpatient treatment, the patient needs to go to the hospital every 4 weeks to take X-rays and have clinical examinations; check if the screws holding the nails are loose, the nails are bent or the frames have skewed away; evaluate the development of the cavities to see if the growing speed is normal or not to decide whether to adjust the stretch speed, stop stretching, or schedule an appointment to remove the frames.