There are two different types of fixators that we use in the care of kids with upper extremity differences. One is a unilateral frame and is just on one side of the bone. It usually has 4 pins sticking into the bone and a rail outside the skin. It is useful for lengthening bone- done with a painless turning of a dial 3-4 times/ day.
The patient above (Lola) had a fixator for several months and, as you can, she did great with it. As Lola mentions, there is no pain wearing the fixator or “turning” the dial to lengthen. She mentions wearing a splint- we use a splint to provide a little extra protection while we are lengthening the bone. The length of time the fixator is on the arm differs from child to child depending on the bone we are lengthening (we can lengthen the humerus, radius, ulna, metacarpals, and phalanges) and the desired length.
The other type of frame is a “circular frame” and, as it sounds, it goes around the extremity and gives great control and allows very precise correction of bony and soft tissue abnormalities. We use this type of frame in radial deficiency before we perform a centralization procedure. It helps to stretch the soft tissues and makes the centralization procedure more straightforward to perform and, we believe, more effective.
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| Circular frame for radial deficiency prior to centralization |
My official diagnosis is adactylia and I had this type of procedure done twice as a child, once in 1984 and the second time in 1994. I do not recall this being entirely painless (in some ways, quite the opposite). In my recollection, it didn't hurt every time the fixator was turned (only once per day in my experience), but it did hurt, especially when it was infected or when it had been bumped. I still experience pain in my hand at the sites of operation, particularly when the weather changes. I'm grateful that my parents chose to do these procedures and I figure that my aches and pains are well worth the functionality that I have gained. It may be that my situation is unusual and is partly due to the fact that medical science has changed since I had my procedures, but I really feel that your description of this not causing pain could be misleading.
Christine,
Thank you for the comment on your experience. Your diagnosis of adactylia, meaning absent digits, may be an indication for lengthening. This diagnosis is general and often we can assign a more specific diagnosis.
I have no reason to mislead and in most cases, lengthening is truly pain free. If the lengthening process is painful, it may be a sign of infection (as you note) or may indicate that the lengthening has been maximized. Finally, I agree that there are likely improved lengtheners today compared to 1984 and 1994.
Finally, it is helpful to hear that you are pleased that you did undergo this surgery.