Monday, March 7, 2011

In Which Connor Goes To The Orthopedist

So we got some good news, and we got some bad news.  I'll get to both.

Connor's appointment with the orthopedic surgeon was this afternoon, and when the doctor walked in we simultaneously recognized each other but had no idea why.  After a couple of minutes of playing the "where do I know you from" game we realized that she'd done Jer's skin graft!  That was why she looked so familiar.  Turns out she was filling in the pediatric ortho's slot for a few months because the old one had just retired and the new one was still on the way.  She was excited to hear about how well Jer is doing and happy to meet the little guy.

Connor, I'm sad to say, was not exactly at his best.  The recent nights of little-to-no sleep seemed to all catch up to him at once today, and I had to wake him up at noon to go into the doctor's office.  He fell asleep in the car on the way there, which is pretty much unheard of for him.  Then he fell asleep in my arms after the resident's examination and slept right through two thirds of the appointment with the orthopedic doc-- even when I carried him into the next room to look at his x-rays.  After we got home I put him down and he slept for another three hours, and when Jeremy put him to bed at seven in the evening he went down immediately.  That was one tired kid.  Hopefully this will mean the return to a normal sleep cycle-- something that I would be extremely happy about.

But on to the news.  The doctor said that she doesn't think Connor's scoliosis will require surgery yet, and if we can keep it from getting worse with braces and positional seating it may not ever require surgery.  So that was very good news.  Unfortunately Connor's leg was another story.

So remember when the developmental doc called us and told us that Connor's right femur was "uncapping" and I had absolutely no idea what that meant?  Here's how the orthopedist explained it to me.

First of all it's not his right femur, it's his left.  And what's happening is that Connor's muscle tone is pretty weak and because of the scoliosis, there's uneven pressure on his hips all the time.  As a result, Connor's leg isn't lining up perfectly with his hip anymore.  The angle of the joint is wrong, so the "head" of the femur-- the ball part of the ball and socket joint-- is out of alignment and is starting to poke out of the hip joint.  You can see a significant difference in the amount of the femur that's outside the socket joint in the x-rays taken last month and the x-rays taken two years ago.  There's not anything we can do to prevent this, and while it doesn't bother him now eventually Connor's leg bone will start to pop entirely out of his hip, which can be extremely painful and will limit how much he can use the leg.  So while there's nothing that needs to be done immediately, eventually they will probably have to do surgery to fix the problem.

The surgery they will need to do is called a Femoral Derotational Osteotomy.  Basically they'll saw off the top of Connor's leg, realign it so it fits back in the hip joint correctly, and then put in a plate and bolt everything back together.  It doesn't exactly sound like a whole lot of fun to me.  You can read a more detailed explanation of the surgery here

It won't be for a while yet because Connor's condition isn't to the point that he needs surgery right now, but basically it's just a matter of time.  We'll be going back every few months to get more x-rays done and to see how quickly Connor's issue is progressing, and then we'll go from there.  Needless to say I'm not particularly thrilled about this development, but there's absolutely nothing I can do about it short of magically changing Connor's low muscle tone that's going to correct the issue without surgical intervention. 

So that was my good news and bad news today.  Oh well.



krlr said...

Yikes - That just bites. (Grasping at straws) The PT doesn't have any brilliant ideas/exercises/different chair/sitting positions? ORIF is... those are the big guns.

Wherever HE Leads We'll Go said...

Hoping sleep is getting better for all of you - and happening at night rather than the day time. Sorry to hear about the leg issues - that does sound painful! Sometimes it seems like all we do on a daily basis is to prevent awful things from happening. UGH!

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