In the weeks before surgery, your child will commence physiotherapy. This will consist of a training programme to stretch and strengthen particular muscles. Fitness is also important and activities such as swimming and bike riding are recommended. Figure 1

Figure 1

The fixator may be in place for many weeks. During this time exercise and movement are essential to keep bones and muscles fit and strong. The orthopaedic surgeon will tell you when your child should start walking again after surgery. This is normally within the first weeks, since walking is helpful for the formation of new bone as well as maintenance of bone density. Figure 2

Figure 2

In limb reconstruction above the knee, certain muscles will particularly require stretching. These muscles are:

1. The hamstrings: the muscle at the back of the thigh which bends the knee.

2. The quadriceps: the large muscle at the front of the thigh which straightens the knee.

3. The calf muscle: the muscle at the back of the lower leg. Figure 3

Figure 3

Surgery lengthens or re-aligns the bone, but does not lengthen the muscles which attach to it. These muscles may therefore feel tighter after surgery. To prevent serious muscle tightness, we need to:

1. Position the leg correctly in bed so that the knee is straight. Figure 4

Figure 4

2. Exercise to regularly stretch the hip, knee and ankle muscles.

The physiotherapist will visit your child in hospital and teach correct positioning and appropriate exercise.

Before surgery, some simple exercises to stretch and strengthen will also be most helpful.

Exercises before surgery

To stretch hamstrings

Tuck right/left heel near groin with the opposite leg straight. Reach down until a stretch is felt in the back of the thigh. Hold for 30 seconds x 2. Figure 5

Figure 5

OR

Long Sitting: The young child may long sit for 5 - 10 minutes or as tolerated (keep knees and back straight). Figure 6

Figure 6

To stretch quadriceps

Pull right/left heel towards buttock until a stretch is felt in the front of thigh. Hold 30 seconds x 2. Figure 7

Figure 7

OR

Lie on tummy (hips flat). While keeping hips flat, bend knee until a stretch is felt in front of thigh. Assist as necessary. Hold 30 seconds x 2. Figure 8

To stretch calf muscle

Standing stretch: Keep the back knee straight with the heel on the floor and the toes pointing forward. Lean into the wall until a stretch is felt in the calf. Hold for 30 seconds x 2. Figure 9

Figure 9

OR

Towel Stretch: With the knee straight, use a towel to gently pull the foot towards face until a stretch is felt in calf. Hold for 30 seconds x 2. Figure 10

Figure 10

OR

Assisted stretch for young child: With knee straight, gently pull foot towards face. The child should feel a comfortable stretch in the calf. Hold for 30

seconds x 2. Figure 11

Figure 11

OR

To strengthen hip and knee.

Straight leg raise. Tighten muscle on front of thigh, then lift leg from the floor keeping knee straight x 10. Figure 12

Figure 12