The home environment

An optimised home environment is important for a smooth post-operative recovery. Thought will be given to the home environment starting very early in the assessment process, and will be closely addressed during pre-admission as well as during discharge planning. Please raise any anticipated issues with regards to home set-up as early as possible. Consider things like steps, toilet and bathroom access, pets, and who will be around during the day. Think about parental or guardian leave from work, and let us know if any documentation is required.

The Limb Reconstruction service adopts a NON-SMOKING policy. Active and passive smoking is known to have a delaying effect on bone formation, which will prolong healing time and increase the risk of complications. 

Mobility

Most children will have some mobility restrictions imposed on their return bone. They may not be permitted to bear weight through an operated limb, or they may be in cast. The wearing of an external fixator also provides some mobility challenges.

Some children will require the use of a wheelchair, and some may use crutches or a walking frame. What is best for each child will be determined prior to discharge from hospital. The Occupational Therapist, Limb Reconstruction coordinator and Physiotherapist will discuss ways in which to manage stairs, toileting, bathrooms, and the bedroom. Special equipment may be required and can be hired from the hospital

Encouraging mobility within the provided restrictions is important. In the early stages, the use of interactive toys and frequent scenery changes can help to alleviate boredom. Put some thought into activities that your child can participate in to help pass the time. When visiting new places, it is often useful to do some 'research' into the place you intend to visit – check for accessibility options. 

Transport

Most children are able to travel in a car with some minor adjustments.  A seat belt or other approved safety restraint must be used at all times. Your child may be eligible for a Disabled Parking Permit. Forms are available online and must be signed by a doctor. If you have to travel more than 100kms or 500 kms for 5 weeks or more for treatment, you may be eligible for travel assistance through the Victorian Patient Transport Assistance (VPTAS) Scheme. A doctor will need to complete some sections of the form.

School

Let your child's school know of the planned surgery. If use of a wheelchair is anticipated, talk to the school about access. The LR team may liaise with the school to advocate for your child if you wish. Children returning to school need to be able to toilet themselves unassisted.

Children undergoing complex or prolonged treatment will benefit from the involvement of the Education Advisor, who is able to help establish communication with the school. This will ensure the child is well connected with their teachers and peers. 

Diet

As it is common for children to lose their appetite whilst undergoing treatment. Overall fitness and good eating habits prior to surgery will assist in a more rapid recovery. During treatment it is important that your child receives a healthy diet to assist with tissue repair, growth and bone healing. If eating or weight loss become a problem, a dietician's help may be required.        

Clothing

Clothes may need to be modified to fit over a cast or fixator. Additionally, be mindful that the pointed corners on an external fixator may catch on clothing, bedding or soft furnishings. Creative solutions may include pull away track suit pants with Velcro or press-studs down the outside seam, and underwear or boxer shorts can be modified with press-studs or velcro down the seam. It is also simple to make a "sleeve" to go over the external fixator, using a tube of material with elastic at each end.

Home help

Most children are referred to a community agency for management after discharge. Children discharged from the RCH are referred routinely to our RCH@home service, which may provide assistance with Activities of Daily living, respite, Home Help, and performance of the dressings. This assistance is available for a period of four weeks following discharge from hospital.

It is suggested that parents be taught to perform the dressings at home.

Pain management

There is often an ‘ache’ associated with wearing an external fixator, particularly in the ‘active phase’ of treatment – the time when you are making daily adjustments to the fixator, and slowly moving the joints or bones underneath. You will be discharged from hospital with initial pain relief medications, and prescriptions for further medication can be obtained at follow-up appointments with the LR team, or your General Practitioner.

It is important that the patients take pain relief regularly, particularly to allow participation with physiotherapy and exercises that have been prescribed.

Please note that Non-Steroidal Anti-inflammatories (NSAIDs) can interfere with bone healing, and hence it is important to ask the LR team prior to using these medications. NSAIDs include ibuprofen (Neurofen), meloxicam (Mobic), and celecoxib (Celebrex). 

Next section: Follow-Up.

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