Osteotomy

An osteotomy describes when a bone is cut to lengthen, shorten or to change its alignment. Once the bone has been cut, a fixing device is used to hold the bone/s in the correct position.

Before you arrive in hospital

Please notify the hospital before admission, if your child:

• is unwell
• has an ear infection
• has a cough or cold
• is vomiting or has diarrhoea
• has a fever
• has had contact with any infectious illnesses (such as chickenpox)
• has any scratches or broken skin on or near the operation site.

Your child’s operation may be postponed if they have any of these conditions.

Please contact the Clinical Nurse Consultant, Orthopaedics on 07 3068 5892 (Monday to Friday, 7am-4 pm) OR call 07 3068 1111 and ask the operator to page the nurse manager.

On the day of surgery

What to bring

Please bring the following items with you to the hospital:

• pyjamas, clothes
• toiletries, including toothbrush, toothpaste, hairbrush
• comforters (e.g. blankets, teddy bears, pillow)
• your child’s regular medications (including herbal and homeopathic medicines)
• relevant medical information
• nappies/incontinence pads as required by your child
• your child’s formula and any special bottles, teats, cups or spoons they require
• feeding equipment and feeding device connectors
• wheelchair (if your child will need one).

Please notify nursing staff about any special dietary requirements for your child when you are admitted. Also ensure your child has a bath or shower before coming to hospital.

Bed allocations

Bed allocations are made on the day of admission. The allocation of a single room is subject to availability and priority is based on clinical needs.

Things to discuss with your child’s nurse

You can discuss the following with your child’s nurse:

• your plans for staying with your child while they are in hospital
• your child’s medical condition/s and the details of any previous operations
• the expected recovery outcomes from the osteotomy
• your child’s regular medicines, including herbal or homeopathic tonics
• any allergies or reactions to medicines, tapes or foods
• what nursing staff need to know to make your child as comfortable as possible
• fasting instructions before the operation
• your child’s experience of pain
• if your child has a bowel routine
• if you would like your child to have visits by hospital volunteers
• visitation forms
• if your child has complex special needs.

When your child is admitted

On admission, a nurse will apply an identification band to your child’s wrist or ankle. This needs to stay on for safety reasons while your child is in hospital. If the band comes off, please notify nursing staff, as it will need to be replaced. A nurse will record your child’s weight, temperature, pulse, and respiratory rate and enquire about your child’s medical/surgical history.

One parent/carer may stay overnight with your child. A fold out bed or recliner chair will be provided at your child’s bedside.

An anaesthetist will manage your child’s pain during and after the surgery. They will visit your child before surgery and may discuss:

• any previous problems with anaesthetics for the family
• current medications
• the best way to begin the anaesthetic
• the best type of pain relief after the surgery, including epidural, intravenous, oral and rectal routes
• the best type of medication to control muscle spasms, if required
• what to expect and how to manage any postoperative nausea and vomiting that may occur.

The nurse will talk to you about pain rating scales that are used after the operation. Pain rating scales will help determine how well the pain medicine is working. A nurse will also ask you how your child shows pain.

As a parent/carer, you will be involved in helping the doctors and nurses understand your child’s comfort. This will help ensure your child is as comfortable as possible after their operation.

Your child will need to fast before the operation. They will be able to brush their teeth but not swallow the water.

Generally, the anaesthetists will allow one parent/carer to stay with your child until they fall asleep.

While your child is in surgery, you may like to wait in the parents’ lounge. Please inform the nurse where you will be, as your child’s surgeon will need to speak with you after the operation (which generally takes about two to three hours).

After surgery

Your child will be transferred to the recovery unit, Post Anaesthetic Care Unit (PACU), after the operation. A PACU nurse will let you know when you can see your child and both parents/carers can be in the unit.

Your presence when your child wakes up is important because they will be looking for a familiar face. It can be distressing to see your child waking up from an anaesthetic—they may be sleepy, crying or be quietly awake. Often children will begin to cry when they see you.

After the operation:

• your child will have intravenous (IV) fluids and pain medicine as discussed with the anaesthetist before the surgery
• a nurse will make a full assessment of your child and record their temperature, heart rate, respiratory rate and blood pressure; check your child’s medicines, cast, dressing and any tubes/fluids; assess their toes for circulation; and monitor their position and level of comfort
• doctors and nurses will touch your child’s feet and toes and ask if they have any numbness, sleepy sensations or tingling feelings
• nurses will assess your child frequently after the operation and will wake your child throughout the night.

Diet

Your child will be able to have clear drinks, e.g. ice chips, water and ice blocks, when they are fully awake after the surgery. Your child’s normal diet may commence gradually when they are tolerating fluids.

They may have an IV drip for up to three days after the operation or longer if they are unable to tolerate food and drinks. Please ask a nurse before giving your child anything to drink or eat as they will need to record the amounts that your child is consuming.

Nausea/vomiting

Your child may experience nausea and vomiting after their operation. Please let the nurse know if this happens so they can give your child medicine to help reduce these symptoms.

Pain management

Your child will experience discomfort after the surgery and this discomfort needs to be controlled as effectively as possible. There are various forms of pain relief including:

• epidural (this may be used for up to three days)
• intravenous (this may be used for up to first three days
• oral (tablets or liquid medicine)
• nerve block (up to 12 hours).

If you think your child’s pain is not being managed as you would expect, please discuss this with the nurse caring for your child. The nurse will be able to contact the anaesthetist or pain management team for further advice. The Pain Management Service and the nurse will monitor your child’s progress, pain and comfort after the operation.

It is common for children to experience muscle spasms after the surgery. If this occurs, please speak to the nurse caring for your child and they may be able to give medication to reduce the spasms.

Toileting

If your child has an epidural, they may have a urinary catheter for a few days. This will be removed once the epidural is stopped. If your child has a hip spica cast, the nursing staff will show you how to position nappies to best capture the urine without wetting the cast.

Wound

The stitches used in your child’s operation are usually dissolvable and won’t need removal. There will be a dressing over the skin to protect the stiches.

Mobility

A physiotherapist will be involved in the care of your child from the day after surgery. Physiotherapists and nursing staff will discuss with you the appropriate positions for your child. Physiotherapists will also teach you and your child how to use their mobility aids. Your child will be need to be repositioned every two to four hours and nurses will show you how to do this safely.

Hygiene

Your child will have a sponge bath every day and other daily care routines will continue.

The orthopaedic team will also review your child daily.

Visits by volunteers

During your child’s stay, our valuable volunteers, including pastoral carers, Captain Starlight, and Radio Lollipop members, may visit your child. Please inform your child’s nurse if you would prefer not to receive a visit.

Going home

Your child will stay in hospital for approximately three to four days, or until they have met the expected recovery outcomes. Your child’s wound should be healing with no problems and, for children with complex needs, we expect your child’s general state of health will be as it was before surgery.

Your doctor will advise when your child is ready to go home. When they are discharged, your child will:

• be moving with support
• be tolerating food and drinks
• be able to carry out a reduced level of everyday activities
• have effective control of pain and muscle spasm with oral analgesia (medicine)
• be able to move safely (according to the physiotherapist).

You may need to arrange/obtain the following before your child is discharged:

• community nurses/therapists
• care support
• transport (Queensland Ambulance Service)
• reclining wheelchair or other physiotherapy recommended equipment
• slipper pans
• urinals
• nappies
• crutches
• medicines
• mobility instructions.

Follow-up appointment

Your child will need an outpatient appointment within six weeks after their discharge from hospital. Please call the hospital if you have not been contacted to schedule your child’s follow-up.

When to seek help

See your GP or contact us if your child has any problems after surgery.

In an emergency, call Triple Zero (000) and ask for an ambulance.

If you're not sure whether to go to an emergency department, call 13 HEALTH (13 43 25 84) and speak to a registered nurse.

Developed by the Division of Surgery and Perioperative services, Queensland Children’s Hospital. We acknowledge the input of consumers and carers.

Resource ID: FS163. Reviewed: December 2016.

Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.