THE PHYSICAL, OCCUPATIONAL AND PSYCHOSOCIAL FUNCTION OF YOUNG ADULTS WHO UNDERWENT ILIZAROV PROCEDURES AS CHILDREN.

Abstract

Limb lengthening and limb reconstruction using the Ilizarov system is a recognized treatment for children with congenital and acquired lower limb discrepancy and/or deformity. It is a complicated, costly, time consuming and challenging procedure for the multidisci-plinary team, the child and their family. Traditional outcome measures for this group of children tend to focus on X-ray appearances, lengthening indices and problems, obstacles and complications occurring during the treatment phase. At the present time there are unanswered questions as to their functional status as adults. The literature does not appear to have addressed this question as yet. For families considering this difficult treatment option, the potential function for their child as an adult may be valuable in the decision making process The aim of this study was to discover the physical, occupational and psychosocial function of a group of young adults who underwent Ilizarov procedures as children at Great Ormond Street Children’s Hospital.

Forty young adults, aged 18 – 27 years (mean age 19.9 years), who had Ilizarov procedures between 1992 and 2000, were sent questionnaires. Items included in the questionnaire were taken from the Toronto Extremity Salvage Score (TESS) to assess function and the Pediatric Orthopaedic Society of North America (POSNA) Adolescent Musculoskeletal Functional Health Questionnaire to assess psychosocial and occupational domains. Questions were also included to gather demographic information.

A total of 27 responses were received from 14 males and 13 females. Twenty four patients had Ilizarov procedures for limb lengthening or lengthening with deformity correction. Deformity correction only was carried out in three patients. Mean time since treatment was 5.6 years (range 9 – 2 years). A total of 24 tibial frames, 6 femoral, 4 whole leg and 2 foot frames were applied. Four patients had had repeat Ilizarov procedures. Six patients had had previous lengthenings using uniaxial fixators.

Functional ability indicators were high but activities such as kneeling, walking up and down slopes or hills, walking long distances and running were significant problems reported by more than half. Assistive devices (crutches, shoe raises, AFO, knee brace) were needed full time by five, with crutches, sticks and wheelchair used occasionally by three others.

Seven adults chose not to partake in sporting activity, with a further three finding it extremely hard and two impossible. Swimming was the most popular activity. Activity related pain was uncommon but pain in the limb requiring occasional analgesia was reported. All but one respondent worked full time or were students. Most occupations were office or shop based. Three men were manual workers. Time off work for problems related to their limb problem was minimal. Socialising with friends and family was high with only one respondent expressing extreme difficulty. Four men and five women identified scarring from the Ilizarov treatment as a cause of concern. Ten women and eight men raised body image issues. Twenty six adults said they would recommend Ilizarov treatment to others, if asked. Conclusions: We view this data as important to provide information for use when counselling It weill also help prospective patients and families of expectation for function in adult life.