We talked with the surgeon for an hour yesterday.
The plan this go around is to perform an osteotomy on the left ulna, take out the plates and screws from the last surgery, then implant an external fixation device to gradually lengthen the bone. This is a metal device that attaches to both sides of the broken bone (ulna) and slooowly pulls them apart, a millimeter at a time, allowing the bone to fill in and making it longer. The average growth rate is about 1 millimeter a day. We are looking to gain about 17-20 millimeters from the procedure, which will take around 17-20 days. Theoretically.
While this is *probably* the best approach, it is not without its problems. Being a teenage boy and having a metal robot apparatus sticking out of your forearm is not ideal. It's not even marginally ok....it just plain sucks. There is a chance of pin infection, but that can be dealt with by way of antibiotics. I'm guessing having your bone slowly pulled apart involves some pain as well. But, there are advantages. There is no itchy, stinky cast. You can shower, swim, use your arm normally, although not strenuously as in sports. The recovery time seems a little faster than the acute lengthening. It's only in place for a few weeks, then another quick surgery to take out the apparatus. And, if we're plodding along and we find making the bone longer actually makes the situation worse rather than better, we can stop.
Which brings me to the dilemma....what if. This is such an unusual problem that noone has a tried-and-true plan for us. We are basically proceeding on best-guess and what should work. This isn't what we want to hear. We want to hear its been done hundreds of times, or several times, or at least that it has been done before. However, Mason's particular situation is quite unique. So....while the actual surgical procedure has been done a gazillion times, we are not assured of success in this case. We *think* it will work. We just have to take a leap of faith, and that is difficult to do in this situation.
We have a date!
Mason's surgery is scheduled for December 10. He wanted to do it ASAP because he is having quite a lot of pain during certain activities, but this is the earliest we can do. It is not the best timing, because he will miss a Kansas City Youth Percussion Ensemble concert on December 11. He has been practicing for that since late August. And, finals are the next week. However, we don't want to wait til January for various reasons, so we are going for it. We will figure out the rest.
We have a meeting scheduled with the surgeon for November 17, and then we will find out what exactly the doc is planning to do. All the nurse told me is that he "is a candidate for ulna lengthening". I am guessing that means a recovery time similar to the last surgery (6 months) When I find out what that means exactly, I will post it here.
October 14, 2010
We are waiting...
Since the end of March, Mason has had pain in his elbow. He did about 10 weeks of occupational therapy, with slight improvement, but lost any gains within a few weeks after he stopped. Before Mason had his first surgery the doc told him if he did not have the surgery, eventually the disparity between the length of the ulna and radius would pull his elbow apart. I think that is what we are now seeing as a result of recent growth spurt he is experiencing.
He had an MRI of his elbow two weeks ago, and the nurse told me it was "abnormal", although she did not have the findings in front of her. The doc who did the last surgery is waiting to consult with another doctor - an orthopedic extremeties specialist type - before she decides exactly how to proceed. We expect it to be surgical, and are hopeful we can get something on the schedule soon so he can heal up by summer.
Mason is unable to dribble/shoot a basketball without considerable pain, and has decided not to try out for the high school basketball team.....which is heartbreaking, but survivable. This is not an unexpected event, but is still burdensome. It is very difficult to lose skill sets like this - especially for a teenage boy. So far he is still able to play piano and drums...I am anxious to "fix" him before he loses that, too.
When I get some more information, I will put it here.
Before 9/07/2007 After 10/10/2007
Mason had some wacky growth plate defect that caused his ulna to stop growing while his radius kept on growing, resulting in a bowed arm. It was previously misdiagnosed as a benign bone tumor. On September 7 he had it fixed (straightened) surgically.
Original Diagnosis Below
In mid-June our family vacationed near San Diego California. While there, we took Mason to a skateboard park. That evening, we noticed his left wrist appeared "deformed", for lack of a better description. Something was definitely wrong, and although he insisted that it did not hurt and he did not injure it, we took him to the ER to have it examined. An x-ray was taken (see photo page) and clearly showed the ulna (the small bone on the pinky side of the forearm) not extending to the wrist. We were then refered to the Children's Hospital, where it was determined it was not broken (just like Mason told us). We were told to follow up with a doctor when we returned home, so we continued our vacation, then saw a pediatric orthopedic surgeon at home as suggested.
After more testing, Mason has been diagnosed with a solitary Osteochondroma in his left forearm. It is growing on the end of his ulna and has caused the ulna to stop growing, resulting in the gap between it and his wrist bones. This has also caused his radius (the large bone on the thumb side of the forearm) to bow, and the elbow is starting to show the effects as well. We think it became more noticeable because of a recent growth spurt Mason had, but it has likely been there for some time. At any rate, all of this can be fixed surgically with good results. Mason is scheduled to have surgery at Children's Mercy Hospital.
Check back for updates as we find out more information.
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