RSD limb lengthening

[CHERRY KOVOOR]

Dear Friends

Kindly suggest what would be the best course of action

9 yr old girl -posteromedial LEFT tibial bowing with shortening of 5.5 cm. Ilizarov fixator applied with double level corticotomy on 6/11/2021. Distraction  started and after 2 weeks severe pain for which I couldn’t find any cause and attributed to distraction pain.

The child came to see me on 9/12/2021 -she was in severe pain and depressed, skin was shiny and mother informed that she couldn’t tolerate the fan being put on.

I feel it is now reflex sympathetic dystrophy

What would be the best treatment? I feel sympathetic ganglion block with long acting anesthetic would break the cycle

Attaching x-rays and clin pics

 

Regards

CHERRY