Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[Anndr000]

Hi everyone, I am here for some advice on what might be the issue with these random aching pain attacks that I’m experiencing every couple months or so…

The pain has only presented itself on my right leg, and it first starts out with a sore feeling around the lowest part of my calf muscle to the higher part of my Achilles’ tendon… then it progressively gets worse with the area around my locking screws becoming extremely tender to the touch. My entire lower leg will have random pulsating pain, and sleeping at night is impossible due to extremely unbearable shin splint aching pain… I have to constantly adjust my right leg position every few minutes to find a position that will alleviate the pain.

This whole debacle takes anywhere from 7-9 days to go away completely… and they are generally months apart. I have a theory or so on why this is happening, but I’m inexperienced at this and hopefully someone else who has gone through the same problem can tell me what is going on…

Here is a little background:
I did tibial lengthening using LON method back on January 8, 2020.

Gained about 6cm and got the frames removed on March 10th, 2020.

Started walking completely normal again around November 2020.

Was able to play competitive tennis again around January 2021.

Incident occurred:
First random aching pain attack occurred around july, 2020 when I was still slowly walking again.

Second attack occurred late April, 2021 after a grueling tennis match.

This third attack (currently right now) September 20, 2021.

My theory:
I got X-rays regularly and noticed there was something strange at the end of one of my locking screws on my right leg. My theory is that the screw is rubbing or pinching against something every now and then whenever I make some awkward movement that I am not aware of… I’ll post the X-rays here.
PLEASE ADVISE!!!

https://imgur.com/a/XIUQmOE

[canterk]

It has been 1.5 years since you finished lengthening when are you going to remove the hardware inside? Maybe the pain will go away once those are removed?

[LLprime3]

He should not remove the nail, his Tibia is not even consolidated fully on the second image.
It doesn't look like that one locking screw is hitting the fibula, but that spot is exactly where the screw would hit it, if it could...


Maybe a certain rotation between Tibia and Fibula makes it possible for the screw to touch the Fibula, like this
https://imgur.com/gu9t9Tf

[Anndr000]

Oh sorry, those xrays were actually taken this past February..  so about 8 months ago. I’m going to the doctor this Friday to get a new X-ray. My consolidation should be much better now.

You think I can at least get 1 or both of the locking screws removed? Not the internal nail.

[Anndr000]

He should not remove the nail, his Tibia is not even consolidated fully on the second image.
It doesn't look like that one locking screw is hitting the fibula, but that spot is exactly where the screw would hit it, if it could...


Maybe a certain rotation between Tibia and Fibula makes it possible for the screw to touch the Fibula, like this
https://imgur.com/gu9t9Tf

Oh sorry, those xrays were actually taken this past February..  so about 8 months ago. I’m going to the doctor this Friday to get a new X-ray. My consolidation should be much better now.

You think I can at least get 1 or both of the locking screws removed? Not the internal nail.

[Anndr000]

It has been 1.5 years since you finished lengthening when are you going to remove the hardware inside? Maybe the pain will go away once those are removed?

I would like to get the hardware remove, but I got the operation done in a different country, and currently their border is closed due to covid… I’m unsure if the doctors in the US will have the necessary tools to remove my hardware, since hardware can differ countries to countries.

[eric.cartman]

Oh sorry, those xrays were actually taken this past February..  so about 8 months ago. I’m going to the doctor this Friday to get a new X-ray. My consolidation should be much better now.

You think I can at least get 1 or both of the locking screws removed? Not the internal nail.

I'm sure you can get at least one of the distal screws removed. Given that your bone is strong enough, although not fully consolidated, you should be able to get away with three screws.
Having said that, playing competitive tennis with those screws in your tibia is perhaps not the best idea. Weight bearing is one thing but the forces acting on your joints with sudden changes in speed/direction is a different story. It doesn't matter how strong your bone growth, the screws will always keep rubbing against the soft tissue in some form or another until they are removed.

[Activatedxx]

I would like to get the hardware remove, but I got the operation done in a different country, and currently their border is closed due to covid… I’m unsure if the doctors in the US will have the necessary tools to remove my hardware, since hardware can differ countries to countries.

They will have the necessary tools and if you wait to long removal will be much harder of the nail
Should be covered if you have insurance

The screws are probably backing out. Very common issue
I would take all hardware out but you can take screws out only should do the trick

[LLprime3]

I would like to get the hardware remove, but I got the operation done in a different country, and currently their border is closed due to covid… I’m unsure if the doctors in the US will have the necessary tools to remove my hardware, since hardware can differ countries to countries.

Then removing this one screw should be good enough to deal with the issue. That's what I would do. This screw is very suspicious.

[Anndr000]

Sounds like removing the locking screws should alleviate most of my problems.. it’s just so bizarre to me that this only happens every 6-8 months, and with really no indication on how it even happened…

Thank you everyone for your inputs!

[Medium Drink Of Water]

I would like to get the hardware remove, but I got the operation done in a different country, and currently their border is closed due to covid… I’m unsure if the doctors in the US will have the necessary tools to remove my hardware, since hardware can differ countries to countries.

If you give them information about the nail they can get the tools.  Ask your doctor and relay the information.

[Mayday]

A similar problem occurred with Stryde screws, maybe the same situation. Your bone seems healed enough to remove 1 screw. You can consult your surgeon and remove the screw from the painful area.

[Michael J. Assayag, MD]

few things here:

The reaction in front of the screw seems to be a little heterotopic ossification, usually indicating of soft tissue trauma. that screw is most likely irritating soft tissues . that’s one potential cause.

The screws are Not backing out, this is not a reaction similar to stryde lysis/periosteal reaction (your trauma rod is most likely titanium, which has not been found to create those issues.

Finally, the nail being very rigid ,( more than your bone) could be causing pain after intense effort due to the difference in elasticity between nail and bone.

lastly, the tools necessary to remove those rods are quite universal.. all a surgeon may need is a 4/4.5/4.7mm hex screw driver, and a conical extractor. It is a skill most orthopedic surgeons have HOWEVER, not all orthopedic surgeons believe in removing hardware… It may sound silly but there’s two distinct school of thoughts: the hardware removers, and the non removers ..

Bottom line is: Removing the locking screws may or may not resolve the issue.

hit us back with new recent xrays and i’ll tell you if the rods are ready for removal.

Most insurances will cover the cost

[Anndr000]

few things here:

The reaction in front of the screw seems to be a little heterotopic ossification, usually indicating of soft tissue trauma. that screw is most likely irritating soft tissues . that’s one potential cause.

The screws are Not backing out, this is not a reaction similar to stryde lysis/periosteal reaction (your trauma rod is most likely titanium, which has not been found to create those issues.

Finally, the nail being very rigid ,( more than your bone) could be causing pain after intense effort due to the difference in elasticity between nail and bone.

lastly, the tools necessary to remove those rods are quite universal.. all a surgeon may need is a 4/4.5/4.7mm hex screw driver, and a conical extractor. It is a skill most orthopedic surgeons have HOWEVER, not all orthopedic surgeons believe in removing hardware… It may sound silly but there’s two distinct school of thoughts: the hardware removers, and the non removers ..

Bottom line is: Removing the locking screws may or may not resolve the issue.

hit us back with new recent xrays and i’ll tell you if the rods are ready for removal.

Most insurances will cover the cost

Hi, thank you for your insight.. I took a new X-ray today and it seems the area right where the locking screws are on my right leg is experiencing Proximal Tibiofibular synostosis? I’ll post pics below… if anyone can give insight to what they think this might be…

https://imgur.com/a/TkmctAr

[Michael J. Assayag, MD]

Hi, thank you for your insight.. I took a new X-ray today and it seems the area right where the locking screws are on my right leg is experiencing Proximal Tibiofibular synostosis? I’ll post pics below… if anyone can give insight to what they think this might be…

https://imgur.com/a/TkmctAr

very interesting.

the synostosis per se should not cause you much issue, but it may be a good idea to get those rods removed.

I would be willing to bet one of those distal locking screws are irritating soft tissues.