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[sixfootandhalf]

I am going to be consulting with the following surgeons soon: Paley, Lee, and Parihar, and Betz 

My concern is the following:

I have been informed from one of the above, who uses a weight bearing nail, that they have only had 4-5 non-unions in the last 20 years, and the risk of non-union is higher for Tibias than Femurs.

Theoretically speaking, if i was 175.5cm tall, and was lengthening femurs by 7cm, using a weight bearing nail, as someone in their 20s...

How could i mitigate the risks of non-union? What if i took X-rays more frequently?

What would i need to ask the surgeons about to mitigate this risk?

[Dirona]

The osteotomy technique in addition to your nutrition/moving about plays a big role. Please ask each of the doctor you are considering the osteotomy technique that they would be employing to prevent non-union.. Dr Lee has a very high success rate

[sixfootandhalf]

thank you for the reply - what do you mean by osteotomy technique?

[TheDream]

Never heard of a non union happening in the Femurs.

[boklecrt]

Never heard of a non union happening in the Femurs.

yeah ok professor

The osteotomy technique in addition to your nutrition/moving about plays a big role. Please ask each of the doctor you are considering the osteotomy technique that they would be employing to prevent non-union.. Dr Lee has a very high success rate

he means that some doctors absolutely shatter your bones when they break it in the surgery, leaving you a bunch of little bone pieces hanging in there creating a massive unnecessary additional trauma:

 


while other doctors are super precise and slowly and methodically knock on the bone with a chisel and produce a very clean break:

 

good doctor's osteotomies look perfect like if cut with a reciprocating bone saw - to be noted however that in LL we do not do osteotomies with a bone saw, because the clean cut would not produce the required body response, develop a blood clot and callus

bone saws are used for amputations

EDIT: changed chain saw to bone saw LOL chainsaws for amputations are used only in the horror movies!

[Michael J. Assayag, MD]

Technically an oblique osteotomy is one of the best a patient can get as it increases bone to bone contact.

The problem in this first set of x-ray is the varus deformity.

However you are correct that osteotomy technique is very important

[boklecrt]

Technically an oblique osteotomy is one of the best a patient can get as it increases bone to bone contact.

The problem in this first set of x-ray is the varus deformity.

However you are correct that osteotomy technique is very important

Thank you for clarifying Dr Assayag, i always thought the first type of osteotomy was just shoddy workmanship but I guess it does make sense that a bigger surface area would provide a better adhesion.

The second type of osteotomy looks aesthetically better however with the lack of bone shards in there.

And youre right, there is a deformity, again if you notice the nail has been inserted at the tip instead of the piriformis

[Dirona]

Technically an oblique osteotomy is one of the best a patient can get as it increases bone to bone contact.

The problem in this first set of x-ray is the varus deformity.

However you are correct that osteotomy technique is very important

@Dr Assayag..

There are 2 components to prevent non-union right?

1. Patient component - no smoking, follow right amount of lengthening, vitamin D supplements, moving about carefully, no comorbidities like diabetes etc
2. Surgeon's component - right osteotomy technique, not allowing the patient to lengthen too much

Am I missing something that is important? I am really scared of non-union. If non - union does occur in femur, what is the success rate of it being treated?