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[Thegosis]

My IM nails were planted in both my tibiae in mid-May this year in Beijing after 8cm of bilateral leg lengthening. I've since been walking on them and they are not proposed for removal until December 2016.

Another user of this forum, Little Liam who is about to undergo his first surgery in Beijing, has said that he may leave in his IM nails indefinitely. This surprises me because I did not know it was a realistic option. The IM canal is where the presence of bone marrow generates certain beneficial effects for the body. If a titanium nail is there instead for more than two years then how smart is that?

Dr Birkholtz in South Africa? Anybody?

[Medium Drink Of Water]

Dr. Birkholtz has said on here that in adults, the long bones in the body (like the tibia and femur) don't have much marrow anymore and are filled mostly with fatty tissue.

It is a realistic option, and in a lot of cases (mostly non-cosmetic), doctors will sometimes decide it's better to leave the nails in than to subject the patient to the trauma of another major surgery.

[GROWtalORdieTRYING1]

Dr. Birkholtz has said on here that in adults, the long bones in the body (like the tibia and femur) don't have much marrow anymore and are filled mostly with fatty tissue.

this is interesting. can you please elaborate in more detail?

[TRS]

Adult long bone contains yellow marrow which is mainly fatty tissues. Basically red bone marrow (which contains stem cells) gets converted into yellow bone marrow as we age. It depends on which bones are involved but since IM nails involve the long bones (femur & tibia), the canals mostly contain yellow bone marrow.
Now whether leaving the nails in the bone, it depends what nail is inside. For example, many doctors that use PRECICE advice to remove the nail because of the rare earth magnets and the corrosive moving parts in the nail. This could also mean that the ratcheting nails should also be removed because of the moving parts.
But the IM nail used in LON/LATN is inert and since it does not contain any earth magnets or moving parts, many doctors do believe that the IM nail could stay indefinitely and avoid the additional trauma caused by nail removal.
I will ask Dr.Birkholtz for his opinion on this. 

[Sweden]

My doctors here in Sweden told me it's better to leave the rod inside the leg than removing it.

They don't bother me that much so I'm not going to remove them. I can jump and run so there is no need to remove them.

My doctors even told me its a reinforcement of the tibias.

[G-Man]

Just don't get into a ski accident! 

[KiloKAHN]

Wouldn't one have to worry about impact though if they keep the nails in? Say you jump from a high place or something, couldn't the vibration from the nail damage your bones?

[programdude]

Pretty sure your bones grow back stronger than before, which would mean vibrations wouldn't do anything.

[Uppland]

Are there any official drawbacks and advantages to leaving the nail?

Is there even any point in removing them at all?

[AtlasSearching]

Speaking from personal experience, you will always feel the presense of the nails if you keep them in. You might get used to the sensation, but it will be present. I lengthened 10.5cm and had the 13mm BetzBone for 1.5 years after completing consolidation and could always tells it was there, particular when jogging or running. The sensation is most apparent on the distal screws since weight is transfered to the lower femur during an activity such as jogging. My experience is also not unique. The other guys who did femur LL during the same period also say the same thing. Aside from the sensation other things to consider:

• greater tissue trauma if you are unfortunate enough to have an accident that breaks the bone
• the nail takes up space that would otherwise contain yellow bone marrow
• if you have the titaniums put in after lengthening, they are much stronger but titanium is a 'soft' metal and after some years, the bone fuses into the metal making it impossible to ever remove the nail. This actually happened to a patient

[Uppland]

Thank you so much for sharing. Is the feeling of nails present unpleasant or hindering in any way?

Also isn't there additional trauma associated with removing them, or is that harmless in the long run?

I understand the yellow bone marrow will regenerate if the nail is removed, correct?

[AtlasSearching]

The sensation of the nail after consolidation is not unpleasant when walking. Usually you'll not feel it unless you do a high impact activity like running. This is for the femur nail. I haven't had the tibia nail so I can't speak on that. I used to run long distance before LL, so in my case, I was keen to have the nails removed so that I can get back to running and not be concerned about the nails.

Getting the nails removed does require surgery but its pretty easy and short (around 1 hour) compared to the insertion surgery. I had my removal surgery in the morning and by noon, I was back on my feet walking as usual. Then one day later, I travelled back to the US from Germany without any issues.

Yes, the yellow bone marrow does regenerate after the nail has been removed.

[Uppland]

ok thank you just one last question to clarify if I may: you said the nails made running very uncomfortable, or just an unusual sensation?

[AtlasSearching]

For me the sensation is unconfortable when running, but it didn't stop me from running. Every time the foot strikes the ground, I'd feel the sensation, which is now gone after I had the nails removed. Bear in mind that everyone is different and the extent of lengthening probably plays a role. If you look at the diary for OldieButGoldie, you can see a video of him running while he still had his nails. I had my nails removed on the same day as he did, and the day before the surgery he went for a jog around the hospital in Neunkirchen.

[Uppland]

10,5 cm lenghtening is qute alot. I hope you are feeling alright, is there anything you can tell us about your recovery and physical ability?

Thanks for answering my questions it helps alot.

[AtlasSearching]

10,5 cm lenghtening is qute alot. I hope you are feeling alright, is there anything you can tell us about your recovery and physical ability?

I've posted some info here http://www.limblengtheningforum.com/index.php?topic=1120.0 that is relevant to your questions.