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[Ozymandias]

Interesting stuff, Greco (and kinda worrying, to be honest)

As for reaming the "head" of the bone, I'm not sure. I've seen x-rays where the nail is placed next to the top, however others look like this one:

http://www.abc.es/Media/201406/02/image%202--478x891.jpg

In a paper by Frank Birkholtz I posted here quite recently, he discussed a failure of nail distraction during femoral lengthening, which was apparently caused by an insufficient reaming. Therefore, it seems that surgeons are quite cautious about reaming too much.

I will try to investigate this as far as I can. Hope others contribute as well.

[Ozymandias]

Found some nice stuff about bone reaming and its consequences (I have highlighted the words "bone" and "reaming" in order to make lecture kinda easier)

Obviously the book is huge, and includes some interesting data about intramedullary rodding, but focusing on the reaming part (pages 279-281)

https://books.google.es/books?id=8sLNBQAAQBAJ&pg=PA279&lpg=PA279&dq=bone+reaming&source=bl&ots=WfOqZcHm-F&sig=TX21I_CTVfsWpsdoKnOqL7RoP-I&hl=es&sa=X&ved=0ahUKEwjxy_mAhevOAhWBXRoKHSk4AEgQ6AEIHDAA#v=onepage&q=bone%20reaming&f=false

(Hope the link works for everyone. I have screencaped some parts in case it doesn't. If some pages are not shown, you can always google the following parts, and hopefully they will appear)

"Destruction of the medullary contents by reaming has both local and systemic consequences. Reaming obliterates the remaining medullary blood supply after injury. This vascular system reconstitutes in 2 to 3 weeks."

"Therefore, destruction of marrow during reaming does not produce anemia, apart from that created through blood loss into the soft tissues"

So I'm guessing that the vascular system of the bone does not suffer long-term effects. Can someone confirm this?

[TIBIKE200]

Why are proportions, biomechanics, soft tissue damage or anything else any less important than this basically "new" thing about bone marrow?
  Bone reaming is also being done for the installation of titanium rods which have nothing to do with LL or CLL... If the method would have dire consequnces, the reaming for any reason would not be practiced....
  Adult bone marrow is a viscous fluid made of fats and water (And that's from where the risk of fat embolism comes from during internal CLL). There is nothing important in this fluid according to what science know till now. Maybe it is important maybe it isnt but no one knows now... People live pretty good without an entire leg (loss of limb for whatever reason)... They dont suffer any kind of anemia or immune disfunction which means that the body can compensate..

 Sorry, but it almost sound like trying very hard to find a reason as to why not to do this surgery... There are enough risks as it is... No need to add a new imaginary one

[El Greco]

Ok. I did expect that some people would lash back at me when I try to start a detailed scientific discussion, since details get people worried and consequently are not popular. But here is the thing: Refraining from thinking and researching will not make the consequeces and dangers go away. Just because you do not see something on somes doctor's website FAQ section does not mean it is not there. I say this with no hard feelings, and I can understand that you(I am assuming you did internals) do not want to think about this stuff.

Now, I will reply in as much detail as possible:

Why are proportions, biomechanics, soft tissue damage or anything else any less important than this basically "new" thing about bone marrow?

If you go back to my posts you can see that I was talking about biomechanics as something which IS IMPORTANT. As for proportions: I sit down in the train and look around me and find 10 guys whose proportions I would have if I did 20 cms. A person with average proportions would need to do a drastic amount to become disproportionate, not to mention most short guys have very low leg/body ratios. In any case proportion is not a health concern. When it comes to soft tissue damage, the reason bone quality is more important(I am not saying soft tissues are not important) is that soft tissues almost always get better after the procedure given enough time. I cannot say the same is true with bones(bone remodelling does not have to restore your bones to their previous strength if they get reamed, and if you do not like what I am saying give me evidence(Maybe now, you will say that there is no evidence to the opposite, but the opposite is what one would intuitively expect.))

Bone reaming is also being done for the installation of titanium rods which have nothing to do with LL or CLL... If the method would have dire consequnces, the reaming for any reason would not be practiced....
  Adult bone marrow is a viscous fluid made of fats and water (And that's from where the risk of fat embolism comes from during internal CLL).

Yes doctors have been doing this for a while, but this does not mean they know what physiological changes it causes within a 50 years span(I would appreciate articles about follow up after REAMED nailing(sometimes nailing is done with no reaming))

There is nothing important in this fluid according to what science know till now. Maybe it is important maybe it isnt but no one knows now...

Remember that we are talking about reaming and loss of bone marrow. These are not the same thing.
By the way, some articles which I have read say that the material released from reaming plays a role in the healing of the fracture(look up the section "Autografting by debris from intramedullary nailing"):

https://www.google.de/url?sa=t&source=web&rct=j&url=http://medicaljobinterview.org.uk/orthopaediceducation/books/images/pdf/FRCS%2520Orth%2520evidence%2520base%2520course/Presentation%2520for%2520Delegates/IM%2520Nailing%2520Biological%2520and%2520physiological%2520effect%2520%255BCompatibility%2520Mode%255D.pdf&ved=0ahUKEwiY_JecsO7OAhVDNxQKHXWPC_44ChAWCCcwBA&usg=AFQjCNF2INneFQuTGSRezU_mGxMxnlS5sA

...so reaming makes you lose more than just fat.

People live pretty good without an entire leg (loss of limb for whatever reason)... They dont suffer any kind of anemia or immune disfunction which means that the body can compensate..

Remember that we are talking about the effect of reaming on the operated bone segments and what happens when this segment loses ITS OWN marrow. If the segment has been amputated, everything we are talking about becomes irrelevant.

Sorry, but it almost sound like trying very hard to find a reason as to why not to do this surgery... There are enough risks as it is... No need to add a new imaginary one

I am very detrmined about having the procedure(for both tibiae and femurs) but I want to figure out the best procedure, and I can't unless I ask the big hairy questions.

I will not answer any more replies written in the same tone and attitude as the last one.

Best,
El Greco

[TIBIKE200]

Ok. I did expect that some people would lash back at me when I try to start a detailed scientific discussion, since details get people worried and consequently are not popular. But here is the thing: Refraining from thinking and researching will not make the consequeces and dangers go away. Just because you do not see something on somes doctor's website FAQ section does not mean it is not there. I say this with no hard feelings, and I can understand that you(I am assuming you did internals) do not want to think about this stuff.

Now, I will reply in as much detail as possible:

If you go back to my posts you can see that I was talking about biomechanics as something which IS IMPORTANT. As for proportions: I sit down in the train and look around me and find 10 guys whose proportions I would have if I did 20 cms. A person with average proportions would need to do a drastic amount to become disproportionate, not to mention most short guys have very low leg/body ratios. In any case proportion is not a health concern. When it comes to soft tissue damage, the reason bone quality is more important(I am not saying soft tissues are not important) is that soft tissues almost always get better after the procedure given enough time. I cannot say the same is true with bones(bone remodelling does not have to restore your bones to their previous strength if they get reamed, and if you do not like what I am saying give me evidence(Maybe now, you will say that there is no evidence to the opposite, but the opposite is what one would intuitively expect.))

Yes doctors have been doing this for a while, but this does not mean they know what physiological changes it causes within a 50 years span(I would appreciate articles about follow up after REAMED nailing(sometimes nailing is done with no reaming))

Remember that we are talking about reaming and loss of bone marrow. These are not the same thing.
By the way, some articles which I have read say that the material released from reaming plays a role in the healing of the fracture(look up the section "Autografting by debris from intramedullary nailing"):

https://www.google.de/url?sa=t&source=web&rct=j&url=http://medicaljobinterview.org.uk/orthopaediceducation/books/images/pdf/FRCS%2520Orth%2520evidence%2520base%2520course/Presentation%2520for%2520Delegates/IM%2520Nailing%2520Biological%2520and%2520physiological%2520effect%2520%255BCompatibility%2520Mode%255D.pdf&ved=0ahUKEwiY_JecsO7OAhVDNxQKHXWPC_44ChAWCCcwBA&usg=AFQjCNF2INneFQuTGSRezU_mGxMxnlS5sA

...so reaming makes you lose more than just fat.

Remember that we are talking about the effect of reaming on the operated bone segments and what happens when this segment loses ITS OWN marrow. If the segment has been amputated, everything we are talking about becomes irrelevant.

I am very detrmined about having the procedure(for both tibiae and femurs) but I want to figure out the best procedure, and I can't unless I ask the big hairy questions.

I will not answer any more replies written in the same tone and attitude as the last one.

Best,
El Greco

 Muscle tissue, nerve tissue or any other mesenchimal tissue cannot repair themselves completely... This is why there is a big concern regarding "soft tissue" (Although, I recently had a cup of coffee that exploded for some reason in my hand cutting part of my Tenar muscles groups which resulted in scar tissue in the muscle itself... Fortunately, I am happy to report that after the removal of all the stitches, the function of my thumb has almost returned to 100% almost 1 month after the incident. This has given me some relief in terms that muscle function can recover pretty good even if something like 20% of my muscle fibers according to the doc who operated my hand were completely cut).

 Now about the bone marrow stuff. Since it's not full of any pluripotent cells like young human marrow, the liquid is replenished (as far as I know... I might be wrong) which means that after nail removal, things go back to how they were... Post nail removal x-rays that were posted here and on old forum didnt seem to hint at a "hollow bone" so this is no concern as much as I believe.

Frankly, I dont really care what will happen to me when I will reach my 50's or 60's because (1) I want to do it as young as possible in order to "use" the advantages of being taller when they are mostly applied (everyone gets less and less superficial as they age... Especially women for which most of us do this surgery in the first place) (2) by that time I am pretty sure that medicine will be pretty advanced in order to fix any long term concequences.

[goldenegg]

Ok. I did expect that some people would lash back at me when I try to start a detailed scientific discussion, since details get people worried and consequently are not popular. But here is the thing: Refraining from thinking and researching will not make the consequeces and dangers go away. Just because you do not see something on somes doctor's website FAQ section does not mean it is not there. I say this with no hard feelings, and I can understand that you(I am assuming you did internals) do not want to think about this stuff.

Sorry El Greco, but I don't think you've magically discovered some big risk that the entire LL medical community has missed. the yellow marrow in an adult bone doesn't have any vital function which is why reaming and internal nails are acceptable in the first place not only for LL, but regular broken bones too. further, the marrow grows back after removal like others have pointed out.

I would be more concerned about real risks like PE from reaming. LL has plenty of important risks you should be worried about, but I think you're making a big deal out of a non-issue on this one. If still concerns you though, then I would go ahead and ask your surgeon before you do LL.

[gokharol]

even with a good doctor like Paley/Guichet and training your flexibility months before?? This is nonsense...

The real answer is that it varies by the individual. If you are athletic, exercise and stretch regularly, have a good doctor doing the procedure, and have a positive outlook during lengthening, you will find it very rewarding. I myself haven't lengthened yet but from reading the diaries of ppl that were lengthened by good doctors, I can tell that you will be more happy if you put 100% effort into it and focus on your goal.

I don't get why so many people on this forum have a self-defeating attitude of potentially being "crippled" and worry about all the possible complications in the world. Get off your ass, and train your legs and flexibility at least a year before your surgery. Stay active. If lengthening was easy, then everyone would be doing it but it takes hard work and if you're not willing to give it your all, then frankly you don't deserve to be taller in the first place.

I think that's a beautiful reply!
In case of having an actual chance to do it, I would surely workout and stretch a lot before doing it and really put myself into it!
I guess it could even be life changing and, maybe, while looking for this one goal of surgery, non-active people could find in sports a new reason to feel good with their own height.

[GirlOnline]

Wooov.. I can go thru anything with tall height .. just not limb amputation or paralyzed :p

[The Kaiser]

Wooov.. I can go thru anything with tall height .. just not limb amputation or paralyzed :p

then go with expert doctor, not ones in your height. trust me you will destroy your marriage and everything if something wrong happen.

[IwannaBeTaller]

I don't get why so many people on this forum have a self-defeating attitude of potentially being "crippled" and worry about all the possible complications in the world. Get off your ass, and train your legs and flexibility at least a year before your surgery. Stay active. If lengthening was easy, then everyone would be doing it but it takes hard work and if you're not willing to give it your all, then frankly you don't deserve to be taller in the first place.

Height is not something that is "deserved" at all. So many people get a good height completely for free, they do nothing to "deserve" it, they are born with a certain set of genetics, they grow up, and when they are 16 or 17, they reach their final height, that's it. Height is not some kind of award for great deeds, and should not be treated as such. If someone decids to do LL, he should know it's a step with many consequences, and if he prepares well or if he doesn't prepare well, both ways will have different consequences. But that's not because someone doesn't "deserve to be taller".

[onemorefoot]

Final height of males is reached until 18 in most of the cases, spine is the last part that stops growing.

[Lgazer]

then go with expert doctor, not ones in your height. trust me you will destroy your marriage and everything if something wrong happen.

That's right man. Things can go wrong and then you loose the best years of your life

[Antonio]

New study shows that increasing Tibia/Femur ratio beyond 0.8 is correlated with long-term arthritis.

Copy paste from link https://www.ncbi.nlm.nih.gov/pubmed/26398436:

The Association of Tibia Femur Ratio and Degenerative Disease of the Spine, Hips, and Knees.
Weinberg DS1, Liu RW.
Author information
Abstract
BACKGROUND:

When individuals with asymmetric lower extremities present for evaluation of limb-length inequality, correction can occur at the tibia, femur, or in both bones; however, there are limited data available to justify either technique. The aim of this study is to examine the normal ratio of tibia length/femur length (T/F), and to explore the relationship between T/F ratio and osteoarthritis of the spine, hips, and knees.
METHODS:

Bone lengths of 1152 cadaveric femora and tibiae from the Hamann-Todd osteological collection were measured. Degenerative joint disease was graded in the hip, knee, and spine. Correlations between the ratio of T/F and osteoarthritis were evaluated with multiple regression analysis.
RESULTS:

The average ratio of T/F was 0.80±0.03. There was a strong correlation between age and arthritis at all sites, with standardized β ranging from 0.44 to 0.57 (P<0.0005 for all). There was a significant correlation between increasing T/F and hip arthritis (standardized β=0.08, P=0.006), and knee arthritis (standardized β=0.08, P=0.008).
DISCUSSION:

Increasing tibia length relative to femur length was found to be a significant predictor of ipsilateral hip and knee arthritis. Therefore, we recommend that when performing limb lengthening, surgical planning should lean toward recreating the normal ratio of 0.80. In circumstances where one bone is to be overlengthened relative to the other, bias should be toward overlengthening the femur. This same principle can be applied to limb-reduction surgery, where in certain circumstances, one may choose to preferentially shorten the tibia.
CLINICAL RELEVANCE:

This is the first study to report long-term consequences of lower extremity segment disproportion.

[Dhdhdjuru]

What could go wrong so badly at a reputable doctor, they dont want to kill you and an official death has bever been reported. Surely if something goes wrong they can somehow find a way around it, no?

[LLSouthAmerica]

What could go wrong so badly at a reputable doctor, they dont want to kill you and an official death has bever been reported. Surely if something goes wrong they can somehow find a way around it, no?

Putting aside the risk of thromboembolism and fat embolism which can kill you, and all the risks of the surgery itself that can happen but its frequency is reduced when going to a top doctor? Sure, your bone healing might be slow and you might end up with an exponentially longer recovery time that you considered making you lose your job and going into bankruptcy.

[onemorefoot]

What could go wrong so badly at a reputable doctor, they dont want to kill you and an official death has bever been reported. Surely if something goes wrong they can somehow find a way around it, no?

Reputable is not the same that capable. The worst thing that can happen is amputation, death is ridiculous now. Most of the times yes they can find a way, just go to a good doc, we have diaries here, not to hungry moneymakers.

[Thatdude950]

What could go wrong so badly at a reputable doctor, they dont want to kill you and an official death has bever been reported. Surely if something goes wrong they can somehow find a way around it, no?

There have been a *number* of patients who have had to get corrective surgery during/after lengthening. Often more than once. All this costs tens of thousands more. Unless you're a multi-millionaire, this can destroy your life financially. This will severely limit your choices in life-- anything from getting a loan, to taking a spur of the moment trip with friends will be compromised. Not to mention the toll on your body from multiple surgeries. And the income you lose during this period.

So you probably won't die but it can still pretty much destroy your life.

[backrandom]

There are many anonymous patients (some of them without an account in this forum) who had indeed their lives destroyed by LL. Respect to all those people who lost their time, health, money, and love from their dearest ones after the surgery and its many complications.

[TemakiSushi]

Looking at the change of the man's picture in the following site, it seems 5 cm lengthening of tibia is even too much.
Is it because he seems to have lost too much muscle?
anyway looking at this I probably will be happy with 3 cm lengthening of tibia considering too much risks of this surgeries.
However people may think I7m too crazy for doing only 3 cm.  But, since I'm an asian my tibia is a little too short aesthetic wise.

https://pds.exblog.jp/pds/1/201709/14/65/d0092965_03402268.jpg
http://shirabeau.exblog.jp/25605778/

[Android]

Looking at the change of the man's picture in the following site, it seems 5 cm lengthening of tibia is even too much.
Is it because he seems to have lost too much muscle?

That is precisely why. He lost a good amount of muscle and fat, which can make people look sickly. It's not a good look, but alas it's temporary.

It's better to look for patients a year or two after consolidation.

[Tiger9898]

Looking at the change of the man's picture in the following site, it seems 5 cm lengthening of tibia is even too much.
Is it because he seems to have lost too much muscle?
anyway looking at this I probably will be happy with 3 cm lengthening of tibia considering too much risks of this surgeries.
However people may think I7m too crazy for doing only 3 cm.  But, since I'm an asian my tibia is a little too short aesthetic wise.

https://pds.exblog.jp/pds/1/201709/14/65/d0092965_03402268.jpg
http://shirabeau.exblog.jp/25605778/

I don't know whether the picture is deceptive or not. But even though he has done 5 cm, his tibia looks so long.

[myloginacct]

That is precisely why. He lost a good amount of muscle and fat, which can make people look sickly. It's not a good look, but alas it's temporary.

It's better to look for patients a year or two after consolidation.

Yep.

And the longer tibias look better to me. He just needs to recover from LL.

[Wwoman26]

I totally agree with you, I had it done when I was only twelve because i was born with a leg longer than the other one and its been hell to me this past 18 years living in pain not being bale to function 100 percent its the worst especially as a female, like wearing heels on a special occasion is a challenge. I wish my dad had never allowed that surgery

[LAGrowin]

I’m female and plan to do cross lateral, 4 or 3 cm on femur and 3 cm on tibia. Is this relatively low risk because not lengthening large amounts??

Would be one femur and one opposite tibia then after the other 2 cross sections.

I’m about to give up my job, my apartment, leave all my stuff in boxes to go and do this and change my life. I’m so scared but feel I have to do it.

Good for you that you've made your decision to take this step.  Where are you doing it?  How tall are you currently ?

[myloginacct]

I totally agree with you, I had it done when I was only twelve because i was born with a leg longer than the other one and its been hell to me this past 18 years living in pain not being bale to function 100 percent its the worst especially as a female, like wearing heels on a special occasion is a challenge. I wish my dad had never allowed that surgery

I wish we had asked her more questions when she'd still be reading the forums.

Wwoman26 is the classic example of justified LL: correcting a limb length discrepancy in a child whose growth plates are still not closed. Even despite that, she thinks she'd rather have lived with the discrepancy.

Of course, she may have had a completely different opinion and went for LL herself (as an adult) had her parents not decided on this for her when she was a child, but this we'll never know.

[Hamiltonzac]

I got a private message about this and wanted to share it with the rest of the forum.

Here's the Universal Pain Assessment Tool:
http://www.docstoc.com/docs/25724858/UNIVERSAL-PAIN-ASSESSMENT-TOOL

When walking it's 0.5 to 1.  I notice it but can ignore it and just keep walking, for hours if necessary.  After using the knees a lot I barely notice it at all.  If my knees were metal, I'd say they get rusty easily and that using them lubricates them.

When kneeling it's 1 to 3.  I always notice it, and sometimes I can ignore it.  But other times it interferes with tasks.  The worst situation would be walking on my knees on a hard surface.  I'd definitely feel it and it would interfere with how I walked.  Working out doesn't help this at all.  I guess I'd better behave myself since apologizing on my knees would hurt. 

Not trying to sound smart but I'm going to assume that kneeling down on concrete would hurt anyone and not just former LL patients.

[taller_in_Kiev]

I did LL 14 yrs ago, read my diary

[6'2_dream]

Hello Friend
I would like to know how it is now, the pains are better, are you training enough?

[Sweden]

I can update my pain level as well. I almost feel no pain at all in my knees anymore and I run, jump, do martial arts and all there is to it today and I feel barely anything.

I got used to the pain so nowadays I’m surprised I don’t feel it anymore.

There is still a little bit of stiffness in the mornings but it’s nothing really. I mean, who isn’t stiff in the morning?

I was just out for a long run and there is no sensitivity or any pain in the knees.

I’ve been actively trying to fix my Xlegs with many exercises and have special made insoles I use when I walk.
Maybe it has helped, don’t know - but life without pain is better!!

And no, I won’t remove my rods in my legs. I will die with them in there.

[6'2_dream]

Hello Friend Sweden
How nice that you can jump and run.
congratulations for the dedication, no doubt you had evolution and few pains today because you were very dedicated in training.
how interesting I did not know there was surgery that did not remove the internal rods.

[myloginacc]

And no, I won’t remove my rods in my legs. I will die with them in there.

Interesting.