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[Wannabegiant]

This was talked about in several other topics but i figured it deserved its own since its a very important issue.

I have heard that you can walk with fixators during lenghtening phase, as well as consolidation phase, and the fixator and pins are supposed to keep the bone in place and prevent the gap from closing from pressure during lengthening and consolidation phase.

But it seems some people have lost height mysteriously, after lengthening was done. So is it true that the gap created in the bone for height gain can actually compress if you stand up and/or walk? Are the fixators not reliable? and during consolidation phase is it still possible for the gap to compress even though you are wearing the fixator? in this phase shouldnt the bone already have formed enough callus in the gap to make it impossible to compress unless it was fractured?

[Moubgf]

It is spine compression. Deal with it.

[Wannabegiant]

It is spine compression. Deal with it.

So are you sure that the height loss isnt due to compression of the bone gap? Some comments in that other thread made me confused. I was hoping that the external fixator would be able to guarantee that the height gain was maintained. However in swedens case it must be something else like the spine i guess as he had nails inserted as well..

[Smallguy]

So are you sure that the height loss isnt due to compression of the bone gap? Some comments in that other thread made me confused. I was hoping that the external fixator would be able to guarantee that the height gain was maintained. However in swedens case it must be something else like the spine i guess as he had nails inserted as well..

Hey Wannabegiant.

You only wear the external fixture during the lengthening phase. And any lost you made during your lengthening phase you can make up for. It just means you have to spend more time lengthening.

He measured his height several times when he came back home. And his noticed his height lost yesterday? And his bones were already 98% consolidated. I don't know. Personally, these are my speculations

1. Inaccurate measurement before (eg. measuring standing on ballerina foot)

2. Spinal compression?

Yup, I have no clue.

[somecm]

I am convinced if you or exercise a lot on the first year after LL you can loose some height.

[Medium Drink Of Water]

I am convinced if you or exercise a lot on the first year after LL you can loose some height.

Why are you convinced of something that doesn't make sense, and for which no evidence exists?

The bone will either stay where it is or break.  It doesn't shrink or slide or compress or anything like that.

[Doflamingo]

I'm pretty sure it's the spine compression.

[Wannabegiant]

Hey Wannabegiant.

You only wear the external fixture during the lengthening phase. And any lost you made during your lengthening phase you can make up for. It just means you have to spend more time lengthening.

He measured his height several times when he came back home. And his noticed his height lost yesterday? And his bones were already 98% consolidated. I don't know. Personally, these are my speculations

1. Inaccurate measurement before (eg. measuring standing on ballerina foot)

2. Spinal compression?

Yup, I have no clue.

Hey yeah in Swedens case he removes the frames after lengthening cause he inserted nails as well, LON or LATN, not sure. So he cannot have lost height by compression of the gap. so probably spine or inaccurate measurment.

And i know i can make up for lost height during lengthening phase, but as you did, i will probably lay down most of the time to make sure i dont waste time making up for lost height gain.

What i really want to know is if you do externals only like me (which means i need to wear them for like 3 months after lengthening phase is over) then is it possible for the gap to compress while im walking around during consolidation phase? Since i want to fly home to my own country after lengthening is done, i wont be able to make up for any losses that could happen then. But I thought the external fixators would be reliable in holding the bone and the gap in place, so you dont lose any height. Is it really possible for me to lose height during this phase? it doesnt seem reasonable, if its true then i might not dare to go home until the bone is consolidated and i can remove the frames.

[Medium Drink Of Water]

Most pin bending happens in the beginning.  Once they've bent however much they're going to bend from bearing your weight and resisting lengthening, they're done bending.

[Wannabegiant]

Most pin bending happens in the beginning.  Once they've bent however much they're going to bend from bearing your weight and resisting lengthening, they're done bending.

Oh i see, i thought for some reason that the doctor would replace pins that began to bend. what you said makes perfect sense though. So when i know the pins cant bend anymore, then it should be safe.

awesome thank you!

On the other hand, i guess that means i need to be really careful in the beginning of consolidation phase, like when im flying home and im carrying my luggage, that would increase the weight load on my fixators, which might cause extra bending? but i guess the pins have a limit to how much they can bend which should already have been reached? unless they break which seems unlikely

[Medium Drink Of Water]

Yeah they have a limit to how much they're going to bend, and breaking is really unlikely.  But you can't be too careful when recovering from LL in my opinion.  Get someone to help you with your bags and other heavy lifting.

[Adriano]

1) if u cut a piece of timber with a saw and put it back together,  the 2 parts  put together are shorter than the original length of the uncut piece of timber.

2) our leg bones ( especially) femurs are not 100% vertical.

this is why amount lengthened is always greater than actual height gained.

[Wannabegiant]

1) if u cut a piece of timber with a saw and put it back together,  the 2 parts  put together are shorter than the original length of the uncut piece of timber.

2) our leg bones ( especially) femurs are not 100% vertical.

this is why amount lengthened is always greater than actual height gained.

I agree with 2) although i always thought tibias where on average less straight than femurs, i could be wrong.

1) doesnt apply because a piece of timber doesnt have the regenerative ability of the bone.

[somecm]

Why are you convinced of something that doesn't make sense, and for which no evidence exists?

The bone will either stay where it is or break.  It doesn't shrink or slide or compress or anything like that.

In my opnion, it compresses, however less with a nail inside. But after the first months it can really compress if you put a lot of streess on it. Remember the bone is not steel, and on the first months after LL, density may not be the same. I remember Dr. Guichet saying something about this too. That is why I never run or worked out my legs before 1 year after LL.

[Medium Drink Of Water]

1) if u cut a piece of timber with a saw and put it back together,  the 2 parts  put together are shorter than the original length of the uncut piece of timber.

2) our leg bones ( especially) femurs are not 100% vertical.

this is why amount lengthened is always greater than actual height gained.

1. On the operating table, surgeons will lengthen you much more than what you'd lose from the osteotomy.  They don't leave the two pieces touching.

2. True, but if the gap is properly measured from a standing x-ray this can be compensated for as well.  Never trust how many clicks/turns you did.  That number is going to be WAY off.

[KiloKAHN]

Not entirely sure this has to do with the topic at hand, but this is what Dr. Parihar wrote about compression during the consolidation phase of lengthening.

At the end of distraction, Ilizarov recommends "training the regenerate'. Simply put, this involves overlengthening the limb by 7 to 10 mm and then compressing this back to the proper length in a gradual fashion. This ensures a larger cross sectional area of regenerate to participate in the consolidation. The fixator has to be neutralized to ensure that the weight bearing stresses will be transferred to the newly formed osseous tissue. Neutralization is achieved by reversing (compressing) the rings at a rate of 0.25 mm an alternate days till the rings no longer move towards each other. At this point there is no more tension in the system, and most of the weight bearing forces are transmitted through the bone. This procedure may render the wires relatively lax, and they may need to be tensioned if the patient complains of pain or instability can be demonstrated. At this time a monthly follow up will usually suffice. During the consolidation phase the risk of complications is reduced markedly, and the patient's functional abilities increase. Movement and ambulation are encouraged to ensure a speedy consolidation of the regenerate.

Was thinking that if you overlengthen the limb by 7 to 10 mm as he says, then when you compress gradually until you hit the intended length, you wouldn't have any more room for compression afterward. Just an idea. Might be looking at this the wrong way.

[Wannabegiant]

Not entirely sure this has to do with the topic at hand, but this is what Dr. Parihar wrote about compression during the consolidation phase of lengthening.

At the end of distraction, Ilizarov recommends "training the regenerate'. Simply put, this involves overlengthening the limb by 7 to 10 mm and then compressing this back to the proper length in a gradual fashion. This ensures a larger cross sectional area of regenerate to participate in the consolidation. The fixator has to be neutralized to ensure that the weight bearing stresses will be transferred to the newly formed osseous tissue. Neutralization is achieved by reversing (compressing) the rings at a rate of 0.25 mm an alternate days till the rings no longer move towards each other. At this point there is no more tension in the system, and most of the weight bearing forces are transmitted through the bone. This procedure may render the wires relatively lax, and they may need to be tensioned if the patient complains of pain or instability can be demonstrated. At this time a monthly follow up will usually suffice. During the consolidation phase the risk of complications is reduced markedly, and the patient's functional abilities increase. Movement and ambulation are encouraged to ensure a speedy consolidation of the regenerate.

Was thinking that if you overlengthen the limb by 7 to 10 mm as he says, then when you compress gradually until you hit the intended length, you wouldn't have any more room for compression afterward. Just an idea. Might be looking at this the wrong way.

Wow so i would basically need to lengthen 5 cm to get 4 cm? i wonder if that is taken into account since Mirzoyans price is set per cm.
This is very confusing, on one hand i would not want to lengthen more than necessary because of the increased time spent and longer recovery. But still i would hate to pay for and lengthen 4 cms and end up with 3 cms height gain in the end because of compression.

I hope the doctor is aware of all this and has a solution. i wish the external fixators where more reliable.

[Sweden]

Even my Dr told me to do 7,5cm if I wanted 7cm.

If you have pin bending you have to do more than desired length.

I would advice you to do 5,3 or something like that. You will probably have pin bending bc you're going to stand up a lot. I didn't do that and I suffer like hell bc of it.

[Medium Drink Of Water]

Wow so i would basically need to lengthen 5 cm to get 4 cm? i wonder if that is taken into account since Mirzoyans price is set per cm.
This is very confusing, on one hand i would not want to lengthen more than necessary because of the increased time spent and longer recovery. But still i would hate to pay for and lengthen 4 cms and end up with 3 cms height gain in the end because of compression.

I hope the doctor is aware of all this and has a solution. i wish the external fixators where more reliable.

He's not saying you should lengthen 5 if you want 4 because you'll shrink 1cm.  He just means turn 5 and then shorten back to 4 if you want 4.

Also, this is an original Professor Ilizarov writing that mentions wires, which (as far as I know) no doctor is using anymore.  It might not be relevant now that everyone's switched to pins.

[Medium Drink Of Water]

Even my Dr told me to do 7,5cm if I wanted 7cm.

If you have pin bending you have to do more than desired length.

I would advice you to do 5,3 or something like that. You will probably have pin bending bc you're going to stand up a lot. I didn't do that and I suffer like hell bc of it.

I lost way more than half a cm due to pin bending.  This is why you measure gains with x-rays rather than how much you've turned the fixator.

[Wannabegiant]

He's not saying you should lengthen 5 if you want 4 because you'll shrink 1cm.  He just means turn 5 and then shorten back to 4 if you want 4.

Also, this is an original Professor Ilizarov writing that mentions wires, which (as far as I know) no doctor is using anymore.  It might not be relevant now that everyone's switched to pins.

Okey thanks but what does it actually mean shorten back to 4? il need to stay the extra time to be able to turn between 1mm and 2mm a day until i reach 5, and then can i shorten it back myself with the fixator? i thought the thing that shortened me back to 4 was compression from standing up?

[Medium Drink Of Water]

This is something else entirely.  It has nothing to do with losing height for any reason other than intentional turns in the other direction.   Apparently Prof. Ilizarov believed this would improve the strength of the new bone and/or make it consolidate faster.

Again, you lose length due to pin bending, which happens mostly at the beginning.  Once your legs are lengthened they either stay that length or break.  Dr. Peng told me I lengthened 7.5cm and that's how much taller I am now.

[Wannabegiant]

This is something else entirely.  It has nothing to do with losing height for any reason other than intentional turns in the other direction.   Apparently Prof. Ilizarov believed this would improve the strength of the new bone and/or make it consolidate faster.

Again, you lose length due to pin bending, which happens mostly at the beginning.  Once your legs are lengthened they either stay that length or break.  Dr. Peng told me I lengthened 7.5cm and that's how much taller I am now.

Yeah sry for asking the same thing so many times, but different answers from different people made me unsure. Just to make it clear when you say "once your legs are lengthened they stay that way or break", you mean at the end of the lengthening phase  right before the consolidation phase starts, right? if that is what you meant, am i correct in assuming that part of the bone will already have consolidated at this point, meaning that it would have to break again to shrink?

thank you for your help

[Medium Drink Of Water]

Rather than get deeper into the confusion, let me just tell you what I know on the subject.  Any genuine height loss in the legs is going to be due to pin bending.  It has nothing to do with the bone and everything to do with the fixators.  Your pins will be done bending by the time you're done lengthening unless you haven't done any weight bearing.

As long as you don't put more stress on them during the consolidation phase than you did during the lengthening phase, you're not going to lose any height.  So don't run or jump with the fixators on during consolidation if you hadn't already been doing that during lengthening.

Once your bones are fully consolidated, you don't have to worry about height loss anymore.  The new bone is strong just like your old bone.

[Wannabegiant]

Rather than get deeper into the confusion, let me just tell you what I know on the subject.  Any genuine height loss in the legs is going to be due to pin bending.  It has nothing to do with the bone and everything to do with the fixators.  Your pins will be done bending by the time you're done lengthening unless you haven't done any weight bearing.

As long as you don't put more stress on them during the consolidation phase than you did during the lengthening phase, you're not going to lose any height.  So don't run or jump with the fixators on during consolidation if you hadn't already been doing that during lengthening.

Once your bones are fully consolidated, you don't have to worry about height loss anymore.  The new bone is strong just like your old bone.

okey i get it now, awesome thanks again 

[Wannabegiant]

But then again, some people have reported losing some height after the fixators where removed  , like a few mm but still. Is this true and if so what is the cause of it? maybe i would have to lengthen a few mm extra to make up for it in that case.

[Medium Drink Of Water]

Whether you're measuring height or the bone gap, you're not going to be exact down to the millimeter.  The edges of the gaps are fuzzy in x-rays so it's unclear exactly where to measure.  Height fluctuates throughout the day and is difficult to measure down to the mm anyway.

I gained probably somewhere between 7.4cm and 7.6cm.

[Wannabegiant]

Whether you're measuring height or the bone gap, you're not going to be exact down to the millimeter.  The edges of the gaps are fuzzy in x-rays so it's unclear exactly where to measure.  Height fluctuates throughout the day and is difficult to measure down to the mm anyway.

I gained probably somewhere between 7.4cm and 7.6cm.

yeah thats true, though i guess if the doctors let me, il add a few mm extra over my 4 cm to make sure.

[Wannabegiant]

I guess what i really wanted to know was kind of not mentioned because i didnt clarify exactly what i meant:

I will ask the doctor as well in our next meeting, but I might as well ask here as well.

When doing External only (no rod inside the bone), once you are far into the consolidation phase, shouldnt the gap have already hardened to a degree, meaning that for any height loss to happen, it would need to "break" or "crack" a bit.

What i mean is that even if you where to remove the fixators slightly earlier than the expected time, if the x-rays shows you have good bone formation, but that it is still not 100% recovered like before, the danger would be that there is a bigger risk of breaking if you where to remove the frames before the predicted time schedule, but the bone at this point wont be able to compress and lose height by simply walking etc? is this correct?

to long didnt read version:

when you are far into the consolidation phase, the reason you still need the frames for a while longer is because they are weaker and more likely to break, but they cannot actually compress from walking at this point? is this correct or is there a risk of compression and height loss as well?

[paco]

 I have fear to loss some mm when the doctor removes the device. i am interesting in external only and my goal is 5 cm, but i think in

 LON too because i think the new bone and nail is more much solid and reliable that only the new bone. i'm thinking in doctor salameh.

[paco]

i'm going to email to doctor salameh about this. then i reply here.