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[Taller]

Does the femur or the tibia play a more significant role in stride length, and how would CLL Impact waking and running stride overall?

[Franz]

Thank you Dr. Franz.

What nerves are the most likely to be damaged? what is the functional loss if a permanent nerve damage happens? complete loss of function of leg or something more localized like being unable to move a toe?

Hi, the most common nerve is the peroneal nerve during tibial lengthening. This can lead to a foot drop.

[Franz]

Does the femur or the tibia play a more significant role in stride length, and how would CLL Impact waking and running stride overall?

I have no idea 😀. Presumably both will contribute to stride length and I do not think that the ranges we lengthen in will make a big difference whether it is femur or tibia.
Stride length will probably increase slightly after CLL, but will possibly be offset by tighter muscles.

[Oniria]

Hi Dr Franz,
thank you for your kindness and availability.
if the peroneal nerve during tibia lengthening is damaged, it can lead to a foot drop. Is the foot drop permanent or can be resolved?

[alps]

Also is nerve damage uncommon during femoral lengthening? Which nerve is most prone to damage there?

[Franz]

Hi Dr Franz,
thank you for your kindness and availability.
if the peroneal nerve during tibia lengthening is damaged, it can lead to a foot drop. Is the foot drop permanent or can be resolved?

It depends on the severity of the damage to the nerve. So it can recover, but can take a long time to do so. Occasionally it will not recover. This is usually the case with overstepping the safe limits and/or with deformity corrections together with lengthenings.

[Franz]

Also is nerve damage uncommon during femoral lengthening? Which nerve is most prone to damage there?

Nerve dysfunction during femoral lengthening is more due to the femoral nerve and usually translates into sensory disturbances (changes in feeling / numbness / tingling)

[Revenge]

What is the worse scenerio?

[Average2Tall]

Which scenario can be favorable for a solid recovery? Assuming there is no cost factor.

1. 2-3 cm Internal femur (Precice), 2 cm External Tibia

2. 4-5 cm Internal femur (Precice)
 

[Average2Tall]

Dr. Franz, thanks for been kind to us and patient with our endless questions.....this is a pretty new procedure in general hence our curiosity, doubt and fear. Very few doctors so far have been advocates of lengthening limits, that makes me take you more seriously since it's a very logical warning. Once you get time please i have the following question:

Which scenario can be favorable for a solid recovery? Assuming there is no cost factor.

1. 2-3 cm Internal femur (Precice), 2 cm External Tibia

2. 4-5 cm Internal femur (Precice)

I'm residing in the Netherlands (177 cm) and trust me i am a pretty short guy there, and yes it's pretty hard for a short guy there especially if you are in a showbiz industry where no morals apply as long as you get a win. In short, CLL will change my life and i will create more opportunities by simply becoming average. I know it's a pretty tough road, but i have heavily invested here so rather than ignoring this social stigma, i believe i have a legit reason to do CLL. By the way, even girls are taller than me!

[Franz]

Dr. Franz, thanks for been kind to us and patient with our endless questions.....this is a pretty new procedure in general hence our curiosity, doubt and fear. Very few doctors so far have been advocates of lengthening limits, that makes me take you more seriously since it's a very logical warning. Once you get time please i have the following question:

Which scenario can be favorable for a solid recovery? Assuming there is no cost factor.

1. 2-3 cm Internal femur (Precice), 2 cm External Tibia

2. 4-5 cm Internal femur (Precice)

I'm residing in the Netherlands (177 cm) and trust me i am a pretty short guy there, and yes it's pretty hard for a short guy there especially if you are in a showbiz industry where no morals apply as long as you get a win. In short, CLL will change my life and i will create more opportunities by simply becoming average. I know it's a pretty tough road, but i have heavily invested here so rather than ignoring this social stigma, i believe i have a legit reason to do CLL. By the way, even girls are taller than me!

Interesting question. I think that your first scenario has a better chance of recovery. We know that CLL complications are related to the amount of lengthening per segment. Both however are short overall distances and should give good recovery.
Remember that tibial lengthening almost always gives the most bang for your buck, because visually people tend to use the knee level to estimate overall height. Ie longer tibias make you appear longer much easier than the same amount of femoral lengthening.

[Average2Tall]

Thanks a lot Dr.Franz, i thought you would never respond since i'm above the recommended limit for CLL

Well if you don't mind, i have another one!

Tibia lengthening has been associated with late recovery, more complications than femur lengthening according to a lot of diaries i have gone through, in that case:

-Which option is better if i decide to do Tibia, Internal or External? (If Internal, is there a way to evade knee complications?)

-I remember in one of your post recommending a weaker/softer bone for CLL rather than strong bone. Does weak mean, small/thin bones?

-Let's assume i smoked for 2 years then i stopped last year, can that complicate my procedure if i do it early 2016?.....i mean, will the residue still be in my system to affect the procedure?

-For some of us who don't take pain pills due to stomach ulcers, can we use medical marijuana back in Amsterdam after lengthening as an alternative or it doesn't have significant pain relief like the counter painkillers?

-I do mountain climbs and hike at least twice every year, how many years or month are more realistic to safely go back to related activities?

Thanks for taking this seriously, we need people like you to enlighten us about this procedure. By the way, i have an African American friend of mine who is also interested with CLL but he is kinda worried about the racism nature in South Africa and wonders if this can interfere with his CLL procedure?!???

[alireza]

hello,
i am 5ft 10in

is there any limitation for surgery

[Franz]

Thanks a lot Dr.Franz, i thought you would never respond since i'm above the recommended limit for CLL

Well if you don't mind, i have another one!

Tibia lengthening has been associated with late recovery, more complications than femur lengthening according to a lot of diaries i have gone through, in that case:

-Which option is better if i decide to do Tibia, Internal or External? (If Internal, is there a way to evade knee complications?)

-I remember in one of your post recommending a weaker/softer bone for CLL rather than strong bone. Does weak mean, small/thin bones?

-Let's assume i smoked for 2 years then i stopped last year, can that complicate my procedure if i do it early 2016?.....i mean, will the residue still be in my system to affect the procedure?

-For some of us who don't take pain pills due to stomach ulcers, can we use medical marijuana back in Amsterdam after lengthening as an alternative or it doesn't have significant pain relief like the counter painkillers?

-I do mountain climbs and hike at least twice every year, how many years or month are more realistic to safely go back to related activities?

Thanks for taking this seriously, we need people like you to enlighten us about this procedure. By the way, i have an African American friend of mine who is also interested with CLL but he is kinda worried about the racism nature in South Africa and wonders if this can interfere with his CLL procedure?!???

Firstly, the choice between external or internal is best made on an individual basis. Cost-wise exfix only tibias is the cheapest, followed by LON/LATP. Fully internal lengthening is the most expensive. Knee pain after nails seems to be lower in our patient population than what is quoted in literature.
The recommendation is that, due the the resistance during lengthening, supple, flexible legs are better than bulky muscular ones.
Smoking effects on bone healing should be negligible after two years of cessation.
Not all the analgesics burn the stomach. It is mostly the non-steroidals. In principle I cannot condone the use of Marijuana for this purpose. As far as I am aware, it should not have a negative effect on bone healing, though.
Give yourself at least 18 months to 2 years to return to high strain activities.
90 percent of our country's population is black, so racism should not be an issue.

[Franz]

hello,
i am 5ft 10in

is there any limitation for surgery

Our official guideline is a limit of 165cm, but it is something that needs to be individualized in each patient. You are welcome to contact me to discuss further at franz.birkholtz@walkamile.co.za

[Average2Tall]

Finally someone gave me the answers! Thanks Dr. Franz

[Taller]

Would you be willing to perform plating and frame removal for patients who got their frames installed and lengthening done with another doctor?

[Franz]

Would you be willing to perform plating and frame removal for patients who got their frames installed and lengthening done with another doctor?

Obviously I would prefer to do this in planned cases where I performed the first surgery. Having said that, I am always available to help patients with problems, including complications or a change in plans. This is a sensitive area, since I can only take over a patient's care if they request it. The first surgeon is usually the best person to continue the treatment.

[Revenge]

Do you think femur leng. with Lon is safe ?

[alps]

Hi Dr. Franz,

with regards to the rubber band analogy, is there really such a thing as a "safe limit"?

I understand that if a rubber band is stretched *beyond a point*, it loses its strength and elasticity permanently. But even if a rubber band is *slightly* stretched and held for hours together, it would still lose strength and elasticity. Does this analogy hold 1:1 with soft tissues, muscles and nerves?

Thank you

[Alittletooshort]

Dr. Birkholtz,
Perhaps this is an odd question. How much wheight would be gained after lengthening 5cm´s on the femurs compared to the same amount on the tibias? It obviously depends on the individual and the size of the bones but I´d like to know how much more wheight would be gained on the femurs. The idea of being light for the height you get after lengthening the tibias displeases me a lot and is one of the reasons why I lean towards a femur lengthening. Thanks in advance for your reply!
Regards,

[Franz]

Do you think femur leng. with Lon is safe ?

Good question, but not easy to answer. AS with any surgery it is as safe as the surgeon you choose.

It is technically quite difficult and has a risk of infection, so we tend to shy away from it.

[Franz]

Hi Dr. Franz,

with regards to the rubber band analogy, is there really such a thing as a "safe limit"?

I understand that if a rubber band is stretched *beyond a point*, it loses its strength and elasticity permanently. But even if a rubber band is *slightly* stretched and held for hours together, it would still lose strength and elasticity. Does this analogy hold 1:1 with soft tissues, muscles and nerves?

Thank you

You are right. There is no absolute safe limit, but from our experience in managing thousands of cases of deformity, congenital conditions, bone defects etc, the least complications happen below the 5.5cm mark.

[Franz]

Dr. Birkholtz,
Perhaps this is an odd question. How much wheight would be gained after lengthening 5cm´s on the femurs compared to the same amount on the tibias? It obviously depends on the individual and the size of the bones but I´d like to know how much more wheight would be gained on the femurs. The idea of being light for the height you get after lengthening the tibias displeases me a lot and is one of the reasons why I lean towards a femur lengthening. Thanks in advance for your reply!
Regards,

Hi, good question. I don't have a scientific answer for you, but the weight gain between femoral or tibial lengthening should be very similar.

There is probably more weight gain with the lack of sports and BicMacs because of boredom during lengthening! ;-)

[TIBIKE200]

Hello dr.

  I would like to know, from your past experience, what was the safest upper limit of internal femural lengthening in centimeters that you have wintnessed? I mean how many long term complications did you encountere?

[Deads]

Hello dr.

  I would like to know, from your past experience, what was the safest upper limit of internal femural lengthening in centimeters that you have wintnessed? I mean how many long term complications did you encountere?

He has already made it clear that 5-6cm for Femurs is the safest limit in his eyes.

[The View]

Hi Dr Birkholtz

I want to know what you think about pre-op preparation.

How important is flexibility?

I've heard conflicting things about leg muscle/ strength.

Some say strong muscular legs are good and others say they are bad and suggest reducing muscle mass before the procedure. What is your view on this?

What would be optimal?

Would strong and flexible legs like that of a martial artist or gymnast be ideal?

Thank You

[Franz]

Hello dr.

  I would like to know, from your past experience, what was the safest upper limit of internal femural lengthening in centimeters that you have wintnessed? I mean how many long term complications did you encountere?

It is so individually dependent that it is very difficult to give a blanket answer. For femoral cll our max gain has been just less than 80mm without issues, but this is not the norm. Relatively safe limits on femur is around 55-65mm

[Franz]

Hi Dr Birkholtz

I want to know what you think about pre-op preparation.

How important is flexibility?

I've heard conflicting things about leg muscle/ strength.

Some say strong muscular legs are good and others say they are bad and suggest reducing muscle mass before the procedure. What is your view on this?

What would be optimal?

Would strong and flexible legs like that of a martial artist or gymnast be ideal?

Thank You

Flexibility is everything. Core strength and upper body strength is also important. Not weight lifting strength, but functional strength to be able to use your arms to assist with mobilizing (ie crutches). Great excercizes here are things like (simple?) push-ups, pull-ups, planking etc. I think pilates and yoga would be better time spent than weight lifting or building muscle bulk. Generally good physical fitness will stand you in good stead as it also gives you mental tenacity. This is a brutal process and you will need all the mental discipline and strength that you can muster.
Gymnasts and martial artists would have a great advantage. Of course I am biased as a karate practitioner ;-)

[TIBIKE200]

It is so individually dependent that it is very difficult to give a blanket answer. For femoral cll our max gain has been just less than 80mm without issues, but this is not the norm. Relatively safe limits on femur is around 55-65mm

First, thank you for your answer.
  Secondly, when you say without issues, do you mean that after the process is over the people can walk normally (As if they never had an operation)?

[ub40]

Dr. Birkholtz, which do you prefer LON or LATN? Is there any way to avoid the knee pain or damage, and how much time does using these nails save. Are they worth it or do you prefer straight EXFIX?