General Information and response from Dr Daniele Pili, based in Milano, Italy. Contact for specific information and latest updates.
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Profile (From Website):Dr Pili graduated as a Medical Doctor with Summa cum Laude in Italy and trained as an Orthopaedic Surgeon in Italy and the United Kingdom. From his first experience as an Erasmus student in Germany in the Freie Universität of Berlin understood the importance of an international training. Just after graduating he enrolled at GMC and moved to the United Kingdom to gain more experience in Emergency and General Medicine in Liverpool and Rotherham. He began his training in Orthopaedic Surgery and Traumatology in Newport Isle of Wight and Wakefield south of Leeds together with renowned surgeons.
He returned to Italy to complete his training in Italy and soon returned to the UK to work in Peterborough in the Cambridgeshire, where he worked as a Senior Registrar together with renowned surgeons collaborating with the University of Cambridge and with Martin Parker, famous orthopaedic surgeon renowned for his experience in the treatment of hip fractures. During these years he learned the most advanced surgical techniques to treat orthopedic conditions and developed a wide experience in the treatment of the most common orthopedic disorders.
Selected by SIOT (Italian Society Orthopedic traumatologists) to represent Italy in the Travelling Fellowship in London in 2011 he compared his experience with best orthopaedics surgeons across Europe.
Throughout his career he has presented his work in various scientific congresses in Italy, Europe, South America and the USA. He owes a great contribution to his surgical training to Professor Maurizio Angelo Catagni of Lecco Italy. Working with him as a Ilizarov Fellow he has acquired the Ilizarov technique to treat complicated orthopaedic conditions and learned about limb reconstruction and limb lengthening.
Back to Italy he now works closely with Professor Catagni in Lecco as a Consultant Orthopaedic Surgeon practicing limb reconstruction surgery and limb lengthening, treatment of deformity and bone infections in adults and children. At the same time he is practicing minimally invasive surgery, hip and knee arthroscopy and shoulder surgery as well as hip and knee replacement together with general orthopaedic surgery.
Limb Lengthening Methods:I perform limb lengthening mainly to correct limb deformities on a daily basis. Our institution is well established in this kind of procedure and we have more than 30 years experience in limb lengthening. We offer surgical treatments to correct lower limb deformities as well as upper limb with the most advanced methods. I do LL with intramedullary nails (internals) and HEF (Hybrid Externel Fixator).
Leg Lengthening with Hybrid External Fixator (HEF)This technique is an evolution of the Ilizarov technique. It is a very versatile technique which can correct deformities and can generate large amount of bone lengthening. Late consolidation, a feared complication in bone lengthening techniques, is easy dealt with compression of the not well developed new formed bone. In fact bone grafting is rarely necessary with this technique. This can not be achieved with most of the intramedullary (internal) devices. The lengthening speed is of 0.5-0.75 mm/day for a single osteotomy and double (up to 1.5 mm/day) for a double osteotomy. This can also be an advantage with respect of intramedullary (internal) devices.
The HEF has to be kept in place for the all duration of the treatment till full consolidation is achieved. Usually it takes around 100 days for lengthening up to 8 cm and 5-6 months to achieve a full consolidation. During the lengthening time the patient will walk with crutches and follow our rehabilitation protocol to avoid muscle contractures such as ballerina foot. With HEF these complications are better dealt due to the possibility of passive physiotherapy to stretch the muscles. Even though in theory a full weight could be applied to the frames, walking with crutches is advised. As the consolidation progresses and as the patient gains confidence a full weight can be applied. When the HEF is removed a splint is applied to the leg to protect the new formed bone. Sport activities are usually possible within 6 months. The recovery is usually complete.
Possible risks of this procedure- Pin and wires tract infection. This is usually a very superficial infection which is treated with local disinfectants or antibiotics and usually recovers fully without serious problems.
- Delayed bone consolidation which rarely needs a second procedure such as bone grafting
- Deformities are easy dealt acting on the frame
- Neurovascular problems due to blood vessels or nerve stretching. This complication have never been experienced by our patients but are described in the literature.
- All these complications, with the exception of pin and wires tract infection, is common to all bone lengthening methods including intramedullary (internal) nails.
Leg Lengthening with intramedullary (internal) nail Precice I/II or ISKD The nail is inserted in the leg (femur or tibia) and after the osteotomy (cut of the bone) it is fixed proximally and distally with screws. To start the lengthening the Precise uses a magnetic mechanism while the ISKD is operated with a mechanical mechanism triggered by rotational movements of the segment lengthened (clicks).
This method is quite comfortable for the patients. There are no external devices. Muscular contractures are still possible as for all other techniques. The operation is longer, there is a considerable blood loss and carries the risk of fat embolism. In case of delayed consolidation using ISKD the only option is to have another procedure consisting in bone graft.
At the end of the treatment, when a solid consolidation of the new bone is achieved the nail is removed.
Down points-Lengthening the tibia with a nail is often associated with permanent anterior knee pain.
-This method is more expensive (2 or 3 times the cost of an external fixture) due to the high cost of the nails.
Possible risks of this procedure-Wound and bone infection
-Delayed bone consolidation needing a second procedure such as bone grafting
-Deformities needing further surgery
-Metalwork fatigue and break
-Fracture during the surgery. This complication have never been experienced by our patients but are described in the literature. This will need to stop the lengthening and deal with the fracture.
-Muscle contractures
-Neurovascular problems due to blood vessels or nerve stretching. This complication have never been experienced by our patients but are described in the literature.
Pricing:Prices depend on the method and starts from 20.000 Euro with Hybrid External Fixator for tibia, for the procedure. Internal lengthening can also be performed with Precice I/II or ISKD and go up to 55.000 Euro.
Accommodation:Accommodation is available if needed nearby the hospital and depends on your needs and preferences, price starts from 500 Euro a month.
Physical Therapy:Physio is also available with different options depending on your possibilities and preferences, prices starts from 50 Euro a session.
FAQs:1) How long will I stay in hospital after surgery?Some operations are performed as day-surgery, for major surgery you will need to stay in hospital for 2 to 7 days.
2) Will I need physio?Physiotherapy is key to success in some operations. If physiotherapy is indicated we will prescribe you. In any case you will be explained what are the best exercises to do for the best rehabilitation.
3) What do I have to do i case of emergency?During working days and times you can ring us for advice. You can also seek advice via email, we will reply as soon as possible. In any case if you need urgent help you can go to your local Emergency department.
4) When is it appropriate to request surgery for limb lengthening?Limb lengthening is performed routinely on patients suffering from dwarfism, in order to be helped in carring out normal daily activities. This procedure is also carried out on patients with idiopathic short stature or for aesthetic reasons.
5) How is limb lengthening performed?Limb lengthening can be performed with different techniques. In most cases we use external fixators or extendable intramedullary nails. The lengthening is achieved in three main phases:
Surgery
Lengthening
Consolidation
The different methods have advantages and disadvantages that should be carefully evaluated before surgery. The extendable nails can stretch up to a maximum of 8 cm and if you want to achieve lenghtening greater than this you will needed more than one procedure. Obviously, the level of lengthening is carefully assessed in order to maintain the correct proportions and comply with the capability of muscles and tendons to stretch.
6) Which are the leg lengthening techniques available?The available techniques are:
- External Hybrid Circular Frames with single or double osteotomy. This technique is the most versatile and the lengthening time can be up to 1.5 mm a day with two osteotomies. With this method acquired or already present deformities are easily corrected.
- Internal leg lengthening to the femur or tibia wit an extendable nail such as Precise (I/II) nail inside the bone.
Contact Information:Websitehttp://drpiliortopedico.it/en/E-Mailinfo@drpiliortopedico.it
Phone Number+44 2035294777
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Topic: Dr Daniele Pili (Milano, Italy) (Read 34295 times)