Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[rami]

What are the techniques available to walk during the consolidation phase without support (without external as well), if internal this is fine but having external will make your surgery obvious to everyone and i am sure that most people here do not wish that to happen.

[LLSouthAmerica]

LON and LATN for externals. The surgery will be obvious to anyone who knows you either way if you lengthen more than 5 cm..

[The Kaiser]

LON and LATN for externals. The surgery will be obvious to anyone who knows you either way if you lengthen more than 5 cm..

What about someone don't know this kind of surgeries exist? what do you think their reaction will be? just curious.

[LLSouthAmerica]

Ask me again in 2 months. I'm still hidding at home until I walk normal and don't use crutches anymore haha

In a country where the average is 177 and you go from 160 to 165, you can get away with it. The closer you get to the average and the closer the people around you are to your height, the more noticeable it will be. For example I surpassed my father at 170 and my brother at 165, anyone who know us will immediately notice if they see us together.

[rami]

What technique did you use, height gained, and how long have you been on crutches and till when?

[LLSouthAmerica]

Internal femur with Guichet Nail, gained 6 and 6.5 cm. Been on walker for the first 7 days after surgery then crutches for 2 months. I started walking after that but although the doctor has allowed me to be completely off crutches. I still use them for stairs, sitting and standing, also for people on the street to know I'm not normal.

[rami]

Guichet Nail is too expensive for me, i am thinking to make LATN or complete external with Dr Milorad Mitkovic, however he is somehow complication the LATN for me and making it not worthy, i am not sure if what he is saying is correct or he is trying to convince me with his external.

[LLSouthAmerica]

You are doing tibias then. Forget about LATN or LON. Do pure externals. No amount of gain is worth the permanent pain and also it is less invasive than the nail and you would have to do another surgery for LATN.

[The Kaiser]

Guichet Nail is too expensive for me, i am thinking to make LATN or complete external with Dr Milorad Mitkovic, however he is somehow complication the LATN for me and making it not worthy, i am not sure if what he is saying is correct or he is trying to convince me with his external.

Do your best to make it internal femur, its the safest fastest and less complicated one. You will recover faster than any method, your health is priceless so no excuse just save the money and go to a respectful doctor. Good luck

[onemorefoot]

Do your best to make it internal femur, its the safest fastest and less complicated one. You will recover faster than any method, your health is priceless so no excuse just save the money and go to a respectful doctor. Good luck

It is not the safest, the safest is only external method.

[LLSouthAmerica]

Internal femur is safer than external tibia or femur in almost every aspect

[onemorefoot]

Internal femur is safer than external tibia or femur in almost every aspect

Is more comfortable, but for example if there is a misalignment, can you correct if with precice inside? But if you have Ilizarov frames It can be corrected, also Internal tibias or femurs are bloody surgeries, fat emb is almost impossible in an Ilizarov procedure.

[The Kaiser]

Is more comfortable, but for example if there is a misalignment, can you correct if with precice inside? But if you have Ilizarov frames It can be corrected, also Internal tibias or femurs are bloody surgeries, fat emb is almost impossible in an Ilizarov procedure.

tibia is more complex and weaker bone than femur. You need to cut two bones, x leg and most complications come from tibia. If i don't have money for internal then i will not risk my life with this risky surgery. You want to lie to yourself but face the truth. All experts and top docs prefer internal femur, AS Guichet said if there is cars why riding horses? 

[onemorefoot]

tibia is more complex and weaker bone than femur. You need to cut two bones, x leg and most complications come from tibia. If i don't have money for internal then i will not risk my life with this risky surgery. You want to lie to yourself but face the truth. All experts and top docs prefer internal femur, AS Guichet said if there is cars why riding horses? 

Then I dont know, but yes cars are more comfortable.

[Body Builder]

Tibias with an external stable device like a hexapod and not too much lengthening is the less risky way to do LL and leads to the less long term effects.

Less risky surgery than drilling through the bone, less chances of non alignment, misalignment can be fixed, it is weight bearing and the cheapest method.
The only drawback (major one) is patient's comfort but in everything else is superior.

Internal nails in femurs is a good way but you need two major surgeries to put and remove the nail, it can cause non alignments (especially albizzia nails like Guichet's and Betz's), best nails are non fully weight bearable, are very pricely and finally femur lengthening most of the times is not as good looking as tibia lengthening and many studies say that inevitably causes knee arthritis (which I can't say for sure.of course).

So, whatever top doctors say (as puting a nail needs less experience than puting an Ilizarov device and they can earn much more money than doing externals as internals are far more expensive and they earn money from the manufacturers too), external tibias with a good frame and a sensible lengthening is the best way of LL with the best long term outcomes.
If I needed only one LL, regardless of money I would have done again external tibias but with taylor frames and 6cm lengthening.

[onemorefoot]

Body B, do you know how long is an Ilizarov surgery, 2 hours? Another advantage, becuase femur surgery lasts 4 or more hours.

[paco1]

External only is very bad idea. Because you have to stay with the fixator a lot of time. For 6cm more than 1 year.
I had my surgery my first leg in 18th on february and the second in july. And in 8 on november i started to study one course.
Nobody suspect nothing.

[LLSouthAmerica]

Externals only in tibias is a much better idea than LATN or LON because of an increased risk of infection and also the possibility of permanent knee pain due to the insertion of the nail. Internal tibias also has the same issue with insertion of the nail and also that healing is very slow. The best option to do tibias is as Body Builder said an external stable device and stay the whole period in frames that is to say for a 6 cm lengthening around 11 months (1.5- 2 months per cm of gain)

All in all, lengthening tibias is worse than lenghtening femurs, because there are 2 bones involved, there is worse healing, and the soft tissue is less compliant than in femurs so it tolerates less gain. There is a mechanical reason why the femurs are longer than tibias and sometimes this is altered by the lengthening. There is a risk of knee pain if you alterate the proportion of femur/tibia too much.

External methods are worse than internal because of several reasons and that's why top doctors prefer internal. Overall, there is a lot of pin tract infections (there is on average 1 to 2 infections per patient) which could be severe. Remember the skin is the first barrier against infections and this is altered. Also there is more joint stiffness and contractures. It is also less tolerable and it brings worse cosmetic results.

The best combination is internal femurs and lengthen a conservative amount and the risk of misalignment would be small. Second best is pure external tibia.

[paco1]

I did internal tibias and i don't have any pain in my knees.

[LLSouthAmerica]

Good for you paco1, how much did you lengthen and how long did it take you to full consolidation? As I said there is a bigger risk and a real possibility, but that does not mean you inevitably get knee pain.

For example there are patients from third world countries who lengthen 6-7-8 cm without major issues but I still wouldn't recommend going there.

[paco1]

6 cm. The insertion of the nail was in top of the knee, and there isn't any problem with the knees.
More than 1 year sure i need for consolidation. 1'5 years more or less .

[LLSouthAmerica]

You are aware than normally it takes 7-9 months for tibia to consolidate and this is the time it would take with an external device? How did you manage to handle being 18 months without consolidation? When did you start walking with crutches? When did you start walking without crutches and when for running/sports?

[paco1]

i had consolidation but not full consolidation. That is more time that 7 or 9 months.

[Wazzup]

6 cm. The insertion of the nail was in top of the knee, and there isn't any problem with the knees.
More than 1 year sure i need for consolidation. 1'5 years more or less .

How do you insert the nail in both internal femur (not antegrade) and internal tibias without hurting the knee?

For example how does the insertion of the fitbone and precise nail in femurs with the knee approach avoid damaging the patellar tendon? Isn't it blocking the insertion of the nail? I have seen some videos and it does seem that they just go through the tendom... Is that so or they just pick a side and do near it without touching the tendom?

[paco1]

Here you have one link how it is.
Instrumentación suprarrotuliana para clavo tibial Expert.

[Body Builder]

External only is very bad idea. Because you have to stay with the fixator a lot of time. For 6cm more than 1 year.
I had my surgery my first leg in 18th on february and the second in july. And in 8 on november i started to study one course.
Nobody suspect nothing.

That's not true.
I lengthened 7.5 cm and my bones were consolidated completely 10 months after although I kept the monorails for 1 month more for sure.

Also, tibia LL always looks better than femur LL and the feet looks longer while with longer femurs you look bulkier but not so tall compared to tibias.
Finally, breaking 2 bones means nothing. Fibula cut is very easy and if it is fixated with a screw to tibia it won't cause any problem at all. Even a non alignment in fibula (which can be fixed of course) still won't cause any real problem, all doctors agree to that.
So breaking 2 bones instead of one really isn't of any importance.

@onemorefoot, I think the surgery lasts about 3-4 hours for Ilizarov. I had monorails and my doctor needed about 2.5 hours, Ilizarov needs more time.
But it is a less risky surgery than drilling through bones. The only risk is infection but it can easily prevented with antibiotics because it is on the skin near the pins.
In internals infection is rare but if it happens it can lead to infection inside of the bone which is very dangerous.

So for many reasons external tibias is the best solution for long term results.
And I think that be less comfortable for up to a year is less important than multiple surgeries, maybe more long term effects and of course plenty of money more, as internal femurs are ridiculousky expensive.
You can do external LL with a respectable doctor with about 20k euros while for internals you need at least twice these money.
So external tibias has also a much better vfm .

[LLSouthAmerica]

The law says 1.5 to 2 months per cm so for 6 cm, it can be as early as 8-9 months to 12 months or more. Healing is patient dependent and varies due to many factors age gender smoking. There is higher non union than in femurs.  The advantage with externals and Newer internal nails Precise and Fitbone is that they can go backwards to reduce the gap and compress the bone if necessary.

[Body Builder]

The law says 1.5 to 2 months per cm so for 6 cm, it can be as early as 8-9 months to 12 months or more. Healing is patient dependent and varies due to many factors age gender smoking. There is higher non union than in femurs.  The advantage with externals and Newer internal nails Precise and Fitbone is that they can go backwards to reduce the gap and compress the bone if necessary.

You are right. Most patients need about 1.5 month for 1cm in tibias lengthening so for 6cm someone needs about 9 months but not a year as it was mentioned.

And also, nonunions are more often in tibias than femurs but more often also in internals than externals.
Comparing an internal nail in femurs (especially albizzia nails) to external only tibias I am sure that non alignment is more probable in the first.

Anyway, both are the best options for tibias and femurs.
I think that someone who wants only one LL and not more than 6 cm lengthening should better do external tibias as it is a less invasive surgery, much cheaper, better aesthetically (unless you already have very ling tibias which is very rare) and with better long term results if everything goes fine.
But if someone wants to do femurs instead of tibias, then internal nails is a very good option.

[programdude]

What about someone don't know this kind of surgeries exist? what do you think their reaction will be? just curious.

I did the full 8- Only one person who was in the medical field and one person who knew about and wanted the surgery themselves and saw me still bed bound guessed what it was. Everyone else, even those who saw me crippled had no idea. Since there was no hiding it I even played a guessing game with my roomies and answered their questions for hints and they couldn't guess lol. To those who never  saw me bed bound, but either slightly crippled or fine they had no idea, although a few were floored by the height change.

[Wazzup]

They do not notice your longer femurs? You were 1.72m so your femurs was more or less 46cm. You did 8cm so now you have 54cm. That equals the femurs of someone that is 2.01m but you are 1.8m. That is more than a 20 cm difference.

I'm 1.66 and I intend to lengthen only 5cm. Even so I will be 1.71 with the femurs of someone that is 1.84. That is a 13cm more. I might just do 4.5 cm and then use 2cm insoles. Average in my country is only 1.74 

More important than how soon you start walking is how does it feel. The ultimate goal in the ling term is to do everythinf without even remembering that leg lenghtening was made.