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[419]

I have decided to pursue external tibias in next 6 months -  while I have 2-3 doctors in mind (Xia/Li, Barinov, Parihar) I need advice/suggestions here from experts, also need advice on which option to chose - LaTN, LON, lizarov etc,. Thanks a lot. Really look forward to your guidance and advice.

[0184946]

just look up the pros and cons to each method and pick what is best for u.. tired of all these stupid threads man.
also, 99.9% of people in this forum are fake experts that haven't even done a limb lengthening surgery in their life so just consult with those doctors and speak to them via email/in person/skype/etc and as said before dont do stupid threads that can be answered by using the search button on here.

[Overdozer]

LON-LATN - doesn't guarantee good bone/knee alignment + can't fix initial x-legs or o-legs. Plus additional surgeries, expense and trauma from the nail rimming, risk of permament knee pain. IMO don't.

Whatever you do when externally lengthening make sure the doctor uses hexapod-like device. It is the only thing that can fix any created during the lengthening misalignment of the bone and also fix knee alignment.

[Tartessus]

LON-LATN - doesn't guarantee good bone/knee alignment + can't fix initial x-legs or o-legs. Plus additional surgeries, expense and trauma from the nail rimming, risk of permament knee pain. IMO don't.

Whatever you do when externally lengthening make sure the doctor uses hexapod-like device. It is the only thing that can fix any created during the lengthening misalignment of the bone and also fix knee alignment.

Does this mean it is possible to fix knock knees at the same time as doing external tibias? I have knock knees and I would love to be able to fix it at the same time.

[419]

LON-LATN - doesn't guarantee good bone/knee alignment + can't fix initial x-legs or o-legs. Plus additional surgeries, expense and trauma from the nail rimming, risk of permament knee pain. IMO don't.

Whatever you do when externally lengthening make sure the doctor uses hexapod-like device. It is the only thing that can fix any created during the lengthening misalignment of the bone and also fix knee alignment.

Thanks, I did look up, but I also believe that getting inputs from other members is useful. Thanks a lot.

[419]

LON-LATN - doesn't guarantee good bone/knee alignment + can't fix initial x-legs or o-legs. Plus additional surgeries, expense and trauma from the nail rimming, risk of permament knee pain. IMO don't.

Whatever you do when externally lengthening make sure the doctor uses hexapod-like device. It is the only thing that can fix any created during the lengthening misalignment of the bone and also fix knee alignment.

Thanks, I tend to agree with you. Btw - when you say hexapad like device - I guess you mean the usual/normal lizarov frame , right?

[Overdozer]

Does this mean it is possible to fix knock knees at the same time as doing external tibias? I have knock knees and I would love to be able to fix it at the same time.

A good surgeon who cares about bone/knee alignment should fix it. A bad one could make it worse.

Thanks, I tend to agree with you. Btw - when you say hexapad like device - I guess you mean the usual/normal lizarov frame , right?

Hexapod looks like this.

[FDR101]

LON-LATN - doesn't guarantee good bone/knee alignment + can't fix initial x-legs or o-legs. Plus additional surgeries, expense and trauma from the nail rimming, risk of permament knee pain. IMO don't.

Whatever you do when externally lengthening make sure the doctor uses hexapod-like device. It is the only thing that can fix any created during the lengthening misalignment of the bone and also fix knee alignment.

Hey Overdozer,

I thought the main advantedge of LATN is that a hexapod-frame can be used to get the best bone alignment, and then the internal nail allows you to walk / exercise more to keep muscles trained / better PT stretching etc.

Correct me if I'm wrong, but the alternative is purely externals which means that you have to keep frames on for a long time (until full consolidation) and there is a bigger risk of developing joint and other pains along with not being able to keep muscles up thus bigger risk of developing ballerina / duck-ass?

[Overdozer]

Hey Overdozer,

I thought the main advantedge of LATN is that a hexapod-frame can be used to get the best bone alignment, and then the internal nail allows you to walk / exercise more to keep muscles trained / better PT stretching etc.

Correct me if I'm wrong, but the alternative is purely externals which means that you have to keep frames on for a long time (until full consolidation) and there is a bigger risk of developing joint and other pains along with not being able to keep muscles up thus bigger risk of developing ballerina / duck-ass?

LATN - lengthening and then nail.

To nail the bone after you've lengthened it with external frames you first need to remove the external frames (because pins go through the hollow center of the bone), before you  remove the external frames the bone must be consolidated enough to actually allow it. You can't just remove the externals when you're 0% consolidated, your newly formed bone or "regenerate" will simply collapse.

Yes it can save some time wearing external fixators, but it's not that much, as you still have to wait before the bone is consolidated well enough before the nailing part of the LATN.

there is a bigger risk of developing joint and other pains along with not being able to keep muscles up thus bigger risk of developing ballerina / duck-ass?

Joint contractures, not pains. Ballerina and duck-ass rapidly start to cease when you remove the frames and start active live. With LATN it means it will be a little earlier but that's it. You don't develop ballerina or duckass during consolidation, it happens during the distraction (lengthening) process, when your soft tissue stretches and isn't able to adapt fast enough to the new bone length.

[FDR101]

LATN - lengthening and then nail.

To nail the bone after you've lengthened it with external frames you first need to remove the external frames (because pins go through the hollow center of the bone), before you  remove the external frames the bone must be consolidated enough to actually allow it. You can't just remove the externals when you're 0% consolidated, your newly formed bone or "regenerate" will simply collapse.

Yes it can save some time wearing external fixators, but it's not that much, as you still have to wait before the bone is consolidated well enough before the nailing part of the LATN.
Joint contractures, not pains. Ballerina and duck-ass rapidly start to cease when you remove the frames and start active live. With LATN it means it will be a little earlier but that's it. You don't develop ballerina or duckass during consolidation, it happens during the distraction (lengthening) process, when your soft tissue stretches and isn't able to adapt fast enough to the new bone length.

So you'd recommend going purely external with hexapod?

How long would one have to keep external hexapod frame on for a 4 cm increase, if we assume there are no complications?

I've heard it takes 1-2 years for full consolidation

[Overdozer]

So you'd recommend going purely external with hexapod?

How long would one have to keep external hexapod frame on for a 4 cm increase, if we assume there are no complications?

I've heard it takes 1-2 years for full consolidation

Between LON and LATN yes, I recommend external-only with the ability to correct any created misalignment of the bone/knee during the lengthening with a hexapod-like device.

You can search on pubmed for "healing index" and limb/leg lengthening. It takes 1-2 months for every cm lengthened - depends on your bone consolidation speed which is individual, so no one can tell the exact time you will spend with exfix.

I wore exfix for 8 months for 7.5 cm FEMUR lengthening once. The other time it was 10 months.

Tibia is slower to heal generally. But 1-2 years for 4 cms is not the norm. 6-8 months is.

[419]

Between LON and LATN yes, I recommend external-only with the ability to correct any created misalignment of the bone/knee during the lengthening with a hexapod-like device.

You can search on pubmed for "healing index" and limb/leg lengthening. It takes 1-2 months for every cm lengthened - depends on your bone consolidation speed which is individual, so no one can tell the exact time you will spend with exfix.

I wore exfix for 8 months for 7.5 cm FEMUR lengthening once. The other time it was 10 months.

Tibia is slower to heal generally. But 1-2 years for 4 cms is not the norm. 6-8 months is.

thanks, so basically you are saying that pure lizarov is better  than LON or LATN, correct? what is your opinion/input on internal method for tibia? thanks

[myloginacct]

Have you already decided on a doctor and method, Prakash?

[419]

Have you already decided on a doctor and method, Prakash?

Method - Yes, Doctor - No.

For Method I am going to have external lizarov hexapod for tibia and internal precise II for femur.
For Doctor - I am still undecided, considering Parihar, Birkholtz, Mahboubian and Giotikas. I am leaning towards Giotikas or Parihar at the moment. 

[myloginacct]

I've read good things about Catagni and Pili. Their Ilizarov apparatus seems really good. Catagni also published studies on CLL with Ilizarov. I've never done LL, though, so don't take my word for it. This is my merely inexperienced, and still evolving, impression. Just thought I'd also mention them.

[419]

I've read good things about Catagni and Pili. Their Ilizarov apparatus seems really good. Catagni also published studies on CLL with Ilizarov. I've never done LL, though, so don't take my word for it. This is my merely inexperienced, and still evolving, impression. Just thought I'd also mention them.

I never thought about Catagni (have heard the name but dont have much info) and I heard some really bad things about Pili (from his former patients, though personal messages) - so I dropped him from list.

[419]

I never thought about Catagni (have heard the name but dont have much info) and I heard some really bad things about Pili (from his former patients, though personal messages) - so I dropped him from list.

All, since I am getting many anxious PMs from many asking me what I heard about Pili etc, I want to clear the air here. I did not do much research on Pili neither was he one of my top choices (though my impression was and is that he is highly capable), he was like a back of mind option for me. What I had noticed is the high prevalence and recommendation(by the doctor) of Achilles tendon lengthening for Pili patients, this was odd (I have perfect GMAT, GRE, PMP, Stats match score and if there is anything odd - I see/notice it faster than others, lets say this is a skill of mine - made my living as a software tester for 7 years, at least I think I am good at picking up oddities/anomalies) at least to my eyes( may not be to others) . Since I dont kno much about LL (still a novice) I was asking a Pili patient (wont take names, plz don't ask for name) that why so (this was just a side talk, we were not discussing Pili, I was seeking his opinion on something else when Pili topic came up by chance)? why other doctors are not recommending Achilles lengthening to the extent Pili does? is Pili right in doing so? what is his opinion and he ripped apart the idea of Achilles lengthening (he said it had ruined his life and he had to get tendon shortening surgery done to get back to life). I trust this guy (who gave me the feedback) and his feedback, couple with the oddly high number of Achilles lengthening cases in Pili patients, I have decided to keep Pili off my list of possible options (not to say he was one of my first choices - not because he is bad - I think he is good - but because of logistics related reasons). I may be wrong, I am a third person, plz don't go by what I heard from somebody, I have not done enough research on Pili, plz talk directly to Pili patients. Thanks.

[myloginacct]

Thanks for elaborating, Prakash.

From what I've read in a study by Catagni, they seem to favor ATL and seemed to associate it with regaining athletic ability:

During treatment 30 patients (15 students and 15 office workers) continued to attend school or work full time, four (three physicians and one engineer) delegated some of their work, 19 (manual and factory workers) took sick or unpaid leave for ten to 12 months; and one was unemployed. All patients resumed fully their previous sporting activities, with the exception of the patient who refused lengthening of tendo Achillis.

However, most of the users I've seen on the forums have expressed distaste at ATL, when they had an opinion on it. I don't know who is correct.

Anyone know if there is a "time frame" for doing ATL? Could I just try postponing it as much as possible and still get whatever beneficial results I'm supposed to get from it by doing ATL at a later date?

[419]

Thanks for elaborating, Prakash.

From what I've read in a study by Catagni, they seem to favor ATL and seemed to associate it with regaining athletic ability:

However, most of the users I've seen on the forums have expressed distaste at ATL, when they had an opinion on it. I don't know who is correct.

Anyone know if there is a "time frame" for doing ATL? Could I just try postponing it as much as possible and still get whatever beneficial results I'm supposed to get from it by doing ATL at a later date?

One thing I will say - I don't trust any study or survey coming out of Italy (just like I don trust any study or survey coming out of India, China etc.), the only surveys/study I can trust are those coming out of US and maybe UK and Scandinavian countries, that's about it. I recommend you take Paley's opinion on ATL , that would be a useful data point.

[myloginacct]

Italy has a high number of scientific Nobel laureates per capita, so I think that's an unfair judgement. It's a developed EU country which gifted us many great minds.

With that said, can you tell me where I could find Paley's opinion on ATL? That sounds like a great read.

[419]

Italy has a high number of scientific Nobel laureates per capita, so I think that's an unfair judgement. It's a developed EU country which gifted us many great minds.

With that said, can you tell me where I could find Paley's opinion on ATL? That sounds like a great read.

See dude, at the end it is your decision - if you trust Pili and Catagni so much go with them. does not matter if Italy has high no. of nobel laureates per capita, so does Israel, poland etc. we are talking about a survey/study that is directly correlated to cosmetic limb lengthening, it is not a study from a high level research university, so don't compare apples with oranges. Also, it is impossible that the Italian doctors are right and all other are wrong, because only they are making tibia lengthening synonymous with tibia enthening + ATL. medial practitioners is US and UK earn so much that they do not have any incentive to fudge data to get business, they are rich without working hard, Italy (in my opinion) is a poor country (debatable I know but I think it is a poor country, and a second world country if not third world. dont get confused by GDP per capita, Czech Republic has a high GDP per cpaita but go there and see what real situation is - even China and India have better living standards. Russia has higher gdp pr capita than China an dmuch higher than India but in truth you will see living standards are higher in China and India. Doctors in India earn many times more than in Russia, not even close) and medical profession does not pay as much, there is huge incentive to lie/fudge and the work and educational standards in many of these european countries are pathetic to say the least. All the Indians who earn their medical degrees from top institutes in Russia an Italy etc. fail to clear the basic practitioners' test in India, so there goes the standard of education in european countries, very low. And my personal opinion on the moral and educational standards in (current day) italy is not very high. You can contact Paley directly from his paley institute website.

As I said - at the end it is your decision, your legs, hear all opinions but go by your gut feeling, you will be much happier. I do not want to confuse you. If you believe Catagni is the right choice for you go for it. I personally have decided that Pili or Ctagani are not those that I would trust to get my LL with. All the best.

[419]

And before anybody tries to correct me - I know Russia is not technically in europe, I am just making a point.

[myloginacct]

Also, it is impossible that the Italian doctors are right and all other are wrong

I wasn't really trying to make any point like that. I just thought your description of Italy was a bit on the unfair side. I don't mean to say it's a country without problems.

I also don't have a set opinion on ATL or the doctors, which is why I'm asking these questions, doing research, etc.

You can contact Paley directly from his paley institute website.

Thank you. I'll see what I can find about ATL.

[0184946]

LON-LATN - doesn't guarantee good bone/knee alignment + can't fix initial x-legs or o-legs. Plus additional surgeries, expense and trauma from the nail rimming, risk of permament knee pain. IMO don't.

Whatever you do when externally lengthening make sure the doctor uses hexapod-like device. It is the only thing that can fix any created during the lengthening misalignment of the bone and also fix knee alignment.

LON can fix x-legs/o-legs but the surgeon must add-on a ring to the frame. Lots of LON patients had their x-legs fixed successfully. Course, a hexapod is less invasive and shorter,more flexible but that is rarely used for cosmetic purposes.

[onemorefoot]

I never thought about Catagni (have heard the name but dont have much info) and I heard some really bad things about Pili (from his former patients, though personal messages) - so I dropped him from list.

Which are the bad things about Pillo you heard?

[Bander72]

Its not ground breaking that external is better than lon or latn, but the thing is if the time you have to be in those frames are worth it in your opinion.

[myloginacct]

So... getting back on-topic: are all Ilizarov apparatuses hexapods? Or are them only a few specific models?

https://en.wikipedia.org/wiki/Ilizarov_apparatus

I can't find any info on that...

[419]

So... getting back on-topic: are all Ilizarov apparatuses hexapods? Or are them only a few specific models?

https://en.wikipedia.org/wiki/Ilizarov_apparatus

I can't find any info on that...

Good question, I have the same question, would be thankful if somebody explains here.