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[Overdozer]

This is the weirdest bone break I ever saw.
It is not a straight cut but a Z one? Isn't the bone very prone to premature consolidation with a cut like that?

I am not sure if it will cause anything bad but for sure this cut is not usual. I never saw any respectable doctor doing that kind of cut.

Also, on your femurs you have a modified Ilizarov? Why not a monorail? Anything external on femurs is a bad idea but Ilizarov is way too barbaric and also causes extreme problems on knee rom.
Anyway, in your surgery everything is too extreme to cope with.
But please ask your doctor why he did that kind of cut and why he didn't prefer a straight cut as most doctors do.

The first pic is a S-osteotomy. It increases the surface of bone contact and as such should decrease healing time. Premature consolidation is very rarely a problem for tibia lengthening, all it should do for him is make him heal faster.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3779558/

External fixation index in group A (21.02 ± 3.16 days/cm) was significantly lower than that in group B (76.19 ± 8.32 days/cm; P < 0.05). Consolidation index was significantly lower (more rapid healing) in group A (43.38 ± 5.35 days/cm) than that in group B (76.19 ± 8.32 days/cm; P < 0.05).

In group A, 78 tibial lengthenings were performed with longitudinal S-osteotomy and LATN technique. In group B, 98 tibial lengthenings were performed with the classic method.

Conclusion

The novel method combined longitudinal S-corticotomy and LATN technique safely reduces the consolidation time, rate of pin-tract problems and axial deviation during leg lengthening, compared with the classic Ilizarov method.

[Body Builder]

The first pic is a S-osteotomy. It increases the surface of bone contact and as such should decrease healing time. Premature consolidation is very rarely a problem for tibia lengthening, all it should do for him is make him heal faster.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3779558/

I was almost healed at 6 cm with 0.66mm lengthening oer day and I increased to 1mm up to 7.5 (thats why I had bf problem).
And I had a straight cut.

So yes, if that S cut don't lead to premature consolidation it will help with faster bine healing.
But I really think that it may cause premature consolidation because most of the sides are almost touch each other.
Anyway we'll see. But I've never seen any respectable doctor using that cut.

[Sweden]

S-cut is practiced in the Slavic countries. Mirzoyan uses it.

There is really no need for it no.

[Body Builder]

I was almost healed at 6 cm with 0.66mm lengthening oer day and I increased to 1mm up to 7.5 (thats why I had bf problem).
And I had a straight cut.

So yes, if that S cut don't lead to premature consolidation it will help with faster bone healing.
But I really think that it may cause premature consolidation because most of the sides almost touch each other.
Anyway we'll see. But I've never seen any respectable doctor using that cut.

[Jim_dabarber]

Good luck Jim, cross lengthening is extreme in my opinion, but you took a good decision in choosing moderate amount of 4 cm over both segments.

From what I understand you plan on lengthening at home. Have you organized PT's and a plan for recovery training? Remember although it is going to be a very hard journey, it is vital that you keep up the training of your legs.

Best of luck, keep up us updated. 4 cm lengthening should take less than 2 months if you go for 0.81mm a day, so just stay strong!

Exactly why i decided to only do 4cm across all four segments. Proportions and tissue muscle recovery ade important to me. I have an orthopedic near my hometown who will continue the treatmeant. I am from florida so finding reputable orthopedics who would take my health insurance was not hard. At the moment i havent discussed the pt plans yet. He wasnts to see me in person and figure out where we are and what our approach will be. I will be doing .80mm a day on my tibia where as my femur i will be doing 1.15mm per day depending on callus formation and to not have preconsolidation.
Thank you!

[Jim_dabarber]

I discussed the use of z-shaped osteotomy of tibia with dr kulesh and he explained that it helps reduce the possibility of non-union or mal-union formation.
Today i finally started distraction! Tibia was pain free as expected. Once i got to the the femur thats when reality sunk in. This is deffiniately not going to be a walk in the park but its doable. Pain for tibia 1/10 more discomfort than pain. Pain for femur 6/10. Big difference! But once again. Very doable and at my budget i think i made a great choice. People on this forum will bash and talk trash about peoples desicions but at the end of the day this forum is to share personal experiences hands on. Everyone has their entitlement to opinion but unless youve gone thru the process and pain theres no way you can judge on any of their actions. I will and i know i can get thru this. 

[Tiny]

Hi there,

I have a few questions for you. I hope you could share some info as I am finalizing my LL plans, which I will do this coming summer!

• Who was your surgeon? Was it Solomin or Kulesh? I'm really confused on how their partnership works.
• Did you have the option to choose one of them?
• How are the doctors treating you so far?
• How is the quality of MEDEM?
• How hard and how long was the visa process? I'm from North America as well (USA/Canada).
• What was your method of payment? wire transfer, credit card, or cash?

Your responses will be greatly appreciated. I wish you the best bro.

[Body Builder]

I discussed the use of z-shaped osteotomy of tibia with dr kulesh and he explained that it helps reduce the possibility of non-union or mal-union formation.
Today i finally started distraction! Tibia was pain free as expected. Once i got to the the femur thats when reality sunk in. This is deffiniately not going to be a walk in the park but its doable. Pain for tibia 1/10 more discomfort than pain. Pain for femur 6/10. Big difference! But once again. Very doable and at my budget i think i made a great choice. People on this forum will bash and talk trash about peoples desicions but at the end of the day this forum is to share personal experiences hands on. Everyone has their entitlement to opinion but unless youve gone thru the process and pain theres no way you can judge on any of their actions. I will and i know i can get thru this.

Why do you think there is such a pain difference between femurs and tibias.
Are the pins causing the trouble (because femurs are encircled with much bigger muscles than tibias) or the cut causes more pain on femurs compared to tibias?

My tibia LL was almost painless as you described but most LLers with internal on femurs didn't described much pain too. Thats why I wonder if the Ilizarov is what gives you pains in femurs.

[Jim_dabarber]

Hi there,

I have a few questions for you. I hope you could share some info as I am finalizing my LL plans, which I will do this coming summer!

• Who was your surgeon? Was it Solomin or Kulesh? I'm really confused on how their partnership works.
• Did you have the option to choose one of them?
• How are the doctors treating you so far?
• How is the quality of MEDEM?
• How hard and how long was the visa process? I'm from North America as well (USA/Canada).
• What was your method of payment? wire transfer, credit card, or cash?

Your responses will be greatly appreciated. I wish you the best bro.

-My main surgeon who i have always been in touch and guided me through all this has been Dr. Kulesh although during the operation they were both precent. Dr Solomin was the one who inserted the LON nail on my femur while Kulesh performed all the other stuff.

-Yes i had the option to choose between either one but obviously Dr Solomins price was way higher than Dr Kulesh and so i decided to go along with Kulesh and i was confindent since hes been working along side Solomin for 10+ years that hes highly trained.

- The doctors are good. They all speak english so if you have any questions or concerns you can can always reach out to them. Dr Kulesh is always an email away and responds fairly quickly.

- i actually decided on getting operated at the municipal clinic which is st elizabeth as the cost was way lower and they had availailable spots. Dr kulesh sent out an asstant to pick me up from my hotel that morning and he was in charge of translating and helping me get around the hospital. After i got situated he left and the aenesthesia guy came in along with the gp doctor who both understand good english and explained the rest for me. The nurses and other staff have no idea how to speak english but im getting along just fine with a translating app that i downloaded before coming and if any qs i just call Dr kulesh and he speaks for them.

- The visa process took aproximately 3 weeks in total but i had everything expidited and paid extra just incase. Im sure the regular time frame for visa is around 5-6 weeks. It was actually really easy to aquire with the agency that Dr Kulesh recomended me with.

- I honestly just brought $5k cash and hid it in my pants the whole time here. Omce here i just simply went to a local bank and changed currencies although Dr Kulesh did say i could wire the money but then you would have to have somebody from your country doing all that for you and to me it was just too much of a hassle. I believe he doesnt accept credit card payments. Never really ask him. But i could if yould like?

[The Dreamer]

https://imgur.com/gallery/2Cirl

These should work

Those link don't work,at least for me
It says:"Ops,couldn't find the page"

[Android]

Those link don't work,at least for me
It says:"Ops,couldn't find the page"

They work for me as long as I open it in a new tab.

[Tiny]

Wow. Thank you for this thorough response.

-Yes i had the option to choose between either one but obviously Dr Solomins price was way higher than Dr Kulesh and so i decided to go along with Kulesh and i was confindent since hes been working along side Solomin for 10+ years that hes highly trained.

How much was this price difference in your case?

The doctors are good. They all speak english so if you have any questions or concerns you can can always reach out to them. Dr Kulesh is always an email away and responds fairly quickly.

Based on patient's feedback, Dr. Kulesh seems to be going the extra mile all the time. That's good to hear!

- i actually decided on getting operated at the municipal clinic which is st elizabeth as the cost was way lower and they had availailable spots. Dr kulesh sent out an asstant to pick me up from my hotel that morning and he was in charge of translating and helping me get around the hospital. After i got situated he left and the aenesthesia guy came in along with the gp doctor who both understand good english and explained the rest for me. The nurses and other staff have no idea how to speak english but im getting along just fine with a translating app that i downloaded before coming and if any qs i just call Dr kulesh and he speaks for them.

Wait. I thought you had your surgery at MEDEM as written in your earlier entries. You may want to clarify that up for the other readers. Anyway, since you were able to visit both hospitals, what can you say about the quality difference between them? And how do you compare them to hospitals in North America? (Although I know that MEDEM is top notch. Hence it's semi-ridiculous prices.)

- The visa process took aproximately 3 weeks in total but i had everything expidited and paid extra just incase. Im sure the regular time frame for visa is around 5-6 weeks. It was actually really easy to aquire with the agency that Dr Kulesh recomended me with.

How much did this process cost you in total?

- I honestly just brought $5k cash and hid it in my pants the whole time here. Omce here i just simply went to a local bank and changed currencies although Dr Kulesh did say i could wire the money but then you would have to have somebody from your country doing all that for you and to me it was just too much of a hassle. I believe he doesnt accept credit card payments. Never really ask him. But i could if yould like?

Nah, I think I'm good. I'm going to start talking to them in 2 weeks anyway (after exams). I guess I could just bring cash. My only concern is pickpockets. It's a huge thing in Europe, let alone Eastern Europe. No disrespect, just want to take the necessary precautions. 


Again, thank you for taking the time to answer my questions. Take care.

[Jim_dabarber]

I had surgery at the medem clinic for those wondering.

Sorry guys my surgery was at the municipal clinic and not MEDEM

[Jim_dabarber]

Why do you think there is such a pain difference between femurs and tibias.
Are the pins causing the trouble (because femurs are encircled with much bigger muscles than tibias) or the cut causes more pain on femurs compared to tibias?

My tibia LL was almost painless as you described but most LLers with internal on femurs didn't described much pain too. Thats why I wonder if the Ilizarov is what gives you pains in femurs.

Honestly now on day 2 the pain has gone down to like a 2/10 for femurs. Walking hurts tibia and femur regardless and i think alot of that has to do with the pins. The most discomfort from the femur frame is at the top where the big bolts go into the side of my hip. Dr kulesh calls those my favorite pins 😭 very uncomfortable but the pain has gone down alot. Ive managed to finally find my sleeping position as that was another problem. Any little movement to those top bolts at night and i would wake up imeddiately and going back to sleep was almlst impossible.

[Jim_dabarber]

Wow. Thank you for this thorough response.

How much was this price difference in your case?

Based on patient's feedback, Dr. Kulesh seems to be going the extra mile all the time. That's good to hear!

Wait. I thought you had your surgery at MEDEM as written in your earlier entries. You may want to clarify that up for the other readers. Anyway, since you were able to visit both hospitals, what can you say about the quality difference between them? And how do you compare them to hospitals in North America? (Although I know that MEDEM is top notch. Hence it's semi-ridiculous prices.)

How much did this process cost you in total?

Nah, I think I'm good. I'm going to start talking to them in 2 weeks anyway (after exams). I guess I could just bring cash. My only concern is pickpockets. It's a huge thing in Europe, let alone Eastern Europe. No disrespect, just want to take the necessary precautions. 


Again, thank you for taking the time to answer my questions. Take care.

- Price difference between Doctors was about 300000 rubles and since Dr kulesh would write back to my responces faster i just decided to go with him.

- Total for 8 hospital days and the surgery and the nail on my femur, transport to airport , and walker came to exactly  263.710 rubles. My flight ticket was $800 usd roundtrip. My visa i ended up paying about $500 usd for the whole process.

- Medem hospital is obvioulsy of way higher standards and i probly wouldve got better after care but for the time i was staying in russia i didnt feel like that would be a good investment afterall whichever clinic i wouldve picked i wouldve got the same surgery done by the same Drs.

- pick pocketting was my biggest fear. I had a little pouch that wrapped around the inside of my thigh under 2 pairs of pants so i felt a little safer that way.

[ghost in your house]

does DR Dr kulesh do LON with monorails for tibias? If he does, do you know how much does he charge?

[Tiny]

How is it goin?

[Android]

Updating here since Jim posted this elsewhere:

Im currently doing cross lengthening with dr kulesh and i just reached 3.5cm and ive been lengthening for about 35 days. I can be honest with you external femur is not the easiest but its managable. The first 2-3 weeks are gonna be extremely tough not because of the pain but the discomfort of the frame and not being able to sleep comfortable. I was only sleeping max 2 hours before i would have to wake up and stretch and finally go back to sleep. Overdozer managed to do 7.5cm on his femurs externally but me personlly i think i would only be able to reach 5cm tops just because im really tired of wearing the fixator although im only shooting for 4cm maybe 4.5cm. I already have my set date in a couple weeks to remove my fixator so well see how much more i can achieve by then.

[Jim_dabarber]

https://imgur.com/gallery/PwObh
Current xray update
Sorry for not updating guys just been really busy lately and not in the mood to post any updates as this whole process has been wearing me down. LL is deffinately not for the weak!

[Android]

https://imgur.com/gallery/PwObh
Current xray update
Sorry for not updating guys just been really busy lately and not in the mood to post any updates as this whole process has been wearing me down. LL is deffinately not for the weak!

Understandable. Looking good Jim, thanks for keeping us in the loop!

When do you go back to Russia?

[Tiger9898]

Hope you are getting better.How is the pain level on your femur? Is it something that can be controlled with painkiller? And is it difficult to lengthen your femur compared to your tibia?

[hemhem]

Hi Jim! First, many thanks for your valuable informations and comments, and happy recovery! Do you know that? Does Dr. Kulesh do LON with monorails for the femur and tibia lengthening? Does he do with any other modern internal methods, too? Good luck! 

[Tiny]

They don't. Also Dr. Solomin does the nailing.

[Jim_dabarber]

Understandable. Looking good Jim, thanks for keeping us in the loop!

When do you go back to Russia?

Thank you! My flight is the 21st so in a couple days. Surgery will be a day or 2 after.

[Jim_dabarber]

Hope you are getting better.How is the pain level on your femur? Is it something that can be controlled with painkiller? And is it difficult to lengthen your femur compared to your tibia?

Pain level on femur is about 6/10 at night. During the day about a 4/10 but most of the pain was from me trying to bend my knee and stretch as the pins in that area really irritated my skin and most of the pain would be from the pinsites. I started getting really bad muscle contractions at around 2cm as i was instructed to lengthen 1.50 mm per day to avoid preconsolidation and thats when i would wake up in pain. I started using IcyHot Rub cream and bumped up my pain meds so that seemed to help alot at managing the pain. Im pretty sure with strong pain meds the pain would be way more tolerable. I am only taking acetomophine and nsaids.
The difference between lengthening my tibia vs my femur was that for my tibia i am having nerve pain in the front of my tibia which is like a constant numbing tingling feeling which is very irritating and also i started getting ankle stiffness once i hit 3cm but no pain from pinsites. Femurs most of pain is from the pinsites since theres way more soft tissue around those areas and muscle contractions from lengthening fast. Again pain would be more tolerable if i was on stronger pain meds but i decided to stay away from opiods.

[Tiger9898]

I am thinking about external femur. What do you think how much experience does Dr Kulesh have on that? By the way, are you doing LON on your femur or LATN?

[Tiny]

That's LON.

[Tiger9898]

There is higher risk of nail infection in LON method compared to LATN. But I don't understand why people mostly choose LON

[Android]

Jim's probably on a plane right now, hope he has a good flight.

There is higher risk of nail infection in LON method compared to LATN. But I don't understand why people mostly choose LON

I think more people choose LON because LATN involves more taxing surgeries, increasing initial recovery time. Many doctors offer LON but not LATN, so that'll skew the numbers (though Dr. Solomin / Dr. Kulesh does). LATN has advantages over LON like correction before nailing, so I'd go for LATN given the choice.

[Jim_dabarber]

I am thinking about external femur. What do you think how much experience does Dr Kulesh have on that? By the way, are you doing LON on your femur or LATN?

He has plenty of experience which is why i trusted him and ended up going thru with this surgery. Dr soloman is the one who does the nailing tho and hes has alot of experience also. Together i think they make a great team of surgeons. I am doing LON on the femur.

[Jim_dabarber]

I arrived to St petersburg Russia yesterday morning at around 10:30am. My surgeons assistant Roman was there to assist me and help me with my stuff from hospital to hotel. Plane ride was really exhausting. Its a nightmare to fly for 12+ hours and not be able to fully extend your legs with these frames on. I think i got like 2 hours of sleep the whole time so as soon as i got to the hotel i slept for id say atleast 15 hours. Best sleep ive had this whole ll journey haha.
Anyways in a couple hours Roman will be here to take me to the hospital where i will have consultation then xrays and then dr kulesh will set the hexapods for correction and then xrays again. I will be staying at the hospital after that. Again guys sorry for not keeping up with this diary on a daily basis from the beginning but if theres any questions you guys have ill be glad to answer them!