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Author Topic: LON/LATN nail weight bearing? and walking  (Read 1867 times)

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7231

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LON/LATN nail weight bearing? and walking
« on: April 23, 2018, 08:20:48 PM »

Android/Kilo or anybody else - my questions are i) is there is any time difference between LON and LATN in being able to walk with crutches and ii) I know LATN nail is thicker than LON nail but my question is - are these weight bearing or only partially weight bearing? I intend to use crutch after I complete lengthening and get the nail and do not intend to put full wight, but still want to know if it is weight bearing and how much can it (LATN/LON nail) be trusted to bear weight. Thanks.
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Android

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Re: LON/LATN nail weight bearing? and walking
« Reply #1 on: April 23, 2018, 10:09:32 PM »

LATN patients take a couple weeks longer to start walking after the second surgery since it's more intense compared to LON. There's correction before the second surgery for LATN too.

I'm sure it depends on the patient's weight and healing rate, but this paper (LON vs Ilizarov) suggests partial weight bearing until full consolidation. A paper focused on LATN also mentions partial weight bearing.

You can refer to Dr. Donghoon's chart comparing LON, LATN, and PRECICE 1.0. It's a bit old, but should help in answering your question. Here's another page comparing LON and LATN.

Here's a pros and cons list (starting page 3) by Dr. Paley back in 2012, and LON/LATN has pros of weight bearing for transfers, meaning a few steps here and there.

TL;DR - partial weight bearing for both LON and LATN.
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7231

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Re: LON/LATN nail weight bearing? and walking
« Reply #2 on: April 24, 2018, 05:05:59 AM »

LATN patients take a couple weeks longer to start walking after the second surgery since it's more intense compared to LON. There's correction before the second surgery for LATN too.

I'm sure it depends on the patient's weight and healing rate, but this paper (LON vs Ilizarov) suggests partial weight bearing until full consolidation. A paper focused on LATN also mentions partial weight bearing.

You can refer to Dr. Donghoon's chart comparing LON, LATN, and PRECICE 1.0. It's a bit old, but should help in answering your question. Here's another page comparing LON and LATN.

Here's a pros and cons list (starting page 3) by Dr. Paley back in 2012, and LON/LATN has pros of weight bearing for transfers, meaning a few steps here and there.

TL;DR - partial weight bearing for both LON and LATN.

Thanks a lot Android. Much appreciated.
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doomsday

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Re: LON/LATN nail weight bearing? and walking
« Reply #3 on: April 24, 2018, 04:58:55 PM »

LATN patients take a couple weeks longer to start walking after the second surgery since it's more intense compared to LON. There's correction before the second surgery for LATN too.

I'm sure it depends on the patient's weight and healing rate, but this paper (LON vs Ilizarov) suggests partial weight bearing until full consolidation. A paper focused on LATN also mentions partial weight bearing.

You can refer to Dr. Donghoon's chart comparing LON, LATN, and PRECICE 1.0. It's a bit old, but should help in answering your question. Here's another page comparing LON and LATN.

Here's a pros and cons list (starting page 3) by Dr. Paley back in 2012, and LON/LATN has pros of weight bearing for transfers, meaning a few steps here and there.

TL;DR - partial weight bearing for both LON and LATN.
BS, every frame  is different. Some frames are weight bearing some are not. Stop misinforming people.
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Android

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Re: LON/LATN nail weight bearing? and walking
« Reply #4 on: April 24, 2018, 05:05:28 PM »

BS, every frame  is different. Some frames are weight bearing some are not. Stop misinforming people.

I meant with the frames off, I suppose it was open to misinterpretation.
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7231

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Re: LON/LATN nail weight bearing? and walking
« Reply #5 on: April 24, 2018, 05:09:22 PM »

I meant with the frames off, I suppose it was open to misinterpretation.

one question - the links you sent basically say that LATN patients walk (after nailing, limping walk, I don't mean normal walk) faster (I used to think so as well) but you mention that LON patients can walk faster, am a bit confused, can you advise. Thanks.
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Android

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Re: LON/LATN nail weight bearing? and walking
« Reply #6 on: April 24, 2018, 05:36:58 PM »

LON, the nails are inserted in the first surgery and then locked in place when frames come off. Not as invasive second time around, so the patient can walk (assisted) sooner after surgery with less pain.

LATN, after lengthening you need a few weeks for correction using a hexapod. After that, nails are inserted and locked in second surgery when frames come off. So there's more pain involved on the second round. Luckily bone healing speeds up at this stage for LATN patients.

Benefit of LATN is outlined on page I linked to earlier:

Quote
A large advantage of LATN is that bone formation is fast and because of strong internal fixation, compared to LON, patients can return to normal activity  2 or more months faster. Also, since it undergoes a correction process, precise bone alignment can be met.

And here's another comparison, again from link above:

Quote
There may be several advantages of the LATN over the lengthening over a nail technique, including the ability to insert a full-length large-diameter nail for more stability. In the lengthening over a nail technique a small-diameter nail is used so the bone can slide over the nail. In addition the nail is pulled out of the distal fragment with lengthening leading to suboptimal stability; also, distraction over a nail can sometimes be difficult and mechanical binding from nail impingement can prevent lengthening [18]. This problem is avoided with the LATN technique. With the LATN technique, there is no concomitant use of internal and external fixation, and this should lower the risk of infection. In the lengthening over a nail procedure, if a pin tract infection occurs during the distraction phase, the presence of the nail increases the chances that the infection will spread to become a deep infection. If a pin tract infection develops during the LATN technique, it can be treated with antibiotics or with pin removal prior to IM nail insertion. Additionally, the timing of intramedullary nail insertion can be adjusted if need be. Like the classic method, LATN affords the ability to gradually correct diaphyseal deformity and lengthen prior to nail insertion. Lengthening over a nail or use of an internal lengthening nail requires an acute deformity correction which compromises bone healing potential during subsequent lengthening. A distal third tibial deformity could not be treated with lengthening over a nail since the IM nail would be pulled out of the distal segment during lengthening.

TL;DR of above quote: compared to LON, LATN allows for stronger nails for stability, less mechanical resistance during lengthening, infections are less serious, and allows for deformity correction.
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5'4" and 1/4" (163.2 cm) | United States | early 30s | Cross-lengthening with Dr. Solomin & Dr. Kulesh

doomsday

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Re: LON/LATN nail weight bearing? and walking
« Reply #7 on: April 24, 2018, 07:39:10 PM »

my mistake, yes nails in lon and latn are weight bearing although latn are better positioned and therefore stronger.
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7231

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Re: LON/LATN nail weight bearing? and walking
« Reply #8 on: April 25, 2018, 03:44:39 AM »

LON, the nails are inserted in the first surgery and then locked in place when frames come off. Not as invasive second time around, so the patient can walk (assisted) sooner after surgery with less pain.

LATN, after lengthening you need a few weeks for correction using a hexapod. After that, nails are inserted and locked in second surgery when frames come off. So there's more pain involved on the second round. Luckily bone healing speeds up at this stage for LATN patients.

Benefit of LATN is outlined on page I linked to earlier:

And here's another comparison, again from link above:

TL;DR of above quote: compared to LON, LATN allows for stronger nails for stability, less mechanical resistance during lengthening, infections are less serious, and allows for deformity correction.

ok , thanks  a lot
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Android

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Re: LON/LATN nail weight bearing? and walking
« Reply #9 on: April 25, 2018, 03:49:08 AM »

my mistake, yes nails in lon and latn are weight bearing although latn are better positioned and therefore stronger.

No harm, no foul. Glad we cleared it up.
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5'4" and 1/4" (163.2 cm) | United States | early 30s | Cross-lengthening with Dr. Solomin & Dr. Kulesh
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