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[RB]

Hey guys,

Following the news that stryde could be pushed back to late August or possibly beyond that, my femur surgery with Giotikas in March has obviously been cancelled. Due to work and other commitments, I simply cannot wait till August or beyond that to do LL so I currently have 2 options I am considering and would like honest opinions / pros and cons of each if you guys can provide them.

Option 1: Do precise with Dr Giotikas in March / April (will be available in Greece by late March). I am well aware of the limitations of precise and am quite scared at the possibility of being wheelchair bound / not able to weight bear for months on end. But on the other hand the lengthening mechanism is much more sophisticated than betzbone and has been studied used more widely. But is it really a suitable option for cosmetic lengthening?

Option 2: Betzbone with Dr Betz in April. I know this forum has a generally negative few of Betz and mechanical nails but from all accounts the latest betzbone is fully weightbearing, which is perhaps the biggest factor for my decision. My concerns about the betzbone are the fact that the clicking to lengthen can be painful and the nail itself has drawn some valid criticism for its shortcomings, however many Betz patients have had good results.

If you were in my situation and had to choose between these 2 options, what would your thought process be? I am planning to have consults with Giotikas and Betz next week to discuss each nail. Will appreciate any objective insights.

Thanks guys

[TallerVL]

Have you considered external nails like LON Method? It’s way cheaper and weight bearing. But LON on femurs is not recommended, LON on tibias has a high success rate and it’s also used worldwide.

[Jamesy998]

Have you considered external nails like LON Method? It’s way cheaper and weight bearing. But LON on femurs is not recommended, LON on tibias has a high success rate and it’s also used worldwide.

What he said, you could actually get it done early March and still end up saving. Initially not all that different from the others but it will be much more uncomfortable so theres that.

[Tomhard]

I would do it as early as possible during this covid time.
Precise is a good option too but I would go with Betzbonr, since Betzbone is weightbearing and you will be back to normal faster than with Precise.

How much do you want to lengthen?

[permanentlybanned]

Precice, Betzbone has a history of not being safe.

[Tomhard]

Precice, Betzbone has a history of not being safe.

So never did LL so dont write too much when you havent done any experience. You wanted to go with Stryde and now they stopped shipping this nail, so that means Stryde is not a safe option eather.

[Girl22]

I have the Betzbone nails still in my legs rn, I haven't experienced
anything negative with them.

[Tartar]

I would wait for Stryde but i would consider even that "covid time" is the best to go under surgery and that stryde comeback could be delayed, who knows for sure...

[V21]

I would wait for Stryde but i would consider even that "covid time" is the best to go under surgery and that stryde comeback could be delayed, who knows for sure...

I'm willing to wait for Stryde until early september, if not I will do Precice 2 100%. Do you think is THAT bad?

[Tartar]

I'm willing to wait for Stryde until early september, if not I will do Precice 2 100%. Do you think is THAT bad?

A bit bad for sure. It's a good nail, it works very well, but neither with stryde is guaranteed that you'll be able to walk unaided in few months, let alone Precice 2, you'll probably be in a wheelchair for months. I suggest you to check what's your femur diameter, ask your doctor which size can fit you by taking Xray. The biggest precice nail is not that bad about max tolerated weight.

[Stryde2021]

Between these two I'd choose Precice.  Speaking from experience here: Do not assume that just because a nail is fully weight bearing that you will actually be able to walk unaided with it.   It's *very* possible to go through the entire distraction phase with Stryde, for instance, and never be able to walk unaided.  Granted, with Precice you still have to wait until you're a month+ into consolidation.  But that may not be much later than you'd be walking with Stryde anyways. 

[permanentlybanned]

So never did LL so dont write too much when you havent done any experience. You wanted to go with Stryde and now they stopped shipping this nail, so that means Stryde is not a safe option eather.

I said precice, not stryde.

[V21]

I just want to do 5 cm so... maybe 4 month until walking unaided is reasonable? Before that, can you "walk" with crutches or walker or are  you confined to a wheelchair?

[Tartar]

It's up to the nail size. I can reasonably tell you that with stryde you are able to walk with crutches with every size available.
With precice 2, in all probability, you can use wheelchair or maybe a walker (but not the small ones, the biggest ones with 4 wheels and the place to put your arms, I don't know the english name for them; this because you should be unable to stand to avoid excessive weight bearing) for several months before starting with crutches...if you are lucky even crutches could be fine at the beginning, but for the most I'd say no. In my opinion 4 months to walk unaided is feasable with stryde only.
For precice I'd say 5-9 months to walk unaided. You have always to consider the risk, nothing is guarantee and you have to take a good window of time. Every lenghtening is very different, very individual.

[RB]

Have you considered external nails like LON Method? It’s way cheaper and weight bearing. But LON on femurs is not recommended, LON on tibias has a high success rate and it’s also used worldwide.

I've thought about LON but I really want to avoid tibias and stick to femurs due to the faster recovery and possibility of more length. I wouldn't feel comfortable going above 5cm on the tibias as well.

I have the Betzbone nails still in my legs rn, I haven't experienced
anything negative with them.

Have you been able to weight bear / walk on crutches during the distraction phase? How has the clicking process been for you? Painful? How much length have you gained?

I would do it as early as possible during this covid time.
Precise is a good option too but I would go with Betzbonr, since Betzbone is weightbearing and you will be back to normal faster than with Precise.

How much do you want to lengthen?

I am 163cm and my goal is 7cm, possibly 8cm depending on how I tolerate the lengthening.

[Stryde2021]

View this Paley video, starting at about 48:00, to understand weight-bearing limits of Precice 2.2 v. Stryde.  The biggest diameter P2.2 can accommodate up to 146 pounds.  Even if you are above that, I'm guessing you're not above by a whole lot.  I would think that means you can probably use crutches until consolidation.   By no means would you have to be confined to a wheelchair.

[V21]

View this Paley video, starting at about 48:00, to understand weight-bearing limits of Precice 2.2 v. Stryde.  The biggest diameter P2.2 can accommodate up to 146 pounds.  Even if you are above that, I'm guessing you're not above by a whole lot.  I would think that means you can probably use crutches until consolidation.   By no means would you have to be confined to a wheelchair.

I know that, but I think it may be too big? I know the standard one can only take 45 kgs. Anyway, I may take some X rays and send them to Giotikas. Dude, if I was lucky enough to fit for that nail... 146 pounds is good, I would take it without hesitation, having crutches at least

[RB]

View this Paley video, starting at about 48:00, to understand weight-bearing limits of Precice 2.2 v. Stryde.  The biggest diameter P2.2 can accommodate up to 146 pounds.  Even if you are above that, I'm guessing you're not above by a whole lot.  I would think that means you can probably use crutches until consolidation.   By no means would you have to be confined to a wheelchair.

I'm not sure the big nail would fit for me, but it would be amazing if it could as I am 138 pounds...I am going to ask Dr G if the bigger nail could be reamed a bit to fit and if that is safe to do because 146 pounds I could get around on crutches no problem.

[Tartar]

few people can fit the 12,5, most of the short guys fit the 10mm for stryde.
What I've said is the raw truth, even if your weight is close to the max weight allowed (I mean, even if you are LIGHTER) it's very easy to exceed and to bend them, because the pressure you apply walking is not straight parallel to the major lenght of the nail and there are many accelerations of the weight that have to be considered in a normal walk. It's not your own weight the number they give us but the force applied.
This is a difficult procedure you're not making a cake, don't dream because it could be underwhelming. LL needs patience, expecially precice 2

[Stryde2021]

few people can fit the 12,5, most of the short guys fit the 10mm for stryde.
What I've said is the raw truth, even if your weight is close to the max weight allowed (I mean, even if you are LIGHTER) it's very easy to exceed and to bend them, because the pressure you apply walking is not straight parallel to the major lenght of the nail and there are many accelerations of the weight that have to be considered in a normal walk. It's not your own weight the number they give us but the force applied.
This is a difficult procedure you're not making a cake, don't dream because it could be underwhelming. LL needs patience, expecially precice 2

I agree with most of this: even with the biggest P2.2 diameter, you are still going to want at least crutches until some meaningful consolidation.  I'm not sure, though, if it's fair to say that few can fit the 12.5.  There are several users here who were quite short who have taken the 13mm Stryde (MyEvo immediately comes to mind.  He was about 5'4 when he started).

Either way, you guys probably want to discuss this with Giotakis/whoever and figure out what your canal can handle.

[V21]

few people can fit the 12,5, most of the short guys fit the 10mm for stryde.
What I've said is the raw truth, even if your weight is close to the max weight allowed (I mean, even if you are LIGHTER) it's very easy to exceed and to bend them, because the pressure you apply walking is not straight parallel to the major lenght of the nail and there are many accelerations of the weight that have to be considered in a normal walk. It's not your own weight the number they give us but the force applied.
This is a difficult procedure you're not making a cake, don't dream because it could be underwhelming. LL needs patience, expecially precice 2

Luckily, I'm "average", so I will take Xrays in order to see if I am lucky enough for it to fit in. And what you say, I'm aware it is not making a cake, I literally have been working 14 hours a day for the last 6 months to pay for this, I know what I'm getting into. And I don't expect to walk with precice, I just want to see if there are options of not being 4 months in a wheelchair. Not because of commodity, but because of the muscle atrophy and the problems that can bring.

[Tartar]

With precice 2 wheelchair is not a must but a possibility up to which nail you're going to have. Anyway, even in the best scenario nothing more than crutches will be possible for many months, probably even a big walker will be needed.

[Girl22]

Have you been able to weight bear / walk on crutches during the distraction phase? How has the clicking process been for you? Painful? How much length have you gained?

Yes I walked on crutches and inside the house I walked without them after some time. The clicking hurts in the beginning but it's bearable (by that I mean I didn't cry or sth)..After a while it gets easier and easier. I "only" made it to 8 cm (prolly because I was quite lazy with the muscle-stretching-exercises). Some other patient did 11 and was fine.

[V21]

With precice 2 wheelchair is not a must but a possibility up to which nail you're going to have. Anyway, even in the best scenario nothing more than crutches will be possible for many months, probably even a big walker will be needed.

Yeah, it's tough but I would be happy with that, as long as there is some movement. Being like 4-5 months in a wheelchair sounds crazy, a coworker was in bed due to illness for 2 months, and after that it was really difficult for her to walk decently. I just want to make sure I can do something in order to keep muscles as active as possible, taking also into account slower consolidation

[Tartar]

Luckily, I'm "average", so I will take Xrays in order to see if I am lucky enough for it to fit in. And what you say, I'm aware it is not making a cake, I literally have been working 14 hours a day for the last 6 months to pay for this, I know what I'm getting into. And I don't expect to walk with precice, I just want to see if there are options of not being 4 months in a wheelchair. Not because of commodity, but because of the muscle atrophy and the problems that can bring.

With "making a cake" I don't mean that you're underestimating the procedure, but I mean that there's not a time when you are sure to be ready. You can only have a big average range of time needed. Bone growth is very individual.

[Tartar]

Yeah, it's tough but I would be happy with that, as long as there is some movement. Being like 4-5 months in a wheelchair sounds crazy, a coworker was in bed due to illness for 2 months, and after that it was really difficult for her to walk decently. I just want to make sure I can do something in order to keep muscles as active as possible, taking also into account slower consolidation

You'll be always able to use the big walker even with minimal weight bearing, but if you can't stand they are useful just to keep legs active, you can't do daily activities with that if your weight is too much standing. If you go with precice 2 keep in mind the time I told you before, don't understimate it.

[V21]

You'll be always able to use the big walker even with minimal weight bearing, but if you can't stand they are useful just to keep legs active, you can't do daily activities with that if your weight is too much standing. If you go with precice 2 keep in mind the time I told you before, don't understimate it.

Thank you for your advice. I just hope Stryde is available before September but... worst case scenario? Precice 2 is what I can have