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[analyser]

penguinn's x-rays https://imgur.com/a/nYiru https://imgur.com/Tn2bn6O

most docs break the femurs much below

[analyser]

here are some x-rays from US surgeons Dr M and Dr Paley

https://imgur.com/A4COg20

https://imgur.com/aYp9Brb

https://imgur.com/TqNLOlT

https://imgur.com/1WXNKZi

https://imgur.com/a/XXgTafU

https://i.imgur.com/nwR6ELIl.jpg

Where Dr Parihar has done the osteotomy is a very unusual place. What are the pros and cons of a more proximal osteotomy  vs a distal one?

[analyser]

here are Dr Debiparshad's x-rays

https://i.imgur.com/9MiaaqR.jpg https://i.imgur.com/tdrGcBT.jpg

again far more distal

[tallmen]

It doesn't matter

[KiloKAHN]

At least according to Dr Birkholtz, proximal osteotomies are preferred by many surgeons because they tend to create more reliable bone formation.

[analyser]

Check out this thread by Ascending http://www.limblengtheningforum.com/index.php?topic=64696.msg170208

He and Mr Ian Bararese-Hamilton believe that the nail doesn't respond to proximal osteotomies that well. Interestingly, even Penguinn's nail did not work after surgery and they had to change it.

There has got to be a reason why every surgeon in the US does more distal osteotomies. It's science, not opinions.

[KiloKAHN]

Check out this thread by Ascending http://www.limblengtheningforum.com/index.php?topic=64696.msg170208

He and Mr Ian Bararese-Hamilton believe that the nail doesn't respond to proximal osteotomies that well. Interestingly, even Penguinn's nail did not work after surgery and they had to change it.

There has got to be a reason why every surgeon in the US does more distal osteotomies. It's science, not opinions.

If proximal osteotomy was something the Precice nail would have issue with, then that's something the Nuvasive rep who was in the OR for Penguinn's surgery would have mentioned to Dr Parihar, but nothing was said. All devices have a likelihood of having a mechanical error, which is why faulty nails are covered at no cost to the patient. It's a stretch to belive a nail failed because of the osteotomy site as opposed to the mechanics of the nail itself.

Also, 3 surgeons =/= every doctor in the US, and even listing every doctor on this site wouldn't be a fraction of that, but there are many surgeons who prefer more proximal femur osteotomies

What exactly are you worried about regarding the area chosen for osteotomy anyway?

[analyser]

If proximal osteotomy was something the Precice nail would have issue with, then that's something the Nuvasive rep who was in the OR for Penguinn's surgery would have mentioned to Dr Parihar, but nothing was said. All devices have a likelihood of having a mechanical error, which is why faulty nails are covered at no cost to the patient. It's a stretch to belive a nail failed because of the osteotomy site as opposed to the mechanics of the nail itself.

Also, 3 surgeons =/= every doctor in the US, and even listing every doctor on this site wouldn't be a fraction of that, but there are many surgeons who prefer more proximal femur osteotomies

What exactly are you worried about regarding the area chosen for osteotomy anyway?

No idea why Ellipse representative didn't say anything. Maybe this is a newly discovered problem?

The concern is really just that
a) the nail might not respond because the osteotomy is proximal. I don't have any official documentation stating this but only anecdotes
b) if it was decision taken because of lack of equipment in the OR

To quote Ascending about his surgeon

I suspect that the reason Dr E chose to do a high osteotomy in my case was because my femur was curved and he did not have a flexible drill to hand during the surgery and so he took whatever steps he could to continue the surgery.  I remember he told me after the surgery that it took 5 hours because he did not have a flexible drill for reaming which was needed because of femur curvature and so he had to go very slowly and carefully with the straight drill.

Then again, it's just strange that after going through 50 diaries I couldn't find one x-ray of such a proximal osteotomy. So I'm just looking for an explanation.

[analyser]

but there are many surgeons who prefer more proximal femur osteotomies

Do you have a source for this?

[Tartar]

penguinn's x-rays https://imgur.com/a/nYiru https://imgur.com/Tn2bn6O

most docs break the femurs much below

You have a good eye. He performed an higher one. Giotikas too is used to do it sometimes.
Nuvasive recommends a lower osteotomy, some cms under the trochanter. Not a big deal anyway, but these are indications of the company.

[analyser]

You have a good eye. He performed an higher one. Giotikas too is used to do it sometimes.
Nuvasive recommends a lower osteotomy, some cms under the trochanter. Not a big deal anyway, but these are indications of the company.

Hi Tartar, are you a Giotikas patient? Did he change his ways now or does he still do proximal osteotomies? And do you have a source from nuvasive about this or did giotikas tell this to you?

[KiloKAHN]

Do you have a source for this?

Every surgeon is going to have their own preference.

This is what Dr Franz Birkholtz (https://www.emedevents.com/speaker-profile/franz-friedrich-birkholtz) said about proximal osteotomies:

http://www.limblengtheningforum.com/index.php?topic=137.msg65429#msg65429

"1) Is the placement of the break relevant in regards to recovery or even the look of the soft tissue surrounding it? For example, if one was to break and lengthen the center of the calf muscle vs just above the ankle.

Yes,absolutely. The choice of osteotomy site will determine the rate and quality of bone growth, as well as the final appearance of the limb. As a general rule, the preference in the femur is proximal. In the tibia we also prefer proximal as that creates the most reliable bone formation."

[curlyfella]

I think its 1/3 of the way down the guidelines are , or its half way, can't remember

[PerfectBody]

He straight up fractured that guy’s femur with a hammer. There are actual fragmented bone shards in that X-ray. 🤯🤯🤯

[curlyfella]

oh i see what you mean ya

[KiloKAHN]

He straight up fractured that guy’s femur with a hammer. There are actual fragmented bone shards in that X-ray. 🤯🤯🤯

A shattered break during osteotomy is not uncommon, and patients with solid bone density will tend to shatter at the osteotomy site instead of being able to cut cleanly. This isn't a bad thing, and many surgeons will actually perform an osteotomy like this on purpose because it creates more surface area to promote bone growth.

[analyser]

A shattered break during osteotomy is not uncommon, and patients with solid bone density will tend to shatter at the osteotomy site instead of being able to cut cleanly. This isn't a bad thing, and many surgeons will actually perform an osteotomy like this on purpose because it creates more surface area to promote bone growth.

While I agree I've read similar things before, I see no surgeon intentionally creating an osteotomy like this. Not Paley, not any of the US surgeons who are known for LL.

In Penguinn's case, it is understood that it unintentionally turned out this way because the nail had to be reinserted.

[analyser]

Every surgeon is going to have their own preference.

This is what Dr Franz Birkholtz (https://www.emedevents.com/speaker-profile/franz-friedrich-birkholtz) said about proximal osteotomies:

http://www.limblengtheningforum.com/index.php?topic=137.msg65429#msg65429

Maybe so, but if it's a Precice thing, it's something the surgeon should change his approach just for the nail.

The unknown now is whether Nuvasive officially recommends more distal osteotomies. I will see if I can get an answer somehow.

[KiloKAHN]

Maybe so, but if it's a Precice thing, it's something the surgeon should change his approach just for the nail.

The unknown now is whether Nuvasive officially recommends more distal osteotomies. I will see if I can get an answer somehow.

Dr Parihar's other Precice patients appear to be just fine. I think you're worrying too much, dude.

 

[analyser]

Dr Parihar's other Precice patients appear to be just fine. I think you're worrying too much, dude.

 

There is only one Dr Parihar Precice diary here. Are you sure these are his patients?

But yeah, it is done more distally in these.

[KiloKAHN]

There is only one Dr Parihar Precice diary here. Are you sure these are his patients?

But yeah, it is done more distally in these.

100%

They're anonymous and don't have diaries on the forum.

[analyser]

100%

They're anonymous and don't have diaries on the forum.

Nice, that's reassuring. Is this one patient or two patients? Sorry, can't tell from the images.

If I were to make a guess, his personal preference was to do it proximally but Nuvasive later communicated to everyone that more distal is preferred.

[KiloKAHN]

Nice, that's reassuring. Is this one patient or two patients? Sorry, can't tell from the images.

If I were to make a guess, his personal preference was to do it proximally but Nuvasive later communicated to everyone that more distal is preferred.

2. He's also had 2 precice tibias for LLD.
Possible, or maybe he figured Penguinn's bones were on the narrow end and went higher to encourage the bone growth. Only Dr Parihar could really say why though.

[appgain]

Dr Parihar's other Precice patients appear to be just fine. I think you're worrying too much, dude.

 

May I know how you got these xrays? I found one source of leak for another Precice patient who went to India (with Dr. Suhas Sha) and maybe your source is the same.

[appgain]

Please send me a PM if possible.