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[V21]

Hey guys,
Giotikas told me today that Precise will be back in Europe in September, but he will also start using G-nail because it's weight bearing. My first thought is to wait for Precice and, if there are more delays, do G-Nail. However, I would like to know your opinions.
More info:


https://www.athensbjr.com/introduction-of-g-guichet-nail/

https://www.athensbjr.com/methods-of-bone-fixation-in-limb-lengthening/#1586804812044-2153da5a-68a1

[RB]

This is great news. I genuinely think this is now one of the best options in the market. You get a proven weight bearing nail performed by Giotikas who will also do an ITB release. My situation worked  out great in the end but if I had this option in March I would have chosen this over going to Betz. Weight bearing is a huge advantage.

[Highest]

Wasn't the issue with g nail runaway lengthening and the inability to reverse? Have these been corrected?

[V21]

Wasn't the issue with g nail runaway lengthening and the inability to reverse? Have these been corrected?

No, it can't reverse. It's obviously a clear disadvantage, but of course, I have also to consider weight bearing instead of being months on wheelchair. I don't know what runaway lengthening is. I apologize, as English is not my main language. I'm so conflicted right now.

[Want-3-inches]

runaway lengthening is when the clicks happen unintentionally and you keep lengthening even when you don't want to.

The biggest risk of Guichet nail is non-union.

If you don't want to use a wheelchair at all, you can do one leg at a time on Precice but you will need a long time to finish it.

[V21]

runaway lengthening is when the clicks happen unintentionally and you keep lengthening even when you don't want to.

The biggest risk of Guichet nail is non-union.

If you don't want to use a wheelchair at all, you can do one leg at a time on Precice but you will need a long time to finish it.

But non union can be prevented by doing very regular x rays right? If there is bad bone growht, I can stop lenghtening. To be honest, my main worry is malfunction. It would be horrible to waste all this money and effort for the nail to suddenly stop working. However, Precise has also the risk of bending, so I don't reallt know what to do. I think I will wait to September for Precice and, if there are more delays, I would take G-nail. However, the weight bearing part is tempting.

[Want-3-inches]

But non union can be prevented by doing very regular x rays right? If there is bad bone growht, I can stop lenghtening. To be honest, my main worry is malfunction. It would be horrible to waste all this money and effort for the nail to suddenly stop working. However, Precise has also the risk of bending, so I don't reallt know what to do. I think I will wait to September for Precice and, if there are more delays, I would take G-nail. However, the weight bearing part is tempting.

If there is runaway lengthening then you can't stop. See Unicorn's diary.

Giotikas is new to the nail, so that is an extra problem.

[V21]

If there is runaway lengthening then you can't stop. See Unicorn's diary.

Giotikas is new to the nail, so that is an extra problem.

I thought Unicorn's problems were because Guichet made her click too much? Regarding Giotikas being new to the nail, yeah, that's something to consider.
Anyway, would you choose Precice? I'm leaning to wait to September. After all, I just want 5.5 cm.

[SirStretchAlot]

I thought Unicorn's problems were because Guichet made her click too much? Regarding Giotikas being new to the nail, yeah, that's something to consider.
Anyway, would you choose Precice? I'm leaning to wait to September. After all, I just want 5.5 cm.

I'm on Betzbone, which is almost identical to the Guichet nail. Both derive from the Albizzia nail.

1) Guichet uses a similar knee rotational mechanism to lengthen the nail. The rotation angle is perpendicular to your walking stance and was chosen specifically because it is not used in day-to-day activity.  It cannot "runaway." I think some people are confusing it with ISKD.

2) Not reversing would only be an issue with tibias, where malunion is much more likely to occur. Femur malunion almost never happens in healthy young adults.

3) I agree with Want-3-inches that Giotikas being new to the nail may be the biggest problem. The operational procedure and aftercare may be different. I would want to see Giotikas perform at least 5 or so procedures before trying his Guichet nail.

[V21]

I'm on Betzbone, which is almost identical to the Guichet nail. Both derive from the Albizzia nail.

1) Guichet uses a similar knee rotational mechanism to lengthen the nail. The rotation angle is perpendicular to your walking stance and was chosen specifically because it is not used in day-to-day activity.  It cannot "runaway." I think some people are confusing it with ISKD.

2) Not reversing would only be an issue with tibias, where malunion is much more likely to occur. Femur malunion almost never happens in healthy young adults.

3) I agree with Want-3-inches that Giotikas being new to the nail may be the biggest problem. The operational procedure and aftercare may be different. I would want to see Giotikas perform at least 5 or so procedures before trying his Guichet nail.

Thanks for the insight. In your research about Betzbone, would you say that there is a higher malfunctioning rate compared to Precice? To be honest, my biggest fear is investing all this money and effort for the nail just to stop working mid lengthening. Of course, with Precise there is also risk of breaking the nail.

[Body Builder]

Gnail like all albizzia craps are an obsolete joke with serious risks of uncontrollable lengthening and with a barbaric procedure to lengthen which also makes rehabilitation longer.

A very bad decision for Giotikas to use that nail unless he charges the half amount compares to precise 2 (not even stryde) something I am sure he won't do.

[V21]

Does anyone now how much weight can G-nail take? I can't find it, all places just say it's "full weightbearing", but no actual numbers are shown.

[Jack Hanma]

Yes this is actually a better option than precise-2. It says the faliure rate is just 2% which is nothing much to worry about. Most importantly it allows for full weight bearing. Anyone have any experience with this nail?

[Arcon]

"Runaway" was a problem of ISKD distractor nail, not G-nail, Albizzia or Betzbone. Don't get confused.

[Body Builder]

"Runaway" was a problem of ISKD distractor nail, not G-nail, Albizzia or Betzbone. Don't get confused.

You are wrong. There was that kind of problem with all the above nails. Thats the main reason Unicorn had a huge non alignment with g nail crap which lengthened uncontrollably.

All these nails are crap. No sane LLer would use these nails now that precise 2 still exist (although not fully weight bearing) and stryde will be back in business in a year or less probably.

[Highest]

You are wrong. There was that kind of problem with all the above nails. Thats the main reason Unicorn had a huge non alignment with g nail crap which lengthened uncontrollably.

All these nails are crap. No sane LLer would use these nails now that precise 2 still exist (although not fully weight bearing) and stryde will be back in business in a year or less probably.

According to Dr Debiparshad Stryde at the earliest will be returning end of 2022 to the start of 2023. If people want a weight bearing nail they have very few options.

[Arcon]

You are wrong. There was that kind of problem with all the above nails. Thats the main reason Unicorn had a huge non alignment with g nail crap which lengthened uncontrollably.

All these nails are crap. No sane LLer would use these nails now that precise 2 still exist (although not fully weight bearing) and stryde will be back in business in a year or less probably.

No, you are wrong, the main problem with unicorn was that the nail penetrated the bone which was more of a surgeon's performance issue, not the uncontrolled lengthening.  ISKD nail was notorious for uncontrollable lengthening not guichet, betzbone or Albizzia.

Stryde failed in less than 3 years since its introduction and they now need 1.5-2 years to introduce a new "Stryde" (and probably another 2 years to see how it works in the real world). We should stop thinking of it as " the standard" because it has never been as good a nail as we all thought.

Precise-2 is good and proven, but it is non-weight bearing which means more physio and more limitation. So imo, frames may still be the best option in the tibia now but in the femur I think precise-2 , gichet nail and betzbone are all "sane" options if performed by a knowledgeable surgeon.

[V21]

No, you are wrong, the main problem with unicorn was that the nail penetrated the bone which was more of a surgeon's performance issue, not the uncontrolled lengthening.  ISKD nail was notorious for uncontrollable lengthening not guichet, betzbone or Albizzia.

Stryde failed in less than 3 years since its introduction and they now need 1.5-2 years to introduce a new "Stryde" (and probably another 2 years to see how it works in the real world). We should stop thinking of it as " the standard" because it has never been as good a nail as we all thought.

Precise-2 is good and proven, but it is non-weight bearing which means more physio and more limitation. So imo, frames may still be the best option in the tibia now but in the femur I think precise-2 , gichet nail and betzbone are all "sane" options if performed by a knowledgeable surgeon.

I agree with you. For now I think I will wait for Precice 2, specially if I can get the big nail, as I have quite a big frame for my height (I was 85 kg before dieting and getting to 74). I probably will do X rays soon to confirm that. However, if there are more delays with Nuvasive, I will consider G-Nail, and I don't think it's fair to call mechanical nails "crap" nails when there are so many recent success stories with them. I also don't think Giotikas would choose a crap nail, as he earns the same with Precice, the price changes are due to the nail itself.

[RB]

Gnail like all albizzia craps are an obsolete joke with serious risks of uncontrollable lengthening and with a barbaric procedure to lengthen which also makes rehabilitation longer.

A very bad decision for Giotikas to use that nail unless he charges the half amount compares to precise 2 (not even stryde) something I am sure he won't do.

I understand that you don't like mechanical nails and that's fine but stop calling them obsolete when they are the only weight bearing nails in use at the moment. For them to be obsolete it would mean they have no clinical use or benefit (not true since weight bearing is a benefit in itself) and the irony behind a statement like that is, Stryde is the nail that is now obsolete as it basically doesn't exist anymore and failed in less than 3 years. Precise 2 is a good option but using a walker / wheelchair for months isn't something to take lightly and having to be 'cleared' to start walking unassisted can be a long process if you are a slow bone grower.

We need to be more objective on this forum about the benefits and drawbacks of all current methods for future LLers and stop talking about Stryde as if its the holy grail - it is no longer an option and has a chance of never being an available again.

[KrP1]

I sincerelly think that Precice 2 nail is the best option right now. It's a FDA approved nail , with reversal mechanism and most LL surgeons in the world use it.

[V21]

I sincerelly think that Precice 2 nail is the best option right now. It's a FDA approved nail , with reversal mechanism and most LL surgeons in the world use it.

Not approved in Europe though. They are hoping to get the CE mark back by September, but it would not be the first time there are delays.

[Body Builder]

I understand that you don't like mechanical nails and that's fine but stop calling them obsolete when they are the only weight bearing nails in use at the moment. For them to be obsolete it would mean they have no clinical use or benefit (not true since weight bearing is a benefit in itself) and the irony behind a statement like that is, Stryde is the nail that is now obsolete as it basically doesn't exist anymore and failed in less than 3 years. Precise 2 is a good option but using a walker / wheelchair for months isn't something to take lightly and having to be 'cleared' to start walking unassisted can be a long process if you are a slow bone grower.

We need to be more objective on this forum about the benefits and drawbacks of all current methods for future LLers and stop talking about Stryde as if its the holy grail - it is no longer an option and has a chance of never being an available again.

A nail that needs to paimfully rebreak your bone each time to lengthen is an obsolete crap and I am fully aware of what I am writing.
Stryde was a far superior nail in everything and yes, now it is not in market but if someome can't wait then of course precise 2 is a far better choice compared to these albizzia garbages.
With precise you lengthen almost painless, there is reverse lengthening to avoid any non union and the consolidation of the bone is much faster as you don't rebreak it every day for 2-3 months like albizzia. Also, for 2-3 months not walking unassisted is nothing of importance. I haven't walked for much more than that with my monorails and when I started walking again everything wen't fine so it is really not that important as the only reason to prefer albizzia than precise.
Maybe if albizzia had half the price of precise I would think of it as a choice (still not good). But with the same price I will keep writing that it is a joke.

And of course it has the problem of uncontrolled lengthening, and that haooened with Unicorn in contrast with what Arcon wrote.
And finally, it is not even that stable as some people want to believe. Many betzbones (the same as gnail) broke or bended.
But Giotikas probably found an easy way to earn more money, as gnail is much cheaper than precise and I am sure he will charge the same amount of money for both so it is an easy way for extra money. Simple as that.

[RB]

A nail that needs to paimfully rebreak your bone each time to lengthen is an obsolete crap and I am fully aware of what I am writing.
Stryde was a far superior nail in everything and yes, now it is not in market but if someome can't wait then of course precise 2 is a far better choice compared to these albizzia garbages.
With precise you lengthen almost painless, there is reverse lengthening to avoid any non union and the consolidation of the bone is much faster as you don't rebreak it every day for 2-3 months like albizzia. Also, for 2-3 months not walking unassisted is nothing of importance. I haven't walked for much more than that with my monorails and when I started walking again everything wen't fine so it is really not that important as the only reason to prefer albizzia than precise.
Maybe if albizzia had half the price of precise I would think of it as a choice (still not good). But with the same price I will keep writing that it is a joke.

And of course it has the problem of uncontrolled lengthening, and that haooened with Unicorn in contrast with what Arcon wrote.
And finally, it is not even that stable as some people want to believe. Many betzbones (the same as gnail) broke or bended.
But Giotikas probably found an easy way to earn more money, as gnail is much cheaper than precise and I am sure he will charge the same amount of money for both so it is an easy way for extra money. Simple as that.

You are not rebreaking the bone each time you click, you are putting the leg back and forth into varus and valgus positions. The bone is not rebreaking each time, the bone is already broken and still being pulled away from both ends like any method. If it was the case that the bone rebroke every time, clicking would not suddenly became painless after 2-3cm as it did for me and many others.

I am almost fully consolidated on a mechanical nail at 4.5 months, I don't think it has affected my bone growth at all. Betzbone did used to break in the past, but find me a case in the last 3-4 years with the new Betzbone where it broke or bended. I have heard of screws bending but even Stryde screws bent in some diaries.

Weight bearing is not just an advantage for walking, but also for just standing and going to the bathroom/small distances without having to worry about using a walker and how much weight you are shifting onto each leg. I never said Precise was a bad option, I think it's a good nail but mechanical nails are still a good option if weight bearing is important to you. I am walking basically normal now when Precise patients would just be starting to duck walk and that's assuming their bone growth is normal which for many it takes longer. It's not simply 3 months of walking with assistance, it's 4-5 months until enough bone has formed and mostly closer to 5 months for someone who does 8cm. Mechanical nails have limitations but so does Precise.

Unicorn's case was also a complete disaster. He put a 13mm rod into her small bones, made her click 5mm in one day among other things which led to a complete lengthening failure. This is due to Guichet's negligence and not the nail itself.

[V21]

A nail that needs to paimfully rebreak your bone each time to lengthen is an obsolete crap and I am fully aware of what I am writing.
Stryde was a far superior nail in everything and yes, now it is not in market but if someome can't wait then of course precise 2 is a far better choice compared to these albizzia garbages.
With precise you lengthen almost painless, there is reverse lengthening to avoid any non union and the consolidation of the bone is much faster as you don't rebreak it every day for 2-3 months like albizzia. Also, for 2-3 months not walking unassisted is nothing of importance. I haven't walked for much more than that with my monorails and when I started walking again everything wen't fine so it is really not that important as the only reason to prefer albizzia than precise.
Maybe if albizzia had half the price of precise I would think of it as a choice (still not good). But with the same price I will keep writing that it is a joke.

And of course it has the problem of uncontrolled lengthening, and that haooened with Unicorn in contrast with what Arcon wrote.
And finally, it is not even that stable as some people want to believe. Many betzbones (the same as gnail) broke or bended.
But Giotikas probably found an easy way to earn more money, as gnail is much cheaper than precise and I am sure he will charge the same amount of money for both so it is an easy way for extra money. Simple as that.

It's not same price as Precice. It's around 7K more expensive, which is another disadvantage. However, I must consider it in case Precice keeps getting delayed. Hard to trust Nuvasive predictions at this point, and I need to do it on September at the very latest.

[Body Builder]

It's not same price as Precice. It's around 7K more expensive, which is another disadvantage. However, I must consider it in case Precice keeps getting delayed. Hard to trust Nuvasive predictions at this point, and I need to do it on September at the very latest.

Even more expensive? That thing is geting more hillarious now.
Why don't you do lon on tibias then? Much cheaper, more easy and painless. I really wouldn't think a second between using albizzia crap and doing lon on tibias (or purely externals of course).

[Body Builder]

You are not rebreaking the bone each time you click, you are putting the leg back and forth into varus and valgus positions. The bone is not rebreaking each time, the bone is already broken and still being pulled away from both ends like any method. If it was the case that the bone rebroke every time, clicking would not suddenly became painless after 2-3cm as it did for me and many others.

I am almost fully consolidated on a mechanical nail at 4.5 months, I don't think it has affected my bone growth at all. Betzbone did used to break in the past, but find me a case in the last 3-4 years with the new Betzbone where it broke or bended. I have heard of screws bending but even Stryde screws bent in some diaries.

Weight bearing is not just an advantage for walking, but also for just standing and going to the bathroom/small distances without having to worry about using a walker and how much weight you are shifting onto each leg. I never said Precise was a bad option, I think it's a good nail but mechanical nails are still a good option if weight bearing is important to you. I am walking basically normal now when Precise patients would just be starting to duck walk and that's assuming their bone growth is normal which for many it takes longer. It's not simply 3 months of walking with assistance, it's 4-5 months until enough bone has formed and mostly closer to 5 months for someone who does 8cm. Mechanical nails have limitations but so does Precise.

Unicorn's case was also a complete disaster. He put a 13mm rod into her small bones, made her click 5mm in one day among other things which led to a complete lengthening failure. This is due to Guichet's negligence and not the nail itself.

By rebreaking I mean that you disturb the bone gap by doing some extreme movements to lengthen. And I don't know how your lengthening became painless after 2-3 cm but most LLers cried in pain till the very end of their lengthening phase.
Also, I've seen tehths of x rays of LL patients. Patients with albizzia had always the thinest bine bridge after lengthening which means that something was disturbing the bone gap and I am sure that it was the way it lengthens (with the extreme movements).

Anyway I find it really unacceptable for Giotikas to charge so much money for that obsolete nail and that happens only because he found a way to continue doing fully internals, now that stryde and precise are not back in europe, with earning even more money than before.
I used to respect Giotikas but that kind of decisions are not worthy of a respectable doctor.

[V21]

I'm having a videocall with Giotikas this week and I will ask him a few doubts, I will update.

[Apollo676]

Thanks bud,i'm looking forward to hear what he said,i agree with Bodybuilder here,the sole fact that he is charging the exact same price as stryde even though Guichet nail is way more archaic is laughable

[V21]

Thanks bud,i'm looking forward to hear what he said,i agree with Bodybuilder here,the sole fact that he is charging the exact same price as stryde even though Guichet nail is way more archaic is laughable

I will confirm in a few days, but I think he earns the same doing Precice or G Nail. The price difference is because of the nail manufacturer and that amount it's paid to him directly. I agree it's overpriced, but I don't think it's Giotikas fault.

[Arcon]

I think it is good that Giotikas added a weight bearing option for those who are interested. It's not like he stopped offering Precise-2 or that he now strongly promotes gichet-nail over Precise-2!
Imo, it is very promising to not just see Doctors promoting their own inventions (How biased is that!?... Betz=Betzbone, Guichet= Guichet nail, Paley= Precise and Stryde- All were advertised as "Miraculous" by their inventors and we now know that they all have their limitations). Imo, I like it that Giotikas now has all internal and external options available for me to consider (except LON in the femur). I don't really think it makes a lot of difference to him financially and his pricing is still the most competitive.

[Apollo676]

Could you ask him why is he so against Lon femur ? I know that's its the worst for femur but I'd like to know specifically why if it's not good for long term recovery or what