Hello everyone! I recently sent this email to Dr. Franz Birkholtz and the reason I chose to send this email to him out of any other doctor is because of his unique approach to the situation and how honest his answers seem to be about the entire procedure and how honest he seems to be when discussing what is safe. I want to open this thread so that we can all come together and potentially answer some of these questions that are important. Here is the email…
Hello Dr. Birkhoktz! I know you don’t preform cosmetic limb lengthening anymore, but I appreciate your honesty about the procedure and I was wondering if you could give me some guidance and advice because this is something I really want to do. I have bad height neurosis and it’s something that has bothered me my whole life. I wake up at about 172.72 cm before any spine compression and during the day I am anywhere from 172.085 to 171.196 depending on what activities I preform or other factors that could compress my spine at different levels. I want to get cosmetic leg lengthening and I am 100% going to do it and I have been doing research for about 6 months now and I still have remaining questions. I want to do this in the safest possible way and minimize my risk of long term complications (especially arthritis). I’ve read about how internal nails lengthen along the anatomical axis causing a shift in the mechanical axis which leads to misalignment. I was wondering if you think the best way to combat this is reducing the length gained using an internal nail on the femur or by using an external fixator that can maintain the mechanical axis and alignment? I know there are qualified doctors in Russia, such as Dr. Solomin and Dr. Kulesh, who offer ilizarov lengthening of the femur and I know they take steps to maintain the mechanical axis especially after lengthening when they do corrections with the hexapod fixator. What is your opinion on external fixation for cosmetic cases? To me it sounds like something that could be optimal in the long term especially in comparison to an internal nail which doesn’t have anywhere near the same capacity to maintain alignment as an external fixator which can be turned into an external hexapod. I know that external fixators have been used in femurs for a long time and are still used today for fractures so is it possible a good doctor could produce a good outcome with external femurs? Is the damage done to soft tissues irreversible and bad enough to completely remove external femur fixation from the conversation? I was also wondering if the LON method for external femurs changes anything at all? External fixation is still used today to help broken femurs heal and with the LON method wouldn’t the amount of time the external fixator is attached be the same as if it was put on for a broken femur? Does the lengthening cause further soft tissue damage that is significant because you are dragging the muscles and not just keeping the pins stationary to assist bone healing like in cases of fracture fixation? I know that the ilizarov is superior for tibia lengthening and deformity correction, but in terms of femur lengthening do you think monorails or an ilizarov apparatus is superior? If external fixators for femurs are completely out of the picture that reduces the doctors I have been considering and removes doctors like Dr. Halil Buldu, Dr. Solomin, and Dr. Kulesh. If internal nails are the only safe way to lengthen femurs what is the maximum length you would recommend for the femur as to not push the mechanical axis too far out of alignment? I’ve heard you mention 4-5 cm before and I was wondering if you think 6 is okay? Dr. Dror Paley offers 8 cm and I’m just not convinced 8 cm is completely safe. My goal is to lengthen around 11-12 cm total with two separate operations on the femur and tibia and I was wondering if you think this can be done safely and what’s the safest way of doing it? I am pretty convinced on pure externals on the tibia for around 5-6 cm but no more than 6. I don’t want an internal nail to be inserted through my knee and I don’t want my patellar tendon to be cut so pure externals is my only option for tibia. Keeping all this in mind do you think 6 cm with external fixation on the femur and 6 cm with pure externals on tibia is something that is achievable without a huge increase in potential complications for the short and long term? What about 6 cm with an internal nail and 6 cm with pure externals? I also do have questions on preserving bio mechanics. Is it better to preserve the ratio between the femur and tibia or is it better to lengthening both segments the same amount? An example would be a 32.8 cm tibia and 41 cm femur. The ratio between the two is a perfect 0.80. Would it be better to lengthen both the same amount for example 37.8 and 46 lengthening both 5 cm creating a new ratio of about 0.822. Or is it better to maintain the 0.80 ratio lengthening the tibia to 37.8 and the femur to 47.25 recreating the original and perfect 0.80 ratio. I also have questions on measured increase and actual height gain. I assume because the tibia is relatively straight the amount lengthening results in an almost 1:1 increase in height but because the femur is at an angle and isn’t straight like the tibia wouldn’t there be a difference between actual height gained and the amount of lengthening done? If there is a difference what can you expect the discrepancy to be? For example if I lengthening my femur 6 cm what will the actual height gain be? I have further questions but I don’t want to overload you and I understand if you’re too busy to even answer so don’t worry about a response I’m not obligated to receive one. I hope you have a great day!
Author
Topic: Questions about LL and important discussion (Read 616 times)