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[ChangeMyLife]

I've been reading many of the threads here, and one of my biggest nightmares is the possibility of femur fracture after the nails are removed 1 year post-op. Most notoriously in the case of programdude and DreamerLL. For PD it was clear that his bones hadn't fully calcified. This says that this problem can occur on both precice 2.2 and stryde. I'm terrified after seeing DreamerLL's recent post, and I am still searching for an answer to why this happens (despite a doctor's go-ahead for removal):

(1) What are the telltale signs that the bone has indeed fully healed and ready for rod removal? What are the signs that they are not fully healed?

(2) Alternatively, is the extra tension on the muscles post lengthening causing the bones to snap?

(3) Given this possibility, is removal 2 years post op a better idea?

Can anyone with more knowledge / experience please shed some light? Thank you .

[SirStretchAlot]

1) X-rays will show this clearly. The more light that is blocked by the bones (the "whiter" your bone consistency is) the more dense it is. If you see a lot of dark areas in your x-ray, then it means it has not fully consolidated.

2) The muscles don't apply force to the bones. It is how one weightbears (walking/jumping/awkward stretches) that causes bones to snap.

3) The drawback to late withdraw is that the bones can grow over the screws, making withdraw more bloody and requiring more sawing. Most doctors would advise removal between 1-1.5 years. If you're less sure, get it extracted after 1.5 years. There's very little study on the effect of permanently leaving nails in your marrow, so I'd rather not try.

DreamerLL will probably shed more light onto this from his doctor's feedback. Bones don't just snap like that without the patient having done something out of the ordinary. His bones looked very consolidated as well. I honestly don't think the surgeon did anything wrong, besides not paying more attention to him.

Bone fractures to his extent is extremely rare. It is the first time I've seen it even on this forum. I would not base your decisions purely on the most extreme outcome. There are drawbacks to keeping the nail in your body for too long as well.

[Hagane]

Part of it is when the screws are removed there are holes where the screws were.

[Mayday]

Removal of the nail is usually recommended for 1 or 2 years. At the end of this period, if the cortex in the lengthening area is completely white in the X-ray, the nail can be removed and the bone will be as strong as before. Of course, the remodeling period of the bone continues for a long time.

During the lengthening period, extra tension may occur in the muscles, but this tension pressure is on the intramedullary nail, not in the lengthening zone. After the intramedullary nail is removed, this load is fully on the bone, but since the bone has already fully healed, there can be no fracture. In addition, if there is still a lot of tension in the muscles after 2 years, the lengthening limit is seriously exceeded.

[cyborg4life]

Yikes a post rod removal fracture sounds like an absolute nightmare! Sorry to hear this happened to those patients! I agree it's a very rare complication but I remember my surgeon telling me - even post rod removal be cautious for 6-10 weeks

[TheDream]

After the intramedullary nail is removed, this load is fully on the bone, but since the bone has already fully healed, there can be no fracture.

Wouldn't there be big hollow regions inside the bone where the metal rod, nail and screws were located prior to removal, which require time for the bone to fill?

[ChangeMyLife]

Wouldn't there be big hollow regions inside the bone where the metal rod, nail and screws were located prior to removal, which require time for the bone to fill?

This is a great point too. The IM cavity will be devoid of marrow/fat right after rod removal, making it more hollow and perhaps less rigid for a few months until it fills in again.

Is it worth doing the removal in 2 stages? (1) Removing the bottom screws in the first surgery to apply marginally more load on the bone and allow it to harden under this load (2) Removing the other screws and the rods a few months later.

Another 2-staged removal: Remove the nail/screws from one leg first, restrict weight bearing to a minimum on that side, then remove the other nail later.

Personally, I don't mind going into surgery multiple times, I just prefer not to be in constant fear of one (or both) of my femurs snapping unexpectedly.

For all the technology that's been developed, it's surprising that there's no conclusive/quantitative way to tell if a bone has truly hardened or if the x-rays are just misleading  .

[Want-3-inches]

This is a great point too. The IM cavity will be devoid of marrow/fat right after rod removal, making it more hollow and perhaps less rigid for a few months until it fills in again.

For all the technology that's been developed, it's surprising that there's no conclusive/quantitative way to tell if a bone has truly hardened or if the x-rays are just misleading  .

It gets filled in with fat. It doesn't add any bone mass. The screw holes do fill up with bone though.

+100 on x-rays not being sufficient. I do hope Dr D comes around with an explanation on why it happened and how he would prevent it from happening with future patients based on SPECIFIC criteria on the x-ray or other imaging. Not something vague like "it's probably safer to wait for another 5 months".

[SpeedDialer]

Do most doctors also agree 1.5 years is the best time to remove the rod? Curious what they think. I'm also scared

[indication]

Do most doctors also agree 1.5 years is the best time to remove the rod? Curious what they think. I'm also scared

Its a gamble. It can break at any point.

[Activatedxx]

This is a great point too. The IM cavity will be devoid of marrow/fat right after rod removal, making it more hollow and perhaps less rigid for a few months until it fills in again.

Is it worth doing the removal in 2 stages? (1) Removing the bottom screws in the first surgery to apply marginally more load on the bone and allow it to harden under this load (2) Removing the other screws and the rods a few months later.

Another 2-staged removal: Remove the nail/screws from one leg first, restrict weight bearing to a minimum on that side, then remove the other nail later.

Personally, I don't mind going into surgery multiple times, I just prefer not to be in constant fear of one (or both) of my femurs snapping unexpectedly.

For all the technology that's been developed, it's surprising that there's no conclusive/quantitative way to tell if a bone has truly hardened or if the x-rays are just misleading  .

That’s dumb as it will cost exponentially more and having surgery is not easy on the mind and body

[ChangeMyLife]

That’s dumb as it will cost exponentially more and having surgery is not easy on the mind and body

Definitely is more taxing on the body/mind, but would you rather have 2 planned (and rather simple) surgeries, or one surgery and a higher risk of unexpected fracture (which could lead to a major surgery, trauma and more recovery time)?

It would cost twice as more, not exponentially more.

Also it is not dumb, Dr. Assayag even suggested this option in one of his videos. I'm not saying everyone should, I'm weighing the pros and cons as objectively as possible.

[SpeedDialer]

ty!!! What are your thoughts on a better amount of time to wait than 1.5 years to take them out?

[Movie]

after reading of this twice from patients who had them removed close to the 1 year post-op mark, yes preferably aim for 1.5 - 2 years if you really want to take the extra caution.

[SpeedDialer]

ty!!!!!

There is one thing I am a bit curious about. What is the physical mechanism of why 1 year vs 1.5 vs 2 etc might have different results?

Ex: is the bone not fully healed at 1 year? Or is the reason completely unrelated?

I am thinking of doing LL then waiting like 5-10 years to take it out (gonna be a bit busy with things, maybe should do earlier?), dk if that is a bad idea. It takes 2 weeks to recover after taking it out or am I mistaken?