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[Thehighest]

Dr Franz, do you still use ilizarov fro cosmetic becuase of cost some of us cant afford internal?

[kamaruusman]

With second-hand TSF frame, it's 30k. If new, no idea.

By the way, we don't do external just because it's cheaper. There are a lot of advantages.

[4limbed]

Does Dr Birkholtz do retrograde or Antegrade femurs? I read on his old thread where he said that passing 6cm Antegrade will increase joint pressure and risk of osteopetrosis later in life.

But obviously doing retrograde can fk with your knees.

He said in an interview with Victor from cyborg4life on youtube that he can do antegrade or retrograde regardless of the nail used, but that’s a decision the surgeon makes depending on the situation.

[4limbed]

Good luck! Awesome to hear that someone is doing this with Dr. Franz

Are you going to create a diary for your LL journey?

Thank you man. I Sure will!

[Franz]

Does Dr Birkholtz do retrograde or Antegrade femurs? I read on his old thread where he said that passing 6cm Antegrade will increase joint pressure and risk of osteopetrosis later in life.

But obviously doing retrograde can fk with your knees.

It is a very individual decision, depending on many individual factors for every patient. Generally around 80% of our CLL patients end up with antegrade femoral lengthening using a nail.

[Franz]

Dr Franz, do you still use ilizarov fro cosmetic becuase of cost some of us cant afford internal?

I am very comfortable using external devices for lengthening and use the hexapod fixators like the TLHex and TSF as a rule.
We will not consider CLL for femurs using external fixation.

The biggest drawback of external fixators is the time in frame. It is 1.5-2 months for every cm lengthened. That means that a 4cm tibial lengthening needs the frames on for 6-8 months.

[shortisnotfun]

I am very comfortable using external devices for lengthening and use the hexapod fixators like the TLHex and TSF as a rule.
We will not consider CLL for femurs using external fixation.

The biggest drawback of external fixators is the time in frame. It is 1.5-2 months for every cm lengthened. That means that a 4cm tibial lengthening needs the frames on for 6-8 months.

Do you allow patients to lengthen 8cm in femur with Precice?

[Franz]

Officially I encourage a safe limit of 6.5cm on the femurs.
We do find that a lot of patients reach that point and the soft tissues and nerves allow more. Then we do sometimes go to the maximum of the nail, which is 8cm.

My strong recommendation would be to aim for 6.5 as a minimum goal and see how it goes when you get there.

[Vogel]

Officially I encourage a safe limit of 6.5cm on the femurs.
We do find that a lot of patients reach that point and the soft tissues and nerves allow more. Then we do sometimes go to the maximum of the nail, which is 8cm.

My strong recommendation would be to aim for 6.5 as a minimum goal and see how it goes when you get there.

Do you do unilateral lengthening doc?

What’s your recommendation for someone that wants to weight bear right after the surgery?

[Franz]

Hi,

Unilateral lengthening, as in planned bilateral, but staged so that one leg is done at a time?

[Limbfan2020]

Hi,

Unilateral lengthening, as in planned bilateral, but staged so that one leg is done at a time?

Hi Dr. Franz,

do you think unilateral staged lengthening is the safest way to do a cosmetic leg lengthening?

[Franz]

Hi Dr. Franz,

do you think unilateral staged lengthening is the safest way to do a cosmetic leg lengthening?

An interesting question.

It is certainly a smaller procedure than bilateral surgery per setting, but of course it has to be performed twice. That probably pushes the safety statistics back to roughly the same level.

I am not fond of doing this. It induces a significant (6-8cm) leg length discrepancy for the time bewteen the two procedures. That makes real weight bearing quite difficult. And more importantly, if, for some reason the second procedure doesn't get done (logistics, pandemics, wars etc), the patient is left with the significant LLD and would suffer from a significant functional impairment.

Hope it makes sense.

[TheDream]

Dr Franz what would you say is currently the main thing holding back LL patients in terms of athletic ability in the long run?
Is it things like the ITB and Achilles Tendon that don’t respond that well to lengthening or is it a general weakening of the muscles from the lengthening?

[1team]

I read that Dr Franz allows Precise 2.2 patients to weight bear as much as they can handle, is this true?

Wouldn't it break the nail?

[1team]

It is a very individual decision, depending on many individual factors for every patient. Generally around 80% of our CLL patients end up with antegrade femoral lengthening using a nail.

Do you make the decision to go retrograde or Antegrade with the patient before surgery or see what works best once you get cutting?

[Franz]

Dr Franz what would you say is currently the main thing holding back LL patients in terms of athletic ability in the long run?
Is it things like the ITB and Achilles Tendon that don’t respond that well to lengthening or is it a general weakening of the muscles from the lengthening?

It is probably all of the above to different degrees in different patients. It is definitely true that shorter lengthenings recover better.

[Franz]

I read that Dr Franz allows Precise 2.2 patients to weight bear as much as they can handle, is this true?

Wouldn't it break the nail?

Precice nail is limited to 35kg. Fitbone limited to 20kg during lengthening and up to 100kg thereafter.

I allow safe progression to weight bearing in a graduated way depending on bone growth etc

[Franz]

Do you make the decision to go retrograde or Antegrade with the patient before surgery or see what works best once you get cutting?

A detailed plan is made with the patient prior to surgery and we discuss this weeks in advance, usually during a zoom call.

[informationispower]

Jello dr. Franz. A well known surgeon in my country says he prefers to do bilateral femurs but with a 2 weeks distance between each leg in order to minimize risk for PE or fat emboli. What is your take on this approach?

[1team]

Jello dr. Franz. A well known surgeon in my country says he prefers to do bilateral femurs but with a 2 weeks distance between each leg in order to minimize risk for PE or fat emboli. What is your take on this approach?

Which surgeon is this?

[informationispower]

Which surgeon is this?

Wont reveal until I will do an operation with him. He was trained under Rozbruch though and works in one of the best hospitals in my country. Only after I will do the op with him I will think about revealing info

[TheDream]

Dr. Franz when the lengthening rod is inserted into the bone I always hear that it is inserted into the “Hollow” part of the bone. But is there not bone marrow in there? If so you will have to drain the bone marrow, and then you’d be low on it for as long as you have rods in as they occupy a lot of volume?

[Franz]

Jello dr. Franz. A well known surgeon in my country says he prefers to do bilateral femurs but with a 2 weeks distance between each leg in order to minimize risk for PE or fat emboli. What is your take on this approach?

It increases the cost by a fair bit, as well as the total time from surgery to end of distraction somewhat.
It may well be a bit safer, but I am not aware of any data supporting that.

[Franz]

Dr. Franz when the lengthening rod is inserted into the bone I always hear that it is inserted into the “Hollow” part of the bone. But is there not bone marrow in there? If so you will have to drain the bone marrow, and then you’d be low on it for as long as you have rods in as they occupy a lot of volume?

In adults the long bones like femur is mostly filled with fat. It is not the bone marrow that forms blood cells etc anymore. That is only present in adults in flat bones and at the ends of the long bones.
So the nails basically replace fat from within the long bones.

[kamaruusman]

Which surgeon is this?

Dr. Michael Assayag

[toyz]

what are the fit bone nail diametre sizes that are available dr?

[Franz]

what are the fit bone nail diametre sizes that are available dr?

11 and 9 mm

[sphenopetroclival]

Dr. Michael Assayag

Presumably you're under 175cm?

[Bob]

Hello Doctor Franz.

Two questions:

1. When patients have leg surgeries with external circular fixators they use different pin-site care strategy to avoid infections. Some patients clean their pin-site with sterile water and change bandages from time to time. Also I have read that some patients didn’t clean or touched their pin-site and didn't change bandages at all for 5 – 6 months, they just kept it dry and they didn’t get any infections. Have you any thoughts regarding this subject?

2. Do you always give blood thinner medicine in the different kind of leg surgeries you perform such as  lengthening, deformity corrections, knee issues etc.?

[DoctorStrange]

I'm currently getting surgery done with Dr Birkholtz.



Why him:

1. He is a proper orthopaedic surgeon, a limb reconstruction specialist. He has dealt extensively with trauma cases, botched surgeries, and is not just a surgeon that has little orthopaedic experience that went straight into CLL. He has a lot of skin in the game, fixes botched CLL, goes to conferences, teaches, performs research.

2. He has trained US surgeons and has worked with very famous one. No need to name names, you can ask the top US surgeons what they think. I say this because he is someone that performs surgeons based on world class, internationally renowned standards - a natural extension of training with the best, and being one of the best.

3. Excellent surgical technique - not dangerous with proximal cuts, therm-necrosis from use of certain types of saws, and he offers a proper ITB release.

4. Package is $60,000 , in a rich affluent part of Cape Town, SA. Arguably in my view, the most advanced part of Africa in terms of the facilities, resources. You stay in a private hospital, and then are moved to a world class, security gated facility. All meals are taken care off for.3 months , all x-rays, laundry,  transport, and he regularly sees you , meets with you with bi-weekly x-rays, and keeps a close tab on you via internet/phone.


In my view, outside of the US and Donghoon Lee in South Korea, the only other place I'd go to is Birkholtz. He is in the top 5 world wide easily in terms of his caliber.

Now, on this website, online there are a lot of sharks. There are liars, and people just trying to sell you something without value. So I'd say, don't even believe the words I have written. Always perform objective research yourself, find out for yourself and dig deeper. Never just settle.

[Golden]

Hey Doc,

I would like to know the total cost for external fixator on tibias such as TSF device.

Is there any package to only stay for one month not that 3 months? Is there any possibility to have a package that accommodation isn't included?

Thanks