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[boklecrt]

Nice strawman argument you got there buddy boyo(actually you might not know what a strawman argument is, do google it), you only comment on buldu diaries, such an obvious livelifetaller bot

But lets investigate

So rafi went to our favorite turkish mutilator, the one and only halil buldu and got this:



While his xrays should've shown this(Paley result):




So now, the physiotherapist says

I also asked another physiotherapist who told me that my bones will realign once i will start to gain muscles back on my legs.

So, when a bone such as the femur has a 30 cm long metal rod as thick as a finger hammered in it from top to bottom and secured with 4 screws on both ends, how exactly are the bones going to "realign themselves" when the patient gains leg muscles? dont worry, its a rhetorical question

[boklecrt]

rafi, so if this misalignment turns into an X legs situation this will happen:




it will most certainly require corrective surgery, after at least 1 year and a half because the gap has to consolidate first and then they will remove the intramedullary nail, rebreak the bone, realign the bone, put a plate on it(15 cm-20 cm scar down both sides of legs), then you will be on crutches while that heals

[shortisnotfun]

Nice strawman argument you got there buddy boyo(actually you might not know what a strawman argument is, do google it), you only comment on buldu diaries, such an obvious livelifetaller bot

Interesting. Anyone who doesn't follow your position is a Buldu bot. 

Tell me where Buldu touched you on this bear.

I'm just pointing out how immature you are. I hope he doesn't require surgery or get further complications, but it's too early to tell. Wouldn't you agree?

[Maison]

I don't like sarcasm, but if he has a misalignment. I think it is an O leg, not an X leg.
 Femoral lengthening surgery rarely causes x-legs.

[balme]

rafi, so if this misalignment turns into an X legs situation this will happen:




it will most certainly require corrective surgery, after at least 1 year and a half because the gap has to consolidate first and then they will remove the intramedullary nail, rebreak the bone, realign the bone, put a plate on it(15 cm-20 cm scar down both sides of legs), then you will be on crutches while that heals

who is this? it lengthen too much on tibias i assume 

[rafi2296]

rafi you should have laughed at that physiotherapist in his face when he said that

it doesnt cost you anything to write emails to a bunch of LL docs and ask for this misalignment issue. Visually there is misalignment, its plain as day. You want to avoid misalignment because it would lead to X-legs which is very unsightly and can lead to early arthritis. Do not take the word of the doctor at face value, yes, he might not be purposely misleading you but in the end of the day you see your xrays, we see your xrays, it looks misaligned

the physiotherapist i asked has nothing to do with my doctor or  LL company so he has no reasons to lie in their favour. he seems very professional and honest.  his point of view is, that now as i’m very stiff and i lost muscle on legs and back, is early to say if my bones will stay like this. being less stiff after device removal and gaining muscles back  might drag my bones back in place.


right after frame removal i will try those orthopaedic correctors and check might x-rays regularly. seems to be effective for people with “x / o legs” so i have high hopes for me as my bones will be in consolidation phase so easier to correct . *hopefully*

https://ibb.co/xf7nf34
https://ibb.co/vq0SpYb

(someone teach me how do i add pictures in post please)

If you know any email of doctors that might reply please add them below, i will write them and be back with their opinion. i wrote to doctor Donghoon but no reply, and Dr. Usual , who told me that as per current x-rays , i didn’t had the best osteotomy but is nothing to be concerned about.

thank you everyone for taking your time to reply on my post

[shortisnotfun]

the physiotherapist i asked has nothing to do with my doctor or  LL company so he has no reasons to lie in their favour. he seems very professional and honest.  his point of view is, that now as i’m very stiff and i lost muscle on legs and back, is early to say if my bones will stay like this. being less stiff after device removal and gaining muscles back  might drag my bones back in place.


right after frame removal i will try those orthopaedic correctors and check might x-rays regularly. seems to be effective for people with “x / o legs” so i have high hopes for me as my bones will be in consolidation phase so easier to correct . *hopefully*

https://ibb.co/xf7nf34
https://ibb.co/vq0SpYb

(someone teach me how do i add pictures in post please)

If you know any email of doctors that might reply please add them below, i will write them and be back with their opinion. i wrote to doctor Donghoon but no reply, and Dr. Usual , who told me that as per current x-rays , i didn’t had the best osteotomy but is nothing to be concerned about.

thank you everyone for taking your time to reply on my post

Best of luck man, and looking forward to your progress. How are you doing so far and what's your length achieved now?

[boklecrt]

I don't like sarcasm, but if he has a misalignment. I think it is an O leg, not an X leg.
 Femoral lengthening surgery rarely causes x-legs.

look at how the external fixator is pulling on the bones. its pushing the knees together - imminent knocked knees/x legs

the physiotherapist i asked has nothing to do with my doctor or  LL company so he has no reasons to lie in their favour. he seems very professional and honest.  his point of view is, that now as i’m very stiff and i lost muscle on legs and back, is early to say if my bones will stay like this. being less stiff after device removal and gaining muscles back  might drag my bones back in place.


right after frame removal i will try those orthopaedic correctors and check might x-rays regularly. seems to be effective for people with “x / o legs” so i have high hopes for me as my bones will be in consolidation phase so easier to correct . *hopefully*

https://ibb.co/xf7nf34
https://ibb.co/vq0SpYb

(someone teach me how do i add pictures in post please)

If you know any email of doctors that might reply please add them below, i will write them and be back with their opinion. i wrote to doctor Donghoon but no reply, and Dr. Usual , who told me that as per current x-rays , i didn’t had the best osteotomy but is nothing to be concerned about.

thank you everyone for taking your time to reply on my post

rafi nothing is going to pull any bones back to straight because you have a stainless steel rod inside of the usually flexible femur. a long bone - femur, tibia, fibula, they are flexible in order to accommodate physical stress without breaking outright, but now that there is a nail to hold it in place while it calcifies, nothing will pull it back to normal

you upload images from the website turboimagehost like this:

 


so about these straps and braces, do not use this, this is again some nonsense figured out by chinese autists

this contraption will only put unnecessary force on the knee joint. look at how complex a knee joint is:

 

if you wear this strap on your legs you will just put force on one side of this extremely complex and delicate joint, deform it and move it out of its natural balance. this is the fast track to early arthritis and chronic knee pain. you really dont want to fk with your joints. fixing deformed bones is easy, fixing destroyed joints is not


doctors emails you can find for yourself

write these

 assayag
giotikas
rozbruch
mahboubian

[Medium Drink Of Water]

The internal nail is only attached at one end.  It's not holding anyhing in place now.

[boklecrt]

The internal nail is only attached at one end.  It's not holding anyhing in place now.

interesting post from an LL veteran

your statement is indeed correct - the nail is attached on one end, but the job of holding everything together falls on the external frame. nothing can move in any direction but the direction of the frame

and the frame is installed in a way that will push the bones inwards

so then when they remove the frame first they will screw the bottom of the internal nail and then unscrew the external frame

otherwise if they remove the frame before screwing the nail the body will immediately pull the bone back and destroy the gained centimeters

[Medium Drink Of Water]

The reason I'm not pessimistic about this case is that the device isn't strong enough to hold the leg completely stationary.  Other forces like muscle resistance can influence alignment, so what that physiotherapist said will happen is possible.  The resistance currently pulling it inward may get canceled out by opposite forces from other muscles as they recover, or diminished as the muscles that are providing the resistance now stretch more.

[boklecrt]

The reason I'm not pessimistic about this case is that the device isn't strong enough to hold the leg completely stationary.  Other forces like muscle resistance can influence alignment, so what that physiotherapist said will happen is possible.  The resistance currently pulling it inward may get canceled out by opposite forces from other muscles as they recover, or diminished as the muscles that are providing the resistance now stretch more.

I sincerely hope for rafi's sake that you're correct, but me personally i dont see how muscles can push the bone back to alignment(when the bone has internal rod in it for rigidity and stability).

Its just NEGLIGENT INSTALLATION at the first surgery, plain and simple.

Also, the monorail technology doesn't provide adjustment after installation like a TSF frame or illizarov - obviously these frames are unusable on femur surgery

LON Femur is a stupid method to choose when internal nails exist. People just have to put an extra year or two of saving and get an internal femur surgery instead of rolling the dice on a LON Femur


With the current hardware there is no point in time when the surgeon can adjust the bone back to normal alignment, not that he wants to, we heard what rafi said, buldu doesnt see any problem. And how would he see any problem, when we know from Hasaki's case that he would remove an external fixator and screw in the internal nail while the patient has bilateral non union and a raging case of acute osteomyelitis.


But anyway, the fact that rafi hasnt contacted and consulted a bunch of western surgeons like we told him to like 1 month ago means he is just not a very serious person, and I personally am done giving him advice as he doesnt want to listen. He'd rather listen to some random physio and some turkish doctor than assayag or giotikas' opinion. You can take a horse to water but you cant make it drink

good luck rafi

[shortisnotfun]

I sincerely hope for rafi's sake that you're correct, but me personally i dont see how muscles can push the bone back to alignment(when the bone has internal rod in it for rigidity and stability).

Its just NEGLIGENT INSTALLATION at the first surgery, plain and simple.

Also, the monorail technology doesn't provide adjustment after installation like a TSF frame or illizarov - obviously these frames are unusable on femur surgery

LON Femur is a stupid method to choose when internal nails exist. People just have to put an extra year or two of saving and get an internal femur surgery instead of rolling the dice on a LON Femur


With the current hardware there is no point in time when the surgeon can adjust the bone back to normal alignment, not that he wants to, we heard what rafi said, buldu doesnt see any problem. And how would he see any problem, when we know from Hasaki's case that he would remove an external fixator and screw in the internal nail while the patient has bilateral non union and a raging case of acute osteomyelitis.


But anyway, the fact that rafi hasnt contacted and consulted a bunch of western surgeons like we told him to like 1 month ago means he is just not a very serious person, and I personally am done giving him advice as he doesnt want to listen. He'd rather listen to some random physio and some turkish doctor than assayag or giotikas' opinion. You can take a horse to water but you cant make it drink

good luck rafi

Do you think LON Tibia could have the same problem? Regarding bow legs and X legsv

[rafi2296]

But anyway, the fact that rafi hasnt contacted and consulted a bunch of western surgeons like we told him to like 1 month ago means he is just not a very serious person, and I personally am done giving him advice as he doesnt want to listen. He'd rather listen to some random physio and some turkish doctor than assayag or giotikas' opinion. You can take a horse to water but you cant make it drink

good luck rafi

Well, i will email them to ask for a 2nd opinion. i haven’t yet because i tried to be positive and hope that i might not need another surgery.
If they will say that i will need another surgery to fix it, probably I  won’t be able to afford it in other place than in turkey.

The internal nail is only attached at one end.  It's not holding anyhing in place now.

The nail at the moment can move inside my bone. While exercising, i can feel it moving in my bone. i believe  that if i can stay with legs wide open during x-rays, miss alignment will be gone. but we will see the x-rays after removal.

Best of luck man, and looking forward to your progress. How are you doing so far and what's your length achieved now?

Doing well, i lengthened 6 cm so far; i expected more pain at the end (that’s what other pacients told me after reaching +5) but either I got used to the pain or the fact that i got taller makes me not feel the pain so much (being happy seeing results)  i hated and regretted this surgery at the beginning but now, just seeing myself taller than people who were taller than me before really changed my point of view and i’m glad i did it. I hope i’m not speaking to early and i won’t have any major complications until the end.

[boklecrt]

rafi thats very unwise on your part, being positive and putting your head in the sand like a flamingo will not fix ongoing complications. You cant wish away bone misalignment, the more you pull the frame the more it diverts from the neutral axis. Noone said you need to go spend 100 000 usd on a new surgery, the whole reason we told you to contact these doctors - assayag, paley, rozbruch, giotikas, donghoon(although he doesnt respond to emails apparently), parihar, birkholtz, betz even is because these people have seen thousands of cases combined and are well equipped to deal with any misalignment issues such as yours.

Then when you get the opinion of 2-3 surgeons, if they dont tell you how they'd fix it over simple emails, you stick your hand deep in your wallet and fork out $200 for a skype consult with a few of them and ask them to explain to you in details how they will fix your legs

And then you take this information and discuss it with a good ORTHOPEDIC(doesnt have to be limb lengthening) turkish surgeon thats covered under your insurance or whatever the healthcare system is in turkey. You agree on what to do and you go and get it fixed for free or co-paid

If a bunch of these doctors say you got nothing to worry about - great!

In the end of the day, its your legs and your future mobility, better safe than sorry amirite buddy boyo

Also, you better make damn sure you got union on those xrays before you take the frame off. You don't wanna become hasaki #2

[Medium Drink Of Water]

personally i dont see how muscles can push the bone back to alignment(when the bone has internal rod in it for rigidity and stability).

Because the rod is presently providing neither of those things for the bone, which is why muscles were able to pull it out of alignment in the first place.

[Maison]

I think rafi case is similar to LLprime3 .

LLPprime3 topic.
http://www.limblengtheningforum.com/index.php?topic=69283.0

Images of LLPprime3
https://ibb.co/SPx8YJq
https://ibb.co/1TCMk0S

The problem with LLPprime3 was bow-legs, not X-legs.

[boklecrt]

I think rafi case is similar to LLprime3 .

LLPprime3 topic.
http://www.limblengtheningforum.com/index.php?topic=69283.0

Images of LLPprime3
https://ibb.co/SPx8YJq
https://ibb.co/1TCMk0S

The problem with LLPprime3 was bow-legs, not X-legs.

its great when an intelligent person writes a diary, its a pleasure to read

his end result xray looks great compared to his pre-op xray, they fixed him back to normal as perfectly as it could've been done

hope he fixed his walk in the end


as a side note, if you notice his femur xray, the insertion of the nail and the placement of his fixator is again suboptimal which aggravated his pre-op bow legs. i suppose buldu doesnt really go for ultra precision when doing his multiple surgeries a day. "close enough"

[rafi2296]

as a side note, if you notice his femur xray, the insertion of the nail and the placement of his fixator is again suboptimal which aggravated his pre-op bow legs. i suppose buldu doesnt really go for ultra precision when doing his multiple surgeries a day. "close enough"

i couldn’t find in his post what surgery he did to correct his bow legs 🤔

[boklecrt]

i couldn’t find in his post what surgery he did to correct his bow legs 🤔

rafi when he had his tibia frames removed and tibia nails locked, in the same surgery they went up in the femurs, removed his old nails from his previous LON femur, installed new nails, broke the femur again and rotated it to correct the axis, then locked the femur nails. thats a very skilled surgeon for sure, you should keep him in mind if you need your legs fixed too

[shortlifelonghope]

..

[shortlifelonghope]

Hey, i noticed the guy in the picture below. he is Rejai, but he calls himself  "Jay" as a doctor's assistant. (https://ibb.co/VVWPhjv)
He is on dr.YukselYurttas Team,and i had  long conversation with that guy, Rejai, throughou the mail. Anyways, so...your doctor is dr. Yuksel Yurttas. I also talked to other patients on this team, and well.... ihave definitely made up my mind that this team is not reliable and safe. The website may seem well organizedd and informative but on the flip side, maan it is deep s**t.  By the way, though Dr. YukselYurttas might be the oldest and have had many cases, clearly .... it does not mean that he is experienced in this field. I truly wanna go for limb lengthening in Turkey, cause it is way too pricy in other countries like the USA, korea, germany. i havebeen in contact with other clinics in Turkey. I ll compare them and soon decide. i ve been doing a lot research since 2013, and i think from the line of osteotomy, the proximal part of the femur is on the the way of becomiing varus, and it will increase more if your doctor ignores this. Slight misalignment can occur in LON-Femur as far as ı saw in the research papers but this is too much.

[rafi2296]

when i came in turkey, i met Rejay too. dr. Yüksel was one of my options, unfortunately or not, i haven’t done it with them.

[rafi2296]

rafi when he had his tibia frames removed and tibia nails locked, in the same surgery they went up in the femurs, removed his old nails from his previous LON femur, installed new nails, broke the femur again and rotated it to correct the axis, then locked the femur nails. thats a very skilled surgeon for sure, you should keep him in mind if you need your legs fixed too

Thank you, I will show to my doctor for an opinion and to compare mine and his x-rays. hopefully i won’t need that many procedures , i will update you guys with my next x-rays soon. i’m still hoping that, with lengthening, bones angle with decrease.

[Michael J. Assayag, MD]

it's time I chime in on this thread.

I find it extremely unfortunate to see, over and over and over again varus and rotational deformities of the proximal femur after a very straighforward LON or Intramedullary lengthening using a piriformis entry nail.

It is unclear why surgeons do this, but instead of inserting the piriformis nail through the piriformis fossa (!!!) they insert it through the tip of the greater trochanter. The result is varus of the femur, which, in the long run, leads to weakness of the buttock muscles, persistant limb, and lateral hip pain upon exertion.

this is an EASILY avoidable complication.

In addition, the OP xrays show substantial malrotation of the proximal femur.

This is fixable at the end of lengthening, but would require an additional surgery to fix it.

[shortlifelonghope]

when i came in turkey, i met Rejay too. dr. Yüksel was one of my options, unfortunately or not, i haven’t done it with them.

sorry mare! I thought you did it with them, because I saw the picture of that guy. Anyways, they are still not my option after i talked couple of them. so i wonder there left to be dr serkan gurcan then.

[rafi2296]

sorry mare! I thought you did it with them, because I saw the picture of that guy. Anyways, they are still not my option after i talked couple of them. so i wonder there left to be dr serkan gurcan then.

No worries  😁 Once I will finish my journey and leave turkey I will add more details regarding the company. Besides that misalignment, i’m pretty happy with the team yet so i don’t want to give them a bad reputation. They are very friendly and responsive with our needs, no one of current pacients had any infection (we get antibiotics medicine, spray and bandages change very often to avoid that). Yes, when things are odd, they say most of the times “everything is normal” but i guess they don’t want you to freak out but they don’t ignore it at the end of the day.


Thank you everyone for spending time reading and replying to my post 🙏🏼

[boklecrt]

it's time I chime in on this thread.

I find it extremely unfortunate to see, over and over and over again varus and rotational deformities of the proximal femur after a very straighforward LON or Intramedullary lengthening using a piriformis entry nail.

It is unclear why surgeons do this, but instead of inserting the piriformis nail through the piriformis fossa (!!!) they insert it through the tip of the greater trochanter. The result is varus of the femur, which, in the long run, leads to weakness of the buttock muscles, persistant limb, and lateral hip pain upon exertion.

this is an EASILY avoidable complication.

In addition, the OP xrays show substantial malrotation of the proximal femur.

This is fixable at the end of lengthening, but would require an additional surgery to fix it.

Thank you for your input Dr Assayag, the community really appreciates having a surgeon of your prominence as a contributing member

As per the Dr, this is a visualization of the root issue of the entire problem:



Rafi, there you go, the doctor has reviewed and diagnosed your case, could've had this information one month ago so that you can line up a corrective surgery asap

For further information I suggest you get a consult with Dr Assayag so that he can explain how this possible correction can be done "at the end of lengthening", as this is some tricky tricky stuff, as as far as I understand if they take off the external fixator in order to manipulate the bones, the stretched soft tissues would immediately pull back the femurs a bit and lose centimeters of progress.

So, very interesting to know how this is treated

[Michael J. Assayag, MD]

Thank you for your input Dr Assayag, the community really appreciates having a surgeon of your prominence as a contributing member

[…] how this possible correction can be done "at the end of lengthening", as this is some tricky tricky stuff, as as far as I understand if they take off the external fixator in order to manipulate the bones, the stretched soft tissues would immediately pull back the femurs a bit and lose centimeters of progress.

So, very interesting to know how this is treated

you’re welcome!

You are right! if the ex fix is released before locking, the regenerate springs back…. tricky stuff indeed…

[shortisnotfun]

Nice strawman argument you got there buddy boyo(actually you might not know what a strawman argument is, do google it), you only comment on buldu diaries, such an obvious livelifetaller bot

But lets investigate

So rafi went to our favorite turkish mutilator, the one and only halil buldu and got this:



While his xrays should've shown this(Paley result):




So now, the physiotherapist says

So, when a bone such as the femur has a 30 cm long metal rod as thick as a finger hammered in it from top to bottom and secured with 4 screws on both ends, how exactly are the bones going to "realign themselves" when the patient gains leg muscles? dont worry, its a rhetorical question

Hilarious. This man didn't even go to Halil Buldu and yet he lives rent free in your head. I agree LLT does have its issues, but posts like these are hilarious, yet destroy the quality of this forum. Please retract or modify statement.

[boklecrt]

Hilarious. This man didn't even go to Halil Buldu and yet he lives rent free in your head. I agree LLT does have its issues, but posts like these are hilarious, yet destroy the quality of this forum. Please retract or modify statement.

rafi has not said explicitly who his surgeon is, nor has he denied our theories that it is buldu, as he is currently doing it with someone(who smells like buldu from the 1.5mm per day lengthening and the low quality surgery as already outlined in detail by Dr Assayag), so he doesn't want to risk antagonizing his doctor while still not having finished the process and having to do the fixator removal. its understandable

if rafi comes out and says his doctor's name, and its not buldu, of course I will make a whole new post retracting my allegations of misconduct on buldu's part