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[Dirona]

Day 26 – Reached the Half Inch Mark, Average Heights in the U.S., +1.275cm (0.50 inch)

https://heightjourney.wordpress.com/2022/08/09/day-26-reached-the-half-inch-mark-average-heights-in-the-u-s-1-275cm-0-50-inch/

Hey HJ,

one quick question..What does Dr Assayag think about non unions ? Do they depend on the type of osteotomy done? Are they treatable 100 % in case of LL as the fracture here is induced ?

[Height Journey]

Hey HJ,

one quick question..What does Dr Assayag think about non unions ? Do they depend on the type of osteotomy done? Are they treatable 100 % in case of LL as the fracture here is induced ?

I asked Dr Assayag about non-unions a while ago. I don't think the type of osteotomy is a significant factor. A qualified limb lengthening doctor should follow these guidelines.

1) Prevention is the best medicine. Analyze X-rays carefully to detect a delayed union which can lead to a non-union. If a delayed union is detected, adjust the lengthening rate as follows.
a) Slow down lengthening rate
b) Temporarily stop lengthening
c) Reverse lengthening, if the device allows it

2) Bone graft. This is the last resort, so make sure you can prevent it in step (1) so you don't have to resort to this.

[Height Journey]

Day 29 – Bi-Weekly Appointment with X-rays, +1.50cm (0.59 inch)

https://heightjourney.wordpress.com/2022/08/12/day-29-bi-weekly-appointment-with-x-rays-1-50cm-0-59-inch/

[Height Journey]

Day 31 – Review of Week 4, Physical Therapy, +1.65cm (0.65 inch)

https://heightjourney.wordpress.com/2022/08/14/day-31-review-of-week-4-physical-therapy-1-65cm-0-65-inch/

[Height Journey]

Day 37 – Review of Week 5, Losing Dorsiflexion Angle, Scars, +2.10cm (0.83 inch)

https://heightjourney.wordpress.com/2022/08/20/day-37-review-of-week-5-losing-dorsiflexion-angle-scars-2-10cm-0-83-inch/

[Dirona]

I asked Dr Assayag about non-unions a while ago. I don't think the type of osteotomy is a significant factor. A qualified limb lengthening doctor should follow these guidelines.

1) Prevention is the best medicine. Analyze X-rays carefully to detect a delayed union which can lead to a non-union. If a delayed union is detected, adjust the lengthening rate as follows.
a) Slow down lengthening rate
b) Temporarily stop lengthening
c) Reverse lengthening, if the device allows it

2) Bone graft. This is the last resort, so make sure you can prevent it in step (1) so you don't have to resort to this.

Thanks HJ.. I think the osteotomy technique does make a difference though.. It is the reason why Dr. Lee hasn't had even 1 for stature lengthening.. Paley's site mentions about osteotomy technique as well IIRC

[Height Journey]

Day 39 – Physical Therapy Progress, Videos of my PT Exercises, +2.25cm (0.89 inch)

https://heightjourney.wordpress.com/2022/08/22/day-39-physical-therapy-progress-videos-of-my-pt-exercises-2-25cm-0-89-inch/

[TheDream]

Hi HJ

I have a question for you / maybe Dr. Assayaq if you find it good enough and have the chance to ask him:

With Tibia lengthening my impression is that while the tibia bone is hold firm into place the bone next to it (fibula) is not. But the fibula is also bent at an angle while the tibia is more straight. How do they avoid the fibula changing its natural “bent” angle during tibia lengthening when it is not “kept in place” like the tibia is. And maybe it is impossible to do this due to its natural bent angle. Will this not be a problem if one lengthens a lot on tibias? I would guess there is some important bio-mechanical reason for the fibulas to have this natural bent angle, which from before and after X-Rays seems impossible to conserve with lengthening.

[Height Journey]

Hi HJ

I have a question for you / maybe Dr. Assayaq if you find it good enough and have the chance to ask him:

With Tibia lengthening my impression is that while the tibia bone is hold firm into place the bone next to it (fibula) is not. But the fibula is also bent at an angle while the tibia is more straight. How do they avoid the fibula changing its natural “bent” angle during tibia lengthening when it is not “kept in place” like the tibia is. And maybe it is impossible to do this due to its natural bent angle. Will this not be a problem if one lengthens a lot on tibias? I would guess there is some important bio-mechanical reason for the fibulas to have this natural bent angle, which from before and after X-Rays seems impossible to conserve with lengthening.

As long as you have a qualified orthopedic surgeon, it should not be a worry. The natural bent angle of the fibula is very small and as the gap expands, callus formation will replace the gap and then calcify into bone. Also, the large locking screw to secure the end of the fibula to the tibia is very secure and will not be displaced, unless you place recklessly excessive loads or force on your lower leg. If you do go that far, then the internal nail or locking screws will most likely bend or break anyway and you get what you deserve for being so reckless.

[TheDream]

As long as you have a qualified orthopedic surgeon, it should not be a worry. The natural bent angle of the fibula is very small and as the gap expands, callus formation will replace the gap and then calcify into bone. Also, the large locking screw to secure the end of the fibula to the tibia is very secure and will not be displaced, unless you place recklessly excessive loads or force on your lower leg. If you do go that far, then the internal nail or locking screws will most likely bend or break anyway and you get what you deserve for being so reckless.

Hey Hj thanks for your response.

The natural bent angle of the fibula is very small and as the gap expands, callus formation will replace the gap and then calcify into bone.

But surely the angle of the fibula will change as a result of the lengthening right? As the lengthening is along the tibia axis which is straight, the new callus forming along the fibula will follow the tibia angle, and therefore the fibula will change as a result?

Maybe if they break the fibula at the right point this risk is minimized and the probability of non-union minimized or something along that logic.

[boklecrt]

Hey Hj thanks for your response.

But surely the angle of the fibula will change as a result of the lengthening right? As the lengthening is along the tibia axis which is straight, the new callus forming along the fibula will follow the tibia angle, and therefore the fibula will change as a result?

Maybe if they break the fibula at the right point this risk is minimized and the probability of non-union minimized or something along that logic.

i propose we stop saying HJ - that sounds like a hand job


so basically with the fibula - it can go in many different ways due to the fixation - some docs like assayag screw the top part and the bottom part to the tibia, some doctors dont touch the fibula(incompetent), some doctors affix only the bottom part of the fibula

here are my Xrays:




so, on my surgery the doctor passed one of the lower pins through the tibia and fibula therefore affixing the ankle portion of the fibula with the tibia. the ankle portion is what matters in the end because its what gives your ankles stability when walking/running

however, yes the fibula curved towards the tibia

this is not the end position of this fibula though, because since there is union in my fibulas, they will initially heal in this position you see from the xrays, HOWEVER, over time and due to weight bearing stress(daily walking), the bone will modify itself and straighten itself out

[TheDream]

i propose we stop saying HJ - that sounds like a hand job


so basically with the fibula - it can go in many different ways due to the fixation - some docs like assayag screw the top part and the bottom part to the tibia, some doctors dont touch the fibula(incompetent), some doctors affix only the bottom part of the fibula

here are my Xrays:




so, on my surgery the doctor passed one of the lower pins through the tibia and fibula therefore affixing the ankle portion of the fibula with the tibia. the ankle portion is what matters in the end because its what gives your ankles stability when walking/running

however, yes the fibula curved towards the tibia

this is not the end position of this fibula though, because since there is union in my fibulas, they will initially heal in this position you see from the xrays, HOWEVER, over time and due to weight bearing stress(daily walking), the bone will modify itself and straighten itself out

Very interesting post thank you, also for the x rays to see.
I did not know that they attached pins to the fibula as well. I always wondered about that. It is not many tibia lengthenings that include this bit, I don’t remember seeing it before, or am I remembering wrong?

The last part about the bone over time modifying itself and straightening out as well is very interesting. Do we know for sure this is a fact? I apologize if I sound rude here, I am not saying this is not true, I am just amazed if this works it would be perfect, but I can imagine this is complicated as it would depend on the patient walking a lot early, and maybe also on the patient not lengthening too much?

[boklecrt]

Very interesting post thank you, also for the x rays to see.
I did not know that they attached pins to the fibula as well. I always wondered about that. It is not many tibia lengthenings that include this bit, I don’t remember seeing it before, or am I remembering wrong?

The last part about the bone over time modifying itself and straightening out as well is very interesting. Do we know for sure this is a fact? I apologize if I sound rude here, I am not saying this is not true, I am just amazed if this works it would be perfect, but I can imagine this is complicated as it would depend on the patient walking a lot early, and maybe also on the patient not lengthening too much?

the phenomenon of bones straightening themselves out over time depends on the severity of the initial fracture

the fibula is not affixed like the tibia with a nail or a plate so it will heal the way the body pushes it to heal. by walking and exerting stress on it while its still calcifying it will move in the direction where the stresses push it to

in the xrays, the position is not straight, so if after 1 year it has not migrated back to its original straight position and consolidates in the position of the xray, it will be possibly considered fibular malunion. if that happens to me i can get a quick surgery to get it realigned if my doctor thinks its medically necessary(if i have pain, instability or a risk of early arthritis). but since im now about 6 weeks after this xray and in total 4 months into recovery from frame removal and my ankles feel very stable that tells me that the fibula is not presenting issues for now so we will see on my 6 month xray whats going on with it. ideally it should have started moving back to straight position

[Height Journey]

Day 43 – Bi-Weekly Appointment with X-rays, +2.55cm (1.00 inch)

https://heightjourney.wordpress.com/2022/08/27/day-43-bi-weekly-appointment-with-x-rays-2-55cm-1-00-inch/

[Height Journey]

i propose we stop saying HJ - that sounds like a hand job

It's okay to refer to me as HJ, because the first thing when everyone else thinks HJ means is Height Journey.

If the word "hand job" first comes to your mind when seeing HJ, it gives us a clue of what your private lifestyle is like. But I'm not here to judge or pry into your private lifestyle.

[EndGame]

HJ, thanks for sharing your experiences. What is the picture in your profile? Grey purple plastic looking thing? Something used in PT maybe?

[Height Journey]

HJ, thanks for sharing your experiences. What is the picture in your profile? Grey purple plastic looking thing? Something used in PT maybe?

It's the electronic magnetic controller (ERC) used to lengthen the Precice internal nail.

[Height Journey]

Day 45 – Review of Week 5, Foot Supination, +2.65cm (1.04 inch)

https://heightjourney.wordpress.com/2022/08/28/day-45-review-of-week-5-foot-supination-2-65cm-1-04-inch/

[Height Journey]

Day 50 – Review of Week 7, Muscle Tightness and Pain, Astym Treatment, Updated Goal, +2.90cm (1.14 inch)

https://heightjourney.wordpress.com/2022/09/02/day-50-review-of-week-7-muscle-tightness-and-pain-astym-treatment-updated-goal-2-90cm-1-14-inch/

[Height Journey]

Day 52 – Reached 3cm, Videos on Transferring from Wheelchair to Toilet or Shower, +3.00cm (1.18 inch)

https://heightjourney.wordpress.com/2022/09/04/day-52-reached-3cm-videos-on-transferring-from-wheelchair-to-toilet-or-shower-3-00cm-1-18-inch/

[user9999999]

Really enjoying your posts HJ. Your videos are great too. Hope you continue to recover well. How many cm until you stop with tibias?

[Height Journey]

Really enjoying your posts HJ. Your videos are great too. Hope you continue to recover well. How many cm until you stop with tibias?

I mentioned my goal in my latest blog post. But some people don't read it, so here it is again.

My goal is 3.5cm

[user9999999]

I mentioned my goal in my latest blog post. But some people don't read it, so here it is again.

My goal is 3.5cm

Thanks, I must have scrolled past it. Do you have any concerns about your wingspan at the end? Seems like even if you go over ~10cm, you still look great.

[EndGame]

Thanks, I must have scrolled past it. Do you have any concerns about your wingspan at the end? Seems like even if you go over ~10cm, you still look great.

Speaking of proportions, I was curious what your sitting height is? Congrats on almost being done.

[Height Journey]

I did not measure my sitting height.

About my wingspan, I have no problems with it and I do not anticipate it to be a concern. I read somewhere that when the deficit of your wingspan is 3.5 inches (9cm) less than your height, your arms start to become noticeably shorter than usual. Every millimeter beyond that, it gets more noticeable. But it's only a matter of perception (that is, how much you really care and how much it gets to you of what other people think of your arm length).

The deficit of my wingspan to height will be well less than 3 inches (about 2.6 inches) and it looks fine to me and everyone else.

[AimHigh]

i went from +2 inch WS to - 1 Inch WS , nobody noticed or commentted at all.

[Siegfried]

Hello HJ,

given that we are both doing tibias with Precice 2, started around the same time and and are finishing at 3.5cm as well, Im following your blog very closely. I will be done lengthening in about 10 days, my doc told me to slow down a little towards the end, since the bone healing in my tibias is not the best atm.

Hope your doing better.

[Height Journey]

Thanks Siegfried. I'm at 3.15cm and I'll be done lengthening in a week to reach 3.5cm.

And about the wingspan to height discussion, I really think it's overrated. For example, I've seen videos by women saying they don't want to date short men. But have you ever seen, or can you show us, a video on dating preferences saying something like, "That guy is 6 feet tall and handsome, but I'm not dating him because his arm lengthen is more like for a 5'9" man".

[Bagga]

HI HG
Can you use the walker to the toilet and shower or simply wheelchair?
How are the wounds at Tibias? big marking and obvious?
How are you feeling - any more pains or discomfort?

[Height Journey]

HI HG
Can you use the walker to the toilet and shower or simply wheelchair?
How are the wounds at Tibias? big marking and obvious?
How are you feeling - any more pains or discomfort?

I can use the walker to toilet or shower chair, but it is easier and more convenient using the wheelchair. I will need a raised toilet seat with handles for a walker. I have videos on walker to toilet or shower chair as well.

Rwad my blog, starting from my surgery date of July 14, for details on scars and pain. In summary, there are more tibia scars than femur scars, but they are small and not so obvious. There are 2 longer scars on the side of my knees, but still better hidden. Pain is still manageable and on the lower side, about 3/10.

[Height Journey]

Day 57 – Last Bi-Weekly Appointment with X-rays, Last Weekly Review (Week , +3.25cm (1.28 inch)

https://heightjourney.wordpress.com/2022/09/09/day-57-last-bi-weekly-appointment-with-x-rays-last-weekly-review-week-8-3-25cm-1-28-inch/