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[Ghostfish]

Hi Dr. Monegal

I have read this thread from the beginning and am very happy to find especially this information. 
I can actually see that you are a nice doctor who cares about the patients. 
Thank you so much for your willingness to help and to share your knowledge and time with LL users in this forum.  I am sure that a lot of people are encouraged and/or helped by this thread and you. 
Please don't be too much upset by some bad or disrespectful comments.  You know there are a lot of different people out there who may have different opinions, attitudes, experiences, preferences, etc.  I am sure that most of people here are grateful for you joining this forum.
I know you are an extremely busy person as a renowned doctor in the specialty.  Thanks again for your time being here.

Happy New Year!
P.S. I may see you someday.

[GeTs]

Omg the bumlicking in the post above is unreal

[TomD]

it was from this forumn.

http://www.limblengtheningforum.com/index.php?topic=237.msg6876#msg6876

also it does not matter if it is quadrilateral lengthening. dr paley was stating how each leg will behave, and have a max limit of 10 cm.
doing 1 leg at a time will not change the soft tissue strain per leg. that is simply a ridiculous statement. you don't even understand basic physiology if you believe those statements.

and actually you are incorrect in saying I have no medical training. but no I am not a dr. but very far from a laymen.

This doctor does not recommend quad. He recommends 2 stage procedures either bilateral or one leg at a time. Yeah. That makes a huge difference. Paley never discusses 1 leg .

I have 2 doctors who say 1 leg at a time both segments is fine. You have Dr Paley saying all 4 segments is too risky. Do you honestly expect anyone to throw out the 2 doctors advice and listen to you parrot another doctor talking about a different procedure completely?

Paley says 10 cm max on quad lengthening. Great. Its one doctors opinion. I respect it. Lets hear about 1 leg lengthening max. If its the same great. Put up the link for it.

You realize you are one guy hiding behind the internet using a fake name with no credentials whatsoever. Right? In spite of that you honestly think you can strut around like you can give others medical advice? Now you are 'far from a layman' yet again for the 10th time put up no proof of that. You just make it all up at will.

. You are coming to this thread to smear the doctor without any evidence from medical professionals whatsoever . I think you are here to troll those who take the doctor at his word . You even had the doctor tell you to shut up on 2 occasions because your whining is unsubstantiated.

We have given you opportunity after opportunity to do the right thing and substantiate your claims through abstracts or other links to doctors. You have systematically refused every step of the way. In the end, you put up a one flimsy quote from Paley discussing a different and much more dangerous procedure that this Spanish doctor himself doesnt even approve of.

We all have the right to state our opinion, but smearing the doctor repeatedly through 10 posts over and over without any evidence  ruins the  thread for those who want to ask the doctor question or those who have visited him at his facility. Those are the people who can share their experience..

I am certain we all get the fact you are not a fan of 1 femur and 1 tibia operation. You laymans opinion is duly noted. You can feel free to leave now. Stop trolling the thread.

[ForcedPuberty]

I am not trolling.

that statement is ridiculous.

it is irrelevant that it is quadrilateral lengthening. the soft tissue on 1 leg does not interfere with the soft tissue on the second leg.

dr paley stated that each single leg has in his opinion a 10cm limit due to lengthening both the femur and tibia at the same time.

that is all I am saying. but you keep refusing to accept it.

I am doing what a forumn was intended for, to warn others or risks or benefits of surgery.

there are many better methods compared to this procedure. doing the whole leg will result in more time and more pain and strain.

people who try to save time and/or make it easier for themselves will ultimately make it harder for themselves.

[Ghostfish]

Omg the bumlicking in the post above is unreal

Hello

We are here to get information and help each other for LL.  No need to make bad comments or insult other people.  I thought most of people here are just short of height but not of heart.  Be respectful!  Young man

[GeTs]

Hello

We are here to get information and help each other for LL.  No need to make bad comments or insult other people.  I thought most of people here are just short of height but not of heart.  Be respectful!  Young man

u serious?

[GeTs]

You cynical guy, Hallijah! You should be ashamed for saying things like that!

I'm not cause I didn't say anything bad about monegal, so I didn't touch him, therefore u shouldn't even be bothered had u paid attention to my words

[Ghostfish]

Hi musicmaker

Thanks for your reply!  I am actually quite interested in this procedure over bilateral femur or tibs at one time.  I think it makes a lot of sense to me to have one leg done while the other leg helps move around, so that it could help minimize the absence time of working or studying.  That is very important for me since I can't afford too much time for this.  The whole process may take a little longer than one bilateral surgery including recovery.  But it should be much faster than two sequential bilateral surgeries, meaning that one surgery for two femurs followed by another surgery for two tibs.  There was one arguement about how much height you can gain by one leg with two segments.  ForcedP said that 10cm is max while others say it is possible to achieve 12-14cm.  I am not aiming like 13-14 cm.  10cm would be fine with me. 

Thanks again!


Hi ForcedP

I really respect your concerns and warnings.  Those are alos important opinions no matter what they are.  However, it is also important to know how to address the same messege, that could make a huge difference in the end.

Cheers, 

[ForcedPuberty]

thank you ghostfish, you sound like a kind person. good luck with your procedure.

and if you do 1 leg, be sure to write a diary. 

also I recommend you read disobedient diary. its the closest diary we have to seeing how soft tissue responds to lengthening both segments.

you might find it interesting.

http://www.limblengtheningforum.com/index.php?topic=119.0

[Ghostfish]

Hi ForcedP

Thanks for your reply.  Sure, if I do this surgery, I will write a diary, but it won't be soon, since I am stuck with my current work.

Thanks for your link.  I haven't finished it since it has really really a long thread and I have dysrelxia.    I will do read that all.

Happy New year!

[TomD]

Hi musicmaker

Thanks for your reply!  I am actually quite interested in this procedure over bilateral femur or tibs at one time.  I think it makes a lot of sense to me to have one leg done while the other leg helps move around, so that it could help minimize the absence time of working or studying.  That is very important for me since I can't afford too much time for this.  The whole process may take a little longer than one bilateral surgery including recovery.  But it should be much faster than two sequential bilateral surgeries, meaning that one surgery for two femurs followed by another surgery for two tibs.  There was one arguement about how much height you can gain by one leg with two segments.  ForcedP said that 10cm is max while others say it is possible to achieve 12-14cm.  I am not aiming like 13-14 cm.  10cm would be fine with me. 

Thanks again!


Hi ForcedP

I really respect your concerns and warnings.  Those are alos important opinions no matter what they are. However, it is also important to know how to address the same messege, that could make a huge difference in the end.

Cheers,

Hi

This is why many of us are considering Mongeal . In fact, I have spoken with him several times now in private. As others have said to me, you might want to email the doctor yourself at the hotmail link he provided.

As far as opinions go, everyone is welcomed to theirs . However, there is a difference between giving an opinion and giving the same opinion over and over again 10 times on a thread taking the position of a medical expert without backing any of it up with medical abstracts .

The fellow in question does not agree with the one leg surgery and his hell bent on trolling the whole thread in hopes that others wont either regardless of his lack of proof.

[ForcedPuberty]

everyone could also say you are trolling tomD.

you are giving the same opinion over and over again. insisting that I am wrong.

anyway the point has been heard so I have no desire to go on about it. but just remember your soft tissue runs up your entire leg and is in the tibia and femur.

if you stretch the femur and tibia you are stretching the same tissue, not 2 separate tissues. you have limiting factors that run through the entire leg.

it would be like someone telling me they are going to break the tibia at 2 points and expect the soft tissue to be able to lengthen twice the amount because there are 2 surgical sites. it is preposterous.

god luck.

[TomD]

thank you ghostfish, you sound like a kind person. good luck with your procedure.

and if you do 1 leg, be sure to write a diary. 

also I recommend you read disobedient diary. its the closest diary we have to seeing how soft tissue responds to lengthening both segments.

you might find it interesting.

http://www.limblengtheningforum.com/index.php?topic=119.0

I am sure glad you 'recommend' he keeps a diary. Without your recommendation who knows what the guy would do?

And your link is to our famous quad patient who did all 4 (6 actually) bones at the same time . With externals to boot. Its not the same as doing 1 leg and then the other a year later.Not even close.

The soft tissue strain Paley discusses are for a patient doing all 4 segments at the same time. Your body cannot keep up with the strain of it. This is why he feels our bodies cannot handle more than 10cm . That is 20cm of lengthening at once.

When we do bi lateral its only 2 segments and therefore doing one leg is also only 2 segments. I am sure 14cm is fine for one leg or bilateral  at the same time if 20cm  is fine doing all 4segments  at the same time.


I assume you have no evidence that doing 1 leg at a time is overwhelmingly poor compared to bi lateral or you would have put it up by now. I 'recommend' you put your ego down and let it go. 

[TomD]

everyone could also say you are trolling tomD.

you are giving the same opinion over and over again. insisting that I am wrong.

anyway the point has been heard so I have no desire to go on about it. but just remember your soft tissue runs up your entire leg and is in the tibia and femur.

if you stretch the femur and tibia you are stretching the same tissue, not 2 separate tissues. you have limiting factors that run through the entire leg.

it would be like someone telling me they are going to break the tibia at 2 points and expect the soft tissue to be able to lengthen twice the amount because there are 2 surgical sites. it is preposterous.

god luck.

Yeah. Except nobody has. In fact I have had the doctor thank me in private.

On the other hand, several people have told you that you are trolling ..........including the DOCTOR who this thread is named off of. But why should a delusional guy like you care about something as concrete and obvious as that ?

You gave your layman opinion on it. Let it go.Let us who are interested in this procedure carry on with the thread. Feel free not to have the procedure.

You have no right to tell others what to do or hijack a doctors thread.

Thank you in advance. 

[ForcedPuberty]

I am sure glad you 'recommend' he keeps a diary. Without your recommendation who knows what the guy would do?

now your just acting weird.  its a common statement. your paranoid acting like there's some sinister nature to it.

you are trolling ..........including the DOCTOR who this thread is named off of

sarin also said 6 people are trolling him. doctors will always say this to discredit anyone who doesn't worship the white coat they wear as gods.
a troll is someone who is not sincere. obviously the doctor does not understand the definition to troll. not my problem.

there has never been  single study to prove that lengthening the entire leg at a single time is safer, effective and faster or better in any way shape or form. you keep asking me for sources yet YOU HAVE NONE YOURSELF. you have no proof of your claims. your just some guy who sided with a random doctor in a white coat with no studies to back you up or the doctor.


SECOND ISSUE
the link to disobedient was not meant to represent this Spanish doctors surgical technique, you just randomly said that I was saying it was.
I said it would be interesting to read, as it demon straights what happens to soft tissue when you lengthen to fast. you get massive ballerina. I never said this proves or shows anything in relation to the Spanish doctor. in fact I said it is the closest diary we have to his procedure and would be only of value for interest sake. stop saying I said things that I never said.

listen here you imbecile I have studied ligaments, tendons, soft tissue, biomechanics, physiological and anatomical sciences and a hell of a lot of other things at university level, these subjects which are over a dozen cross and are accredited for the medicine degree. I know a   load more about the body then you ever will.

and quadrilateral and single leg make no difference, because soft tissue on 1 leg does not affect the soft tissue on the other leg. you have no idea what your talking about because you are the laymen not me. I am actually accredited to comment on these issues. because I have a tertiary education in this.

[galaxy1]

I don't know the correct answer and it's a good question for Dr. Monegal to give his expert opinion. It would be best to ask him directly about it if you are seriously interested in this. With my total goal being 9 cm, 4.5 cm + 4.5 cm, I would be the perfect candidate for this one whole leg at once method.. Then, because of my age I might have the benefit to lengthen at a much slower rate and not over tax the soft tissues.

The experimental "double cut" method everyone raved about ended up being a very bad idea except for one guy, but I believe he only lengthened 6 cm and he might have lengthened at a slow rate, not sure. You could always choose to lengthen super slow, but then you risk being sent back to the OR to rebreak the bone because you consolodated from the slow lengthening rate.

PS - It is not going to do any good for those interested in this to make one another out to be a troll because two people are in disagreement. FP is much more credible than his previous statements on embolism risk and being wheelchair bound, which I did not agree on. It's probably the reason Dr. Monegal responded negatively towards him.

Tom, being that you are in your 40's, it's possible lengthening over 10 cm and doing at slower a rate will work out for you great. You won't have a very high risk of preconsolidation as a younger person would. Did Dr. Monegal in your PM communications give his expert opinion on the matter?

[ReadRothbard]

The only problem with Dr. Monegal is the time I'd have to take off. With other internal device doctors, I could lengthen over the summer overseas, then come back home to go back to school (college). With Dr. Monegal, I'd have to spend the whole six months overseas.

[Ghostfish]

Hi ReadRothbard

As far as I know, you don't need to stay for 6 months.  You stay about one month for the first stage or one leg surgery and go back home.  And then you can lengthen your leg and do PT at home.  When your first leg is almost or completely healed/consolidated, which I don't know how long it will take 4mon?, you come back to Spain again for another leg. And then stay again about 1 month and go back home.  That is pretty much it.  Of course, you need to do lengthening and PT and check X-ray regularly and communicate with Dr. Monegal until it is done.  Once two legs are consolidated, which may be about 8-9 month?, you probably can do most of normal life.  About 1.5 years later, you go back to Spain again to remove nails.

Cheers,

[ShortyMcShort]

What are peoples thoughts on lengthening at home? So that means you got to go find your own physio who has somewhat of a clue dealing with patients with broken legs or do you think a normal physio is more than enough?

What are the Visa rules for Spain, from my understanding if you are staying for less than 3 months then you dont need a Visa?
Is there a limit on how many times one can come back in one given year?

[Taller]

now your just acting weird.  its a common statement. your paranoid acting like there's some sinister nature to it.


sarin also said 6 people are trolling him. doctors will always say this to discredit anyone who doesn't worship the white coat they wear as gods.
a troll is someone who is not sincere. obviously the doctor does not understand the definition to troll. not my problem.

there has never been  single study to prove that lengthening the entire leg at a single time is safer, effective and faster or better in any way shape or form. you keep asking me for sources yet YOU HAVE NONE YOURSELF. you have no proof of your claims. your just some guy who sided with a random doctor in a white coat with no studies to back you up or the doctor.


SECOND ISSUE
the link to disobedient was not meant to represent this Spanish doctors surgical technique, you just randomly said that I was saying it was.
I said it would be interesting to read, as it demon straights what happens to soft tissue when you lengthen to fast. you get massive ballerina. I never said this proves or shows anything in relation to the Spanish doctor. in fact I said it is the closest diary we have to his procedure and would be only of value for interest sake. stop saying I said things that I never said.

listen here you imbecile I have studied ligaments, tendons, soft tissue, biomechanics, physiological and anatomical sciences and a hell of a lot of other things at university level, these subjects which are over a dozen cross and are accredited for the medicine degree. I know a crap load more about the body then you ever will.

and quadrilateral and single leg make no difference, because soft tissue on 1 leg does not affect the soft tissue on the other leg. you have no idea what your talking about because you are the laymen not me. I am actually accredited to comment on these issues. because I have a tertiary education in this.

I too have some university education in the field of biomechanics and medicine and I must say that everything you've written on this forum about LL does seem accurate according to what I've been taught.


I've personally toyed with idea of doing 4+4CM quadrilateral (internal femurs and LATN tibiae), but wonder if even this would be too taxing on my soft tissues. Some patients of Dr. Paley have been able to pull this off, but it depends on a lot of individual factors. 4+4CM does seem dangerously close to the soft tissue limit of quadrilateral lengthening in general, though.

If quadrilateral lengthening of 4+4CM proves to be unrealistic after I consult with a few doctors, I'll do 6.5-7.5CM on a single segment (leaning towards femurs) and move on with my life.

[TomD]

Hi Fpuberty

f you go back to the original assessment on this thread you harped on and on about 1 tibia and 1 femur being a 'horrible' idea. You harp on and on about it being 'bull crap' and even insult us as having 'weak minds' for a fad.

Go re read the thread. Read your own words.   

Over the course of this thread  we have asked you to prove your profane objections. You have never done so. Now  you have been backed into a quadrilateral corner. Nobody asked to do all four segments . You have purposefully twisted it into this  because you could not produce any evidence regarding the single femur and tibia operation.

The fact you claimed to have studied some medical information in university and dropped out is fine but it is utterly irrelevant compared to a medical doctor who performs these surgeries. Surely we can all agree on that.

We who believe in the procedure read your objections. You dont need to keep repeating yourself. This thread is about the doctor and its up to us to decide . To be fair, we understand you are entitled to that opinion, but it stands to reason we will take the opinion of two medically trained doctors over yours.

 Paley says you can do it but you should limit yourself to 10cm per leg. 20cm growth at the same time. He never states you 'cant' do it or that its dangerous. Many doctors on here recommend 5cm maximum using bilateral or even single segment surgery of all stripes. That means 10cm as well . Just as Paley indicated for the quad.

The Disobedient thread indicated at only 5ft tall she did 11cm easily but the doctor told her to stop in fear of doing too much. This was on both legs at the same time using externals.  Stands to reason someone of our stature being 5ft 7 only doing 1 leg internals should be able to do 12 to 14 cm without major complications. Maybe we can, maybe we wont. I can live with 11 cms if I had to.

For the third time, we get it. You dont like the one leg surgery. Your laymans opinion was duly noted long ago. Feel free not to do the surgery. . We got it the first time. Move onto something constructive.


Suggestion; Start up a Qaud thread and serve up all your concerns about it there.  This thread is about Doctor Mongeal's facility and his 1 leg or one segment or bilateral options.

I have some feedback from Dr Mongeal I wish to share. I am going to follow up with 2 objections

1) What if you lengthen 13 or 14 cm and then your other leg cant lengthen that much?

2) What about the range of motion and the ability to lengthen both bones at the same time. What kind of stress does that put on the knee?

I assume he cuts the femur higher up towards the hip and the tib/fib lower down so the leg muscles and tendons at the knee are not strained anywhere near as much. That is my layman guess. We shall see what he says. 

[TomD]

I have some feedback from the Doctor that might be interesting to some of you.

Dear Tom

Please find my answers as follows

1) Are you prepared to do LON for 1 femur and 1 tibia for the same leg at the same time?

This is technically possible but I do not recommend this. First of all because of the disturbance that might cause having to external fixators in the same limb. And second because temporary LL discrepancy that is created. But of course this can be done. 
When doing simoultaneous procedures using LON technique the most commonly done is bilateral femur or tibiae. Some doctors perform tibia in one side and femur in the contralateral limb. I do not recommend this crossed-limb technique. When doing this procedure knee joint is temporary at different height and it obligates patients to undergo second crossed limb procedure.
Sometimes when performing bilateral femur or tibiae, some patients are happily satisfied with the result of the first procedure and they prefer not to perform second procedure.

2) If so , how much is the Cost?

For a bilateral procedure using LON technique cost is
3500€ Clinic and Medical expenses
15000€ materials (2 ex fix/2 nails/12 hydroxiapatyte pins)
5000€ Medical team (2 surgeons/anaesthaesist/scrub Nurse)
Price includes preoperative tests and planning

3) Are you prepared to do Fitbone for femur and LON for tibia for the same leg a the same time?

I have never done this in the past. This is technically possible but I do not think this is a good idea. The reason is that pinsite infection occurs in almost 100% of cases and I am not happy to implant a 12000€ device with a "close risky infection zone" that close.
I know all patients are mostly concerned about cost and time. I always try to show them to the safe zone. I don t think it s a matter of being conservative, it s a matter to stay away from problems. And do believe me in LL sometimes trying to speed up slows down the process, and cheap becomes more expensive.

4) If so , how much would that Cost?
It is approximately 4000-4500 euros more expensive than 2 LON. Diffference is basically because of implants different price.

5) If I do LON, could I keep it on until the bone is 100% weight bearing ? I ask because I have to come back to Spain to get the external pins removed and I wonder if I could do the other leg while I was There.

When performing LON what I normally do is to proceed inmediately to lock the nail and remove the external Fixator.
I don t think this is a good idea for 2 reasons:
1- having pins during such a Long time increases risk of infection and cosmetic result of the scars is much worse.
2- having the ex fix on does not allow recovery of the knee joint and can create stiffness and delay the full recovery.

So as I told you before, sometimes fast becomes allow and cheap becomes expensive.
In 2001 Paley wrote a paper about introducing a nail when doing monolateral ex fix lenghtening. One of the reasons why they Did recommend LON over ex fix itself Was early removal of the ex fix and early recovery of knee joint.

I hope my replies were helpfull and not very confusing. If you need any other support or you want me to answer to other questions just let me know.
By the way...whhere are you from?

All the best

Dr Alex Monegal


Notes: I get the impression that the only way to do one leg is fitbone for both. Otherwise he recommends bi lateral surgery using LON or other external methods.

I will follow up with soft tissue and knee objections when doing 1 leg

[TomD]

Tom, being that you are in your 40's, it's possible lengthening over 10 cm and doing at slower a rate will work out for you great. You won't have a very high risk of preconsolidation as a younger person would. Did Dr. Monegal in your PM communications give his expert opinion on the matter?

You raised a good point. Yes he did. He indicated that someone my age would have no issues someone in their 20s would have, save for the rate of recovery. In other words, what you guys can lengthen at age 25 is the same I can, but you will on your feet much faster 

[ForcedPuberty]

you keep repeating the same nonsense tomD.

1)soft tissue stress on 1 leg does not affect or interact with soft tissue stress on the second leg. so everything you say is completely irrelevant. you need to learn how the body works before we can debate this because you are not educated.

2) disobedient did 10cm as I understand it. and it was not easy. she will recover I believe. but she had a 7cm ballerina if I remember correctly at 1 time and she is still recovering after a very painful and long journey. I wish her well.

3) I did not drop out. you made that up. and further more your argument is going in circles, you were calling me an uneducated laymen for so long and I resisted telling you that I was actually educated, only after finding out do you then proceed to tell me being educated does not matter. this is a silly tactic where you keep trying to discredit people based on education but magically if they are accredited then it is irrelevant. you don't need an education to learn things, it was you who brought it up not me. I just happened to be accredited and was sick of you tring to discredit my opinion based on academics.

4)

Stands to reason someone of our stature being 5ft 7 only doing 1 leg internals should be able to do 12 to 14 cm without major complications.

this statement is groundless, I can tell you now that your rational for thinking you can do 12-14cm is wrong. as I pointed out earlier disobedient had a very long and grueling time and is still recovering after a extremely tough time because of soft tissue restrictions. and she only did 10cm.


AND FINALLY: YOU HAVE NEVER ONCE GIVEN ME PROOF TO YOUR CLAIMS OR CLINICAL STUDIES SHOWING THAT LENGTHENING 1 ENTIRE LEG SIMULTAINIOUSLY IS BETTER OR EQUAL. YOU KEEP DEMANDING PROOF WHEN YOU HAVE NO PROOF.

LET ME REPEAT YOU HAVE NO PROOF. YOU NEVER WILL BECAUSE YOUR WRONG. and you will never understand why unless you gain a tertiary education.

[ForcedPuberty]

from dr mongeal:

When doing simoultaneous procedures using LON technique the most commonly done is bilateral femur or tibiae. Some doctors perform tibia in one side and femur in the contralateral limb. I do not recommend this crossed-limb technique. When doing this procedure knee joint is temporary at different height and it obligates patients to undergo second crossed limb procedure.

think about it guys.

[ShortyMcShort]

Seriously Forcedpuberty, you ought to compared apples with apples and not bloody watermelons.
Disobedient did all externals on all four bones in one go, how is that relevant to the one leg all internals procedure Dr Monegal does...? Le sigh

Plus disobedient was well.... disobedient. She listened to no one but her borderline quack of a doctor and went against everyones advice. She only listened to what she wanted to hear and her doctor only told her things she wanted to hear. She failed to think outside the box. But thats not the point, the point is theres no relevance to your comparison

On another note, you two should take your little debate to another thread and stop hijacking what is essentially the Dr's thread.
Have some decency geez

[Dr Monegal]

Dear participants.

I do not perform simultaneous femur and tibia as an elective treatment. I think that there has been some misunderstanding orround this debate. The only thing I say is I prefer to go for femur/tibia ain one leg and then proceed with the other one for 2 basic reasons:
 
1- Performing the reaming of both femurs is high risk of fat embolism syndrome. this was discussed at last Fitbone user meeting and Profeesor Baumgart said there have been cases in the past where patient died due to this unlikely event.
It s not a matter of being conservative, it s a matter of safety.
 
2- Having a healthy leg during lengthenning allows patients to preserve more mobility and autonomy during lengthening and consolidation phases. Fitbone device does not allow full weight-bearing, in case patient performs bilateral femur or tibiae, they should remain in a wheel chair with straight legs during the procedure.
 
One thing you guys must be aware of is that bone lenthenning was originally indicated in cases of limb length discrepancies. You must be aware of that some of the LL specialists don't even want to talk about Cosmetic procedures.
In most cases of congenital massive LLD ther is a femur/tibia combined deffect. In the early days of LL specialists were treating such defficiencies performing simultaneous femur/tibia using externals (not even performing LON). You can check it http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2328726/

My ideal of cosmetic is to perform 4 segments in 4 different procedures to stay safe, functional and proportioned. But of course there are 2 variables I cannot control: TIME and MONEY
 
Simultaneous femur and tibia is just an option which is valid and can be performed.
So just stop messing arround a stupid question like that because I don t think this is the Point of this forum.

[ShortyMcShort]

Hey Dr Monegal, what about the likelihood of knee pain when doing internal tibias?
What are your thoughts on that? Can it be avoided? Or is there no way around it? 

[Dr Monegal]

Hi shorty

It can be avoided performing a suprapatellar approach for the insertion of the nail.
Like this you avoid to split patellar tendon and we can prevent knee pain.
This is very usefull specialy in thhose patients with patella baja.

Please i am not saying you avoid 100% knee pain because there is always stress in soft tissues while lenghtening. It s then when muscular stretching becomes relevant, but this approach is in my opinion a great way not to harm the tendon (main cause of recurrent knee pain when performing this procedures).

I wish that helps

[TomD]

I want to thank Dr Mongeal for his candor and those who participated to the thread. 


Dear Tom
 
Once again thank you for your words
 
I do not perform simultaneous femur and tibia as an elective treatment. I think that there has been some misunderstanding orround this debate. The only thing I say is I prefer to go for femur/tibia ain one leg rather than proceed with the bilateral for 2 basic reasons:
 
1- Performing the reaming of both femurs is high risk of fat embolism syndrome. this was discussed at last Fitbone user meeting and Profeesor Baumgart said there have been cases in the past where patient died due to this unlikely event.
It s not a matter of being conservative, it s a matter of safety.
 
2- Having a healthy leg during lengthenning allows patients to preserve more mobility and autonomy during lengthening and consolidation phases. Fitbone device does not allow full weight-bearing, in case patient performs bilateral femur or tibiae, they should remain in a wheel chair with straight legs during the procedure.
 
One thing you guys must be aware of is that bone lenthenning was originally indicated in cases of limb length discrepancies. You must be aware of that some of the LL specialists don't even want to talk about Cosmetic procedures.
In most cases of congenital massive LLD ther is a femur/tibia combined deffect. In the early days of LL specialists were treating such defficiencies performing simultaneous femur/tibia using externals (not even performing LON). You can check it http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2328726/

My ideal of cosmetic is to perform 4 segments in 4 different procedures to stay safe, functional and proportioned. But of course there are 2 variables I cannot control: TIME and MONEY
 
Simultaneous femur and tibia is just an option whisch is valid and can be performed.
 
Regarding your questions, please find the answers as follows:
 
1) Why are you prepared to do one leg surgery as opposed to bilateral surgery? .
 
Performing bilateral is high risk of fat embolism yndrome. We can do bilateral performing 1st one leg and the second one 3 weeks later...but as I told you patient will remain on a weelchair during lengthening and consolidation periods.

2) How long do you have to wait after distraction ends (consolidation phase) until you are strong enough to walk on the new leg so you can return to lengthen the other leg?
 
One of the reasons of performing first one leg is that keeping one leg fully functional, allows patients to walk on crutches from day 2 after surgery. Patients walk partially weight bearing (20 kg) on the operated leg from day 2.
Once lengthening is completed patients increase load 10 kg per week until they are able to fully weight-bear.

3) Where do you make the cuts on the femur and tibia?
It depends on each case. Fitbone technique can be done antegrade or retrograde in femur. So the osteotomy is 1,5 cm below lesser trochanter when doing antegrade/9-10 cm above knee joint for retrograde.
When performing tibia, osteotomy is approximately 7-8 cm below knee joint.
 
To prevent patelar tendon split, I recommend antegrade femur and suprapatellar approach for tibia.
SOmetimes this is not possible or adviceable. One of the particularities of the Reverse planning Method is that with the Fitbone technique we can also corrert malalignment. This is only possible in femur performing retrograde procedure.
 

A lot of concern has been the 'range of motion' because of the strain on the soft tissue surrounding the knee as the leg lengthens .Tell us your thoughts on the soft tissue issue with 1 leg surgery.
 
To prevent this we can do different surgical gestures
 
1- is approach (antegrade femur/Suprapatellar Tibia)
2- Tenotomies (adductors/Fascia Latta/Harmstrings
3- Pace of lengthenning (Not 1 mm + 1 mm) I recomend 1,5 mm/day in total.

4) How much can someone lengthen one leg in this procedure?
Implants allow to lengthen 8 cm in femur and 6 in tibia. This is a massive lengthening for an adult (kids are different)
I think that an initial goal of 4-6 or 4,5-5,5 (Tibia/Femur) is good enought. It is important to follow up the soft tissue/the bone creation and the ankle/knee rehab and progress during the procedure.
If everything is fine, there is always a chance to add some extra mm.
 
I hope everything was helpfull. Sorry for the misunderstanding out there.
Do believe me that I care for my patients and I want the best for them. I don t want them to suffer or to be in trouble.
The day this happens I will stop performing cosmetic procedures.
I write in the forum to help people out there. I want to be in touch with you guys to improve my understanding and to share with you thoughts and experiences.
 
, I had patients in the past insisting to go for simultaneous femur and tibia nd they ended up lengthening just one segment, and 6 cm later...they were happy and did not go for the whole lot.
 
Have a pleasent evening
 
Dr Alex Monegal

Notes:

The Doctor sticks by his guns that doing the femur /tib one leg is viable but he wont do it for simple cosmetic procedures.  His goal is to talk us into doing the 4 segments in 4 different surgeries. However, he does prefer the femur/tib combo on one leg to bilateral surgery .

He conclusively puts to rest any concerns regarding lengthening, soft tissue wear and range of motion regarding the 1 leg procedure. Its too bad he insists on 1 segment only. 

My goals do not allow for flying to Spain for 4 different surgeries so I am going to have to pass . 

[galaxy1]

You raised a good point. Yes he did. He indicated that someone my age would have no issues someone in their 20s would have, save for the rate of recovery. In other words, what you guys can lengthen at age 25 is the same I can, but you will on your feet much faster 

7 cm + 7 cm on a single leg will be a tremendous feat I must admit, but if your set on 14 cm, then no harm aiming for it, it's not like it's set in stone.