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[bluebarbie]

Dear, Dr Monegal

May I know what is the chance of losing the achieved length during the internal nailing surgery of LATN method?
How much can u lose? Is there any surgical method to prevent it from happening at all?

I would really appreciate ur help. Thanks
BB

[KiloKAHN]

Hi Dr Monegal,

Are there any advantages that you see Fitbone having over the Precice nail?

[Dr Monegal]

Hi bluebarbie

I don t do LATN procedure.
To prevent the callus to colapse best is to wait until the bone consolidation is enought so It does not collapse. Callus is elastic structure and if ex fix is removed straight away after lengthening is finished you will lose lengthening.
Best is to nail and lock the nail before removal of the ex fix in the procedure. Doing This you will not lose Any length.

Kind regards

[Dr Monegal]

Dear Kilokahn

I have been introduced to all sort of lengthening devices.  What made me decide for Fitbone Are several reasons.

1. Experience. Fitbone started in the 80's and more than 2300 procedures have been performed using the system. We Are Currently using 4th generation of implants.

2. Reliabilty of the system. There Are no failure of the implants. Electronic control gives the Patient an accurate control of the distance lengthened. You can see some issues from the group of Munster (Germany) in the following article http://informahealthcare.com/doi/full/10.3109/17453674.2014.913955

3. Triple correction. Whereas other implants Are just intramedullary devices, Fitbone is not exactly that. Implant is positioned in the bone according to a very exact pre-planning so you can achieve correction in length, torsion and allignment.

4. Instrument set. Special reamers and sleeves, allow to perform all kind of technical approach. Including suprapatellar for tibiae or parapatellar for retrograde femurs which prevents patellar tendon spreading and future anterior knee pain.

5. Management and handling. Control set unit is a small device and very easy to use. Magnetic system of the Precice nail is quite big, not as precise as the electric of the Fitbone, and more difficult to use.

6. Fitbone system has Also devices for limb reconstruction such as bone transport nails, lengthening prostheses or stum lengthening devices. This means that all users have the possibility to be trained in all kind of limb reconstruction procedures.

7. CEO. Stands for Centers of excellence. WITTENSTEIN selects and carefully trains the users, and choses clinics following a hight Standard and Medical equipment and quality. We do have users meetings every year sonWe can discuss cases, share experiences and improve our knowledge and techniques.

Kind regards

[bluebarbie]

Thanks alot for ur information, Dr.Monegal.

[Alittletooshort]

Dear Dr. Monegal,
I have posted this question in another thread earlier but no one seemed to be able to give a decent answer to this.

From what I've read so far it's advised to stay as close to the 0,8\1 tiba\femur ratio as possible. What if you already have an almost perfect ratio (in my case, 390-460mm) and there is not enough space in either segment to get 7cm's.
Would it be adviseable to get the lengthening done in both segments but therefore in smaller amounts? 4\3,2cm's for instance.
Is there a benefit for the atheltic recovery if the biomechanical axes keep their initial ratio?
Many thanks in advance to your answer,
Cheers!

[Dr Monegal]

Dear Alittletooshort

When lengthening there is always a modification of the mechanical axis due to lengthening.
It is very important to allign the limb and to predict How the axis of the limb will end-up at the end of lengthening. For that reason, and because the liver arm of the lengthened bone will be increased I think It is better to get the limb close to an ideal mechanical axis as much as possible.
I have seen plenty of deformities (tibia valga/femur varus) when lengthening with ex-fix or X shape limbs when doing antegrade internals on femurs. Tibia is not an issue most times. It is much more important to have an alligned leg rather than the lengthening itself.

On the other hand It is ideal to lengthen all 4 segments to keep the initial ratio. In some cases We can see a hypometry of femur or tibia and This leaves us the chance to lengthen only 1 segment and stay in a biomechanical safe ratio. In your case maybe 5 cm on tibiae + what you can get from limb allignment migth be good. But i would not recommend to go beyond that (in case you only consider to perform 1 segment only).
I always perform preop simulation of each case on x-rays and clinical pictures to figure out the best solution on each case.

Kind Regards

[Dingo]

Dear Dr Monegal,

- I think you've said previously that it is only possible to also perform alignment of the femur through Fitbone if it is entered through the knee. If the Fitbone nail is entered through the hip then it's very difficult to also do alignment in addition to lengthening. Is this correct?

- You've also said that there are techniques to avoid the patella tendon when doing the knee approach. But I'm curious about other parts of the knee also, like the contact surfaces between the femur and the tibia, the patellar surface and the lateral and medial condyles. When drilling through the knee, are these contact surfaces afected? Do they heal afterwards? Doesn't this bring problems in the future?

- If I do one full leg (tibia + femur simultaneously) through Fitbone, could I reach 10cm? When would I be able to come back and do the second leg? Would it be possible to also do aligment? Can this one full leg approach be done in one operation only and insert both Fitbone nails through the knee?

- When doing Fitbone in the tibias, how do you maintain the aligment and position of the smaller bone, the fibula? Are they also fixed to the tibia?

Thank you in advance for your answers and your participation in this forum.

[Alittletooshort]

Thank you very much for your detailed and helpful answer!

[Dr Monegal]

Dear Dingo

Yes It is correct. To perform correction in limb allignment It is much easier when doing retrograde nail. Antegrade is an option but It is not always possible due to femur curve and Also because of the femoral shape. I have seen some antegrade cases using other implants that end up with X shape legs due to lengthening along the mechanical axis which might cause This malalignment.

Lateral and medial condyles remain intact as the entry point is at the femoral notch which does not support any load. The reaming is performed theough special tubular sleeves so there is NO contact neither with femur/tibia and/or patella. Reaming is not an issue. I always try to avoid patellar tendon to prevent damage to It. I can go either parapatellar for femur or suprapatellar for tibia.

It can be performed simultaneous tibia/femur lengthening on the same leg and yes you can reach 10 cm. It is adviceable to addjust the lengthening pace and focus on PT and muscle stretching. When Doing This kind of procedures I do perform some soft tissue release (tenitomies) to reduce soft tissue stress. We Also perform limb allignment correction.

We do fix the fíbula to tibia distally with a screw. Some like Baumgart advice to fix Also proximal fíbula with a cannulated screw when lengthening goes beyond 4 cm in tibia

Kind regards

[Uppland]

Dr. Monegal these kinds of accusations are commonplace on most internet forums, I have also yet to see a thread with more than 10 pages that didn't have some sort of argument in it. Pay it no mind, surely you're a bigger man than to let some anonymous user keep you and your potential patients apart?

Anyway, I had a question: if the biomechanical angle changes due to femoral lengthening, could that cause back problems in the future?

[Dr Monegal]

Thanks Uppland

Now talking about serious things, limb allignment can affect the distribution of the load at the main joints of the lower limbs. So This migth cause problems at hip, knee and ankle joints rather than in spine. One of the reasons It migth cause back pain could be the way It can affect the walking motion or even the slight LLD the malalignment migth cause.
Lower back pain is more usual when there is a significant limb length discrepancy which might alterate the body balance. It can appear Also due to tense or short Harmstring muscles after lengthening.

Regards.

[Uppland]

Thank you doctor. I know there's hardly any way for me to repay the favour you're doing us serious forum members from my laptop hundreds of miles away but if there is something just ask.

Also, is there any way to treat the back pain should it occur?

Finally, if you bear with me, would you say 7CM femoral lengthening is a reasonable goal for a person who is 179CM tall, I know this very much depends but if you had a spontaneous opinion?

[Dr Monegal]

Dear Uppland

Yes harmstring stretching and abdominal muscles excercising might be good to prevent Back pain.
It can Also help to make a proper allignment study as well as a podologist static and dynamic study. In some cases foot splints Migth be needed and extremely helpful.

About lengthening a 179 guy...This Is a tricky question.
Probably i would say no straight away but I might see x rays to se either If there is an axial deviation OR tibia/femur misproportion That should be corrected. In such case LL and allignment migth be considered.

Regards

[Uppland]

Thanks doctor but I'm not sure I understand completely, are you meaning to say there is some medical reason a 179CM man shouldn't lengthen, will my body handle it differently than a shorter person?

[crimsontide]

i can answer this question, since it's obvious

cosmetic ll is not necessary, and is much  riskier than other cosmetic procedures, and recovery is much more difficult..

most surgeons would not lengthen a 179 cm man because the risk to award ratio is way too high.. a man that's 164  has a lot more to gain from the surgery...

there are people that are 180 cm and above that feel the need to lengthen, but objectively, they likely have a mental disorder... a man that's 164 cm has issues that can objectively be attributed to his height.... 

[Uppland]

I see, hopefully I can convince the doctor of my choosing to take me on, or I might decide against the whole thing. Who knows?

[G-Man]

 they likely have a mental disorder...

Nothing new here, you have to be mental to go thru ll anyway!

[crimsontide]

uppland, youre 179???

ive had the surgery and it was worth it...  my ankle issues seem to have goine away,which was my biggest worry... my left leg can be corrected, its just bone... the ankle thugh were really bothering me, and seemed to be soft tissue related.... they feel almost 95% now

but i was under 170 cm when this started and am still under 179. i can say for sure id never consider doing this again... wouldnt be worth it for me even at 175-176

[Uppland]

Yes I'm not that short honestly, still below the average where I live though. I'd like to gain 6-7CM if I can. Obviously most people my height never consider this but I'm a special case.

[Alittletooshort]

Yes I'm not that short honestly, still below the average where I live though. I'd like to gain 6-7CM if I can. Obviously most people my height never consider this but I'm a special case.

I can relate to Uppland, being surrounded by very tall people gives you the impression of being short even though you are quit average

[vil0]

Hm, I do think is little unfair to callout a 179cm guy, what I know about Uppland is that he posted a tread long time ago, and he mention that his father was around 187-189.
Just that is a hard thing to live and deal with.
Also as I think a lot of people on this forum is from the states, there the average height is around 176~ while in Sweden its 181~ (not exactly but give 1+or 1-).
That's means that Upplands 179 cm is yours around 173-4.

Also one more thing to note, people all the world has a bad look at cosmetic surgery, nose,breast,hair,ear,lips, and tell them about LL, I do think 99% would stay away from you/me.

And also mostly alot of all here is feeding our self with good propaganda to feel better, really the idea of breaking your healthy legs for some cm, Its a big NO for many.. But for me it's, and also for the majority on this forum also.

And no one is really a candidate , but rather we are all a special case as mention above.

There for we are all driving us self to do this surgery who everyone who is objective would call stupid and crazy,but  with a lot to lose,and alot to get, we are doing it.

/V

[crimsontide]

no one's calling him out, but your height analogy doesnt work

179 is not equivalent to 173, anywhere... it just does not work that way

you also arent  taking into considerstion other factors

america is much more diverse than the nordic countries.. if you just single out white males, and further restrict this to new york city, trust me... the avg white male in nyc is quite tall...

uppland is free to get the surgery, not going to bash him.. I just  feel the need to give him an opinion , and since i  had the surgery, i think it can be valuable to him... the cons outweigh the pros imo

[vil0]

Very nearly.
And yes it's,as I said above (1-+1)
and to be honest I also think that white swedes are much taller than the foreigners in sweden, and therefore they are driving the average height down.

Yes he is free, never said he was caught by someone tho.

Your opinions are fine, and about your limb lengthen diary who I have read several times, is very good and a lot of informationto bring,
but I would rather call it more dangerous and risky than a guy who is 6'3 going to Paley and are doing 2+2 on femur and tibia for like 200K

About the cons&pros its seems 50/50.

[Alittletooshort]

This discussion might be in the wrong thread, this has nothing to do with Dr. Monegal and his clinic

[vil0]

yeah I also wanted to say that but forgot 

[spaller2015]

Musicmaker, I've been reading this thread for a while. I'm considering doing LL in Spain (perhaps) and you're my role model, so positive and helpful. Don't be discouraged by negative people like Heightangel. He's a real badass.

I know you don't want to post your X-rays because of privacy, but tell me how many cm you got on your first leg. It must be fully consolidated right now. Are you walking unaided? Are you doing your second leg now?

Thank you very much for your help and regards

[theuprising]

Dr Monegal I am not sure if I am understanding you correctly but it seems you are saying that fitbone does not cause axial deviation when lengthening the femur?

[morethan167]

Musicmaker, I've been reading this thread for a while. I'm considering doing LL in Spain (perhaps) and you're my role model, so positive and helpful. Don't be discouraged by negative people like Heightangel. He's a real badass.

I know you don't want to post your X-rays because of privacy, but tell me how many cm you got on your first leg. It must be fully consolidated right now. Are you walking unaided? Are you doing your second leg now?

Thank you very much for your help and regards

I'm also thinking about doing this in Barcelona with Dr. Monegal. Definitely going for a consultation and then we see.

I hope Musicmaker is doing great with Fitbone

[spaller2015]

DrMonegal I want to do LL and go back to work as soon as possible. How  many months should I require? Thanks for your time!

[Dr Monegal]

Dear Spaller

It depends on the type of work you are performing.
For a person working at an office they can deal with the procedure and walk on crutches to their jobs after 3-4 weeks.

As an example, i have a patient who works as a computer programmer who Was out of office 3 weeks for the first Limb, and 16 days for limb 2.

Surgery 2 Took place 3.5 months after surgery 1 for a bilateral 6 cm lengthening.
He is Currently working and lengthening (1 cm to final target).

Other type of jobs (more physical) require full recovery of the ability to walk unaided.

Kind regards