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[jerrytheman]

Chatted with my USA doctor who did my CLL. I sent in an x-ray I took on 5/30 (60mm) and he just got a chance to look at it today. Office said something is slightly wrong and the nail is cracked. Told me it will need to be replaced but it is insured. On the x-ray I didnt see much other than the fact my right nail seems to be lengthened a bit shorter than the left one?
I'm so confused, doctor will call me in 3 days, but the suspense on whats going on is killing me. Never had a fall or any issues, I always use my walker. This is Precise 2.2 on my femur.
They even told me to continue to lengthen as normal, "but the rotation will get worse."

I have no idea what this means, if anyone knows what to expect or has something similar happen please let me know. This was not a complication I expected. I'll have more info Saturday but for now I don't seem to have much more access. It doesn't seem urgent enough and want me to continue to lengthen normally, yet the nail needs to be replaced?? will I need another friggen surgery

[Yau]

Sorry to hear that your nail is cracked. Would u mind to show your X ray pic here? Therefore maybe someone can  give u some suggestions. I think u should stop lengthening now. Or u consults one more doctor as soon as possible.
Hope everything is going well! Best Wishes!

[jerrytheman]

Sorry to hear that your nail is cracked. Would u mind to show your X ray pic here? Therefore maybe someone can  give u some suggestions. I think u should stop lengthening now. Or u consults one more doctor as soon as possible.
Hope everything is going well! Best Wishes!

They told me to keep lengthening as normal and I can keep putting partial weight (50%) on it, and doctor will speak with me in 3 days. Likely he will need to replace the nail (for free).

[slowed & reverb]

The PRECICE® nail only allows for 50–75 lb (22–34 kg) of weight-bearing..

[Yau]

The PRECICE® nail only allows for 50–75 lb (22–34 kg) of weight-bearing..

He said he always uses the walker and never had a fall.

[slowed & reverb]

i mean if you think a walker can take up 50% of his weight during every motion theres a reason why most people with precise were bound to wheelchair 24/7 during the lengthening phase. personally i will never get off my wheels when im gonna get the surgery done.

[youyin12]

I think that there is still a risk of exceeding the weight limit at certain times even if you use a walking aid, after all, Precice 2.2 is not a fully weight-bearing nail.

[jerrytheman]

I think none of you had the surgery because you're supposed to put weight on it and use a walker unless youre over 180 pounds. Even at paley or any other US institute (at least with the 12.5mm nail)

[jerrytheman]

i mean if you think a walker can take up 50% of his weight during every motion theres a reason why most people with precise were bound to wheelchair 24/7 during the lengthening phase. personally i will never get off my wheels when im gonna get the surgery done.

this is false lol

[hippo60]

I think none of you had the surgery because you're supposed to put weight on it and use a walker unless youre over 180 pounds. Even at paley or any other US institute (at least with the 12.5mm nail)

What's your weight and how many steps (roughly) you were taking each day / were told is ok?

[jerrytheman]

What's your weight and how many steps (roughly) you were taking each day / were told is ok?

Started at 155 but pretty much 147 ish post surgery and maintained that. Taking maybe 0.1 miles of walking a day on average, I didn't have a limit. The nails can bear my weight so walk as much as I want as long as i'm off loading half my weight per leg. You've done surgery, you know how we walk on the walker so the weight bearing part was not the issue. There's gonna be a bad apple in the bunch and I happened to get the bad nail.

[hippo60]

Started at 155 but pretty much 147 ish post surgery and maintained that. Taking maybe 0.1 miles of walking a day on average, I didn't have a limit. The nails can bear my weight so walk as much as I want as long as i'm off loading half my weight per leg. You've done surgery, you know how we walk on the walker so the weight bearing part was not the issue. There's gonna be a bad apple in the bunch and I happened to get the bad nail.

Honestly I'm not so sure about it. Personally I'm heavier (170-180ish) so despite having the largest nails I'm still over, and didn't use the walker much (just a few steps to transfer).

I think some doctors are just more conservative than others. I'm pretty sure Rozbruch wouldn't let you walk as much. I know he's ok with walking maybe 100 steps a day for lighter patients. And yes, I'm sure some people got away with walking more, but it doesn't mean it's worth taking the risk.

[jerrytheman]

Honestly I'm not so sure about it. Personally I'm heavier (170-180ish) so despite having the largest nails I'm still over, and didn't use the walker much (just a few steps to transfer).

I think some doctors are just more conservative than others. I'm pretty sure Rozbruch wouldn't let you walk as much. I know he's ok with walking maybe 100 steps a day for lighter patients. And yes, I'm sure some people got away with walking more, but it doesn't mean it's worth taking the risk.

Thats how your bone heals better..with added pressure down. Thats why there's much more non unions in stryde than precise 2. Yeah at 180ish it's too heavy to bear the risk. 150 and lower you're supposed to walk. Also whats the difference between 100 steps and 500 steps for the nails. It's not like more steps means your nails will break, it's only if when it hits the threshold of what it can hold that it breaks. The nails advertise as 75 but we all know thats a conservative limit when the nail is extended to 8cm. And only your weight above the ostetomy counts as the weight that is added on the nail. Your 2 legs weigh like 30 pounds too

[jerrytheman]

I'm just saying I highly doubt a couple walks on the walker at 147 pounds contributed to the crack. I just want top know what to expect next tbh, i dont get a phone call with the doc for another 2 days.

[hippo60]

Thats how your bone heals better..with added pressure down. Thats why there's much more non unions in stryde than precise 2. Yeah at 180ish it's too heavy to bear the risk. 150 and lower you're supposed to walk. Also whats the difference between 100 steps and 500 steps for the nails. It's not like more steps means your nails will break, it's only if when it hits the threshold of what it can hold that it breaks. The nails advertise as 75 but we all know thats a conservative limit when the nail is extended to 8cm. And only your weight above the ostetomy counts as the weight that is added on the nail. Your 2 legs weigh like 30 pounds too

I know it encourages bone growth but it doesn't mean you should do it. One of the best doctors in the field (if not the best) thinks it matters but I guess you know better. There is a difference between 100 and 500 steps, it's more pressure on the nail, which can cause the nail to bend.

[jerrytheman]

I know it encourages bone growth but it doesn't mean you should do it. One of the best doctors in the field (if not the best) thinks it matters but I guess you know better. There is a difference between 100 and 500 steps, it's more pressure on the nail, which can cause the nail to bend.

Yeah well my nail is not at all bent, it's as straight as Andrew Tate. There's a small crack on the bottom that wouldnt be caused by putting too much weight on it lol. And it's only in 1 nail.

[Hagane]

What's your weight and how many steps (roughly) you were taking each day / were told is ok?

interesting
Dr Gdalevitch encourages all her patients to walk approx 2k steps per day with walker or crutches

[jerrytheman]

yeah cause most doctors will tell you to do some walking if youre 155 or under (on the largest diameter nail). This is an extension of your PT. You need muscle and you need semi pressure on the bone for it to grow stronger.

[Hagane]

yeah cause most doctors will tell you to do some walking if youre 155 or under (on the largest diameter nail). This is an extension of your PT. You need muscle and you need semi pressure on the bone for it to grow stronger.

i did tibias so i think my nail was the second largest diameter. any ways the point i was trying to make was even with tibs and a smaller nail, my nails are still perfectly fine. its unfortunate that your nail has cracked. but like you said, it might not be from weight bearing. it might just be a defect of that particular nail.

but yeah im 100% in agreeance, early mobilization has been imo such a big contributor to the ease of lenghtening
it blows my mind that some people end up spending essentially their entire lengthening period wasting away in a wheelchair. Then when its time to consolidate they have to spend so much more time retraining their gait

[jerrytheman]

i did tibias so i think my nail was the second largest diameter. any ways the point i was trying to make was even with tibs and a smaller nail, my nails are still perfectly fine. its unfortunate that your nail has cracked. but like you said, it might not be from weight bearing. it might just be a defect of that particular nail.

but yeah im 100% in agreeance, early mobilization has been imo such a big contributor to the ease of lenghtening
it blows my mind that some people end up spending essentially their entire lengthening period wasting away in a wheelchair. Then when its time to consolidate they have to spend so much more time retraining their gait

Some people have to if they're 200 pounds. But the ignorance of people who have NOT done limb lengthening and are just perspective patients that sees on the website that they only bear 75 pounds of weight so if you put 76 pounds of weight on it, the nail breaks, is just plain stupid. Passing false information and not helpful to the question I asked.

Anyways - I'll update on the situation. I think the curious part is WHAT happens when the nail breaks because of a non patient error. I did not fall or walk without a walker so if I do need a nail replacement, I should not be liable for it. But we'll see what they do.

If this was in Turkey, 100% I'm out of luck and Halil Buldu will blame it on me. But this is a large USA clinic (amongst one of the popular 6, so we'll see). They bet there will be legal consequences if they handle it poorly.

[hippo60]

interesting
Dr Gdalevitch encourages all her patients to walk approx 2k steps per day with walker or crutches

Have you done that?

but yeah im 100% in agreeance, early mobilization has been imo such a big contributor to the ease of lenghtening
it blows my mind that some people end up spending essentially their entire lengthening period wasting away in a wheelchair. Then when its time to consolidate they have to spend so much more time retraining their gait

How long did it take you?

[Hagane]

Have you done that?

How long did it take you?

yes! and my physios would regularly ask if i was getting my steps in ( although there have been many days especially the weekends where i would fall short of that goal)

im still consolidating atm so i cant give you an acurate timeframe.
ill let you know when im fully weightbearing.

[jerrytheman]

Just an update to my situation. Doctors told me to stop lengthening for now. I took a closer look at the x-rays and something is definitely broken to the point I think it is unlikely I'll be able to reach 8cm without a rod replacement.

Zoom call with doc will be on Saturday morning, I think what will likely happen is discussion of a surgery to replace the rod to fix the issue. Originally I was hoping I can reach 7.5cm with the broken rod and call it a day. Let the bone consolidate even if the rod is a bit unstable because once the bone consolidates in 2 months, it wouldn't even matter. Apparently this crack has been there for the last 1 month, but was just noticed now.

[hippo60]

yes! and my physios would regularly ask if i was getting my steps in ( although there have been many days especially the weekends where i would fall short of that goal)

im still consolidating atm so i cant give you an acurate timeframe.
ill let you know when im fully weightbearing.

That's crazy! I know Real (he went on Cyborg4Life a few times) does that, but I didn't realize everyone does. What your consolidating time looks like? Is it any different?

Zoom call with doc will be on Saturday morning, I think what will likely happen is discussion of a surgery to replace the rod to fix the issue. Originally I was hoping I can reach 7.5cm with the broken rod and call it a day. Let the bone consolidate even if the rod is a bit unstable because once the bone consolidates in 2 months, it wouldn't even matter. Apparently this crack has been there for the last 1 month, but was just noticed now.

Damn that sucks man. Do you know if you'll keep the lengthening you've done so far?

[Hagane]

What your consolidating time looks like? Is it any different?

at the moment im about 10 days into consolidation. im currently parital weighbearing with crutches. current xrays look good. Dr G says potentially full weightbearing with crutches at the end of the month depending on xrays. 

[jerrytheman]

Damn that sucks man. Do you know if you'll keep the lengthening you've done so far?

yeah 100%. So it's 62mm on my left leg which is healthy. From my guess on the xray it's about 54mm on the right leg.


I think what will happen is the doc will do a surgery to swap out the broken right nail with a new nail. And that should lengthen to 80mm. So I should still get to 8cm, but I just need another surgery on my right leg. Will know details tomorrow, but should be all free.

[jerrytheman]

Gonna need a surgery to replace the nail this week. I'll have more info on Monday since they need to call my insurance. But I'm facing some crazy pain worse than even in the beginning of the surgery. Possibly the crack is leading to wobbly nails and just ruins the integrity of the strength so he wants it replaced. Why does this have to happen to me..

[TheDream]

At least it sounds like the doctor is moving fast on this, best of luck jerry I’m sure you will overcome it and reach your goal.

I wonder how frequent nail cracks are? I tried doing a quick search on the forum but could only find unicorns nail crack with guichet.

If the precise nails easily crack due to walking on crutches I’m sure we’d have seen more cases.

[jerrytheman]

yeah I think it's pretty rare. Honestly the cracked showed up on the x ray 3 weeks ago. I'm pretty sure he missed it, I mean I missed it too, but im not a fking doc. But it's more obvious this time because the lengthening amount on both legs seems uneven. But what I think is happening is that small crack on the crown is causing some really really small side to side movement which causes the pain.
Either way, he's pretty confident that once we swap out the nail, everything will be okay. Said it's a quick surgery. I'm really hoping Wednesday is good to go, and at the latest Friday. He does surgeries M, W, F, but they'll call my insurance to get everything sorted on monday and get back to me.

Cracks are super rare without a fall. I'm probably an unlucky 1 in 400. But the doctor reassured me that it's a pretty easy surgery and even with the soft callus, taking out the rod, and putting in a new one is pretty simple stuff.

[jerrytheman]

https://www.reachyourheight.com/wp-content/uploads/2022/01/2015-Paley-PRECICE-Expert-Reviews.pdf

my guess is something like figure 13, but smaller.

[Marie_Bard]

interesting
Dr Gdalevitch encourages all her patients to walk approx 2k steps per day with walker or crutches

2k per day with Precise! Isnt this too much? What other doctors recommend?