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[raku]

I have find a doctor in China using pure external method with traditional frame.
What interests me is the bone cut way. The doctor cut tibia bone twice (upper and lower) and make upper and lower lengthening together, which also make the consolidation quicker.
Does anyone know about the double cut?



I am sorry English is not my first language. Thanks you.

[raku]

https://pan.baidu.com/s/14sdHLOMftYYzbojBeLKXmg

[Ascending]

https://pan.baidu.com/s/14sdHLOMftYYzbojBeLKXmg

Yeh I have seen this before in some other surgeon's site.  I would advise against it.  The Tibia is best done slow and easy.  The vascular supply to the tibia is much less than for the femur and the soft tissue is more resistant to stretching.  Too risky in my opinion.

[raku]

As it is known to us, pure external is safer than Lon or Latn in tibia.
So do you think if keeping 1.0mm a day lengthening safe? and just let the consolidation period quicker for the gap is smaller both sides?
Thanks

[Ascending]

As it is known to us, pure external is safer than Lon or Latn in tibia.
So do you think if keeping 1.0mm a day lengthening safe? and just let the consolidation period quicker for the gap is smaller both sides?
Thanks

I still think that having two cuts must at least double the risk.  Keeping alignment is probably harder too.  In any case I would probably do .3mm to .6mm a day max even with a single cut.

[raku]

Thanks. As for 5-6cm pure external would be wearing 10-12months frame, Do you prefer pure external or Lon/Latn?

[Ascending]

Thanks. As for 5-6cm pure external would be wearing 10-12months frame, Do you prefer pure external or Lon/Latn?

I would not do LON/LATN - if you are going to ream your bones and insert a nail then why not just go for a fully internal nail like Precice or Stryde?  LON/LATN are legacy technologies in my opinion.
For pure externals I would use a more compact fixator like the SalamehFix - you can wear trousers over them.  I met an LLer who completed his Tibias this way and he was able to go to work during lengthening.  He had a really good result.

[fivetenneeded2016]

I have find a doctor in China using pure external method with traditional frame.
What interests me is the bone cut way. The doctor cut tibia bone twice (upper and lower) and make upper and lower lengthening together, which also make the consolidation quicker.
Does anyone know about the double cut?



I am sorry English is not my first language. Thanks you.

Its dual oesteotomy, Pili and Catagni too used to perform. Its faster simce you can go 1.5mm a day, .75mm at each cut. However as others mentioned there is a risk of mal alignment and ATL(stiffness of soft tissues). but of your doctor is confident, and you know how you are lengthening, you should do fine. Good luck

[Kenda]

Thanks. As for 5-6cm pure external would be wearing 10-12months frame, Do you prefer pure external or Lon/Latn?

What about this TSF method people are saykng its 4-5 months frame time ??

[Ascending]

What about this TSF method people are saykng its 4-5 months frame time ??

TSF is just another external fixator - Paley uses it for deformity correction and I believe the Athens Dr uses it for cosmetic LL.  It is big and cumbersome but very good for complex bone correction.
The length of time will depend on the lengthening rate and time taken to consolidate.  In terms of time with apparatus installed - there is not much difference between internal and external methods.  However, external methods present an increased risk of infection and they are more noticeable and inconvenient.  Internal nails once lengthening is complete - can be largely forgotten if they are weight bearing until consolidation is complete and the nail is to be removed.

[KiloKAHN]

I was told by Dr Parihar that it's a really bad idea to do a double osteotomy outside of specific instances where it is necessary in a bone deformity case (such as when the bone is bowed). It's easier to get ballerina foot with the double cut method, and if you are one of the unlucky ones who has bad bone regeneration, your poor healing will be in two places instead of just one. He also said it's almost always the case that one osteotomy site will heal before the other, meaning you're not going to be healing faster than someone with a single osteotomy. He even said that there have been studies showing the double cut method doesn't result in any statistically significant speed up in recovery time compared to a single cut osteotomy.

The Beijing institute experimented with the double cut method back around 2008 (?) I believe, but stopped using it due to the increase of complications present in their patients

[Kenda]

TSF is just another external fixator - Paley uses it for deformity correction and I believe the Athens Dr uses it for cosmetic LL.  It is big and cumbersome but very good for complex bone correction.
The length of time will depend on the lengthening rate and time taken to consolidate.  In terms of time with apparatus installed - there is not much difference between internal and external methods.  However, external methods present an increased risk of infection and they are more noticeable and inconvenient.  Internal nails once lengthening is complete - can be largely forgotten if they are weight bearing until consolidation is complete and the nail is to be removed.

Oh I didnt know that ! I thought its like the most convenient ilizarov upgrade as the amount of nails is less and i saw someone removing the nails which are around 6-8 nails but not as Big as LON, so that why i thpught i would consider TSF vs Precice 2 and cancel all the other options.
Do ypu have any idea if Dr paley /Rozbruch/ Lee does TSF for Limb lengthening??
Also if my tibia is 35 cm what is the absolute maximum i can get with this method ?

[notatroll]

double cut is too dangerous. it might be indicated in some deformity cases but not as a rule in CLL

[Ascending]

Oh I didnt know that ! I thought its like the most convenient ilizarov upgrade as the amount of nails is less and i saw someone removing the nails which are around 6-8 nails but not as Big as LON, so that why i thpught i would consider TSF vs Precice 2 and cancel all the other options.
Do ypu have any idea if Dr paley /Rozbruch/ Lee does TSF for Limb lengthening??
Also if my tibia is 35 cm what is the absolute maximum i can get with this method ?

I was told by one of the Drs that I saw that as a general rule >30% increase in lengthening of a limb and you will run into significant problems.  So for 35cm - that's about 10cm.  But for tibia I would limit it down to 8cm max.

[Kenda]

I was told by one of the Drs that I saw that as a general rule >30% increase in lengthening of a limb and you will run into significant problems.  So for 35cm - that's about 10cm.  But for tibia I would limit it down to 8cm max.

But why do you think most people using The Precice 2 metjod in Femurs stop at about 6.5-7 cm ?!
This is something that discourage me alot .
Like why pay all this money and get all that pain just for 6.5 ? Why not achieve 8 cm!

[Ascending]

But why do you think most people using The Precice 2 metjod in Femurs stop at about 6.5-7 cm ?!
This is something that discourage me alot .
Like why pay all this money and get all that pain just for 6.5 ? Why not achieve 8 cm!

I think the main reason is that they have signed up to a lengthening program that is dictated by time and hence there is a tendency to lengthen as quickly as possible.  If you do things slowly then I think you can achieve 8cm.  But you would need to lengthen at a rate of something like .5mm a day instead of 1mm a day.  Remember, most of the problems come from the soft tissue not catching up with the lengthened bone.