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[Mzacr]

Is it really worth it to pay more for the precise nail? I´ve been digging and I don´t find it more appealing to be crippled on a wheelchair more than have a huge apparatus on my tibias and be able to walk. What do you guys think?

[TemakiSushi]

Is it really worth it to pay more for the precise nail? I´ve been digging and I don´t find it more appealing to be crippled on a wheelchair more than have a huge apparatus on my tibias and be able to walk. What do you guys think?

Precice is obsolete now unless your bone is too thin
With Stryde no wheelchair needed

[Sanity]

get pure ilazarov if ur going for tibias and nail if going for femurs

imo its a waste to pay extremely huge amounts to gain the same results in shorter time.

[Mzacr]

I compare them because stryde is stupxdly expensive. I guess pure external is going to be a reality for many around here that don't have the privilege to pay that much.

[heightconsultant]

Precice 2.2 is not obsolete in today's reality. Yes Stryde is announced and already being used, but it is not widely available worldwide yet, and is unbelievably expensive.

It cannot be really justified if a person who has enough money for Precice (even better Stryde), goes with external methods. Because using an internal nail significantly eliminates the risk of infection. In internal methods, small cuts are performed, internal nails are inserted and the cuts are stitched, so it is nearly impossible for infection to penetrate easily. Since there are no pins and open pin sites, no need for regular dressing change and dealing with mess.

Yes, external devices allow you to walk while lengthening and recovering, and Precice doesn't, but believe me after operation, most patients want it end as soon as possible, which is not the case with Ilizarov method, which requires living with devices for up to 1 year.

I would prefer using the wheelchair for 2-3 months and leave everything behind, rather than being able to walk with difficulties for 1 year, always risking infection and other possible problems.

[Ascending]

Precice 2.2 is not obsolete in today's reality. Yes Stryde is announced and already being used, but it is not widely available worldwide yet, and is unbelievably expensive.

It cannot be really justified if a person who has enough money for Precice (even better Stryde), goes with external methods. Because using an internal nail significantly eliminates the risk of infection. In internal methods, small cuts are performed, internal nails are inserted and the cuts are stitched, so it is nearly impossible for infection to penetrate easily. Since there are no pins and open pin sites, no need for regular dressing change and dealing with mess.

Yes, external devices allow you to walk while lengthening and recovering, and Precice doesn't, but believe me after operation, most patients want it end as soon as possible, which is not the case with Ilizarov method, which requires living with devices for up to 1 year.

I would prefer using the wheelchair for 2-3 months and leave everything behind, rather than being able to walk with difficulties for 1 year, always risking infection and other possible problems.

Stryde is about $5000 more expensive than Precice 2 which is nothing when you consider that with Precice you will effectively be disabled for a good few months.  Even the recovery will be much faster with Stryde and you should also lose less muscle and retain more flexibility.

I think external methods are worth considering for Tibia for the reasons outlined in one of my previous posts and shown again below for convenience.  I have changed my mind with respect to Tibia lengthening with external methods and I now think they provide a better long term outcome at a fraction of the cost of internal methods:

Hi,

I have been researching and reading the opinions of posters about Tibia lengthening and I note that whilst there is consensus that Femur lengthening is best done using an internal distraction nail, such concensus doesn't exist for the Tibia.  My opinion is that a very good internal load bearing nail such as the Stryde trumps external methods mainly because it is more tolerable than external apparatus, has less infection risk and produces less scarring.  Interestingly nails are kept in the limb just as long as external fixators post lengthening - the difference being that the internal nail produces less discomfort/inconvenience for the patient and virtually no risk of infection.

Tibia Facts:

• There are two bones that must be broken and extended simultaneously - Tibia (Shin Bone), Fibula (Calf Bone).
• Complications of premature consolidation of one the two bones will lead to bow legs.
• The bones are thinner
• Greater resistance of soft tissue to lengthening when compared with Femurs
• Drop foot/Ballerina seems to be a frequent occurrence
• Blood supply is generally poorer than for the Femur

External Methods

Advantages:

• Load Bearing
• Can precisely control lengthening
• Can correct complex deformities
• Does not require reaming of bone
• Does not damage the knee
• Frame can be reused
• Much cheaper than internal methods
• Suitable for those with small diameter bones - adults and children
• Mechanically simpler than internal methods and problems can be fixed more easily
• Removal of apparatus has very little risk and is cheaper

Disadvantages:

• Pins fix the apparatus to the bones going through the skin and muscles - creating further resistence to muscle stretching.  This is more noticable for femural lengthening where the muscle mass is greater.
• Pin Site Infection - great care must be taken when showering
• Frame removal times are very long - removing too early risk fracture.  A nail can be inserted after lengthening but this will bring some of the disadvantages with internals methods
• Bulky frame make the surgery very noticeable and make it difficult to sleep - with the exception of Dr. Salameh's Salamehfix fixator
• Pins can and do break requiring replacement
• More scarring than internal methods

Internal Methods

Advantages:

• New nails such as the Stryde nail allow full Load Bearing
• Can precisely control lengthening if using Precice or Stryde
• Very low infection risk, negligible post surgery
• Soft tissue is lengthened without obstruction
• Nails can be kept in until consolidation fully completes without much inconvenience
• Much less scarring than external methods
• Much more comfortable experience for the patient - easier to disguise and easier to sleep

Disadvantages:

• Much more invasive than external methods - requires nail to be inserted through the knee and the bone to be reamed to make room for the nail
• Expensive
• Nails cannot be reused
• Bone marrow is lost from the bone
• Risk of fat embolism - caused by bone marrow being displaced by the nail and entering the bloodstream.
• Nails can bend and break requiring expensive surgery to replace
• The nail lengthening mechanism can break - leading to runaway lengthening or non lengthening
• Nail removal is an expensive and brutal process - nails are hammered out.
• Some nails such as Albizzia derivatives are extended using a very painful mechanical process - not true for Fitbone, Precice and Stryde nails.
• Not suitable for children or adults with thinner bones - more so with load bearing nails which are typically thicker.

[TemakiSushi]

Which doctor you think is good for external?

[Ascending]

Which doctor you think is good for external?

I would recommend Dr Salameh - his unique hinge based fixator (Salamehfix) is compact and much more tolereable - you can wear trousers over them.

[TemakiSushi]

I would recommend Dr Salameh - his unique hinge based fixator (Salamehfix) is compact and much more tolereable - you can wear trousers over them.

I see
Dr Salameh cost 25k euro and frames stays on for at least 6months or even more than a year depending on how much lengthened
Recent diary showed the pain and discomfort of Salameh frames prevented to work and earn money for whole lengthening period
Stryde in Greece will be around 45K euro, and with it I’ll probably be able to start working nomad after one month
I’ll earn much more than 20k in 6 months
So I think price difference is not much at all between Salameh and Stryde
I’d rather stay more comfortable while lengthening without much excruciating pain which can last for days and weeks with frames

I’ve actually met some precice patients and been talking with external patients, so I know how painful externals are. Generally Precice patients had much easier life even with wheelchairs
Stryde without wheelchair will really be so much easier than external
External frames can be a pure tourture for some people
I don’t wanna take that chance to save 20k

[Ascending]

I see
Dr Salameh cost 25k euro and frames stays on for at least 6months or even more than a year depending on how much lengthened
Recent diary showed the pain and discomfort of Salameh frames prevented to work and earn money for whole lengthening period
Stryde in Greece will be around 45K euro, and with it I’ll probably can start working nomad after one month
I’ll earn much more than 20k in 6 months
So I think price difference is not much at all between Salameh and Stryde
I’d rather stay more comfortable while lengthening without much excruciating pain which can last for days and weeks with frames

That's a good rational choice for you.  For others who are more price conscious it might not be.  There will also be patients with small diameter bones for which Stryde may not be an option.  There is also the potential long term problems of drilling through the knee - there has been much discussion about it on this forum.  As for the diary that you read - I think you need to read more than one diary to make a decision.  There are many more Salameh diaries on the old forum.  I met an ex-patient this year and his experience was much smoother.  But we must definitely not ignore the difficult cases and so you are right to point it out.  I would also suggest people go and see a few Drs before making their decision.  Does the Greece price include removal of the nail?

[TemakiSushi]

I don’t know how much is nail removal
The thing is if I cannot work for a long time,
I have to sum up for living cost of up to one year with Salameh
Total cost of Salameh may be more expensive than Stryde

When talking about the cost, Need to think about financial merit of fast recovery, how much one can earn afterwards
“Cheap” May not be really cheap

[legpatient]

I think I would have chosen Stryde with the Greek doctor would I have known about him before.

[Mzacr]

I´ve been wondering. Is stryde really worth it when there are other weight bearing internal nails at a more cheaper price point?

[TemakiSushi]

I´ve been wondering. Is stryde really worth it when there are other weight bearing internal nails at a more cheaper price point?

Which nail are you talking about?
Betz, Guichet, Fitbones and Jamal all have too many troubles, all ancient technology

[TemakiSushi]

Even classical ilizarov has history of many complications
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2266651/#!po=36.4865
I don’t think it’s really the safest option
More important is to choose a real competent doctor in any methods

[Sanity]

Even classical ilizarov has history of many complications
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2266651/#!po=36.4865
I don’t think it’s really the safest option
More important is to choose a real competent doctor in any methods

this is by far not a difficult surgery. Have you ever seen a heart transplant or a neurosurgery? Almost any ortho can perform the cll osteotomies and place the fixators. Most complications occur in the recovery phase either by patient negligence or doctors carelessness. And how those complications are dealt with decides the overall final outcome.

[TemakiSushi]

this is by far not a difficult surgery. Have you ever seen a heart transplant or a neurosurgery? Almost any ortho can perform the cll osteotomies and place the fixators. Most complications occur in the recovery phase either by patient negligence or doctors carelessness. And how those complications are dealt with decides the overall final outcome.

Well external LL is not something so simple neither, not just manipulation of bones
Doctors have to pay attention to manipulation of soft tissues, tendons and facials
Crude doctors can mess up in surgery even just putting frames

[TemakiSushi]

I would recommend Dr Salameh - his unique hinge based fixator (Salamehfix) is compact and much more tolereable - you can wear trousers over them.

Even Dr Salameh seems too risky after reading some journals

Bone was bent in a case on old forum
It’s not just patients fault

[raku]

初めまして, dear temakisushi. Precice nail is pretty good in femur lengthening. But I think if someone want to lengthen tibia, Ilizanov still is the best method for bone alignment. And pure external is safer than Lon/Latn. But someone want to return to work, salamehfix still better than Lon/Latn in my opinion.

[TemakiSushi]

初めまして, dear temakisushi. Precice nail is pretty good in femur lengthening. But I think if someone want to lengthen tibia, Ilizanov still is the best method for bone alignment. And pure external is safer than Lon/Latn. But someone want to return to work, salamehfix still better than Lon/Latn in my opinion.

Hi raku
Did you read diaries on old forum?
Too bad here it’s not allowed to put link to old forum
One of Salamehfix patients has been suffering for complications and not being able to work for 2years.  Think about the economical loss and mental stress you get from it
After reading cases there,
I can’t recommend Salameh who practice externals only with no ther options
The doctors I would trust so far, none of them recommend pure ilizarov to cosmetic patients
But if you really have to do pure ilizarov, Dr Lee can perform that, however he doesn’t really recommed it he’ll do it if necessary
I think he is really the best for tibias after researching and talking to his patients personally especially for Asian

If I were in Europe Dr Giotikas may be good but I’d rather choose Stryde even with him
He does TSF so if you don’t like nails he can do it for you around the same price as Salameh

I think doctors who doesn’t have enough knowledge or experience with nails are doing only pure ilizarov
Good experienced doctors rather choose nails

[raku]

Thanks for your information and advice dear temakisushi.
Some complication appear over safe limit. But I think if anyone lengthening less than 6.5cm in tibia, he or she would come back to normal life within a year. With salamfix frame coming back to work in office also could achieve with pants and crutch. (Actually in this new forum someone came back work after surgery a month in 2018. And he felt good and work without problem.)
I learn from many real former Ller that Lee and some doctors in Beijing have many good result even with nail in Lon method. And people goal more that 7Cm should use nail for provent bone bent and avoid losing time. But the disadvantage is the about 15% or less permanent knee pain and deeper scar. And Lee or BEijing frame is difficult to work until removing the frame. But with nail it really save time and the risk is not so much actually. People always choose the method that they need most. No the best metrod just the most suitable method for every different individual.
I would choose styade or Precice first when doing femur and when coming to tibia lengthening I would do pure external for 6.5cm to keep a real 6cm height gain.
Thanks you!

[TemakiSushi]

Thanks for your information and advice dear temakisushi.
Some complication appear over safe limit. But I think if anyone lengthening less than 6.5cm in tibia, he or she would come back to normal life within a year. With salamfix frame coming back to work in office also could achieve with pants and crutch. (Actually in this new forum someone came back work after surgery a month in 2018. And he felt good and work without problem.)
I learn from many real former Ller that Lee and some doctors in Beijing have many good result even with nail in Lon method. And people goal more that 7Cm should use nail for provent bone bent and avoid losing time. But the disadvantage is the about 15% or less permanent knee pain and deeper scar. And Lee or BEijing frame is difficult to work until removing the frame. But with nail it really save time and the risk is not so much actually. People always choose the method that they need most. No the best metrod just the most suitable method for every different individual.
I would choose styade or Precice first when doing femur and when coming to tibia lengthening I would do pure external for 6.5cm to keep a real 6cm height gain.
Thanks you!

The chance of going back to work in one month after surgery with external is not very high due to severe pain and inflammation
 if thing go wrong it can end up more expensive
So better save up much more than 25K even with Salameh

To avoid permanent  knee pain, need to choose a good doctor
15% chance of permanent knee pain does not mean that all doctors got the same rate

Some doctors can be as low as close to 0%, others can be more than 30%

Even with pure externals if things are not properly done, permanent pain can appear in knees or other parts of legs and body
Some  femur cases got knee problems or even nurve damage in lower leg, without cutting knees of course

External is not a dream method without permanent pains in joints

[Sanity]

The chance of going back to work in one month after surgery with external is not very high due to severe pain and inflammation
If your reason to do Salameh is to go back to work early, better chance is with Stryde


To avoid pPermanent knee pain, need to choose a good doctor
Even with pure externals if things are not properly done, permanent pain can appear in knees or other parts of legs and body
External is not a dream method without permanent pains

Incase of femurs there is no doubt that internals is the only safe and reliable method.

But for tibia's there is a difference of opinions. You claimed earlier that alot of doctors don't recommend that anymore. Alot of doctors don't have incentive anymore for that either especially when compared to the quadrupled costs of internals. Once they start getting much more money for the same surgery they don't prefer going back to 30-40% cut made by exetrnals only.

Alot comes down to the individual as well. If one prefers to resume his everyday life asap then internal tibias is a better option with higher cost. Permanent knee pain and other complications can be avoided same as with externals. If the lesser cost or lesser invasive method is preferred then externals only can do it but longer time and more difficult management will be the downside.

For me as long as the end goal of gaining 7cm is achieved, I'd prefer lesser cost and low invasion into legs coz i can manage the increased time wearing those heavy frames and longer time away from life but its not the case for everbody.

[TemakiSushi]

Incase of femurs there is no doubt that internals is the only safe and reliable method.

But for tibia's there is a difference of opinions. You claimed earlier that alot of doctors don't recommend that anymore. Alot of doctors don't have incentive anymore for that either especially when compared to the quadrupled costs of internals. Once they start getting much more money for the same surgery they don't prefer going back to 30-40% cut made by exetrnals only.

Alot comes down to the individual as well. If one prefers to resume his everyday life asap then internal tibias is a better option with higher cost. Permanent knee pain and other complications can be avoided same as with externals. If the lesser cost or lesser invasive method is preferred then externals only can do it but longer time and more difficult management will be the downside.

For me as long as the end goal of gaining 7cm is achieved, I'd prefer lesser cost and low invasion into legs coz i can manage the increased time wearing those heavy frames and longer time away from life but its not the case for everbody.

Dr Salameh couldn’t avoid patient having severe complications
That’s why I don’t recommend him
The risk overweigh the merit of Salamehfix being small
Doctors should be responsible for managing post surgical process, cannot blame patients

[Sanity]

Dr Salameh couldn’t avoid patient having severe complications
That’s why I don’t recommend him
The risk overweigh the merit of Salamehfix being small
Doctors should be responsible for that not patients

Sorry I don't know much about this doctor salameh. If u read my post it was just generic comparing the 2 methods.

[raku]

The chance of going back to work in one month after surgery with external is not very high due to severe pain and inflammation
 if thing go wrong it can end up more expensive
So better save up much more than 25K even with Salameh

To avoid permanent  knee pain, need to choose a good doctor
15% chance of permanent knee pain does not mean that all doctors got same rate

Some doctors can be as low as close to 0%, others can be more than 30%

Even with pure externals if things are not properly done, permanent pain can appear in knees or other parts of legs and body
Some  femur cases got knee problems or even nurve damage in lower leg, without cutting knees of course

External is not a dream method without permanent pains in joints

I think 0% is difficult. Even like very rare case fat embolism is not close to 0%. From Dr. Paley, having 31years experience of Cll still had 4patient had fat embolism among 250 cases(one of the four was close to die but survive by Paley full experience.
In case of this forum and old, pure external within 7cm, there is no permanent pain cases and after removing the frame, they could run. With nail, though we could come back normal life earlier, but it is the nail working for us, not the power of our bone. With the nail, the full recover of bone would be half a year slower than pure external. Besides, pure internal just having 19 years history,(Fitbone, Dr. Betz stop to use latter now using Precice and beztbone), with preicece 7years history, and Styade lack of 1year history, we still do not know what would happen 10years or 20years later.
As for Dr. Giotikas, he is expreience with nail(Precice styade), but why he does only pure external rather than use TSF plus Lon or Latn?

[raku]

Dr Salameh couldn’t avoid patient having severe complications
That’s why I don’t recommend him
The risk overweigh the merit of Salamehfix being small
Doctors should be responsible for managing post surgical process, cannot blame patients

In his diary, most of the patient (within 7cm lengthening), even dangerous 8cm 9cm patients is satisfied.

[TemakiSushi]

In his diary, most of the patient (within 7cm lengthening), even dangerous 8cm 9cm patients is satisfied.

Did you read the severe complication case of Salameh?

most patients don’t share their experiences on internet
If one severe complication case appear, there can be a lot more hidden  unhappy cases

I understand lots people get interested in cheaper methods
But in reality, considering longer downtime, it can end up even more expensive
Economical loss from recovery time is quite a lot

[raku]

Did you read the severe complication case of Salameh?

most patients don’t share their experiences on internet
If one severe complication case appear, there can be a lot more unhappy cases hidden

Yes I read. I have no idea which ller you are talking about. If you are talking about Sam'case she did 9cm twice (18cm totally)in Tibia. With a very originally bent leg. And she just said if doing in Gemenny it would be better.
This is her original leg. I am sorry I don't know how to use imgur
 https://pan.baidu.com/s/1KKYSy-rfKnUbmaACRXlJsg
Other ller is satisfied.

[TemakiSushi]

Yes I read. I have no idea which ller you are talking about. If you are talking about Sam'case she did 9cm twice (18cm totally)in Tibia. With a very originally bent leg. And she just said if doing in Gemenny it would be better.
This is her original leg. I am sorry I don't know how to use imgur
 https://pan.baidu.com/s/1KKYSy-rfKnUbmaACRXlJsg
Other ller is satisfied.

Well, better to read old forum makes me taller
There’s guy from USA having severe complications with Salameh
Not being able to work for 2years or even more

If you are Chinese I strongly recommend Dr Lee even if you want to do pure ilizarov
He is very experienced with our tibias
https://drdonghoon.com/?lang=en

I warn here because I’ve been in touch with just too many complication cases of CLL
I really hope no one suffere from it
Dr Lee is top notch expert to fix complications coming from Europe also

[raku]

Well, better to read old forum makes me taller
There’s guy from USA having severe complications with Salameh
Not being able to work for 2years or even more

If you are Chinese I strongly recommend Dr Lee even if you want to do pure ilizarov
He is very experienced with our tibias
https://drdonghoon.com/?lang=en

I warn here because I’ve been in touch with just too many complication cases of CLL
I really hope no one suffere from it

Actually I have read 12 dairy of him but  I found everyone is satisfied with the result even very dangerous 9cm (which I don't Recommaned ) While I think anyone with 9cm lengthening in tibia would surely need 2year to go back life no matter whether having nail or not.
Yes I am Chinese have worked in Japan until this year.
Thanks for you advice I think Dr.Lee is good for Styade in femur but if choosing pure external,  within 6.5cm(safe in Dr Salamh cases)would be much easier to come back life without making trouble.
Thanks you