Limb Lengthening Forum
Limb Lengthening Surgery => Information About Limb Lengthening => Topic started by: TRS on March 02, 2014, 08:20:25 AM
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Here is a study I found on LAP by Dr Rozbruch, Dr Fragomen and Dr Harbacheuski.
http://www.limblengthening.com/pdfs/Lengthening%20and%20Then%20Plating.pdf
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Here's another study comparing plating with nailing.
http://www.ncbi.nlm.nih.gov/pubmed/21904230 (http://www.ncbi.nlm.nih.gov/pubmed/21904230)
It concluded that there was a higher rate of malalignment with intramedullary nails than with plates.
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How are the plates inserted? I read in Sweden's diary that the plating process, carried out on another Dr. Sarin patient, left scars that made the leg "look like it had been opened by a grenade".
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The skin would have to be cut wide open all along the plate so all those screws can be put in. You can't slide it in like a nail.
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So is LATP actually better or worse than LATN/LON?
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Here's another study comparing plating with nailing.
http://www.ncbi.nlm.nih.gov/pubmed/21904230 (http://www.ncbi.nlm.nih.gov/pubmed/21904230)
It concluded that there was a higher rate of malalignment with intramedullary nails than with plates.
Thanks Kilokahn :)
So is LATP actually better or worse than LATN/LON?
From the studies, LAP showed lower incidence of malalignment and deep infection compared to LON
LON has a high risk of permanent kee pain (30-50%) from the insertion of the IM nail which LAP avoids.
But the downside of LAP seems to be the scars that would be left behind from the plating.
Here is another study on LAP and LON
http://www.ijoonline.com/article.asp?issn=0019-5413;year=2012;volume=46;issue=3;spage=339;epage=345;aulast=Kulkarni
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The skin would have to be cut wide open all along the plate so all those screws can be put in. You can't slide it in like a nail.
Actually this is not necessarily true. Done properly, Plating is done using a MIPPO (minimally invasive percutaneous plate osteosynthesis) technique. This means a 4cm cut towards the outside of the knee and 3 to 4 smaller 1cm cuts down the side of the leg. Nailing would leave similar scars, namely a 4cm scar over the knee and four 1cm long cuts to introduce the screws.
Older methods of introducing plates would entail long cuts. Certain anatomic regions like the forearm require longer incisions.
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if the scarring is not so bad according to dr franz, I'm thinking this might be my best bet
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Here is another study of LAP and comparing it to external fixation. It seems to reduce time considerably, but a quite high risk of misalignment and even plate breakage. Depending on who does it and if they use a custom made stronger plate or not it might be a good idea.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3348329/
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If modern plating is done as the following images show, then I guess plating is not a bad option at all. The images are from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377147/. Keep in mind that this is lengthening over plating and not lengthening and then plating.
Perhaps LOP may avoid harming the regenerate once the fixators are off.