Let me say it this way..one patient died after bilateral simultaneous femur doing intramedullary device (fortunately not one of my patients) and it s not a matter of safety, it is a matter that if surgeons are aware of this, none of them will carry on doing bilateral because of legal issues.
I asked Dr Parihar's assistant Dr Ahuja (or Dr Divya as I always called him) about doing one leg at a time as opposed to bilaterial tibs or bilateral femurs to help prevent embolism and he responded "But you are still reaming two bones, how are you reducing the risk of embolism?"
I think the subject of fat embolism is interesting here. As Dr. Parihar's assistant suggests, you will still be doing both legs in the end. So the total risk of experiencing fat embolism will not be changed overall.
As I can imagine it, the advantage of doing it in two stages would be that if you are prone to fat embolism (or your surgeon is too aggressive in reaming), doing it in two stages would likely ensure the resulting embolism would be smaller as it would be coming from only one femur, and not possibly both femurs simultaneously.
A fat embolism from one femur would be damaging, but a fat embolism from both femurs simultaneously could be catastrophic.
But if this is the main concern regarding doing both femurs in the same operation, there is another solution. You could do one femur one day. Then one or two weeks later, he could do the second femur. You would still be spacing the operations apart. This provides the benefit of avoiding the possibility of bilateral femoral fat embolism. But it still allows you to get both legs lengthened over the same time frame.
The disadvantage of course is that you need to go under anesthesia twice, but I think could be worthwhile. Also, having both legs broken simultaneously means you can't be weight bearing on one leg during recovery. But for example, for myself, I don't think having one leg to hop around on would be that helpful anyway. I need to be able to stand and walk freely for my job. Personally, I would rather be in a wheelchair for 3 months than hopping around for 6-7 months.
I think Dr. Monegal raises a good point about avoiding reaming both femurs during the same operation. But as I have described, that does not necessitate letting one leg fully heal before doing the other. Even spacing the two operations a few days would be sufficient, providing the first operation goes without complication.
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Topic: Dr Alex Monegal (Barcelona, Spain) Clinica Diagonal (Read 293809 times)