Limb Lengthening Forum
Limb Lengthening Surgery => Limb Lengthening Discussions => Topic started by: ForcedPuberty on February 14, 2015, 05:00:08 AM
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so I had a discussion with my doctor about this so called alleged ability to be able to lengthen more when you do internal.
at the moment my doctor states adamantly that external femurs should be maximum of 5cm.
so I had an in depth discussion about internal femurs and presented the ideas of what this forumn believes.
but in regards to this femur debate. my doctor tells me that the ASAMI board is discussing it next meet. but as you lengthen internally your knees become closer and closer together. when you lengthen externally this does not happen.
below is a leg representation of bone structure
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_______ hip section
_______
\ / femur section slanted
\ /
l l tibia section straight
l l
the more you lengthen femurs(internally) the closer your knees come to each other, this will seriously alter biomechanics. if you lengthen to much you will have to get a reduction. this is why I would never get internal. internal is not superior, it causes lasting changes. the average person who does internal according to my doctor will need an average of 2.8 surgeries.
the price does not represent superior methodology. if you want to be safe and have the same type of body when you finish then do not get internal as you will be different when you are finished biomechanically speaking compared to a normal person.
I think external femurs is superior to internal femurs because you lengthen your height while not changing your body structure. when you finish lengthening externally your knees are not closer together, the distance between them remains the same as before surgery. and my doctor said that 5cm is the safe range for internal femurs also.
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What about the permanent loss of knee range of motion often associated with external femurs, especially monorails?
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What about the permanent loss of knee range of motion often associated with external femurs, especially monorails?
There is no permament loss of ROM with external femurs - many studies exist - it's only temporary and is simply a cause of long immobilization caused by wires and half-pins that prevent knee flexion, as they go through muscles.
However, the main problem with Ilizarov femoral lengthening is the discomfort. Immediately after the surgery your knee flexion is limited to 60-90 degrees (pins going through the soft tissue) and in the proccess of lengthening it decreases to 30-60 degrees. Knee extension also suffers, but the same way as with internals, you can work it out. Now imagine having 2 huge frames around your femurs and at the same time having a maxium of 40 degrees knee flexion. Lengthening even just one femur at a time limits you much more than lengthening femurs bilaterally with internals: sitting, laying, sleeping - everything suffers.
The biomechanics thing is also true. I've read a Kurgan (Ilizarov Centre) article about it, which claimed that lengthening femurs internally, without fixing the mechanical axis, leads to arthritis in the long run. For that very reason they claimed that lengthening femurs externally is superior to internal methods. However, it should be taken with a grain of salt, as they don't have any real data to back it up. Also keep in mind that the femur angle is individual - is it known to depend on the pelvis width - women generally have bigger femur angle. The more the angle, the more your feet are going to 'move in'. Lets say you lengthen 10 cms and your femur angle is 45 degrees (in theory), that means only 50% of the length gained will transfer vertically, meaning you'll only grow by 5 cms. That also means the other 5 cms will transfer horizontally, moving your feet and altering the mechanical axis significantly. Which in the end will cause increased pressure and stress to your knees and quite likely lead to problems with your knees. Now obviously femur is rarely rotated at 45 degrees, I was just trying to explain how it works.
(I've lengthened 7.5 cms on my femur externally)
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Yeah I've heard this as well but I only though it meant you'd get less height for your clicks. Was planning on doing 6,5CM to get an actual 6CM height increase.
Didn't know about the biomechanical issues at all, thanks for telling. Is internals really that bad though? Several people on has done it and it seems like a lot of them recover pretty well.
What method would you guys recommend for a 6CM gain?
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Yeah I've heard this as well but I only though it meant you'd get less height for your clicks. Was planning on doing 6,5CM to get an actual 6CM height increase.
Didn't know about the biomechanical issues at all, thanks for telling. Is internals really that bad though? Several people on has done it and it seems like a lot of them recover pretty well.
What method would you guys recommend for a 6CM gain?
Internal is still the best method for lengthening femurs. Like I said, you simply won't survive lengthening femurs bilaterally with externals, and if you do it 1 after 1 with pure externals it'll take 2 years at the very least. With internals you're mostly done after like 4-5 months. I think the importance of correcting the mechanical axis is highly exaggerated for one simple reason - someone who's naturally tall and has naturally long femurs will have the same mechanical axis as if you imagine he lengthened his femurs. Honestly, I'd disregard the 'mechanical axis problem' completely, I think it's made out of dust.
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Internal is still the best method for lengthening femurs. Like I said, you simply won't survive lengthening femurs bilaterally with externals, and if you do it 1 after 1 with pure externals it'll take 2 years at the very least. With internals you're mostly done after like 4-5 months. I think the importance of correcting the mechanical axis is highly exaggerated for one simple reason - someone who's naturally tall and has naturally long femurs will have the same mechanical axis as if you imagine he lengthened his femurs. Honestly, I'd disregard the 'mechanical axis problem' completely, I think it's made out of dust.
Thanks but I guess I'll ask my doctor of choice about it just to be safe.
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Internal is still the best method for lengthening femurs. Like I said, you simply won't survive lengthening femurs bilaterally with externals, and if you do it 1 after 1 with pure externals it'll take 2 years at the very least. With internals you're mostly done after like 4-5 months. I think the importance of correcting the mechanical axis is highly exaggerated for one simple reason - someone who's naturally tall and has naturally long femurs will have the same mechanical axis as if you imagine he lengthened his femurs. Honestly, I'd disregard the 'mechanical axis problem' completely, I think it's made out of dust.
That tall person would have a wider hip base, so he'd have a natural mechanical axis. Otherwise all tall people would be walking around knock-kneed.
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Lets say you lengthen 10 cms and your femur angle is 45 degrees (in theory), that means only 50% of the length gained will transfer vertically, meaning you'll only grow by 5 cms. That also means the other 5 cms will transfer horizontally, moving your feet and altering the mechanical axis significantly. Which in the end will cause increased pressure and stress to your knees and quite likely lead to problems with your knees.
So will a patient with a 45 degrees be lengthened until they vertically grow to a desired height or will they have to settle with less gains?
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So will a patient with a 45 degrees be lengthened until they vertically grow to a desired height or will they have to settle with less gains?
They will have to settle I think.
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They will have to settle I think.
How about correcting the 45 degrees then the height surgeries later?
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How about correcting the 45 degrees then the height surgeries later?
I don't know much about leg anatomy but I suspect that might be dangerous. I.e the femur bone might be supposed to have a certain angle, it could also be a very invasive surgery to do.
You will have to ask a doctor about your femur angle. A decent rule of thumb to improve safety is to stick to a conservative goal. For example if you're shooting for a gain of 10CM it should be safer (better recovery, less chance of complications) to lenghten your femur 6CM and then your tibia 4CM instead of doing it all in one segment.
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Hi FP
I beg you to read carefully before you start to argue and missprestige doctors and techniques as usual. The use of internal devices can lead to the kind of deviations you refer when lenthenning strictly on the anatomical axis of the Femur. This happens mainly when performing antegrade techniques as it does Not allow any correction at all.
LL we do care about this issues and we do plan our cases. That is exactly one of the reasons why I prefer Fitbone over others like Precice. The implant is Not strictly placed in the canal...it s placed in order to achieve a correction on the mechanical axis so it is close to perdection. We use the "reverse Planning method" published by Rainer Baumgart after more than 500 procedures. You can find a Link and a presentation below. And We Also use powerful Tools as computer assisted Planning to simulate How the bone will behave on the procedure.
Ex fix usually Leads to varus femur and tibia valga for many reasons i can explain you such as a Bad positionning of pins, pin losening (caused by local infection), excentric forces applied on pins, bad allignment of the rod, progressively stiffness of the callus... So it is dangerous to post that ex fix is safer.
You can Also find a paper from Dror Paley in which he advices the use of a nail (LON) as it is much safer than ex fix itself.
I decide to write because it is very Important that all the information you give about the different techniques has to be backgrounded by some professional supervision and/or Medical publications.
My advice as a doc for both tibias and femurs is internal by far.
But i trully appreciate that you posted this issue of malalignment. Planification is extremely important. LL is Not easy and it is vital to plan every case individually.
http://www.llrs.org/PDFs/Annual%20Meeting%20Presentations/Friday%20Meeting/8.Dahl.pdf
http://www.ncbi.nlm.nih.gov/m/pubmed/19685230/
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Great to have you back on the forum Dr. Monegal, we've been missing your insight since you left.
What can we, as patients, do to avoid any harmful deviations?
Also, this might be beyond your professional curtesy so don't feel preassured to answer, but I am considering hiring Dr. Jean-Marc Guichet, what is your professional opinion on him as a surgeon?
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I don't know much about leg anatomy but I suspect that might be dangerous. I.e the femur bone might be supposed to have a certain angle, it could also be a very invasive surgery to do.
For example if you're shooting for a gain of 10CM it should be safer (better recovery, less chance of complications) to lenghten your femur 6CM and then your tibia 4CM instead of doing it all in one segment.
My un-revokeable plan is one segment (femur/femoral region for the following reason) and I will experiment with 2 inch tall sandals so I can once again return to the beach without all the worries of modern life. If elevator shoes are too much of a burden then I might return to the surgeon for the tibias.
To answer you now, 5cm on both segments is more even than 6cm here and 4cm though I was raised with inches in school.
(Welcome back Monegal keep it up)
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My un-revokeable plan is one segment (femur/femoral region for the following reason) and I will experiment with 2 inch tall sandals so I can once again return to the beach without all the worries of modern life. If elevator shoes are too much of a burden then I might return to the surgeon for the tibias.
To answer you now, 5cm on both segments is more even than 6cm here and 4cm though I was raised with inches in school.
(Welcome back Monegal keep it up)
5CM is generally considered safe, I wouldn't worry too much if I were you. Can your proportions handle 10CM though? I've studied mine carefully and I wouldn't add more than 8CM personally.
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5CM is generally considered safe, I wouldn't worry too much if I were you. Can your proportions handle 10CM though? I've studied mine carefully and I wouldn't add more than 8CM personally.
I use large shirts like every average person, the pants though had to be cut smaller so as long as I reach the average pants size I will be alright and fooling a wife will be easy with large shirt plus average pants in the laundry.
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My advice as a doc for both tibias and femurs is internal by far.
Dr. Monegal, can you comment on the following study, which claims 47% mean incidence of (chronic) anterior knee pain after intramedullary nailing of tibia and 18.6% mean incidence after IM nailing of femur? Can this be avoided?
http://www.bjj.boneandjoint.org.uk/content/88-B/5/576
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Dr. Monegal, can you comment on the following study, which claims 47% mean incidence of (chronic) anterior knee pain after intramedullary nailing of tibia and 18.6% mean incidence after IM nailing of femur? Can this be avoided?
http://www.bjj.boneandjoint.org.uk/content/88-B/5/576
Dr. Monegal seems to have left. He's like a medical information ninja, coming at us with actually qualified oponions when we least expect it -but when we need it the most.
Not the hero the forum deserves, but he's the one we need right now.
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Dr. Monegal seems to have left.
I see his online icon green.
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medical information ninja, lol
Now I'm afraid to do all external, but I know he is referring to femurs specifically.
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medical information ninja, lol
Now I'm afraid to do all external.
Don't let anyone discourage you if there's a bright side it's that externals have been in the market for several decades.
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medical information ninja, lol
Now I'm afraid to do all external.
Keep in mind that many surgeons have their own opinions on the matter. They just can't argue because they don't visit the forums. Also keep in mind that cosmetic LL surgeries, just like any other cosmetic surgeries, are a business.
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Don't let anyone discourage you if there's a bright side it's that externals have been in the market for several decades.
Every method will have it's pros and cons. I would have concerns with bone growth in using internal methods and because of my age it's not a concern I should take lightly.
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I beg you to read carefully before you start to argue
I did not read anything. I had a 1 hour discussion with my surgeon in my home.
my doctor discussed the reverse Planning method during this hour, and he said that it is irrelevant as a safe approach because of the retrograde insertion and the massive statistical outcome of permanent knee pain. (you beat me to it exclide I was going to post that study)
http://www.bjj.boneandjoint.org.uk/content/88-B/5/576
1460 patients, mean follow-up was 23.9 months, permanent knee pain: 47.4%
You can Also find a paper from Dror Paley in which he advices the use of a nail (LON) as it is much safer than ex fix itself.
im not sure how this is relevant to knock knees discussion, but either way paley has sent an email saying that for tibia certain styles of monorail are superior to internal devices. although I concede that paley prefers internal for femur.
I decide to write because it is very Important that all the information you give about the different techniques has to be backgrounded by some professional supervision and/or Medical publications.
its funny because I was medically supervised by a doctor who invents/develops limb lengthening devices when we had this discussion. and you have now a study with 1460 patients with an almost 50% permanent knee pain complication rate.
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Hi guys
Regarding anterior knee pain. This is an issue that you Are all aware of.
I trully think that entry Point of the nail is a critical Point and patellar tendon spreading is one of main reasons apart from soft tissue stretching and malalignment outcome.
You might see a great difference when performing tibiae and this is caused because most of the procedures are performed through patellar tendon whereas in femur most are performed throught the piriformis fosae (antegrade).
To avoid that when performing tibiae We can chose a Suprapatellar Approach.
http://www.ncbi.nlm.nih.gov/m/pubmed/24694557/
Check that link wich might be usefull.
PS: i am Not a ninja...just trying to help you guys out There
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There you go FP
You carry on with your cruisade to criticise and try to pull down any single comment We post here.
Go and di whatever. You Are posting a review of articles in which it does Not say a word about malalignment outcome, damage on the patellofemoral surfaces, meniscus or tibial plateau.
As far as I read this is a review of intramedullary nailing (Not Limb lengthening) and in most cases (probably all from traumatic aethiology) there might have been several colateral injuries like soft tissue injuries, joint injuries, shortenning, axial deviations...
But well done. You carry on with your useless point.
Let me ask you a question. What the hell Are you doing in this forum? I thought this Was suposed to be a experience sharing and supporting tool to help people to decide best option for themselves. You carry on posting whatever...and I am Not sure if you already had any experience on you...but after your words i am Not quite sure LL is the best option for you.
Confidence is very relevant for us the surgeons. And you don t seem to Feel confident enought tongo for it. Just think about it.
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Keep in mind that many surgeons have their own opinions on the matter. They just can't argue because they don't visit the forums. Also keep in mind that cosmetic LL surgeries, just like any other cosmetic surgeries, are a business.
True. It's well known that internals will not be compatible for every one person. The method that one chooses to lengthen is very individual to each person.
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But well done. You carry on with your useless point
correction, my surgeons points.
Let me ask you a question. What the hell Are you doing in this forum? I thought this Was suposed to be a experience sharing and supporting tool to help people to decide best option for themselves.
second correction, this thread was started by me due to a 1 hour discussion with my surgeon who invents/develops limb lengthening devices, that 1 hour discussion was the very reason for this thread being created, to tell me that I dare not post the express view point of my surgeon that he stated during that 1 hour would just be ludicrous. the actual topic here is the 1 hour discussion. so I am completely relevant. you are just being a bully because I am not a doctor.
You carry on with your useless point
also please don't call my surgeon and his points useless. its not very nice.
And you don t seem to Feel confident enought tongo for it. Just think about it.
I am already undergoing limb lengthening. so this quote is irrelevant. however you are correct I don't need LL, my life was already amazing, this is just an improvement because perhaps 10-20% of girls who are attractive have height requirements, although I have enough other characteristics to date those girls already. and I don't really care to spend my money on anything else.
To avoid that when performing tibiae We can chose a Suprapatellar Approach.
I concede that does look promising, however it is 36 patients, not 1,460 patients. so your study although looking promising is inconclusive.
please don't bully me because I am not a surgeon. my opinion is valid because it is not my opinion. it is a surgeons opinion. don't shoot the messenger. :)
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Sorry for the word useless. This Was Not referred to the knee pain issue it Was referred to your initial argument about malalignment regarding femoral internals.
First I never bully anyone...neither patients Nor doctors. Someone asked me about Guichet and I Did not mention a word.
I never give opinions on others procedures.
I remain respectfull to all of you guys.
So you Did Not towards me in the past. But I do Not give any relevance to it.
Your study is from 1990 to 2005 based on trauma cases. Obviously medicine and surgical techniques have there own evolution. But a paper in Orthopaedics is no longer relevant after 3 years in most cases. In the USA procedures of tibia nailing Are electively performed suprapatellar..you know why? To prevent knee pain and other issues.
But it s ok. Feel free to post your thoughts, This is why this forum Was created.
I never missrespect you, and you Did this towards me and other users recently. And this pisses me off.
By the way I wish you the best in your lengthening procedure. Probably externals after your words.
And keep in mind that LL is Not easy neither with internals Not with externals.
But As I told you I wish you early recovery, excellent outcome and make your expectancies be fully satisfied as This is a brave decission.
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Sorry for the word useless. This Was Not referred to the knee pain issue it Was referred to your initial argument about malalignment regarding femoral internals.
correction. my doctors initial argument about malalignment regarding femoral internals.
But it s ok. Feel free to post your thoughts, This is why this forum Was created
correction. my doctors thoughts.
this entire thread is just me posting what my doctor told me. if you don't like my doctors opinion feel free to keep telling me that im preposterous.
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i totally agree with Dr Monegal . If really anyone is concerned about difference in opinions of surgeons or the surgery then LL is not for such people , just follow your heart , trust your heart and go for it , whatever be the result you will be happy for it for the Fact that you listened to your heart "WILL" and not to the will of someone else mind. if you layout all the "IF" and "BUT" of any task you want to do , you will simply end up doing nothing just NOTHING. regarding Femoral LL i would go with Internals , after reading dairies of Hannah, Shy Shy , Apo and many others , i think they gained the height they wanted and they are living normal life.
* Looks like someone expects to become spiderman or Mister Fantastic after LL * ugghhh
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Hi FP
As I told you...carry on with your cruisade.
You were discussing with your doc about axial deviation and knee pain and I just tried to clarify there Are solutions for such problems.
What you write is your interpretation after 1hour Meeting with your doc who deserves all my respect. So This is it. What you cannot do is misscredit in a forum internals and say ex fix is much better because it s Not. M
More concerning issues for users when Considering internals Are knee pain and price of the implants. You can find in the literature all sorts of problems, obstacles and complications regarding ex fix procedures (Donan classification).
My concerns about ex fix itself? Pin SiTe infection (98-100%) which can lead to bone abcess, osteomielytis, bacteriemia and amputation of the limb. Others line joint stifness, permanent knee pain or axial deviations (20-30% tibia valga greater than 10 degrees reportes in literature), psychological issues related to treatment and/or complications, bad cosmetic outcome, losening of proximal pins, pinnsite pain...
No thanks. I have used all LL methods and I am serious that my order of preference when doing LL Are:
1- internals for both Femur and tibia
2- LON
3- i only use ex-fix in dwarfism as it is Not possible to place either an internal device or intramedullary nail in short dysplasic bones.
With all my respect to you and your fabulous doctor.
Have a nice day
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Dr. Monegal is it true that you prefer internal methods when lenghtening the humerus bone as well?
In that case, why would you say internal is superior to an external method?
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My concerns about ex fix itself? Pin SiTe infection (98-100%) which can lead to bone abcess, osteomielytis, bacteriemia and amputation of the limb. Others line joint stifness, permanent knee pain or axial deviations (20-30% tibia valga greater than 10 degrees reportes in literature), psychological issues related to treatment and/or complications, bad cosmetic outcome, losening of proximal pins, pinnsite pain...
While true that pin site infections are a very common complication with external fixators, I think it will be fair to note, that it's not considered a major complication and very rarely leads to serious problems:
Dr. Paley http://www.researchgate.net/publication/20751607_Problems_obstacles_and_complications_of_limb_lengthening_by_the_Ilizarov_technique
the site may be injected with an antiobiotic solution of 100mg/mL of cefalozin. This is injected radially around the pin site from within the tract. This will melt away the pin-tract infection within 24 hours in most cases.
It is preferrable to use oral antibiotics quite liberally at the slightest hint of a Grade 2 pin-tract infection. A one-week course will resolve almost any pin-tract infection
http://link.springer.com/article/10.1007/s11751-012-0139-2/fulltext.html#CR2
Although pin track infection is common, very few lead to major complications [2, 5, 7, 10]. Schalamon et al. [7] found that 94 % of infections were mild and responded to local or systemic antibiotic management. Piza also reported that 75 % of their pin site infections were minor infections when using the Checketts–Otterburn classification [9, 35].
permanent knee pain or axial deviations (20-30% tibia valga greater than 10 degrees reportes in literature),
Also, I don't think the reason for the following complications are the external devices themselves, but rather a poor technique, as external (Ilizarov full ring) devices allow for corrections of any deformities and axial deviatons. I haven't heard of knee pain being attributed solely to the use of external devices.
psychological issues related to treatment and/or complications, bad cosmetic outcome
I think that psychological issues aren't unique to lengthening with external devices. I'm not sure what you mean by 'bad cosmetic outcome'. I think you can get a 'bad cosmetic outcome' also with internal devices.
losening of proximal pins, pinnsite pain
Several complications of intramedullary nailing have been described including infection,2,13,14 compartment syndrome,16–29 deep-vein thrombosis,30–32 thermal necrosis of the bone with alteration of its endosteal architecture,33–40 failure of the metalwork16,20,22,23,27
Of which I think 'failure of the metalwork' should be noted as being unique to lengthening with IM nails. A broken nail will result in: 1) additional surgery to replace the nail 2) additional expenses (15000$ nail (20000?)) 3) bone regenerate collapse 4) associated psychological trauma
Also, nails are advised to be removed, which also results in additional surgeries, expenses and trauma.
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Ok guys there you go.
Is this a thread in which We post out opinions?
Or is it a post in which you argue any single argument?
I am speechles on How some of you misscredit any Medical opinion We give.
Pinnsite infection happens in almost 100% of cases. It rarely causes deep infection But it is adviceable Not to have Long-term pins through your skin directly sticked onto the bone. Paley? You might find a paper he wrote regarding inserting a nail to shorten ex-fix period to prevent complications and allow early recovery.
Further surgeries? Well of course in the unlikely event that an implant breaks (probably caused by a bad management of the patient). Same as if osteomelitis occurs, or osteotomies caused by axial deviations, pinnsite infection debridments, MUA to solve stuff knee and so on...
There Are many reasons why MONOLATERAL can cause tibia valga...pin losening, excentric force applied Not following the axis of the bone, bending of the pins caused by progressive stiffness of the callus, bad positionning of the rod...which doEs Not happen with internals or LON.
Anterior knee pain is Not exclussively caused by nailing...it can be caused by axial deviations, knee stifness, tendon and soft tissue stretching...more likely to happen when performing ex-fix.
Complications like compartment syndrome, dvt and others you comment Are not exclussive of nailing...This is caused by the technique itself of cutting a bone and Not perdorming adequate fasciotomy in the anterior tibial compartment...this can Also happen when doing ex-fix.
And Last But Not least: when i mean psychological issues..i refer it is Not easygoing to any individual to deal with ex-fix during quite a long time. Just this. During this time Not only mobility But Also ability to socialize and go to "normal activity" is really compromised in some cases.
Bad cosmetic outcome...having 6 pins (most of them infected) with the stress and tension applied by an external fixator...do believe me the COSMETIC outcome is really poor when compared to internals. You probably have your own experience But I can tell you hundreds of cases. And do trust and believe me...if We Are talking about COSMETIC lengthening the most cosmetic, safe and with best managing by the patient Are internals.
You don t need to convince me...by the way thanks for the lesson
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Hi Uppland
For humerus the elective treatment YES it is monolateral external fixators.
It is a straight forward procedure with good managing and few complications.
Humerus is a non loading bone and you must be aware of risk of radial nerve palsy after surgery and slightly slower bone formation than in femurs for example.
There Are no internal devices and As far as I know no one performs LON on humerus as the insertion of s nail might damage supraspinatus tendon.
So for humerus go for monolateral yes or yes
Best regards
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I think that all parties should respect each other's opinions. Even Dr monegal should not cast aside other member's opinions with words like 'speechless'. I think FP is very rude and when I read the exchange of words between FP and Monegal and I am clearly on the doctor's side. This time, however, exclide was not rude at all and as a matter of basic etiquette, I think Moneegal made the rude comment first.
I honestly do not understand why he is so vigorously trying to make his point, that he casts aspersions on other users like exclide who offered his layperson opinion humbly. I don't think doctors should behave in such a way, though I might well be wrong.
I am not here to give medical advice as I am just medical student. I do not plan to specialise in orthopaedics and have no specialised knowledge in orthopaedics.
Orthopedics is a tough specialisation to enter, but it does not mean that being an orthopaedic surgeon, one knows everything. That is only common sense. Arrogance gives a very bad impression. Even if an orthopaedic surgeon is qualified, there might be business reasons why he promotes a certain device/ certain technique as opposed to another (eg, perhaps to fight lower costs of external fixators in other countries).
I humbly think that there might be sound arguments for and against using external fixator for the tibia and even the femur. One reason of course is that external fixation is less invasive, and the bone marrow is not dissected into, hence less risks of fat embolism. No reaming is required for ex-fix.
As a patient who is currently doing ex-fix for tibia, I humbly disagree with what most of the doctor has said. Ex-fix is not such a horrifying experience, if you go to the right doctor.
I think it might be too premature to say that exclide or forum members have such a point of view that makes him "speechless". This is sheer medical arrogance. I am sure there are pros and cons for each method, though the pros MIGHT be much greater for internals. For example, there are many incisions available to reach the heart for cardiac massage or to get access the pulmonary cavities, anterolaterally/posterior-laterally or medial steronotomy, each have their pros and cons. There are also proponents of open rhinoplsaty and some for closed rhinoplasty.
A carefully modified Illizarov frame is not as trouble-causing as the traditional Illizarov device, from what I have read (anecdotally) and experiencd (as a patient).
Bagirov's frames are quite comfortable as they consist of half rings, do not cause any axial deviations according to the Singapore orthpedic surgeon, do not cause much soft tissue problems, and are not infected all the time. Yes, I had a pin-site infection and yes it was difficult to resolve. But it was superficial and I never got to the stage of intravenuous/subcutaneous antibiotics. I wouldn't think sub-Q antibiotics will be good as it weakens and distorts the pin area. Bagirov's frames do not cause loss of range of motion (I have full knee range of motion), and almost full ankle ROM. I have no knee pains except lateral pains at the hamstrings when I bend my knees. This can be expected with any method.
I think that the doctor is too vigorous in promoting internals. It is very scary to read his comments as a patient who is currently doing external fixators. I am sure there are both sides to the story. I will ask my local orthopaedic surgeon about his comment at my next visit. He should be more sensitive to patients who are currently (and who have done) externals. I am sure it cannot be that bad in a properly selected patient and a proper surgeon and proper device. The Taylor-frame is after all, widely used in the USA and developed countries.
Bagirov's frames on my tibia are not painful at all. pain is controlled at all times. I am even able to go to work (part-time) for a few hours on Wednesdays and Thursdays. I am even planning to go for my internships with the frames on. They can be hidden under cargo pants and u could just say you got into a ski accident.
Dr monegal has kindly privately contacted me a few times, to offer his thoughts, through e-mail. I am puzzled why he is contacting patients and perusing this forum to cast aspersions on other users when he is busy doing so many surgeries. I sincerely appreciate his offer to perform the surgery for me, but I think that this forum is unable to bring much business. there are so few users and many of them have already decided on a doctor. thus there is no need to promote internals for business purposes. Correct me if I am wrong, but I smell business. (I have seen the private (specialist) medical surgery field).
Again I do not wish to be rude to the doctor but I am just offering my point of view, and that all parties should refrain from making rude and childish comments, or personal attacks. the doctor must have had many years of training as a doctor, and not to mention his clinical experience. He has his own reasons for thinking his way and it was very rude of FP to attack him. But I am not comfortable with how the doctor has attacked other members. He has offered to leave, and he has came back, with much anger. I appreciate his technical advice, but I think all parties shd observe basic respect and etiquette.
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Hi Uppland
For humerus the elective treatment YES it is monolateral external fixators.
It is a straight forward procedure with good managing and few complications.
Humerus is a non loading bone and you must be aware of risk of radial nerve palsy after surgery and slightly slower bone formation than in femurs for example.
There Are no internal devices and As far as I know no one performs LON on humerus as the insertion of s nail might damage supraspinatus tendon.
So for humerus go for monolateral yes or yes
Best regards
Thank you Dr. Monegal
Could you just enlighten me, what is radial nerve palsy and can it be cured/treated?
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Hi imf
Probably I get lost in translation.
When i mean speechless...this means i have no words to describe my feelings everytime I Try to give an opinion and there Are some whose only Point is to directly attack what I say.
I am very respectfull to all of you when I attend you even if I am to busy.
In this thread it is a matter on posting our Point regarding CLL. Not discuss to each other.
What I cannot accept is that You can think doctors earn any economic compensation by using internal devices. I have never had 1€ profit from any Company. This is Not my case But cannot say about doctors who use their own devices.
I have been a doc for 16 years Now and always been dealing respectfully with all my patients. I am a normal person trying to help people after a hard trainning and a bunch of years treating patients. This doEs Not make any diffference between you an I guys. But my Point and experience has to be at Least respected and it has Not been like that by some users. So please don t call me arroganteNo because I hate arrogant people and you don t know me at all. I always try to kindly attend all of you.
If you read carefully my last words to FP Are encouraging him to carry on and wishing him best of the best. I am sure you, him and all patients undergoing such procedures will be happy and successfull. You guys Are very brave and you all have excellent doctors. Maybe I have been too vigorous towards some users But one cannot remain shut up when people Are giving miscelaneous information.
I have performed hundreds of cases myself using externals and of course they end up very well most times. But I keep my order of preference at 0€ cost! I promise.
By the way, LL is complicated and whatever technique is performed complications can occur. That is why Medical advice is important. To stay safe. We don t have any God power or We Are Not ninjas...But We do need to go at once with patients to get to a successfull outcome...and sometimes it s Not enought.
As some of you Are aware i decided Not to post any more comments in here. The reason Was missrespect. I decided to write again as the information given could lead to confussion.
So I don t need to argue with none of you. I keep my position and from Now on I am out of here.
PS your Medical arguments Are very valuable and I wish you the best in your LL
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Hi doctor, please see my responses in bold:
Hi imf
Probably I get lost in translation.
When i mean speechless...this means i have no words to describe my feelings everytime I Try to give an opinion and there Are some whose only Point is to directly attack what I say.
I understand how you feel. I do not understand why FP was so rude and disrespectful to your opinion. Even if you are not a specialist, there was no need for him to speak in that way. I am sure you know much more than him and he is just a self-proclaimed medical expert. If he is so interested in bone surgery maybe he should start with a medical degree.
I am very respectfull to all of you when I attend you even if I am to busy.
In this thread it is a matter on posting our Point regarding CLL. Not discuss to each other.
What I cannot accept is that You can think doctors earn any economic compensation by using internal devices. I have never had 1€ profit from any Company. This is Not my case But cannot say about doctors who use their own devices.
Thanks for this clarification. one thing I don't understand is it is always quoted "bad patient management" as a reason why the internal device fails. There must always be some probability that the device fails, simply because of bad luck and/or mechanical failure?
I have been a doc for 16 years Now and always been dealing respectfully with all my patients. I am a normal person trying to help people after a hard trainning and a bunch of years treating patients. This doEs Not make any diffference between you an I guys. But my Point and experience has to be at Least respected and it has Not been like that by some users. So please don t call me arroganteNo because I hate arrogant people and you don t know me at all. I always try to kindly attend all of you.
I am sure I do not know you well enough to say that u are arrogant. If I meant that, I am sorry and keep up the good pro-bono work that you have done. many doctors like to educate patients, and I am sure many of us are thankful for the (only) medical specialist here that is you. There are many arrogant doctors I have seen, and I think you are usually very patient and friendly. FP is really so rude that I feel so bad for you.
If you read carefully my last words to FP Are encouraging him to carry on and wishing him best of the best. I am sure you, him and all patients undergoing such procedures will be happy and successfull. You guys Are very brave and you all have excellent doctors. Maybe I have been too vigorous towards some users But one cannot remain shut up when people Are giving miscelaneous information.
I have performed hundreds of cases myself using externals and of course they end up very well most times. But I keep my order of preference at 0€ cost! I promise.
Yes, I think in MOST cases with a proper doctor, external fixators will do quite well. Skill and experience counts. with my doctor, compared to more inexperienced surgeons, it is scary how a simple ex-fix can be done so differently. If done properly and the nerves are protected and proper surgical procedure is followed, it is not a bad surgery/surgical outcome. Yes, pin breakage is quite common with some doctors (like barinov). but with dr bagirov's frames, it almost never occurs. so sometimes, it is really the device stability/design (too rigid is a problem and too unstable is also a problem) and proper placement. I do not need to quote studies which show that internal fixation has better patient tolerability, etc etc. But I think it might be helpful to allow ur patients to choose ex-fix or internals, like for tibia to cope with each patient's nneeds like costs, and psychological weakness
By the way, LL is complicated and whatever technique is performed complications can occur. That is why Medical advice is important. To stay safe. We don t have any God power or We Are Not ninjas...But We do need to go at once with patients to get to a successfull outcome...and sometimes it s Not enought.
complications can always occur but in medicine if u have a good doctor and no bad luck, many events can be controlled and resolved. internal nailing can cause deep infection which can be extremely difficult to resolve, ex-fix can cause pin site instability when there is severe infection, each method have their problems
As some of you Are aware i decided Not to post any more comments in here. The reason Was missrespect. I decided to write again as the information given could lead to confussion.
So I don t need to argue with none of you. I keep my position and from Now on I am out of here.
PS your Medical arguments Are very valuable and I wish you the best in your LL
thank you, but I do not wish to make medical arguments as I am not trained in surgery, and I did not read up on ex-fix vs int-fix. I only know that in trauma cases, ex-fix is preferred because lower risk of embolism and less blood loss, shorter operating time. after a few days/weeks, a surgery might be done to perform internal fixation. I just wanted to put a few non-medical words, because I think all parties shd respect each other. I am sure many forum members value your contributions. I am stopping with my tibia surgery so I have no reason to read up In such great detail as FP. I wonder why FP is so free; perhaps he has such a strong passion in medicine. But I do not think he can be a good doctor at all, he is too rude, impatient and even without starting medical school he is already so arrogant.
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Dear ItsMyLife,
I think you’ve misunderstood Dr. Monegal. What’s wrong in saying that someone’s words leave you “speechless”, that is, without speech? This word -correct me if I’m mistaken, because I’m not a native speaker- can be applied to a variety of situations and means, above all, that you are surprised. I don’t see anything rude neither in this word nor in his post. Dr. Monegal uses irony (“thanks for the lesson”) and he’s perhaps a little annoyed, but who wouldn’t be? If I had spent 20 years of my life studying medicine and performing hundreds of LL procedures to end up being questioned by laymen, I would be even angrier.
As for internals, if he makes his point so vigorously –not arrogantly, be careful-, I don’t think it’s because of business interests. I am repeating myself, but I deem it necessary, since some of you are still suspicious. I know him personally and he’s not a money-maker. If he recommends internals, it’s because he considers internals better for his patients (and he has performed all the techniques, so he knows what he’s talking about). He acts just out of interest and all of us should be grateful, since he is a very busy person. And don’t call me “bumlicker”, please. I have better things to do in my life than being a bumlicker.
Finally, I would like to point out something, ItsMyLife. You’re saying that externals are not so bad from a psychological point of view, but I’ve read some posts of you where you confess that you’re taking anti-depressants. Why?
Best regards
I am not taking anti-depressants. I have no depressive history or anxiety issues. Which post did u read that from?
I took Lyrica for nerve pains as prophylaxis. Lyrica (much to my horror ) is also indicated for anxiety. So, When I withdrew from Lyrica, I started to have horrible cold turkey symptoms. So now I am back on lyrica, I was feeling horrible about my external fixators because I withdrew from 75 mg x 3 times a day of Lyrica, and went down to 0 mg. needless to say, I developed breathlessness, palpitations and feelings of impending doom, and restlessness, insomnia, sweating, etc. I went back to the hospital after two days as I cannot cope.
Now I am on lyrica 25 mg x 3, and I feel so much better! I think from a psychological point of view (even without lyrica when I was in Moscow), ex-fix is perfectly fine. there are studies that show that internal fixators are easier to cope with psychologically, according to patients. But, at least, in a patient who is psychologicaly stable, ex-fix is an option.
It does not mean that the fact that you are a doctor, you know everything. there have been so many times that a surgeon has performed a mistake and someone not as medically trained has offered his suggestion. two brains are better than one.
I have realised that doctors who are very busy do not go on forums, and do not email patients from forums. maybe dr monegal just wishes to do some social work and help people here, but it can definitely be interpreted as a business move. I am not sure how to prove that he has many surgeries in one day. do not be surprised if many surgeons actually perform only one or two surgeries in one day. I am just saying this forum mght not be a good way to earn more business. the old forum is more populated.
doctors have limited time. my mentors spend their time with their patients,, making their patients feel comfortable and safe. in addition to their surgical work. that already leaves them with 3 hours to sleep. I am not sure if dr monegal is acting out of good -will and not for business, and I do not wish to comment. I am just offering my opinion.
not to be rude, but you appear to be not a patient of his but u might be a representative of his clinic. you have been constantly promoting him to no end such that he becomes a cult personality. Ithe fact that you have not posted any x-rays (x-rays don't identify patients) is very fishy . if your main concern is identity concealing and if you wanna promote him so much, I am still quite surprised why you did not post any x-rays. is it because x-rays would require patient approval? and what if this patient views the forum here and musicmaker x-rays is supposedly his x-rays?
as a non-native English speaker, perhaps you want to find out more about the meaning of "speechless". I think, as dr monegal said, he was lost in translation. thanks. I have spoken English all my life and come from a English-speaking country.
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music, pls see my response in bold.
As for internals, if he makes his point so vigorously –not arrogantly, be careful-, I don’t think it’s because of business interests. I am repeating myself, but I deem it necessary, since some of you are still suspicious. I know him personally and he’s not a money-maker. If he recommends internals, it’s because he considers internals better for his patients (and he has performed all the techniques, so he knows what he’s talking about). He acts just out of interest and all of us should be grateful, since he is a very busy person. And don’t call me “bumlicker”, please. I have better things to do in my life than being a bumlicker.
On the internet, anyone can hide behind an anonymous username. you might be a patient. you might be a clinic representative who earns by commission or per hour (or per month) (there are many clinic representatives on medical forums). I did not say that you are a bumlicker. I am sure you also have better things in life to do than keep saying good things about the doctor. I am sure he does not need you to keep praising him and so on, it gets repetitive. If you are truly a patient and you truly love him so much, then fine, do what u please. I am just saying theres a possibility that you are affiliated to the clinic.
Finally, I would like to point out something, ItsMyLife. You’re saying that externals are not so bad from a psychological point of view, but I’ve read some posts of you where you confess that you’re taking anti-depressants. Why?
And to address this point, I thnkk you mistook me with other users (many people here are either clinically depressed or have issues). In fact, I said this forum is full of people with mental problems and I get offended at first (by these people)but later I realise they are psych patients so I do not lose my cool or get offended. please do not cast aspersions on me.
Best regards
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Yes, it was probably a mistake on my part. I had only a vague reminiscence of your posts: I overread that you were taking a medicine for generalized anxiety disorder and thought you were suffering from it because of external fixators. In any case, you have had a very tough time, isn’t it? “Breathlessness, palpitations and feelings of impending doom, and restlessness, insomnia, sweating, etc” are horrible side-effects which are difficult to cope with. LL is a harsh experience, both with internals and externals, and it can destabilize you if you are not psychologically strong enough.
As far as “speechless” is concerned, I have followed your advice of learning more about the meaning of the word. I have browsed the Oxford English Dictionary –a nice book-, where you can read the following definition: “Unable to speak, especially as the temporary result of shock or strong emotion”. I don’t find anything unacceptable in the meaning of this word. In Spanish we say “sin palabras” which means simply that: ‘without words, especially as the temporary result of an event which surprises you’. Have Dr. Monegal and me really got lost in translation? I don’t know anything about medicine, but I know much about words, and “speechless” is not offensive language, my dear.
For another thing, as I have already told you, Dr. Monegal is not the only doctor in this forum. There are others who have made remarkable contributions in the past. Instead of being malicious, you should recognized their good-will. I don’t know the other doctors, but I know Dr. Monegal, because I’m indeed his patient, whether or not you believe it. It’s precisely because he is making me, his patient, comfortable and safe that I’ve got to know him and have learnt that he usually performs many surgeries per day, some of them very complicated. He writes here in his spare time, between surgeries, just aiming at giving you valuable information. He is not trying to earn more business. As you have said, almost all members here have already chosen their doctors.
As for the issue of me being a representative of the clinic, it’s not true. I have my own job in a different city. I’m praising Dr. Monegal to no end because I feel like it. A priori I won’t post neither pictures nor X-rays of mine because, as I have always claimed, I want to preserve my privacy, both for personal and job-related issues. Have you seen Dr. Monegal’s presentation in the first page of his thread? X-rays identify patients here in Spain. My name features in all the X-rays I have got done and I don’t want my name to be seen. In fact, I don’t have my X-rays with me, because it's the doctor who holds them. Even if I had my X-rays with me, I wouldn't like them to be seen. There are not many people like me doing LL and people could put two and two together and recognize me. By the way, I’m not the only patient who doesn’t post his/her X-rays.
Regards,
The lyrica withdrawals caused me to feel so horrible. Before taking lyrica, I was perfectly fine and in good spirits. Ex-fix is not so bad after the first week (the first week is really painful and uncomfortable). At lower doses of lyrica now, and I am still doing very well with good spirits and good sleep. I take lyrica for nerve pain, not for anxiety issues, but I think it does help calm you down a lot.
I was thinking you could blank-out the identifying information at the top of the x-rays (or bottom); but to each his own, nobody should have the obligation to post their x-rays. but I do not see how an x-ray would identify someone if there is no written information on it.
I did not understand why the doctor had to be "speechless" with exclide's comment. "speechless' must be read together with some mebers are here to discredit medical opinion. The innuendo (esp since FP did not post) is that Exclide is out to attack him and to talk nonsense and mis-inform and/or is so stubborn as to discredit his medical opinion. Exclide was simply offering his point of view, and not attacking or insinuating that the doctor is wrong. he is just saying that maybe ex-fix isn't so bad after all. I do not understand why he has to be exasperated if he is kind and patient. Either way, as I said, I think the doctor did not mean any negativity. and was probably lost in translation. or perhaps he was, on a bad day, being more aggressive.
Either way, I wish you all the best in your recovery if you are indeed a patient of his. I also wish the doctor all the best in his future endeavours. we do appreciate his technical input and he is probably the most qualified persons in this small forum. All the best, and I find no need to continue with this conversation; I have many textbooks to read. Take good care.
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PS: i am Not a ninja...just trying to help you guys out There
Your perspective is always appreciated. Thank you for your time.
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Sorry but this forum is full of arrogant people, from Forced Puberty and Exclide to Dr. Monegal. Even It'sMyLife and MusicMaker are arrogant in their own way.
Dr. Mongeal, you say you hate arrogant people, but 99% of doctors who do CLL are arrogant, because they are defying God, Nature or however you want to call it. You put into risk perfectly functional limbs and do this because you believe you're Gods and you're Omnipotent. You can't really believe your fans' praises. They're blind... or fake. I want to see what will happen when complications arise, because they arise. What will you do?
Please, don't deny evidences. All doctors who do CLL are money-makers. CLL is very expensive and you earn a lot of money from it. Most of you don't really care about us, but take profit from our low self-esteem.
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1.Dr. Mongeal, you say you hate arrogant people, but 99% of doctors who do CLL are arrogant, because they are defying God, Nature or however you want to call it.
2. All doctors who do CLL are money-makers. CLL is very expensive and you earn a lot of money from it. Most of you don't really care about us, but take profit from our low self-esteem.
1. I believe in God yet I disagree with LL as trying to defy God, DNA engineering is something that really defies nature as well as GMO but with surgery you are just breaking bones that were designed to be broken and healed very quickly in young people.
2. You mad because they earn tons of cash? Not everyone here lacks the esteem though, some of us just want fair treatment like when Blacks were the victims, now it's us, we live under the same Constitution but we get a shorter end of the stick.
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1. I believe in God yet I disagree with LL as trying to defy God, DNA engineering is something that really defies nature as well as GMO but with surgery you are just breaking bones that were designed to be broken and healed very quickly in young people.
2. You mad because they earn tons of cash? Not everyone here lacks the esteem though, some of us just want fair treatment like when Blacks were the victims, now it's us, we live under the same Constitution but we get a shorter end of the stick.
Wow awesome word
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Wow awesome word
I could have said it better but I am not trying to sell a product so it's good.