Limb Lengthening Forum
Limb Lengthening Surgery => Limb Lengthening Discussions => Topic started by: sixfootandhalf on August 22, 2022, 07:05:50 PM
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I am going to be consulting with the following surgeons soon: Paley, Lee, and Parihar, and Betz
My concern is the following:
I have been informed from one of the above, who uses a weight bearing nail, that they have only had 4-5 non-unions in the last 20 years, and the risk of non-union is higher for Tibias than Femurs.
Theoretically speaking, if i was 175.5cm tall, and was lengthening femurs by 7cm, using a weight bearing nail, as someone in their 20s...
How could i mitigate the risks of non-union? What if i took X-rays more frequently?
What would i need to ask the surgeons about to mitigate this risk?
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The osteotomy technique in addition to your nutrition/moving about plays a big role. Please ask each of the doctor you are considering the osteotomy technique that they would be employing to prevent non-union.. Dr Lee has a very high success rate
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thank you for the reply - what do you mean by osteotomy technique?
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Never heard of a non union happening in the Femurs.
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Never heard of a non union happening in the Femurs.
yeah ok professor
The osteotomy technique in addition to your nutrition/moving about plays a big role. Please ask each of the doctor you are considering the osteotomy technique that they would be employing to prevent non-union.. Dr Lee has a very high success rate
he means that some doctors absolutely shatter your bones when they break it in the surgery, leaving you a bunch of little bone pieces hanging in there creating a massive unnecessary additional trauma:
(https://s8d5.turboimg.net/t1/79435935_xray8.jpg) (https://www.turboimagehost.com/p/79435935/xray8.jpg.html) (https://s8d5.turboimg.net/t1/79435937_xray9.jpg) (https://www.turboimagehost.com/p/79435937/xray9.jpg.html)
while other doctors are super precise and slowly and methodically knock on the bone with a chisel and produce a very clean break:
(https://s8d3.turboimg.net/t1/79435951_xray7.jpg) (https://www.turboimagehost.com/p/79435951/xray7.jpg.html)
good doctor's osteotomies look perfect like if cut with a reciprocating bone saw - to be noted however that in LL we do not do osteotomies with a bone saw, because the clean cut would not produce the required body response, develop a blood clot and callus
bone saws are used for amputations
EDIT: changed chain saw to bone saw LOL chainsaws for amputations are used only in the horror movies!
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Technically an oblique osteotomy is one of the best a patient can get as it increases bone to bone contact.
The problem in this first set of x-ray is the varus deformity.
However you are correct that osteotomy technique is very important
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Technically an oblique osteotomy is one of the best a patient can get as it increases bone to bone contact.
The problem in this first set of x-ray is the varus deformity.
However you are correct that osteotomy technique is very important
Thank you for clarifying Dr Assayag, i always thought the first type of osteotomy was just shoddy workmanship but I guess it does make sense that a bigger surface area would provide a better adhesion.
The second type of osteotomy looks aesthetically better however with the lack of bone shards in there.
And youre right, there is a deformity, again if you notice the nail has been inserted at the tip instead of the piriformis
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Technically an oblique osteotomy is one of the best a patient can get as it increases bone to bone contact.
The problem in this first set of x-ray is the varus deformity.
However you are correct that osteotomy technique is very important
@Dr Assayag..
There are 2 components to prevent non-union right?
1. Patient component - no smoking, follow right amount of lengthening, vitamin D supplements, moving about carefully, no comorbidities like diabetes etc
2. Surgeon's component - right osteotomy technique, not allowing the patient to lengthen too much
Am I missing something that is important? I am really scared of non-union. If non - union does occur in femur, what is the success rate of it being treated?