Limb Lengthening Forum

Limb Lengthening Surgery => Information About Limb Lengthening => Topic started by: KiloKAHN on October 14, 2013, 10:31:39 PM

Title: Limb Lengthening Methods
Post by: KiloKAHN on October 14, 2013, 10:31:39 PM
There are a variety of approaches that one can choose from to lengthen his limbs. Below is a list of known methods along with their advantages and disadvantages.

What is limb lengthening?

Limb lengthening is the gradual elongation of bone and soft tissues (skin, muscle, nerves, blood vessels). Using an external device called an external fixator or one of various internal devices, the bone and soft tissues are slowly pulled apart and gradually lengthened in a process called distraction. The distraction is done at a recommended average of 1 millimeter per day. If the rate of distraction is higher than this, complications such as muscle contracture (tightness), nerve paralysis, and bone non-union can occur. If distraction is done too slowly, premature consolidation (gap between the bones is filled with regenerate bone) is possible, preventing further distraction. The distraction rate of 1 mm per day is not a strict rule, as there are frequently cases that require a slower distraction rate, and occasionally a faster rate. Once the desired length is obtained, distraction stops and the consolidation phase begins. The consolidation phase is the period when newly formed bone calcifies. Once the bone is fully healed, the lengthening device can be removed.

External Methods of Limb Lengthening

Ilizarov Apparatus

The Ilizarov Apparatus was invented in the Soviet Union by Dr. Gavriil Abramovich Ilizarov in 1951 and has been used in North America since 1981 for correction of leg deformities and lengthening. The Ilizarov Apparatus (also known as the Ilizarov fixator or ring fixator) is an assembly of 2 or 3 rings that encircle the leg or arm and are applied to the bone using screws and wires, each ring connected to the other by connecting rods. The Ilizarov Apparatus is applied through surgery, where the wires are threaded through the skin and muscle that lie over the bone which will be corrected or lengthened. The rings are then secured with telescoping rods and a small cut is made in the limb between the rings.  Through the cut’s opening, the outer layer of bone is sliced, leaving the inner marrow undamaged. The lengthening phase is started about one week after the initial surgery, where the patient turns screws on the Ilizarov Apparatus that turn to stretch the bones slowly. Once distraction is done, the fixator remains in place for the consolidation phase so as to prevent the regenerate bone from breaking under the weight bearing load. A child will have to wear the external fixator for approximately 1 month for each centimeter lengthened. Adults may require 1.5 to 2 months or longer per centimeter.
(http://imageshack.com/a/img69/664/d47l.jpg)

Advantages: Cheapest lengthening option. No additional surgery required after frame removal

Disadvantages: Prolonged time wearing Ilizarov Apparatus has a higher chance of health-related complications such as pin tract infection and decreased range of motion in joints. This can also have a negative psychological effect to the patient, leading to frustration and lack of willingness to participate in physiotherapy. Risk of fracture in regenerated bone after frame removal due to the lack of internal stabilization. May require repeated adjustments to avoid bone misalignment. Discomfort and soft tissue tethering due to pin sites.

LON (Lengthening Over Nail)

Lengthening Over Nails combines a ring fixator for lengthening and a regular intramedullary nail. The LON concept was first introduced by F.C. Bost and L.J. Larsen in 1956 but was popularized by Dr. Dror Paley in 1990 in order to reduce the treatment time in EF (external fixation). During the operation, a hole is made through the bone in order to provide space for an intramedullary nail (nail inside the central cavity of a bone shaft where bone marrow is stored). The hole is made to be approximately 1.5 mm larger than that of the nail itself. This process is called reaming. Once the bone is reamed, the intramedullary nail is inserted into the bone’s central cavity and then locked at the proximal end (the end closer to body’s center) of the nail using screws. A corticotomy (cutting of the bone) is then performed, followed by attachment of the external fixator. The lengthening phase is started about one week after the initial surgery, where the patient turns screws on the Ilizarov Apparatus that turn to stretch the bones over the intramedullary nail slowly. Once the desired length is achieved, two distal (the end farther from body’s center) interlocking screws are inserted into the nail and the external fixator is removed. The purpose of the intramedullary nail is to provide weight bearing support during the consolidation phase. Once the bones are fully consolidated, another operation is needed to remove the nails along with a week’s bed rest for the bones to heal from nail removal.
(http://imageshack.com/a/img812/7775/ccv7.jpg)

Advantages: Requires only 1/3 of the time wearing an external fixator as compared to the purely external method. Intramedullary nail helps prevent misalignment in regenerate bone. Fewer complications than external method overall.

Disadvantages:  Higher rate of pin site infection due to presence of intramedullary nail during lengthening. Requires acute deformity correction which compromises bone healing potential during subsequent lengthening. Comparatively high incidence of deep intramedullary infection. Additional surgery required to remove intramedullary nails years later. Need to be careful of impact on intramedullary nails during consolidation due to risk of re-fracture. Doesn’t appear to reduce the duration needed for bones to heal compared to purely external method. Unlike LATN, LON uses a small diameter nail so bone can regenerate over it, allowing less stability than LATN method. Discomfort and soft tissue tethering due to pin sites.

LATN (Lengthening and then Nailing)

LATN is a newer limb lengthening technique that combines external and internal methods.  The Ilizarov Apparatus is applied through surgery, where the wires are threaded through the skin and muscle that lie over the bone which will be corrected or lengthened. The external fixator is prepared so that an intramedullary nail can be placed inside the bone later. The rings are then secured with telescoping rods and a small cut is made in the limb between the rings.  Through the cut’s opening, the outer layer of bone is sliced, leaving the inner marrow undamaged. The lengthening phase is started about one week after the initial surgery, where the patient turns screws on the Ilizarov Apparatus that turn to stretch the bones slowly. Once distraction is done, a reamed intramedullary nail is inserted into the bone’s central cavity to support the bone during the consolidation phase, allowing early removal of the external fixator. Once the bones are fully consolidated, another operation is needed to remove the nails along with a week’s bed rest for the bones to heal from nail removal.

Advantages: Requires only 1/3 of the time wearing an external fixator as compared to the purely external method. Quicker bone healing rate than pure external method. Lower rate of infection than LON. Infections can be treated more easily and gradually during lengthening due to absence of intramedullary nail present in LON method during lengthening phase. Larger diameter nail than the one used in LON method is inserted into bone cavity during consolidation, allowing greater stability and increased protection against re-fracture.

Disadvantages:  May require repeated adjustments to avoid bone misalignment due to lack of IM nail during lengthening phase. Need to be careful of impact on intramedullary nails during consolidation due to risk of re-fracture. Discomfort and soft tissue tethering due to pin sites.

Unilateral External Fixator (Monorail Fixator)

Monorail Fixators are similar to the standard Ilizarov Apparatus. However, instead of a bulky external frame there is a single bar that runs along the outside of the limb and is attached with between 4 and 6 pins to the bone. It provides more comfort than the Ilizarov fixator and is often used when treating arm deformities. Unilateral lengtheners can be purely external or can be combined with an intramedullary nail as used in the LON method.
(http://imageshack.com/a/img202/650/w4wb.jpg)

Advantages: Fewer scars than standard Ilizarov Apparatus due to less pins, can be worn under clothes, suitable for pediatric patients with smaller limbs.

Disadvantages: Pinhole scars are larger than scars made by the Ilizarov Apparatus due to greater pin size. Pin site infections are common. Less stability than standard Ilizarov Apparatus. Some patients say the larger pinhole sites cause more pain than the standard Ilizarov Apparatus.

Salamehfix (SLDF)

The Salamehfix (SLDF) System is a hinged, Eternal Fixation System developed by Prof. Ghassan Salameh in Syria. It is an arc system rather than a circular system and consists of three small arcs. The arcs are not the same diameter so the system can take the shape of leg.
(http://imageshack.com/a/img855/2390/gym6.jpg)

Advantages: Screws and wires are in minimally painful regions, making it more tolerable than the traditional Ilizarov Apparatus. Provides for stable fixation and early full weight bearing. Device developed to maintain proper alignment during lengthening. Clothes can be worn over it during the lengthening and consolidation phases due to its small size.

Disadvantages: Prolonged time wearing Salamehfix (same as external fixator) can have a negative psychological effect on the patient, leading to frustration and lack of willingness to participate in physiotherapy. Risk of fracture in regenerated bone after frame removal due to the lack of internal stabilization.

Micro-Wound

Developed in Chongqing, China by Dr. Helong Bai, the Micro-Wound is a thin external fixator clip that is attached to one side of the leg and doesn’t have the uncomfortable bulkiness of the classic Ilizarov Apparatus.
(http://imageshack.com/a/img35/8159/3gdb.jpg)

Advantages: More comfortable than the Ilizarov Apparatus. Fewer pinhole sites and scars.

Disadvantages: Only one surgeon seems to use this method. Risk of fracture in regenerated bone after frame removal due to the lack of internal stabilization. Not as stable as standard Ilizarov Apparatus. Minimal peer-reviewed research on this method. Very mixed results from former patients. More costly than other options in China that already have a good track record.

Internal Methods of Limb Lengthening

The advancement of limb lengthening technology has led to internal options for lengthening that avoid the use of uncomfortable external fixators.

Albizzia Nail and its updated nails - Guichet Nail and Betzbone

The Albizzia nail was invented by Dr. Jean-Marc Guichet with assistance from his professor, Paul Marie Grammont. It is a fully implantable nail that is locked into the bone with screws. The nail distracts when the patient rotates the foot or ankle until it makes a clicking noise, alerting the patient that distraction has taken place. The patient can determine the rate of distraction by performing a set number of “clicks” per day. The Albizzia nail has an automatic 'dynamization' system in its mechanism. During weight-bearing and walking, as the nail supports more weight, more bone formation is stimulated. When the bone strengthens, the loading force is gradually transferred to the bone and the load on the nail decreases. With the bone becoming stronger, it eliminates the need to remove screws to remove axial load from the nail to the bone.

The original Albizzia nail is no longer in production, however Dr. Guichet and Dr. Betz have developed the Guichet Nail and Betz Bone respectively. Both are reportedly more sturdy and reliable than the original Albizzia.
(http://imageshack.com/a/img21/5531/0h8m.jpg)(http://imageshack.com/a/img571/8963/bu1d.jpg)

Advantages: Reduced risk of joint stiffness, infection, and pain than external methods. Greater comfort and tolerance compared to externals.  Fewer scars. No soft tissue tethering as with external methods. Weight bearing permitted during distraction phase. Only two operations needed.

Disadvantages: Costly. Requires considerable movement at the hip to initiate lengthening, making it more uncomfortable than other internal methods. Need to be careful of impact on internal nails during consolidation for risk of refracture.

Bliskunov Nail

The Bliskunov Nail was invented by the late Professor Alexander Bliskunov. The Bliskunov Nail is similar to the Albizzia Nail and its successors, but with some notable differences. In addition to the internal nail set inside the bone cavity, the Bliskunov Nail includes a part in the pelvis that connects the femur to the pelvis. The patient uses lateral movements of the whole limb to distract the nail.
(http://imageshack.com/a/img35/3732/zt84.jpg)(http://imageshack.com/a/img833/742/vl8o.jpg)

Advantages: Reduced risk of joint stiffness, infection, and pain. Greater comfort and tolerance compared to externals. Fewer scars than externals. No soft tissue tethering as with external methods.

Disadvantages: More costly than external methods. Longer scars than other internal methods, including a scar on the pelvis. Dynamization (removal of upper or lower femoral screws to allow loading through newly formed bone rather than through nail) can cause between a 2 to 7 mm loss in height gain.

Intramedullary Skeletal Kinetic Distractor (ISKD)

The ISKD was invented by Dr. J Dean Cole, orthopedic surgeon and President of Orthodyne Inc. The ISKD uses a kinetic clutch mechanism to lengthen the limb. One end of a rod is screwed onto another and the rod is inserted into the bone cavity. Small rotational movements by the patient cause the telescopic nail to lengthen. The clutch ensures that the rod can rotate only in one direction and a monitor is included to track how much the leg has distracted at any point in time.
(http://imageshack.com/a/img268/7244/atxx.jpg)(http://imageshack.com/a/img198/876/ljdx.jpg)

Advantages: Reduced risk of joint stiffness, infection, and pain. Greater comfort and tolerance compared to externals.  Fewer scars. No soft tissue tethering as with external methods.

Disadvantages: High rate of mechanical failure requiring additional surgery to replace. Device is not full weight bearing which leads to weakening of muscles. Distraction rate difficult to control due to small degree of rotation required for lengthening, allowing one to possibly lengthen even 5 mm in a single day. Difficulty in controlling lengthening rate can cause trouble when trying to quicken lengthening in the face of premature consolidation or when trying to slow lengthening in the face of weak ossification. The only way to neutralize the implant and stop it from gaining length in an emergency situation is to perform additional surgery to set an external fixator around the nail to lock rotation. Additional complications can lead to much higher cost. Dynamization (removal of upper or lower femoral screws to allow loading through newly formed bone rather than through nail) can cause between a 2 to 7 mm loss in height gain.

Fitbone

The Fitbone was invented by Dr. Augustin Betz and Dr. Rainer Baumgart in 1989 and has been continuously developed with improvements since then. It is a telescopic nail that is driven by a small electric motor located at the end of it. Distraction is caused by forces from the motor that transmit to the internal nail and force it to lengthen. The energy for the fitbone motor is transmitted through the skin from an external transmitter controlled by the patient to the receiver under the skin.
(http://imageshack.com/a/img706/4864/7sa0.jpg)(http://imageshack.com/a/img443/7435/wby9.jpg)

Link to a demonstration of the Fitbone: http://www.youtube.com/watch?v=I6qFbZfFW1Q (http://www.youtube.com/watch?v=I6qFbZfFW1Q)


Advantages: Minimal scarring. No pin sites. Reduced risk of joint stiffness, infection, and pain. Greater comfort and tolerance compared to externals and other internal methods. No soft tissue tethering due to lack of pin sites.

Disadvantages: Far more costly than external methods and other internal methods. Not weight bearing, leading to muscle weakness and prolonging recovery. Additional surgery required for consolidation phase to add stronger nail. More complications than other internals due to mechanical nature of the device. Dynamization (removal of upper or lower femoral screws to allow loading through newly formed bone rather than through nail) can cause between a 2 to 7 mm loss in height gain.

PRECISE System

The Precise System is an internal limb lengthening device that is controlled externally by a magnetic field generator called an External remote Controller (ERC). The internal device consists of a telescopic titanium rod that is placed into the bone cavity of the limb being lengthened and held by screws. Within the rod is a small magnetic motor and gear box that creates force needed to lengthen the rod. The external magnetic field generator powers the internal motor and is pressed onto the skin outside the leg for few minute intervals several times a day. that is held on the skin next to the leg several times a day.
(http://imageshack.com/a/img6/9605/10zs.png)

Link to a CGI demonstration of the PRECISE: http://www.youtube.com/watch?v=5qXu8UDtoYY (http://www.youtube.com/watch?v=5qXu8UDtoYY)

Advantages: Reduced risk of joint stiffness, infection, and pain. Greater comfort and tolerance compared to externals.  Fewer scars. No soft tissue tethering as with external methods. More reliable than Fitbone or ISKD.

Disadvantages: Very costly. Not full weight-bearing, leading to muscle weakness. Current nail can lengthen a maximum of 6.5 cm.
Title: Re: Limb Lengthening Methods
Post by: TomD on October 14, 2013, 10:42:08 PM
Excellent Read!!!

I enjoyed it.

Thank you for this  :)
Title: Re: Limb Lengthening Methods
Post by: ChrisIsaak on October 14, 2013, 10:53:57 PM
Thank you, Kilokahn! Great information  :)

I'll be able to share information regarding the current Fitbone nail price on October 24th-25th. From what I've heard, a single nail costs €16,000, so two nails would cost €32,000 ($43,000). However, I haven't confirmed the price yet, it might be higher, and this amount doesn't include hospital and doctor costs.
Title: Re: Limb Lengthening Methods
Post by: NBW on October 15, 2013, 05:31:45 AM
This is great. A very nice and easy to read representation of the methods. Thanks!
Title: Re: Limb Lengthening Methods
Post by: KiloKAHN on October 15, 2013, 08:03:38 PM
Thanks guys. I figured we needed something that gave a rundown of the various lengthening methods. We need to get more medical aspects of lengthening on here. Hopefully this topic can get stickied. 
Title: Re: Limb Lengthening Methods
Post by: kneehowguys on October 20, 2013, 07:22:47 PM
Can you gather info on

1. Guichet nail
2. Fitbone nail
3. Jamal nail
4. HLN
5. Precise 2
Title: Re: Limb Lengthening Methods
Post by: TomD on October 20, 2013, 07:25:36 PM
Good call kneehowguys.

Title: Re: Limb Lengthening Methods
Post by: KiloKAHN on October 20, 2013, 11:31:21 PM
Can you gather info on

1. Guichet nail
2. Fitbone nail
3. Jamal nail
4. HLN
5. Precise 2

I'll get started on that.
Title: Re: Limb Lengthening Methods
Post by: Medium Drink Of Water on October 21, 2013, 12:07:43 AM
This is a picture of patient Dong Mei at the Beijing Institute of External Fixation wearing Dr. Xia's modified Ilizarov frame with the Dynamic Lengthener.  It's a hinged, spring-loaded heel attachment with adjustable tension.  It prevents ballerina foot and is why Beijing patients typically lengthen their tibiae by greater amounts than patients elsewhere.  Dong Mei ended up lengthening 12cm on her tibiae.
Title: Re: Limb Lengthening Methods
Post by: Adriano on October 21, 2013, 02:47:22 AM
Very nice long legs :D
Title: Re: Limb Lengthening Methods
Post by: Adriano on October 21, 2013, 02:48:08 AM
the frame doesnt even look bulky!!
Title: Re: Limb Lengthening Methods
Post by: Medium Drink Of Water on October 21, 2013, 02:37:03 PM
They come in multiple sizes.  Girls usually get the little frames like the ones Dong Mei has on. :)
Title: Re: Limb Lengthening Methods
Post by: Drybone on October 21, 2013, 11:16:22 PM

Why do you have to wear rings like that? I never understood that. I have seen guys in photos who never had rings. Curious.
Title: Re: Limb Lengthening Methods
Post by: Adriano on October 22, 2013, 02:10:59 AM
They come in multiple sizes.  Girls usually get the little frames like the ones Dong Mei has on. :)

Thats very interesting because i was very close to going for the Salameh-fix (excuse my spelling if its wrong)
The doctor agreed to let me return home to lengthen. but I wasnt sure if i could relly hide the device under my pants and return to work on a part-time basis. ( have a desk job)

The war in syria helped me make up my mind very quickly :D

And for the prices he charges outside Syria, i may as well save up for an internal nail with Jamal
Title: Re: Limb Lengthening Methods
Post by: GetTallOrGoGay on October 22, 2013, 11:15:05 AM
That heel attachment is awesome
Title: Re: Limb Lengthening Methods
Post by: TomD on October 22, 2013, 12:28:01 PM
Why do you have to wear rings like that? I never understood that. I have seen guys in photos who never had rings. Curious.

Drybone

Go read the Introduction section to leg lengthening. It describes all of the techniques used. Some are external and some are internal.
Title: Re: Limb Lengthening Methods
Post by: Goodhead on October 24, 2013, 01:15:53 AM


Hello everyone .My name is David even though some call me Jasmine. I found this site through a friend who comes here.

I am a banking professional who would love to learn more about becoming taller. I have been a short guy my whole life and it is a miracle that we can finally do something about it.

I look forward to meeting all of you .
Title: Re: Limb Lengthening Methods
Post by: mediocre on February 23, 2014, 04:57:22 PM
This is a link (http://www.rnoh.nhs.uk/sites/default/files/patient/13-193_rnoh_a5_pg_precice_nail_web_release.pdf) to patient's guide for Precice limb lengthening.

Title: Re: Limb Lengthening Methods
Post by: Muse on February 23, 2014, 05:28:00 PM
This is a link (http://www.rnoh.nhs.uk/sites/default/files/patient/13-193_rnoh_a5_pg_precice_nail_web_release.pdf) to patient's guide for Precice limb lengthening.

Yes,  the link is here

http://www.rnoh.nhs.uk/sites/default/files/patient/13-193_rnoh_a5_pg_precice_nail_web_release.pdf
Title: Re: Limb Lengthening Methods
Post by: mediocre on February 23, 2014, 06:28:06 PM
Another links, each by Dr Paley and Dr RR on retrospective analysis of Precice 1.
Note that there are cases of lengthening failure if the magnet is held backward. ;)

http://www.llrs.org/PDFs/Annual%20Meeting%20Presentations/Friday%20Meeting/9.Harris.pdf

http://www.llrs.org/PDFs/Annual%20Meeting%20Presentations/Friday%20Meeting/5.Kirane.pdf
Title: Re: Limb Lengthening Methods
Post by: MAN-OF-STEEL on March 25, 2014, 03:16:46 AM
Great info!
Title: Re: Limb Lengthening Methods
Post by: Wannabegiant on June 26, 2014, 11:38:20 AM
One thing i dont understand about this guide is this piece on the LATN method:

"Advantages:Requires only 1/3 of the time wearing an external fixator as compared to the purely external method. Quicker bone healing rate than pure external method.Lower rate of infection than LON. Infections can be treated more easily and gradually during lengthening due to absence of intramedullary nail present in LON method during lengthening phase. Larger diameter nail than the one used in LON method is inserted into bone cavity during consolidation, allowing greater stability and increased protection against re-fracture."

How come LATN has quicker bone healing than pure external? is this accurate? Because it doesnt seem to make sense to me.
Title: Re: Limb Lengthening Methods
Post by: Taller on June 26, 2014, 03:34:21 PM
The same post also says "(LON) Doesn’t appear to reduce the duration needed for bones to heal compared to purely external method. "
Title: Re: Limb Lengthening Methods
Post by: Moose on February 18, 2015, 02:59:52 AM
any chance we can get an update on the methods for precice and betzbone whatnot or other new methods? Thank you!
Title: Re: Limb Lengthening Methods
Post by: texasbruce on February 03, 2016, 04:40:00 PM
PRECISE 2 GOES HERE:

http://ellipse-tech.com/precice-limb-lengthening-technology/

Product Benefits


Same disadvantage as PRECISE 1, but some doctors from patients' diaries mentioned less trauma and more "precise" surgical experience.

Weight bearing depends on the nail the doctor uses:
http://ellipse-tech.com/wp-content/uploads/2015/10/P2-Femur-Operative-Technique-LC0083-A.pdf


8.5 mm = 30 lbs
10.7/12.5 mm = 50 lbs
Title: Re: Limb Lengthening Methods
Post by: Deads on February 03, 2016, 06:08:39 PM
Can we have Jamal Nail included in here?
Title: Re: Limb Lengthening Methods
Post by: TheLichKing on May 09, 2016, 12:33:47 AM
This is a picture of patient Dong Mei at the Beijing Institute of External Fixation wearing Dr. Xia's modified Ilizarov frame with the Dynamic Lengthener.  It's a hinged, spring-loaded heel attachment with adjustable tension.  It prevents ballerina foot and is why Beijing patients typically lengthen their tibiae by greater amounts than patients elsewhere.  Dong Mei ended up lengthening 12cm on her tibiae.

12 cm on tibiae? That's about 4.7 inches where as the safe margin is a max 3-3.5 inch I believe. How did she manage to attain that amount on the tibiae alone w/o serious complications?
Title: Re: Limb Lengthening Methods
Post by: BiggestProblem on November 06, 2016, 11:46:58 PM
Sticky this in information. Not discussion.
Title: Re: Limb Lengthening Methods
Post by: divinggirls on January 12, 2017, 12:31:31 PM
No mention of knee pain of internal methods???
Title: Re: Limb Lengthening Methods
Post by: sandman51 on March 11, 2017, 03:09:42 PM
I'm not sure if I understood correctly, the LATN procedure requires three separate surgeries?
The first one for breaking the bones and installing the external Ilizarov frames. A second one for inserting the nail, after lengthening and before consolidation, and a third surgery after consolidation for removing the nails?.
Is it three surgeries?
Title: Re: Limb Lengthening Methods
Post by: doomsday on March 11, 2017, 09:53:04 PM
Yes it is 3 surgeries but its the best method for tibias.  With the fastest recovery time.
Title: Re: Limb Lengthening Methods
Post by: Mr.Robot on April 09, 2017, 08:37:01 PM
There are so many methods how can you possibly chose the right one? I have opted in to do the surgery but I cant chose what method/doctor there are so many options. Cost is not really a factor for me so I want to stay in US, Europe, and Korea.
Title: Re: Limb Lengthening Methods
Post by: Dhdhdjuru on August 13, 2017, 02:29:34 AM
How much do you want to gain?
Title: Re: Limb Lengthening Methods
Post by: rami on August 21, 2017, 06:56:12 AM
What are the available methods (internal and external) that allows full weight bearing immediately after lengthening is completed?
Title: Re: Limb Lengthening Methods
Post by: rami on August 23, 2017, 02:12:35 PM

LATN is a newer limb lengthening technique that combines external and internal methods.  The Ilizarov Apparatus is applied through surgery, where the wires are threaded through the skin and muscle that lie over the bone which will be corrected or lengthened. The external fixator is prepared so that an intramedullary nail can be placed inside the bone later. The rings are then secured with telescoping rods and a small cut is made in the limb between the rings.  Through the cut’s opening, the outer layer of bone is sliced, leaving the inner marrow undamaged. The lengthening phase is started about one week after the initial surgery, where the patient turns screws on the Ilizarov Apparatus that turn to stretch the bones slowly. Once distraction is done, a reamed intramedullary nail is inserted into the bone’s central cavity to support the bone during the consolidation phase, allowing early removal of the external fixator. Once the bones are fully consolidated, another operation is needed to remove the nails along with a week’s bed rest for the bones to heal from nail removal.

Advantages: Requires only 1/3 of the time wearing an external fixator as compared to the purely external method. Quicker bone healing rate than pure external method. Lower rate of infection than LON. Infections can be treated more easily and gradually during lengthening due to absence of intramedullary nail present in LON method during lengthening phase. Larger diameter nail than the one used in LON method is inserted into bone cavity during consolidation, allowing greater stability and increased protection against re-fracture.

Disadvantages:  May require repeated adjustments to avoid bone misalignment due to lack of IM nail during lengthening phase. Need to be careful of impact on intramedullary nails during consolidation due to risk of re-fracture. Discomfort and soft tissue tethering due to pin sites.


When external in LATN case are removed and the nail is inserted, can we walk with crutches? or what happens exactly at this phase?
Title: Re: Limb Lengthening Methods
Post by: Yonatero on September 06, 2017, 11:42:29 AM
This is probably the most informative thing I've read on the Limb lengthening subject.
Title: Limb Lengthening Methods - Guichet nail
Post by: OverrideYourGenetics on September 25, 2017, 08:52:14 PM
This thread should mention that the two Albizzia variants seem to be quite different in reliability:

Title: Re: Limb Lengthening Methods - Guichet nail
Post by: LLSouthAmerica on September 26, 2017, 03:28:17 AM
This thread should mention that the two Albizzia variants seem to be quite different in reliability:

  • The Betzbone was reported to break or bend surprisingly often - up to 30% (http://"http://www.limblengtheningforum.com/index.php?topic=3069.msg48647#msg48647") of the patients with diaries here. It's not clear if this is due to the nail not actually being capable of bearing that much weight, or due to the patients being careless and stressing their legs too much (http://"http://www.limblengtheningforum.com/index.php?topic=24.msg6077#msg6077") before the bone had consolidating (e.g. by jumping or dancing)
  • I haven't seen any complaints about the Guichet nail, and it allows walking the day of the surgery (http://"https://www.youtube.com/watch?v=rzh34qzGcz4") with crutches/walker. Paley, by comparison, suggests getting a home aide for 16 hours/day for the first two weeks (http://"http://www.paleyinstitute.org/centers-of-excellence/stature-lengthening-center/distraction-phase").

I don't understand why the Betzbone should be much weaker than Gnail (I've seen dozens of patients and none of them had that kind of complication). I believe it is because many of Betzbone users go back to work very fast even during lenghtening and they get careless and the fact that Betz patients usually increase 8 - 9 cm .
Title: Re: Limb Lengthening Methods
Post by: 419 on September 29, 2017, 02:55:33 AM
There are a variety of approaches that one can choose from to lengthen his limbs. Below is a list of known methods along with their advantages and disadvantages.

What is limb lengthening?

Limb lengthening is the gradual elongation of bone and soft tissues (skin, muscle, nerves, blood vessels). Using an external device called an external fixator or one of various internal devices, the bone and soft tissues are slowly pulled apart and gradually lengthened in a process called distraction. The distraction is done at a recommended average of 1 millimeter per day. If the rate of distraction is higher than this, complications such as muscle contracture (tightness), nerve paralysis, and bone non-union can occur. If distraction is done too slowly, premature consolidation (gap between the bones is filled with regenerate bone) is possible, preventing further distraction. The distraction rate of 1 mm per day is not a strict rule, as there are frequently cases that require a slower distraction rate, and occasionally a faster rate. Once the desired length is obtained, distraction stops and the consolidation phase begins. The consolidation phase is the period when newly formed bone calcifies. Once the bone is fully healed, the lengthening device can be removed.

External Methods of Limb Lengthening

Ilizarov Apparatus

The Ilizarov Apparatus was invented in the Soviet Union by Dr. Gavriil Abramovich Ilizarov in 1951 and has been used in North America since 1981 for correction of leg deformities and lengthening. The Ilizarov Apparatus (also known as the Ilizarov fixator or ring fixator) is an assembly of 2 or 3 rings that encircle the leg or arm and are applied to the bone using screws and wires, each ring connected to the other by connecting rods. The Ilizarov Apparatus is applied through surgery, where the wires are threaded through the skin and muscle that lie over the bone which will be corrected or lengthened. The rings are then secured with telescoping rods and a small cut is made in the limb between the rings.  Through the cut’s opening, the outer layer of bone is sliced, leaving the inner marrow undamaged. The lengthening phase is started about one week after the initial surgery, where the patient turns screws on the Ilizarov Apparatus that turn to stretch the bones slowly. Once distraction is done, the fixator remains in place for the consolidation phase so as to prevent the regenerate bone from breaking under the weight bearing load. A child will have to wear the external fixator for approximately 1 month for each centimeter lengthened. Adults may require 1.5 to 2 months or longer per centimeter.
(http://imageshack.com/a/img69/664/d47l.jpg)

Advantages: Cheapest lengthening option. No additional surgery required after frame removal

Disadvantages: Prolonged time wearing Ilizarov Apparatus has a higher chance of health-related complications such as pin tract infection and decreased range of motion in joints. This can also have a negative psychological effect to the patient, leading to frustration and lack of willingness to participate in physiotherapy. Risk of fracture in regenerated bone after frame removal due to the lack of internal stabilization. May require repeated adjustments to avoid bone misalignment. Discomfort and soft tissue tethering due to pin sites.

LON (Lengthening Over Nail)

Lengthening Over Nails combines a ring fixator for lengthening and a regular intramedullary nail. The LON concept was first introduced by F.C. Bost and L.J. Larsen in 1956 but was popularized by Dr. Dror Paley in 1990 in order to reduce the treatment time in EF (external fixation). During the operation, a hole is made through the bone in order to provide space for an intramedullary nail (nail inside the central cavity of a bone shaft where bone marrow is stored). The hole is made to be approximately 1.5 mm larger than that of the nail itself. This process is called reaming. Once the bone is reamed, the intramedullary nail is inserted into the bone’s central cavity and then locked at the proximal end (the end closer to body’s center) of the nail using screws. A corticotomy (cutting of the bone) is then performed, followed by attachment of the external fixator. The lengthening phase is started about one week after the initial surgery, where the patient turns screws on the Ilizarov Apparatus that turn to stretch the bones over the intramedullary nail slowly. Once the desired length is achieved, two distal (the end farther from body’s center) interlocking screws are inserted into the nail and the external fixator is removed. The purpose of the intramedullary nail is to provide weight bearing support during the consolidation phase. Once the bones are fully consolidated, another operation is needed to remove the nails along with a week’s bed rest for the bones to heal from nail removal.
(http://imageshack.com/a/img812/7775/ccv7.jpg)

Advantages: Requires only 1/3 of the time wearing an external fixator as compared to the purely external method. Intramedullary nail helps prevent misalignment in regenerate bone. Fewer complications than external method overall.

Disadvantages:  Higher rate of pin site infection due to presence of intramedullary nail during lengthening. Requires acute deformity correction which compromises bone healing potential during subsequent lengthening. Comparatively high incidence of deep intramedullary infection. Additional surgery required to remove intramedullary nails years later. Need to be careful of impact on intramedullary nails during consolidation due to risk of re-fracture. Doesn’t appear to reduce the duration needed for bones to heal compared to purely external method. Unlike LATN, LON uses a small diameter nail so bone can regenerate over it, allowing less stability than LATN method. Discomfort and soft tissue tethering due to pin sites.

LATN (Lengthening and then Nailing)

LATN is a newer limb lengthening technique that combines external and internal methods.  The Ilizarov Apparatus is applied through surgery, where the wires are threaded through the skin and muscle that lie over the bone which will be corrected or lengthened. The external fixator is prepared so that an intramedullary nail can be placed inside the bone later. The rings are then secured with telescoping rods and a small cut is made in the limb between the rings.  Through the cut’s opening, the outer layer of bone is sliced, leaving the inner marrow undamaged. The lengthening phase is started about one week after the initial surgery, where the patient turns screws on the Ilizarov Apparatus that turn to stretch the bones slowly. Once distraction is done, a reamed intramedullary nail is inserted into the bone’s central cavity to support the bone during the consolidation phase, allowing early removal of the external fixator. Once the bones are fully consolidated, another operation is needed to remove the nails along with a week’s bed rest for the bones to heal from nail removal.

Advantages: Requires only 1/3 of the time wearing an external fixator as compared to the purely external method. Quicker bone healing rate than pure external method. Lower rate of infection than LON. Infections can be treated more easily and gradually during lengthening due to absence of intramedullary nail present in LON method during lengthening phase. Larger diameter nail than the one used in LON method is inserted into bone cavity during consolidation, allowing greater stability and increased protection against re-fracture.

Disadvantages:  May require repeated adjustments to avoid bone misalignment due to lack of IM nail during lengthening phase. Need to be careful of impact on intramedullary nails during consolidation due to risk of re-fracture. Discomfort and soft tissue tethering due to pin sites.

Unilateral External Fixator (Monorail Fixator)

Monorail Fixators are similar to the standard Ilizarov Apparatus. However, instead of a bulky external frame there is a single bar that runs along the outside of the limb and is attached with between 4 and 6 pins to the bone. It provides more comfort than the Ilizarov fixator and is often used when treating arm deformities. Unilateral lengtheners can be purely external or can be combined with an intramedullary nail as used in the LON method.
(http://imageshack.com/a/img202/650/w4wb.jpg)

Advantages: Fewer scars than standard Ilizarov Apparatus due to less pins, can be worn under clothes, suitable for pediatric patients with smaller limbs.

Disadvantages: Pinhole scars are larger than scars made by the Ilizarov Apparatus due to greater pin size. Pin site infections are common. Less stability than standard Ilizarov Apparatus. Some patients say the larger pinhole sites cause more pain than the standard Ilizarov Apparatus.

Salamehfix (SLDF)

The Salamehfix (SLDF) System is a hinged, Eternal Fixation System developed by Prof. Ghassan Salameh in Syria. It is an arc system rather than a circular system and consists of three small arcs. The arcs are not the same diameter so the system can take the shape of leg.
(http://imageshack.com/a/img855/2390/gym6.jpg)

Advantages: Screws and wires are in minimally painful regions, making it more tolerable than the traditional Ilizarov Apparatus. Provides for stable fixation and early full weight bearing. Device developed to maintain proper alignment during lengthening. Clothes can be worn over it during the lengthening and consolidation phases due to its small size.

Disadvantages: Prolonged time wearing Salamehfix (same as external fixator) can have a negative psychological effect on the patient, leading to frustration and lack of willingness to participate in physiotherapy. Risk of fracture in regenerated bone after frame removal due to the lack of internal stabilization.

Micro-Wound

Developed in Chongqing, China by Dr. Helong Bai, the Micro-Wound is a thin external fixator clip that is attached to one side of the leg and doesn’t have the uncomfortable bulkiness of the classic Ilizarov Apparatus.
(http://imageshack.com/a/img35/8159/3gdb.jpg)

Advantages: More comfortable than the Ilizarov Apparatus. Fewer pinhole sites and scars.

Disadvantages: Only one surgeon seems to use this method. Risk of fracture in regenerated bone after frame removal due to the lack of internal stabilization. Not as stable as standard Ilizarov Apparatus. Minimal peer-reviewed research on this method. Very mixed results from former patients. More costly than other options in China that already have a good track record.

Internal Methods of Limb Lengthening

The advancement of limb lengthening technology has led to internal options for lengthening that avoid the use of uncomfortable external fixators.

Albizzia Nail and its updated nails - Guichet Nail and Betzbone

The Albizzia nail was invented by Dr. Jean-Marc Guichet with assistance from his professor, Paul Marie Grammont. It is a fully implantable nail that is locked into the bone with screws. The nail distracts when the patient rotates the foot or ankle until it makes a clicking noise, alerting the patient that distraction has taken place. The patient can determine the rate of distraction by performing a set number of “clicks” per day. The Albizzia nail has an automatic 'dynamization' system in its mechanism. During weight-bearing and walking, as the nail supports more weight, more bone formation is stimulated. When the bone strengthens, the loading force is gradually transferred to the bone and the load on the nail decreases. With the bone becoming stronger, it eliminates the need to remove screws to remove axial load from the nail to the bone.

The original Albizzia nail is no longer in production, however Dr. Guichet and Dr. Betz have developed the Guichet Nail and Betz Bone respectively. Both are reportedly more sturdy and reliable than the original Albizzia.
(http://imageshack.com/a/img21/5531/0h8m.jpg)(http://imageshack.com/a/img571/8963/bu1d.jpg)

Advantages: Reduced risk of joint stiffness, infection, and pain than external methods. Greater comfort and tolerance compared to externals.  Fewer scars. No soft tissue tethering as with external methods. Weight bearing permitted during distraction phase. Only two operations needed.

Disadvantages: Costly. Requires considerable movement at the hip to initiate lengthening, making it more uncomfortable than other internal methods. Need to be careful of impact on internal nails during consolidation for risk of refracture.

Bliskunov Nail

The Bliskunov Nail was invented by the late Professor Alexander Bliskunov. The Bliskunov Nail is similar to the Albizzia Nail and its successors, but with some notable differences. In addition to the internal nail set inside the bone cavity, the Bliskunov Nail includes a part in the pelvis that connects the femur to the pelvis. The patient uses lateral movements of the whole limb to distract the nail.
(http://imageshack.com/a/img35/3732/zt84.jpg)(http://imageshack.com/a/img833/742/vl8o.jpg)

Advantages: Reduced risk of joint stiffness, infection, and pain. Greater comfort and tolerance compared to externals. Fewer scars than externals. No soft tissue tethering as with external methods.

Disadvantages: More costly than external methods. Longer scars than other internal methods, including a scar on the pelvis. Dynamization (removal of upper or lower femoral screws to allow loading through newly formed bone rather than through nail) can cause between a 2 to 7 mm loss in height gain.

Intramedullary Skeletal Kinetic Distractor (ISKD)

The ISKD was invented by Dr. J Dean Cole, orthopedic surgeon and President of Orthodyne Inc. The ISKD uses a kinetic clutch mechanism to lengthen the limb. One end of a rod is screwed onto another and the rod is inserted into the bone cavity. Small rotational movements by the patient cause the telescopic nail to lengthen. The clutch ensures that the rod can rotate only in one direction and a monitor is included to track how much the leg has distracted at any point in time.
(http://imageshack.com/a/img268/7244/atxx.jpg)(http://imageshack.com/a/img198/876/ljdx.jpg)

Advantages: Reduced risk of joint stiffness, infection, and pain. Greater comfort and tolerance compared to externals.  Fewer scars. No soft tissue tethering as with external methods.

Disadvantages: High rate of mechanical failure requiring additional surgery to replace. Device is not full weight bearing which leads to weakening of muscles. Distraction rate difficult to control due to small degree of rotation required for lengthening, allowing one to possibly lengthen even 5 mm in a single day. Difficulty in controlling lengthening rate can cause trouble when trying to quicken lengthening in the face of premature consolidation or when trying to slow lengthening in the face of weak ossification. The only way to neutralize the implant and stop it from gaining length in an emergency situation is to perform additional surgery to set an external fixator around the nail to lock rotation. Additional complications can lead to much higher cost. Dynamization (removal of upper or lower femoral screws to allow loading through newly formed bone rather than through nail) can cause between a 2 to 7 mm loss in height gain.

Fitbone

The Fitbone was invented by Dr. Augustin Betz and Dr. Rainer Baumgart in 1989 and has been continuously developed with improvements since then. It is a telescopic nail that is driven by a small electric motor located at the end of it. Distraction is caused by forces from the motor that transmit to the internal nail and force it to lengthen. The energy for the fitbone motor is transmitted through the skin from an external transmitter controlled by the patient to the receiver under the skin.
(http://imageshack.com/a/img706/4864/7sa0.jpg)(http://imageshack.com/a/img443/7435/wby9.jpg)

Link to a demonstration of the Fitbone: http://www.youtube.com/watch?v=I6qFbZfFW1Q (http://www.youtube.com/watch?v=I6qFbZfFW1Q)


Advantages: Minimal scarring. No pin sites. Reduced risk of joint stiffness, infection, and pain. Greater comfort and tolerance compared to externals and other internal methods. No soft tissue tethering due to lack of pin sites.

Disadvantages: Far more costly than external methods and other internal methods. Not weight bearing, leading to muscle weakness and prolonging recovery. Additional surgery required for consolidation phase to add stronger nail. More complications than other internals due to mechanical nature of the device. Dynamization (removal of upper or lower femoral screws to allow loading through newly formed bone rather than through nail) can cause between a 2 to 7 mm loss in height gain.

PRECISE System

The Precise System is an internal limb lengthening device that is controlled externally by a magnetic field generator called an External remote Controller (ERC). The internal device consists of a telescopic titanium rod that is placed into the bone cavity of the limb being lengthened and held by screws. Within the rod is a small magnetic motor and gear box that creates force needed to lengthen the rod. The external magnetic field generator powers the internal motor and is pressed onto the skin outside the leg for few minute intervals several times a day. that is held on the skin next to the leg several times a day.
(http://imageshack.com/a/img6/9605/10zs.png)

Link to a CGI demonstration of the PRECISE: http://www.youtube.com/watch?v=5qXu8UDtoYY (http://www.youtube.com/watch?v=5qXu8UDtoYY)

Advantages: Reduced risk of joint stiffness, infection, and pain. Greater comfort and tolerance compared to externals.  Fewer scars. No soft tissue tethering as with external methods. More reliable than Fitbone or ISKD.

Disadvantages: Very costly. Not full weight-bearing, leading to muscle weakness. Current nail can lengthen a maximum of 6.5 cm.

Awesome, thanks man
Title: Re: Limb Lengthening Methods
Post by: 419 on September 29, 2017, 03:53:13 AM
Yes it is 3 surgeries but its the best method for tibias.  With the fastest recovery time.

Hi Doomsday, is it even faster than internals for tibia? Also, can you plz advise who are the doctors performing the LATN? I know Xia and Parihar does only lizarov, dont know if Brinov does LATN. Thanks a lot.
Title: Re: Limb Lengthening Methods
Post by: Andy on October 18, 2017, 06:42:45 AM
Hi Prakash, I don't think that LATN is faster than Ilizarov alone.
Title: Re: Limb Lengthening Methods
Post by: Antonio on December 15, 2017, 09:18:16 AM
There are a variety of approaches that one can choose from to lengthen his limbs. Below is a list of known methods along with their advantages and disadvantages.

What is limb lengthening?

Limb lengthening is the gradual elongation of bone and soft tissues (skin, muscle, nerves, blood vessels). Using an external device called an external fixator or one of various internal devices, the bone and soft tissues are slowly pulled apart and gradually lengthened in a process called distraction. The distraction is done at a recommended average of 1 millimeter per day. If the rate of distraction is higher than this, complications such as muscle contracture (tightness), nerve paralysis, and bone non-union can occur. If distraction is done too slowly, premature consolidation (gap between the bones is filled with regenerate bone) is possible, preventing further distraction. The distraction rate of 1 mm per day is not a strict rule, as there are frequently cases that require a slower distraction rate, and occasionally a faster rate. Once the desired length is obtained, distraction stops and the consolidation phase begins. The consolidation phase is the period when newly formed bone calcifies. Once the bone is fully healed, the lengthening device can be removed.

External Methods of Limb Lengthening

Ilizarov Apparatus

The Ilizarov Apparatus was invented in the Soviet Union by Dr. Gavriil Abramovich Ilizarov in 1951 and has been used in North America since 1981 for correction of leg deformities and lengthening. The Ilizarov Apparatus (also known as the Ilizarov fixator or ring fixator) is an assembly of 2 or 3 rings that encircle the leg or arm and are applied to the bone using screws and wires, each ring connected to the other by connecting rods. The Ilizarov Apparatus is applied through surgery, where the wires are threaded through the skin and muscle that lie over the bone which will be corrected or lengthened. The rings are then secured with telescoping rods and a small cut is made in the limb between the rings.  Through the cut’s opening, the outer layer of bone is sliced, leaving the inner marrow undamaged. The lengthening phase is started about one week after the initial surgery, where the patient turns screws on the Ilizarov Apparatus that turn to stretch the bones slowly. Once distraction is done, the fixator remains in place for the consolidation phase so as to prevent the regenerate bone from breaking under the weight bearing load. A child will have to wear the external fixator for approximately 1 month for each centimeter lengthened. Adults may require 1.5 to 2 months or longer per centimeter.
(http://imageshack.com/a/img69/664/d47l.jpg)

Advantages: Cheapest lengthening option. No additional surgery required after frame removal

Disadvantages: Prolonged time wearing Ilizarov Apparatus has a higher chance of health-related complications such as pin tract infection and decreased range of motion in joints. This can also have a negative psychological effect to the patient, leading to frustration and lack of willingness to participate in physiotherapy. Risk of fracture in regenerated bone after frame removal due to the lack of internal stabilization. May require repeated adjustments to avoid bone misalignment. Discomfort and soft tissue tethering due to pin sites.

LON (Lengthening Over Nail)

Lengthening Over Nails combines a ring fixator for lengthening and a regular intramedullary nail. The LON concept was first introduced by F.C. Bost and L.J. Larsen in 1956 but was popularized by Dr. Dror Paley in 1990 in order to reduce the treatment time in EF (external fixation). During the operation, a hole is made through the bone in order to provide space for an intramedullary nail (nail inside the central cavity of a bone shaft where bone marrow is stored). The hole is made to be approximately 1.5 mm larger than that of the nail itself. This process is called reaming. Once the bone is reamed, the intramedullary nail is inserted into the bone’s central cavity and then locked at the proximal end (the end closer to body’s center) of the nail using screws. A corticotomy (cutting of the bone) is then performed, followed by attachment of the external fixator. The lengthening phase is started about one week after the initial surgery, where the patient turns screws on the Ilizarov Apparatus that turn to stretch the bones over the intramedullary nail slowly. Once the desired length is achieved, two distal (the end farther from body’s center) interlocking screws are inserted into the nail and the external fixator is removed. The purpose of the intramedullary nail is to provide weight bearing support during the consolidation phase. Once the bones are fully consolidated, another operation is needed to remove the nails along with a week’s bed rest for the bones to heal from nail removal.
(http://imageshack.com/a/img812/7775/ccv7.jpg)

Advantages: Requires only 1/3 of the time wearing an external fixator as compared to the purely external method. Intramedullary nail helps prevent misalignment in regenerate bone. Fewer complications than external method overall.

Disadvantages:  Higher rate of pin site infection due to presence of intramedullary nail during lengthening. Requires acute deformity correction which compromises bone healing potential during subsequent lengthening. Comparatively high incidence of deep intramedullary infection. Additional surgery required to remove intramedullary nails years later. Need to be careful of impact on intramedullary nails during consolidation due to risk of re-fracture. Doesn’t appear to reduce the duration needed for bones to heal compared to purely external method. Unlike LATN, LON uses a small diameter nail so bone can regenerate over it, allowing less stability than LATN method. Discomfort and soft tissue tethering due to pin sites.

LATN (Lengthening and then Nailing)

LATN is a newer limb lengthening technique that combines external and internal methods.  The Ilizarov Apparatus is applied through surgery, where the wires are threaded through the skin and muscle that lie over the bone which will be corrected or lengthened. The external fixator is prepared so that an intramedullary nail can be placed inside the bone later. The rings are then secured with telescoping rods and a small cut is made in the limb between the rings.  Through the cut’s opening, the outer layer of bone is sliced, leaving the inner marrow undamaged. The lengthening phase is started about one week after the initial surgery, where the patient turns screws on the Ilizarov Apparatus that turn to stretch the bones slowly. Once distraction is done, a reamed intramedullary nail is inserted into the bone’s central cavity to support the bone during the consolidation phase, allowing early removal of the external fixator. Once the bones are fully consolidated, another operation is needed to remove the nails along with a week’s bed rest for the bones to heal from nail removal.

Advantages: Requires only 1/3 of the time wearing an external fixator as compared to the purely external method. Quicker bone healing rate than pure external method. Lower rate of infection than LON. Infections can be treated more easily and gradually during lengthening due to absence of intramedullary nail present in LON method during lengthening phase. Larger diameter nail than the one used in LON method is inserted into bone cavity during consolidation, allowing greater stability and increased protection against re-fracture.

Disadvantages:  May require repeated adjustments to avoid bone misalignment due to lack of IM nail during lengthening phase. Need to be careful of impact on intramedullary nails during consolidation due to risk of re-fracture. Discomfort and soft tissue tethering due to pin sites.

Unilateral External Fixator (Monorail Fixator)

Monorail Fixators are similar to the standard Ilizarov Apparatus. However, instead of a bulky external frame there is a single bar that runs along the outside of the limb and is attached with between 4 and 6 pins to the bone. It provides more comfort than the Ilizarov fixator and is often used when treating arm deformities. Unilateral lengtheners can be purely external or can be combined with an intramedullary nail as used in the LON method.
(http://imageshack.com/a/img202/650/w4wb.jpg)

Advantages: Fewer scars than standard Ilizarov Apparatus due to less pins, can be worn under clothes, suitable for pediatric patients with smaller limbs.

Disadvantages: Pinhole scars are larger than scars made by the Ilizarov Apparatus due to greater pin size. Pin site infections are common. Less stability than standard Ilizarov Apparatus. Some patients say the larger pinhole sites cause more pain than the standard Ilizarov Apparatus.

Salamehfix (SLDF)

The Salamehfix (SLDF) System is a hinged, Eternal Fixation System developed by Prof. Ghassan Salameh in Syria. It is an arc system rather than a circular system and consists of three small arcs. The arcs are not the same diameter so the system can take the shape of leg.
(http://imageshack.com/a/img855/2390/gym6.jpg)

Advantages: Screws and wires are in minimally painful regions, making it more tolerable than the traditional Ilizarov Apparatus. Provides for stable fixation and early full weight bearing. Device developed to maintain proper alignment during lengthening. Clothes can be worn over it during the lengthening and consolidation phases due to its small size.

Disadvantages: Prolonged time wearing Salamehfix (same as external fixator) can have a negative psychological effect on the patient, leading to frustration and lack of willingness to participate in physiotherapy. Risk of fracture in regenerated bone after frame removal due to the lack of internal stabilization.

Micro-Wound

Developed in Chongqing, China by Dr. Helong Bai, the Micro-Wound is a thin external fixator clip that is attached to one side of the leg and doesn’t have the uncomfortable bulkiness of the classic Ilizarov Apparatus.
(http://imageshack.com/a/img35/8159/3gdb.jpg)

Advantages: More comfortable than the Ilizarov Apparatus. Fewer pinhole sites and scars.

Disadvantages: Only one surgeon seems to use this method. Risk of fracture in regenerated bone after frame removal due to the lack of internal stabilization. Not as stable as standard Ilizarov Apparatus. Minimal peer-reviewed research on this method. Very mixed results from former patients. More costly than other options in China that already have a good track record.

Internal Methods of Limb Lengthening

The advancement of limb lengthening technology has led to internal options for lengthening that avoid the use of uncomfortable external fixators.

Albizzia Nail and its updated nails - Guichet Nail and Betzbone

The Albizzia nail was invented by Dr. Jean-Marc Guichet with assistance from his professor, Paul Marie Grammont. It is a fully implantable nail that is locked into the bone with screws. The nail distracts when the patient rotates the foot or ankle until it makes a clicking noise, alerting the patient that distraction has taken place. The patient can determine the rate of distraction by performing a set number of “clicks” per day. The Albizzia nail has an automatic 'dynamization' system in its mechanism. During weight-bearing and walking, as the nail supports more weight, more bone formation is stimulated. When the bone strengthens, the loading force is gradually transferred to the bone and the load on the nail decreases. With the bone becoming stronger, it eliminates the need to remove screws to remove axial load from the nail to the bone.

The original Albizzia nail is no longer in production, however Dr. Guichet and Dr. Betz have developed the Guichet Nail and Betz Bone respectively. Both are reportedly more sturdy and reliable than the original Albizzia.
(http://imageshack.com/a/img21/5531/0h8m.jpg)(http://imageshack.com/a/img571/8963/bu1d.jpg)

Advantages: Reduced risk of joint stiffness, infection, and pain than external methods. Greater comfort and tolerance compared to externals.  Fewer scars. No soft tissue tethering as with external methods. Weight bearing permitted during distraction phase. Only two operations needed.

Disadvantages: Costly. Requires considerable movement at the hip to initiate lengthening, making it more uncomfortable than other internal methods. Need to be careful of impact on internal nails during consolidation for risk of refracture.

Bliskunov Nail

The Bliskunov Nail was invented by the late Professor Alexander Bliskunov. The Bliskunov Nail is similar to the Albizzia Nail and its successors, but with some notable differences. In addition to the internal nail set inside the bone cavity, the Bliskunov Nail includes a part in the pelvis that connects the femur to the pelvis. The patient uses lateral movements of the whole limb to distract the nail.
(http://imageshack.com/a/img35/3732/zt84.jpg)(http://imageshack.com/a/img833/742/vl8o.jpg)

Advantages: Reduced risk of joint stiffness, infection, and pain. Greater comfort and tolerance compared to externals. Fewer scars than externals. No soft tissue tethering as with external methods.

Disadvantages: More costly than external methods. Longer scars than other internal methods, including a scar on the pelvis. Dynamization (removal of upper or lower femoral screws to allow loading through newly formed bone rather than through nail) can cause between a 2 to 7 mm loss in height gain.

Intramedullary Skeletal Kinetic Distractor (ISKD)

The ISKD was invented by Dr. J Dean Cole, orthopedic surgeon and President of Orthodyne Inc. The ISKD uses a kinetic clutch mechanism to lengthen the limb. One end of a rod is screwed onto another and the rod is inserted into the bone cavity. Small rotational movements by the patient cause the telescopic nail to lengthen. The clutch ensures that the rod can rotate only in one direction and a monitor is included to track how much the leg has distracted at any point in time.
(http://imageshack.com/a/img268/7244/atxx.jpg)(http://imageshack.com/a/img198/876/ljdx.jpg)

Advantages: Reduced risk of joint stiffness, infection, and pain. Greater comfort and tolerance compared to externals.  Fewer scars. No soft tissue tethering as with external methods.

Disadvantages: High rate of mechanical failure requiring additional surgery to replace. Device is not full weight bearing which leads to weakening of muscles. Distraction rate difficult to control due to small degree of rotation required for lengthening, allowing one to possibly lengthen even 5 mm in a single day. Difficulty in controlling lengthening rate can cause trouble when trying to quicken lengthening in the face of premature consolidation or when trying to slow lengthening in the face of weak ossification. The only way to neutralize the implant and stop it from gaining length in an emergency situation is to perform additional surgery to set an external fixator around the nail to lock rotation. Additional complications can lead to much higher cost. Dynamization (removal of upper or lower femoral screws to allow loading through newly formed bone rather than through nail) can cause between a 2 to 7 mm loss in height gain.

Fitbone

The Fitbone was invented by Dr. Augustin Betz and Dr. Rainer Baumgart in 1989 and has been continuously developed with improvements since then. It is a telescopic nail that is driven by a small electric motor located at the end of it. Distraction is caused by forces from the motor that transmit to the internal nail and force it to lengthen. The energy for the fitbone motor is transmitted through the skin from an external transmitter controlled by the patient to the receiver under the skin.
(http://imageshack.com/a/img706/4864/7sa0.jpg)(http://imageshack.com/a/img443/7435/wby9.jpg)

Link to a demonstration of the Fitbone: http://www.youtube.com/watch?v=I6qFbZfFW1Q (http://www.youtube.com/watch?v=I6qFbZfFW1Q)


Advantages: Minimal scarring. No pin sites. Reduced risk of joint stiffness, infection, and pain. Greater comfort and tolerance compared to externals and other internal methods. No soft tissue tethering due to lack of pin sites.

Disadvantages: Far more costly than external methods and other internal methods. Not weight bearing, leading to muscle weakness and prolonging recovery. Additional surgery required for consolidation phase to add stronger nail. More complications than other internals due to mechanical nature of the device. Dynamization (removal of upper or lower femoral screws to allow loading through newly formed bone rather than through nail) can cause between a 2 to 7 mm loss in height gain.

PRECISE System

The Precise System is an internal limb lengthening device that is controlled externally by a magnetic field generator called an External remote Controller (ERC). The internal device consists of a telescopic titanium rod that is placed into the bone cavity of the limb being lengthened and held by screws. Within the rod is a small magnetic motor and gear box that creates force needed to lengthen the rod. The external magnetic field generator powers the internal motor and is pressed onto the skin outside the leg for few minute intervals several times a day. that is held on the skin next to the leg several times a day.
(http://imageshack.com/a/img6/9605/10zs.png)

Link to a CGI demonstration of the PRECISE: http://www.youtube.com/watch?v=5qXu8UDtoYY (http://www.youtube.com/watch?v=5qXu8UDtoYY)

Advantages: Reduced risk of joint stiffness, infection, and pain. Greater comfort and tolerance compared to externals.  Fewer scars. No soft tissue tethering as with external methods. More reliable than Fitbone or ISKD.

Disadvantages: Very costly. Not full weight-bearing, leading to muscle weakness. Current nail can lengthen a maximum of 6.5 cm.

For Fitbone, I'd like to add/modify:

Cost per nail is approximately 14k USD. Can weight bear partially up to 25 kg per leg (which means that you can use crutches one week after surgery if you do one leg at a time). No additional surgery required for consolidation if there are no complications. Transmitter cable may break after prolonged lengthening (usually after 7 cm) which may require surgery to remove.

Failure rate of latest version of Fitbone nail is 12 per 10,000 or 0.12%
Title: Re: Limb Lengthening Methods
Post by: backrandom on December 16, 2017, 05:07:31 PM
For Fitbone, I'd like to add/modify:

Cost per nail is approximately 14k USD. Can weight bear partially up to 25 kg per leg (which means that you can use crutches one week after surgery if you do one leg at a time). No additional surgery required for consolidation if there are no complications. Transmitter cable may break after prolonged lengthening (usually after 7 cm) which may require surgery to remove.

Failure rate of latest version of Fitbone nail is 12 per 10,000 or 0.12%

I'm sorry, but this isn't correct. Where did you get that info? Fitbone and the doctors using that system won't give you the real numbers. These data aren't accurate. How many Monegal patients have you met? I'm sure not many. I'm in touch with some of them, and, according to them, the failure rate is much higher. Don't post information that isn't accurate.

Title: Re: Limb Lengthening Methods
Post by: Antonio on December 16, 2017, 05:57:29 PM
I'm sorry, but this isn't correct. Where did you get that info? Fitbone and the doctors using that system won't give you the real numbers. These data aren't accurate. How many Monegal patients have you met? I'm sure not many. I'm in touch with some of them, and, according to them, the failure rate is much higher. Don't post information that isn't accurate.

I got that info from Fitbone,  it was reported to me by the manufacturer. They sent me some results of lab tests and internal QC they had done. Now you may argue that the results may have been falsified, but like everything else you have to take it with a pinch of salt. How accurate are the results of the Samsung Galaxy Note not overheating? If you have more accurate information on Fitbone, please post it as I am sure it would be very much appreciated by the community. And if your data disproves mine or is more up to date, I have absolutely no problems in publishing a retraction. Until that time, the best available data stands....
Title: Re: Limb Lengthening Methods
Post by: backrandom on December 16, 2017, 07:04:49 PM

I got that info from Fitbone,  it was reported to me by the manufacturer. They sent me some results of lab tests and internal QC they had done. Now you may argue that the results may have been falsified, but like everything else you have to take it with a pinch of salt. How accurate are the results of the Samsung Galaxy Note not overheating? If you have more accurate information on Fitbone, please post it as I am sure it would be very much appreciated by the community. And if your data disproves mine or is more up to date, I have absolutely no problems in publishing a retraction. Until that time, the best available data stands....

For Fitbone, I'd like to add/modify:

Cost per nail is approximately 14k USD. Can weight bear partially up to 25 kg per leg (which means that you can use crutches one week after surgery if you do one leg at a time). No additional surgery required for consolidation if there are no complications. Transmitter cable may break after prolonged lengthening (usually after 7 cm) which may require surgery to remove.

Failure rate of latest version of Fitbone nail is 12 per 10,000 or 0.12%

Failure rate is higher. Consider the cases of Helloworld, Musicmaker (at least 3 fitbones failed)... among a relatively small number of patients in Monegal's practice. That Company isn't offering good information, and they know that the nails failed at least in those cases. That's more than 0,12%.
Title: Re: Limb Lengthening Methods
Post by: Body Builder on December 16, 2017, 09:04:02 PM
Fitbone has of course a much bigger failure rate than what Witthenstein claims.
We have more known cases that it failed than 0.12 % even if there have been manufactured 10.000 fitbone nails (which I don't believe).
Also Wittgenstein should better refund the patients and fix the very big failure rate of fitbone than doing funny claims like 0,12%.

That said, fitbone is inferion in everything to precise 2. Weight bearing abilities, inability for reverse lengthening, failure rate etc are things that precise 2 is superior by far.
The only benefit of fitbone is the cheaper price but the difference is not much to prefer it taking in mind all the above I mentioned.
Title: Re: Limb Lengthening Methods
Post by: Antonio on December 18, 2017, 05:15:43 PM
Fitbone has of course a much bigger failure rate than what Witthenstein claims.
We have more known cases that it failed than 0.12 % even if there have been manufactured 10.000 fitbone nails (which I don't believe).
Also Wittgenstein should better refund the patients and fix the very big failure rate of fitbone than doing funny claims like 0,12%.

That said, fitbone is inferion in everything to precise 2. Weight bearing abilities, inability for reverse lengthening, failure rate etc are things that precise 2 is superior by far.
The only benefit of fitbone is the cheaper price but the difference is not much to prefer it taking in mind all the above I mentioned.

There appears to be a misconception, very common amongst non engineering or technical background persons, that the failure rate is the number of failures divided by the population. However, this is incorrect, as the the term failure rate, implies. The failure rate, in it's simplest format, is determined by the number of failures x time interval of sampling / population x time in operation of population. As an example a car that fails after 5 years does not have the same failure rate as one which fails when brand-new.

Fitbone was invented by Dr. Baumgart and Dr. Betz in 1992, and the clinical results were described in Baumgart et al 1997.
https://www.ncbi.nlm.nih.gov/pubmed/9345218

In 2005, in a study of 150 patients, Baumgart reported failures in 3% of the implants.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3235314/#CIT0003

Over the last 25 years, the Fitbone has undergone many updates and the present version has been implanted in at least 2000 cases worldwide.
https://obgynkey.com/motorized-intramedullary-lengthening-an-emerging-technology-for-limb-length-and-deformity-correction/

I cannot give details of the 0,12% failure rate as I signed a confidentiality agreement with Wittenstein.

For those with an open mind, here are some studies on Precice,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5253187/
https://www.ncbi.nlm.nih.gov/pubmed/28439819
Title: Re: Limb Lengthening Methods
Post by: backrandom on December 18, 2017, 07:11:30 PM


I cannot give details of the 0,12% failure rate as I signed a confidentiality agreement with Wittenstein.


Why do you feel the need to promote Fitbone? Fitbone patients I'm in touch with have told me they didn't sign any confidentiality paperwork. Why did they make you sign? Are you working for them now? Did they pay you?

We don't give a fk about the articles you posted. We pay attention to the experiences of real patients in this forum whose devices failed. You can go promote elsewhere but not here, please, because we all know the truth about the failure rate. It's much higher. I don't understand why Wittenstein lies when their lies are so obvious to the LL Forum community.
Title: Re: Limb Lengthening Methods
Post by: Shadow91 on December 18, 2017, 09:33:32 PM
Monegal is back at it. FFS....
Title: Re: Limb Lengthening Methods
Post by: Antonio on December 18, 2017, 11:54:26 PM
Why do you feel the need to promote Fitbone? Fitbone patients I'm in touch with have told me they didn't sign any confidentiality paperwork. Why did they make you sign? Are you working for them now? Did they pay you?

We don't give a fk about the articles you posted. We pay attention to the experiences of real patients in this forum whose devices failed. You can go promote elsewhere but not here, please, because we all know the truth about the failure rate. It's much higher. I don't understand why Wittenstein lies when their lies are so obvious to the LL Forum community.

Thank you very much for your comment.

I do not need to promote Fitbone, I have stated facts that I know as well as all the advantages and disadvantages that I have experienced personally as an LL patient with Fitbone.

You may ignore all the studies and facts that I have stated, I am just laying things out so people can come to their own conclusions. Once again, thank you for your opinion
Title: Re: Limb Lengthening Methods
Post by: Antonio on December 18, 2017, 11:57:06 PM
Failure rate is higher. Consider the cases of Helloworld, Musicmaker (at least 3 fitbones failed)... among a relatively small number of patients in Monegal's practice. That Company isn't offering good information, and they know that the nails failed at least in those cases. That's more than 0,12%.

I don' t think that your level of statistical understanding is sufficient to warrant a meaningful discussion of this
Title: Re: Limb Lengthening Methods
Post by: patientprivacy on December 19, 2017, 01:55:57 AM
Monegal is back at it. FFS....

This guy isn't Monegal. He's a real patient who had surgery two years ago.
Title: Re: Limb Lengthening Methods
Post by: Antonio on January 20, 2018, 06:50:04 AM
Fitbone published product information states significantly less than 1% failure rate

https://www.google.es/url?sa=t&source=web&rct=j&url=https://www.wittenstein.de/download/product-information-fitbone-en.pdf&ved=2ahUKEwiKgt3e-OXYAhVHsBQKHcK3CFAQFjANegQIDxAB&usg=AOvVaw3sefYmrfmKms0BmnoWkTT9
Title: Re: Limb Lengthening Methods
Post by: backrandom on January 20, 2018, 08:08:09 PM
Why are you back at this after so many weeks? Are you here to promote false claims? I beg people to consider what happened to Helloworld, Musicmaker and other patients. That's more than 1% failure rate. Brochures lie. Facts don't lie.
Title: Re: Limb Lengthening Methods
Post by: Antonio on January 21, 2018, 10:15:44 AM
Why are you back at this after so many weeks? Are you here to promote false claims? I beg people to consider what happened to Helloworld, Musicmaker and other patients. That's more than 1% failure rate. Brochures lie. Facts don't lie.

Because you are a liar. I know from published facts and my personal experience as an 'LL patient. When are you going to show us your X-rays and diary as your facts? When are you going to show us more than hearsay what you know?
Title: Re: Limb Lengthening Methods
Post by: Body Builder on January 21, 2018, 10:33:08 AM
Fitbone has a big failure rate, much mire than any other internal nail.
Even here about half of LLers have a failed fitbone so 1% ir what Wittgenstein claims is just a joke.

Every company publishes researches that are far from reality.
Our experience is that fitbone is trash compared to precise 2 and the only reason some doctors use it is to save some money to reduce surgery cost or just to have more money for them.
Fitbone has NO benefit compared to precise 2, moreover to Stryde which will be fully weight bearing and will be a gamechanger.
Title: Re: Limb Lengthening Methods
Post by: M.s on February 05, 2018, 01:11:33 PM
any one can tell me which is better to do my LL with fitbone dr baumgart or with precice nail dr kohne ?
am confused and i need to know which nail is better ?
Title: Re: Limb Lengthening Methods
Post by: Body Builder on February 05, 2018, 01:21:05 PM
any one can tell me which is better to do my LL with fitbone dr baumgart or with precice nail dr kohne ?
am confused and i need to know which nail is better ?
Precise can bear more weight than fitbone, has better reliability and has reverse lengthening function to avoid non unions.
I can't find any advantage of fitbone over precise except from it is cheaper, although most of the times there is no real difference in pruces between doctors who use fitbone compared to the ones they use precise 2.
Title: Re: Limb Lengthening Methods
Post by: raku on January 22, 2019, 02:42:26 PM
Dear kilo

Could you tell me the disavantage of Latp method and the recommended Doctor dor Latp?
Thank you
 
Title: Re: Limb Lengthening Methods
Post by: Hamiltonzac on January 24, 2019, 09:43:59 AM
After the surgery when you're on bedrest, how do you take a   if you can't walk to the toilet? I'm not trolling, I'm honestly really curious.
Title: Re: Limb Lengthening Methods
Post by: Jubartt169 on January 31, 2019, 04:00:32 PM
What Lengthening method is least worst ?
Title: Re: Limb Lengthening Methods
Post by: wannagrowtaller on February 09, 2019, 12:32:24 AM
Could update with stryde.
Title: Re: Limb Lengthening Methods
Post by: Jamee12 on February 20, 2019, 08:33:06 PM
Meet with Dr. Guichet, he invented nail and has the best results.  Maybe check out Betz, he's a better sales man. 

Almost all the doctors have patients on here freaking out about their experiences.  But me a few of my friends to Dr. Guichet and have had absolute great results.  It's seems crazy to me that 10 years ago people where complaining about Doctors and its still goes on.  If they keep it up none of us will get tall.  lol... Most people think we are crazy for lengthening in the first place - words hurt more then the procedure.  :)

Any nail that is inside the leg is the safe route.  Secondly make sure you can walk, this helps with healing and growing faster.  Some methods don't allow walking while lengthening.

I met personally with both Betz and Guichet - I preferred Betz at the time... But I went with Guichet, why?  I liked living in France better then Germany at the time.  It was truly the best decision for me, I was a lousy patient called on Guichet daily whining about life.  Refused to take pain medication, gave up on clicking - Dr. Guichet keep pushing me through so that all was not lost and gain the height I came to seek. 

towards the end of lengthening there was other patients renting in the same apartment I was in I sure had a good time going over there in "helping them click" it was very comforting that I wasn't the only one.  Plus, it gave me the power I needed to carry on like I was some pro at this. 

A bunch of us worked on different clicking techniques which sure made a big difference.  But serious, if you can afford it see Guichet or Betz.  If your poor do what you can - I know others paid for the consultation and agreed to work for those doctors for a reduce rate for the procedure.  They still paid $30,000 which I guess is a lot lower then what I paid at the time.
Title: Re: Limb Lengthening Methods
Post by: enriquecruz8519 on March 28, 2019, 05:07:39 AM
My friend lily got a surgery and is currently recovering fast, she had a medical history with polio, so don't be afraid just look for the right kind of services.  :)

We are all thankful to his doc Dr. Mahboubian for his care and treatment, here is her pic https://heightlengthening.com/picture-gallery/ (https://heightlengthening.com/picture-gallery/)
Title: Re: Limb Lengthening Methods
Post by: Astronomy on March 28, 2019, 08:25:58 AM
Your the greatest messager alive in the whole forum ;D
It's a pity you r rarely active in this forum recently :'(
Title: Re: Limb Lengthening Methods
Post by: ActionSpeaks on May 30, 2019, 06:49:26 AM
Can you add information on STRYDE to this list, specifically the difference between Precise (is the latest 2.2?) only and STRYDE/Precise? I only know the basics, that STRYDE allows for more/quicker weight bearing and is made of stainless steel. How long in a wheelchair with STRYDE vs. Precise, before progressing to a walker then crutches?
Title: Re: Limb Lengthening Methods
Post by: Curiosity on August 03, 2019, 02:43:53 PM
Bone lengthening using the Fitbone® motorized intramedullary nail: The first experience in France.

https://www.sciencedirect.com/science/article/pii/S1877056816000062 (https://www.sciencedirect.com/science/article/pii/S1877056816000062)
Title: Re: Limb Lengthening Methods
Post by: M.s on January 01, 2020, 09:50:45 PM
Offcourse use presise nail Strayed
Title: Re: Limb Lengthening Methods
Post by: M.s on February 23, 2020, 05:58:17 AM
presise nail but not with dr Kohne  , my friend have tried him and regret a lot , go and do it with paley
Title: Re: Limb Lengthening Methods
Post by: Liliana on April 13, 2020, 01:46:05 PM
Would you told about Veklich device for limb Lengthening?
Title: Re: Limb Lengthening Methods
Post by: Vibes on January 29, 2021, 01:46:11 AM
It would probably be helpful to add to OP about the recent STRYDE "recall" of them looking into the bony protrusion issue.

It seems like not a serious complication at all, but people should be aware of it I think.
Title: Re: Limb Lengthening Methods
Post by: Sorcerer on August 30, 2021, 11:38:21 AM
G-Nail should be added into the list and it has been published to surgerical applications recently.

V21 was lengthening with G-Nail and you can have some clues about it in his dairy.
Title: Re: Limb Lengthening Methods
Post by: Super-JR on October 22, 2021, 05:16:57 AM
G-Nail should be added into the list and it has been published to surgerical applications recently.

V21 was lengthening with G-Nail and you can have some clues about it in his dairy.

I totally agree. Dr Guichet has been using Gnail for years and implanted to many of his patients. I know most of you does not know it because his patients are not active in this forum.
Title: Re: Limb Lengthening Methods
Post by: Bantem on October 22, 2021, 08:43:55 PM
I totally agree. Dr Guichet has been using Gnail for years and implanted to many of his patients. I know most of you does not know it because his patients are not active in this forum.
Doesn't he also have some of the highest patient deaths? His prices are pretty expensive, and from the number of deaths, I personally will stay away