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[Dingo]

Dr Guichet, thanks for joining the forum and answering our questions.

What is your opinion on staged lengthening for people who can't take 3 months off from work?

By this I mean doing one femur first and then the other femur a few months later.

I know that you advise against it in your page but would it be even possible?

[lestrac]

The max. gain is not the problem. The calf is fare less flexible than the quadriceps and thus the risk is tip toeing for several months.

Tibia has far less vascular supply than femur, and as a result, the bone blood flow is far less thus resulting in a far smaller healing capacity. In fractures of femur, we rarely have non healing due to no bone formation. In tibial fracture, it is common, because of the vascular problem and also of the smaller quantity of bone progenitor cells. If bone healing can be secured for a 6 cm gain in femurs in 3 months, in tibias it can be ...2 years and bone grafting!

The resulting problem is bone grafting, which is almost never needed in femoral lengthening, but may be required in tibial lengthening.

The second problem of tibias is that the bone is smaller than femur and the diameter of the nail to use is generally smaller resulting in a weaker construct. So, a longer healing time and a nail less resistant mechanically... this is not optimal.

The third element is the healing time of each patient. Some patients heal fast (wide bone heavy muscular caucasian type patients) and some heal slowly (e.g. small diameter brittle bones in some asiatic type patients). Healing time is never known in anticipation, unless there was a previous fracture.

All these reasons orient the choice in an honest way toward performing first femoral lengthening, and when the healing is secured (and when we know the bone is healing fast), we can propose a tibial lengthening in a secondary time. Of course in unilateral non cosmetic tibial shortening, this does not apply.

Tibias has been preferred for a long time by surgeons using external fixators because the pins/wires are very short on the medial skinny side of tibias with respect to longer ones for the lateral aspect of the thigh, through all muscles. The stability (nor motion) is not good in femurs using external fixators and thus there were all reasons to orient the choice toward tibias rather than femur. But times have changed with IM nails as they have the same stability in femurs and tibias.

An additional element for choosing femur versus tibia: Generally females prefer to lengthen femurs (6-8 cm) first as when they wear high heals, the knee is at a reasonable level, while lengthening 8 cm tibias and using 12-15 cm high heels looks awkward...

Cosmetically, there is no real issue, as proportions for attraction is in no way related to anthropometric proportions. The best and more attractive top models are completely disproportionned... When one see images of patients with femoral lengthening, no one prefers the patient/femurs before lengthening... and I always show a patient with a 18 cm isolated femoral lengthening: everyone thinks he has been proportionally lengthening both femurs and tibias, or 6 cm on femurs! Illusion is a surprising thing.

I designed and used the first tibial nail in 1993 and since then I improved the overall technique for tibias like for femurs, but still  tibial bone is not providing results patients ideally dream of.

Salve Dottor Guichet, le pongo anche io una domanda: sappiamo che contemporaneamente all'allungamento osseo (femore e tibia oppure femore o tibia) si ottiene anche un allungamento dei muscoli e che maggiore è la massa muscolare presente nel nostro organismo e maggiore è la quantità di calorie che si bruciano quotidianamente; detto questo volevo sapere quindi: dopo l'allungamento c'è un maggior consumo giornaliero di calorie ovvero c'è un'accelerazione del metabolismo basale? Grazie

[PANDA:BEAR..]

Does anyone know if Petet Wolf is still training for leg lengthening patients?