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Author Topic: What is the Long term effect of LL? Anyone know please answer. Thanks  (Read 50441 times)

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speaknuh

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #31 on: December 21, 2013, 07:08:54 AM »

Actually that particular issue is confirmed through recent research on non-cosmetic patients and not just the word of one doctor:

http://www.limblengtheningforum.com/index.php?topic=99.msg2672#msg2672

And I bet many of them didn't even lengthen much, they simply had a rod implanted to help correct their injuries.

I see... does this issue occur in both internal tibia and internal femur patients, or just tibia patients as the study suggests?  What do we know about the long term effects on patients who undergo internal femoral lengthening?
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LLL

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #32 on: December 21, 2013, 12:25:34 PM »

I see... does this issue occur in both internal tibia and internal femur patients, or just tibia patients as the study suggests?  What do we know about the long term effects on patients who undergo internal femoral lengthening?

Wondering about that myself.
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speaknuh

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #33 on: December 24, 2013, 10:34:16 AM »

Going to just bump this thread since I don't think we've reached any definitive answer on the long term effects of LL.  To me, there's absolutely no reason for me to sacrifice a pair of otherwise healthy legs just for some slight height gain.

Concerning internals:

If arthritis is a common occurrence among patients who undergo internal tibial lengthening, why have I not seen this discussed well enough in the past (on old forum /LL Forum)?  What do we know about the long term experience of patients who've undergone internal femoral lengthening?  How many years are we looking at before we can get a good evaluation of whether a patient sustains long term consequences from CLL? 

I recall various sources stating CLL contains no long term side effects so long as the procedure is done correctly, so it's come as a bit of a shock to me that the internal tibial method has proven to have complications years down the line.  Sure everyone on the forum is as concerned about the short and long term risk factor as I am...?
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speaknuh

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #34 on: December 25, 2013, 10:09:22 AM »

It look like my replies (as well as old forum PartyLeaks's) on the "Site feels dead..." post were moved on over to this one, probably to consolidate relevant information to this one post.  Though I didn't request this, I believe it will help keep all the information in one compact thread.  Just to clear up the confusion as one of my replies starts with "this forum is far from dead" or something along the lines, which was in response to that original post.

Just wanted to bring this thing up as well: on the makemetaller post, there is a very clear statement on the site's must-read post that purports that LL has posed no long-term complications 50 years since its inception:

18. Are there any long-term complications from having LL?
LL has been practised for over 50 years and there are no reports of any long-term complications, and no reason or logic to suggest that there should be.
[source: old forum  Topic: Leg Lengthening FAQs (Frequently Asked Questions)]  http/www link edit

The reason this is strange to me is that it was written in 2011, three years after this pubmed article was published, clearly articulating the long-term issues of LL http://www.ncbi.nlm.nih.gov/pubmed/18758282

Ever since limblengtheningforum.com opened, I've had to completely re-evaluate my understanding of LL.  There's so much misinformation out there on the subject of limb lengthening, it's incredibly discouraging... we need to understand exactly what LL is, and clarify the level of risk we are getting ourselves into.  I'm glad we're now on what I think is a more open/free channel for communication through this forum, but I constantly wonder if this is enough. 

Stay safe, people.
« Last Edit: December 25, 2013, 10:46:49 AM by Admin »
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Muse

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #35 on: December 25, 2013, 11:09:07 AM »

@speaknuh, 

Yeap, I merged those posts into this topic so it's easier for everyone to not miss out on the information posted.  Also edited http/www links to Make Me Taller, as explained in our forum guidelines. 

So this thread will be the consolidated version for anyone interested in the long term effect of LL, it's definitely a topic worth having more insights and discussion about.  I was personally motivated to start the new forum because of a statement that sum up old forum  nowadays

"pick a cheap Doctor and cross your finger hoping it's safe".

That should not be the way.   Safety and Recovery must come first.   Also it's not healthy when one person is constantly shoving his opinion down people's throat and deleting posts that he disagree with, among other things.   

Since I disagree with how old forum  is run,  I decided to do something about it and hope that this forum will be better than old forum .
« Last Edit: December 25, 2013, 11:14:07 AM by Dameon »
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longerlegzzz1980

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #36 on: December 26, 2013, 01:40:45 AM »

We should start a compilation of studies on this thread or another one.  This would provide a central location for solid research derived information involving a large number of patients.  We then discuss the conclusions of the studies, have a better assessment of the real risks, and be able to compile questions to ask current LL doctors using this data.

Do you all agree?
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somecm

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #37 on: December 26, 2013, 02:20:04 AM »

The biggest long term effect I know is height.  ;D ;D
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speaknuh

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #38 on: January 10, 2014, 10:46:18 AM »

We should start a compilation of studies on this thread or another one.  This would provide a central location for solid research derived information involving a large number of patients.  We then discuss the conclusions of the studies, have a better assessment of the real risks, and be able to compile questions to ask current LL doctors using this data.

Do you all agree?

I'm all for this, though I wonder how much has been done in the way of studying these long term effects.  If we were to compile a bunch of studies, it would be useful to note what particular surgery was done, when it was performed, what device was used, etc. (though for my interests specifically I want to know more about femoral internal lengthening).

It's strange to me that people out there are still interested in going through CLL when we haven't yet reached a consensus on its long term effects over our legs.  Two new patient diaries for Dr. Paley have sprung up over the last few weeks on the old forum, which I am pretty suspicious of (moreover, why post on a site where your message gets filtered by the admin before it becomes public?).  While I am anticipating the results of the Precice 2 before I jump into CLL myself, I'm pretty concerned about the welfare of the people undertaking CLL without knowing fully its risks and consequences. 
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greatheight

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You will end up fked bro
That's the price you've to pay
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mini_me

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #40 on: June 15, 2015, 09:15:00 PM »

I'm all for this, though I wonder how much has been done in the way of studying these long term effects.  If we were to compile a bunch of studies, it would be useful to note what particular surgery was done, when it was performed, what device was used, etc. (though for my interests specifically I want to know more about femoral internal lengthening).

It's strange to me that people out there are still interested in going through CLL when we haven't yet reached a consensus on its long term effects over our legs.  Two new patient diaries for Dr. Paley have sprung up over the last few weeks on the old forum, which I am pretty suspicious of (moreover, why post on a site where your message gets filtered by the admin before it becomes public?).  While I am anticipating the results of the Precice 2 before I jump into CLL myself, I'm pretty concerned about the welfare of the people undertaking CLL without knowing fully its risks and consequences.

Joan Rivers and Michael Jackson thought they looked great with all their plastic surgeries even the infamous "cat woman" so they're examples of people taking conventional plastic surgeries too far but were happy with their results even though others thought they were crazy and looked horrible… so this is also a mental issue especially in LL when you're choosing to get your legs broken. To be fair, all plastic surgeries are partly a mental issue anyway, so it's just the degree of safety & risk that should matter.

I don't believe I will ever get LL in my lifetime based on the cumulative information I've read here and doing my own research so it's good that this forum can convince some people to get the surgery while dissuading others. If everyone who visits this forum became gung ho to get the surgery, I wouldn't trust it.

I do credit all the people who elected to get the surgery for paving the way with their experiences to making this a safer, more accepted form of elective surgery for others in the future. I really think the future for this type of elective surgery looks promising and I'm fascinated by the process, but the current risk/rewards of LL is just not for me.
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Sean Connery

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #41 on: June 15, 2015, 09:24:54 PM »

There are no long term studies of CLL, so everyone who does it is taking a gamble. I think that's why there seems to be a big divide between the definitely short doing CLL vs the average height and up people doing CLL. Taking that gamble to no longer deal with all the crap that comes with being short is understandable to a lot of people, whereas taking that gamble for purely aesthetic reasons seems totally mental to a lot of people. I'm in more the average range 5'8, and the people I've let in on my desire to get taller have advised me to see a therapist.

However, even though there are no long term studies, I tend to think in the middle of the road. You probably won't ever be your 100% pre-LL self like some orthopedic surgeons say and what anecdotal evidence seems to show. But at the same time, the claims by certain orthopedic surgeons that CLL is going to make you f***** once you hit middle age seem completely unfounded.
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greatheight

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #42 on: June 15, 2015, 11:49:24 PM »

I would like to hear medical opinions but im afraid they wont be fair. doctors who do CLL would say everything is OK. Other doctors usually say it's totally crazy.
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truthtell100

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #43 on: June 16, 2015, 12:10:32 AM »

Yes, all doctors who perform CLL will say it's OK, especially drs who underplay risks, like dr monegal or dr betz according to many users.but it isnt.

I would like to hear medical opinions but im afraid they wont be fair. doctors who do CLL would say everything is OK. Other doctors usually say it's totally crazy.
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microman

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #44 on: June 16, 2015, 12:14:55 AM »

it's hard to tell what will happen down the line, but people go to sunbeds and everyone knows it's not safe, and people get skin cancer all the time by that, yet it's still given approval.

I'm no expert, but for this i can only think early onset of arthritus in the knees, I can't imagine anything else happening other than that.

but all scientific evidence supports that once the bone is healed everything is back to normal and any doctor looking at your knee bones would conclude that you bone is exactly the same as it was 9 months ago, only longer, so i like to think there are no issues.

very unlike the sun bed people, any doctor would say you will get skin cancer, and your going to get it, and i can see it happening, yet people (mostly girls) do it and you thin why there are many attractive women who are very white.

I would say liposuction is pretty bad, but i don't know much about it, id say sun beds and liposuciton are worse than LL, just because something is painful and invasive doens't mean it isn't safer than other things which are more conventional.
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Descreteuser

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #45 on: June 16, 2015, 01:00:54 AM »

Q: What is the long term effect of limb-lengthening?
A:
 Leg lengthening procedure is a kind of controlled fracture healing and once the bone is healed, there is no long term effects on the lengthened bone, as bone is under constant remodeling, hence the newly formed bone is as strong as the intact original bone.  The real concern is on the long term mechanical effects on the joints.  As change of height and bone length, will lead to change of body balance and loading pattern on the joint will be changed.  However, our body can adjust the gait pattern to adopt the changes, and it will take a few years for the body to fully adapt to the new changes.During this period, we will recommend modest exercise.  We have several patients who had leg lengthening surgery 15 years ago and none of them complained any serious complications such as arthritis.  The long term effect of cosmetic surgery (20-40 years) is not yet known and we don’t anticipate any major complications at this stage based on our clinical observations.

find that on a site
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axelf

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #46 on: June 16, 2015, 03:36:08 PM »

Yes, all doctors who perform CLL will say it's OK, especially drs who underplay risks, like dr monegal or dr betz according to many users.but it isnt.
.  Please tell US what happened!
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Uppland

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #47 on: June 16, 2015, 04:09:25 PM »

There are a number of risks that might happen.

What will happen is that your muscles will have to apply force over a larger area and thus be slower and weaker. Imagine you're swinging a small stick, it's pretty easy and fast. Now imagine you swing a longer and heavier stick, your swings will be much slower and heavier won't they?

This is basic physics and cannot be avoided, it is possible to train and adapt the muscles but I've only seen two examples of people who claim they got back to their previous level.

Don't lengthen too much and don't deviate from a natural ratio between the femur and tibia.
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microman

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #48 on: June 18, 2015, 01:00:13 AM »

well on the ratio thing that can arguably be fixed again by making the femurs longer, so they are back to their original ratio.
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crimsontide

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #49 on: June 18, 2015, 03:41:59 AM »

youll never be 100% again, but youll be okay

i dont  put too much weight into the muscle being weaker

its true it will have a longer axis, but the muscles stretch a bit, and  the body adapts

id say 2 full years to get to 90% or so, especially if external was done
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LLuser1

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #50 on: July 30, 2016, 04:26:50 PM »

For all cases, youll never be 100% ok
For some of them you wont come alive or wont walk anymore. There are some examples in this forum
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LLCaptain

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #51 on: August 02, 2016, 05:24:12 PM »

For all cases, youll never be 100% ok
For some of them you wont come alive or wont walk anymore. There are some examples in this forum

Why do you keep on resurrecting 1 year old topics to scare people? You haven't done LL and won't even do LL.

Anyone expecting to be 100% did not do enough research, but we all know that a high level of recovery is possible. You can go back to playing sports, hike the Alps, jump off walls, dance the night away, just your muscles won't be as explosive as they once were.
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CCMidwest

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #52 on: August 02, 2016, 07:34:46 PM »

For all cases, youll never be 100% ok
For some of them you wont come alive or wont walk anymore. There are some examples in this forum

Yes, LL is so deadly that some guys don't even survive the initial consultation.  ::)

I have a consultation in September...I hope I don't deaded.
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El Greco

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #53 on: August 28, 2016, 06:31:27 PM »

One thing that I find mind shattering on this forum(and on the old forum as well) is the kind of issues people obsess over as they are inquiring about or even doing LL. I find people obsessing over proportions(which does not even register as a concern for me.)

Even 'health' related discussions are mostly about soft tissues, while no body is addressing(or maybe even noticing) the elephant in the room. Your main concern should be: what kind of bones will I have after this is all over? and how will my LL choices affect this aspect of the outcome.

Here, I am referring mainly to osteoporosis(since bone deformities are a short term complication, and by the time lengthening and consolidation are finished a patient will have known if he\she has to deal with it or not.) I have found forums to provide little to no information on this complication. A patient's LL might be over for 15-40 years before they suffer this condition, and it just MAY BE that it was caused by LL.

Upon comparing methods(internal vs external) with this in mind, I find a strong tendency to think that externals provide better LONG TERM outcome(what a shock, right? I mean this is totally against conventional wisdom.) With internals you lose the bone marrow(and perhaps other stuff as well) of the operated bone segments. Bone marrow plays a major role in your bone remodeling

http://www.ncbi.nlm.nih.gov/pubmed/7816067

I am guessing here(but this is an educated guess) that when this process becomes faulty one becomes likely to develop osteoporosis. Sure your body might find a way to compensate for the absence of bone marrow, when you are still young, but will this go on through your older-elderly years?

Any help in answering these questions would be appreciated(especially if it comes in the form of information extracted from medical articles.)
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Ozymandias

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #54 on: August 28, 2016, 10:59:09 PM »

One thing that I find mind shattering on this forum(and on the old forum as well) is the kind of issues people obsess over as they are inquiring about or even doing LL. I find people obsessing over proportions(which does not even register as a concern for me.)

Even 'health' related discussions are mostly about soft tissues, while no body is addressing(or maybe even noticing) the elephant in the room. Your main concern should be: what kind of bones will I have after this is all over? and how will my LL choices affect this aspect of the outcome.

Here, I am referring mainly to osteoporosis(since bone deformities are a short term complication, and by the time lengthening and consolidation are finished a patient will have known if he\she has to deal with it or not.) I have found forums to provide little to no information on this complication. A patient's LL might be over for 15-40 years before they suffer this condition, and it just MAY BE that it was caused by LL.

Upon comparing methods(internal vs external) with this in mind, I find a strong tendency to think that externals provide better LONG TERM outcome(what a shock, right? I mean this is totally against conventional wisdom.) With internals you lose the bone marrow(and perhaps other stuff as well) of the operated bone segments. Bone marrow plays a major role in your bone remodeling

http://www.ncbi.nlm.nih.gov/pubmed/7816067

I am guessing here(but this is an educated guess) that when this process becomes faulty one becomes likely to develop osteoporosis. Sure your body might find a way to compensate for the absence of bone marrow, when you are still young, but will this go on through your older-elderly years?

Any help in answering these questions would be appreciated(especially if it comes in the form of information extracted from medical articles.)

Good post, Greco.

Yep, I'm also shocked by some people's priorities. Things like proportions or being or not able to squat 150 kg post-op should be the last concern!

As for the bone marrow thing, it is a serious question and it would be great if a doctor answers it. Too bad all the registered doctors have abandoned the forum after the continuous trollololing and false accusations.

I'm not an expert, but -as far as I know- the yellow marrow to be found inside femurs does not play the highly important roles the red marrow does.

"Yellow bone marrow is found in the hollow interior of the diaphyseal portion, or shaft of long bones. Its main function is to store adipocytes whose triglycerides can serve as a source for energy. The marrow fat is physiologically different than the subcutaneous fat in the body, and is the last fat to be lost due to starvation."

Source: http://www.conversantbio.com/blog/red-bone-marrow-vs.-yellow-bone-marrow-what-is-the-difference

There is also red marrow inside the femurs, but in adults it is mostly located at the epiphyseal ends ("heads") of the bones.



I'm not sure if this is also reamed when the nails are inserted.

I also appreciate any feedback on this topic.
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El Greco

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #55 on: August 30, 2016, 05:30:59 PM »

Hi Ozymandias,

Well I have asked one of the doctors who do internals about the effects of losing the bone marrow of the operated bone in an email, and he said that it would be better if I talk it over with him in a consultation(so no answer.)

There is also red marrow inside the femurs, but in adults it is mostly located at the epiphyseal ends ("heads") of the bones.



I'm not sure if this is also reamed when the nails are inserted.


The proximal end of the femur(this is the one highlighted in your picture) probably gets reamed as well(the drill goes right through it.)

Reaming also raises other concerns. Here it says that the surgeon would ream the canal so that it's diameter would become 1.5 mms greater than that of the nail to be inserted:

http://www.bjj.boneandjoint.org.uk/content/89-B/11/1421

I would expect that this would mean that your endosteum as well as part of the inner wall of your compact bone would have to go(the compact bone is only a few mellimeters thick)

This is a reference picture for the anatomy of a long bone:



the thinning of the bone wall as well as the loss of marrow also raises biomechanical concerns about the resilience of the resulting bone(a cylindrical object A that has some viscous material inside should be more resilient than a hollow cylindrical object B, even more so when B has a thinner wall than A)

Back to the cellular aspects of the topic:

Your body would still have red bone marrow in other bones, but could this marrow stored far away from your operated bones supply them with osteoblasts and osteoclasts in the same efficiency, as did the marrow which they lost?

It would be great if somebody gets these questions to a surgeon who does internals.

In any case... ideas?
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Ozymandias

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #56 on: August 30, 2016, 07:42:23 PM »

Interesting stuff, Greco (and kinda worrying, to be honest)

As for reaming the "head" of the bone, I'm not sure. I've seen x-rays where the nail is placed next to the top, however others look like this one:

http://www.abc.es/Media/201406/02/image%202--478x891.jpg

In a paper by Frank Birkholtz I posted here quite recently, he discussed a failure of nail distraction during femoral lengthening, which was apparently caused by an insufficient reaming. Therefore, it seems that surgeons are quite cautious about reaming too much.

I will try to investigate this as far as I can. Hope others contribute as well.


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Ozymandias

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #57 on: August 31, 2016, 07:20:16 AM »

Found some nice stuff about bone reaming and its consequences (I have highlighted the words "bone" and "reaming" in order to make lecture kinda easier)

Obviously the book is huge, and includes some interesting data about intramedullary rodding, but focusing on the reaming part (pages 279-281)

https://books.google.es/books?id=8sLNBQAAQBAJ&pg=PA279&lpg=PA279&dq=bone+reaming&source=bl&ots=WfOqZcHm-F&sig=TX21I_CTVfsWpsdoKnOqL7RoP-I&hl=es&sa=X&ved=0ahUKEwjxy_mAhevOAhWBXRoKHSk4AEgQ6AEIHDAA#v=onepage&q=bone%20reaming&f=false

(Hope the link works for everyone. I have screencaped some parts in case it doesn't. If some pages are not shown, you can always google the following parts, and hopefully they will appear)

"Destruction of the medullary contents by reaming has both local and systemic consequences. Reaming obliterates the remaining medullary blood supply after injury. This vascular system reconstitutes in 2 to 3 weeks."

"Therefore, destruction of marrow during reaming does not produce anemia, apart from that created through blood loss into the soft tissues"

So I'm guessing that the vascular system of the bone does not suffer long-term effects. Can someone confirm this?
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TIBIKE200

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #58 on: August 31, 2016, 07:26:45 PM »

Why are proportions, biomechanics, soft tissue damage or anything else any less important than this basically "new" thing about bone marrow?
  Bone reaming is also being done for the installation of titanium rods which have nothing to do with LL or CLL... If the method would have dire consequnces, the reaming for any reason would not be practiced....
  Adult bone marrow is a viscous fluid made of fats and water (And that's from where the risk of fat embolism comes from during internal CLL). There is nothing important in this fluid according to what science know till now. Maybe it is important maybe it isnt but no one knows now... People live pretty good without an entire leg (loss of limb for whatever reason)... They dont suffer any kind of anemia or immune disfunction which means that the body can compensate..

 Sorry, but it almost sound like trying very hard to find a reason as to why not to do this surgery... There are enough risks as it is... No need to add a new imaginary one
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El Greco

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #59 on: September 01, 2016, 02:43:12 PM »

Ok. I did expect that some people would lash back at me when I try to start a detailed scientific discussion, since details get people worried and consequently are not popular. But here is the thing: Refraining from thinking and researching will not make the consequeces and dangers go away. Just because you do not see something on somes doctor's website FAQ section does not mean it is not there. I say this with no hard feelings, and I can understand that you(I am assuming you did internals) do not want to think about this stuff.

Now, I will reply in as much detail as possible:

Why are proportions, biomechanics, soft tissue damage or anything else any less important than this basically "new" thing about bone marrow?

If you go back to my posts you can see that I was talking about biomechanics as something which IS IMPORTANT. As for proportions: I sit down in the train and look around me and find 10 guys whose proportions I would have if I did 20 cms. A person with average proportions would need to do a drastic amount to become disproportionate, not to mention most short guys have very low leg/body ratios. In any case proportion is not a health concern. When it comes to soft tissue damage, the reason bone quality is more important(I am not saying soft tissues are not important) is that soft tissues almost always get better after the procedure given enough time. I cannot say the same is true with bones(bone remodelling does not have to restore your bones to their previous strength if they get reamed, and if you do not like what I am saying give me evidence(Maybe now, you will say that there is no evidence to the opposite, but the opposite is what one would intuitively expect.))

Bone reaming is also being done for the installation of titanium rods which have nothing to do with LL or CLL... If the method would have dire consequnces, the reaming for any reason would not be practiced....
  Adult bone marrow is a viscous fluid made of fats and water (And that's from where the risk of fat embolism comes from during internal CLL).

Yes doctors have been doing this for a while, but this does not mean they know what physiological changes it causes within a 50 years span(I would appreciate articles about follow up after REAMED nailing(sometimes nailing is done with no reaming))

There is nothing important in this fluid according to what science know till now. Maybe it is important maybe it isnt but no one knows now...

Remember that we are talking about reaming and loss of bone marrow. These are not the same thing.
By the way, some articles which I have read say that the material released from reaming plays a role in the healing of the fracture(look up the section "Autografting by debris from intramedullary nailing"):

https://www.google.de/url?sa=t&source=web&rct=j&url=http://medicaljobinterview.org.uk/orthopaediceducation/books/images/pdf/FRCS%2520Orth%2520evidence%2520base%2520course/Presentation%2520for%2520Delegates/IM%2520Nailing%2520Biological%2520and%2520physiological%2520effect%2520%255BCompatibility%2520Mode%255D.pdf&ved=0ahUKEwiY_JecsO7OAhVDNxQKHXWPC_44ChAWCCcwBA&usg=AFQjCNF2INneFQuTGSRezU_mGxMxnlS5sA

...so reaming makes you lose more than just fat.

People live pretty good without an entire leg (loss of limb for whatever reason)... They dont suffer any kind of anemia or immune disfunction which means that the body can compensate..

Remember that we are talking about the effect of reaming on the operated bone segments and what happens when this segment loses ITS OWN marrow. If the segment has been amputated, everything we are talking about becomes irrelevant.

Sorry, but it almost sound like trying very hard to find a reason as to why not to do this surgery... There are enough risks as it is... No need to add a new imaginary one

I am very detrmined about having the procedure(for both tibiae and femurs) but I want to figure out the best procedure, and I can't unless I ask the big hairy questions.

I will not answer any more replies written in the same tone and attitude as the last one.

Best,
El Greco
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TIBIKE200

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #60 on: September 01, 2016, 02:55:35 PM »

Ok. I did expect that some people would lash back at me when I try to start a detailed scientific discussion, since details get people worried and consequently are not popular. But here is the thing: Refraining from thinking and researching will not make the consequeces and dangers go away. Just because you do not see something on somes doctor's website FAQ section does not mean it is not there. I say this with no hard feelings, and I can understand that you(I am assuming you did internals) do not want to think about this stuff.

Now, I will reply in as much detail as possible:

If you go back to my posts you can see that I was talking about biomechanics as something which IS IMPORTANT. As for proportions: I sit down in the train and look around me and find 10 guys whose proportions I would have if I did 20 cms. A person with average proportions would need to do a drastic amount to become disproportionate, not to mention most short guys have very low leg/body ratios. In any case proportion is not a health concern. When it comes to soft tissue damage, the reason bone quality is more important(I am not saying soft tissues are not important) is that soft tissues almost always get better after the procedure given enough time. I cannot say the same is true with bones(bone remodelling does not have to restore your bones to their previous strength if they get reamed, and if you do not like what I am saying give me evidence(Maybe now, you will say that there is no evidence to the opposite, but the opposite is what one would intuitively expect.))

Yes doctors have been doing this for a while, but this does not mean they know what physiological changes it causes within a 50 years span(I would appreciate articles about follow up after REAMED nailing(sometimes nailing is done with no reaming))

Remember that we are talking about reaming and loss of bone marrow. These are not the same thing.
By the way, some articles which I have read say that the material released from reaming plays a role in the healing of the fracture(look up the section "Autografting by debris from intramedullary nailing"):

https://www.google.de/url?sa=t&source=web&rct=j&url=http://medicaljobinterview.org.uk/orthopaediceducation/books/images/pdf/FRCS%2520Orth%2520evidence%2520base%2520course/Presentation%2520for%2520Delegates/IM%2520Nailing%2520Biological%2520and%2520physiological%2520effect%2520%255BCompatibility%2520Mode%255D.pdf&ved=0ahUKEwiY_JecsO7OAhVDNxQKHXWPC_44ChAWCCcwBA&usg=AFQjCNF2INneFQuTGSRezU_mGxMxnlS5sA

...so reaming makes you lose more than just fat.

Remember that we are talking about the effect of reaming on the operated bone segments and what happens when this segment loses ITS OWN marrow. If the segment has been amputated, everything we are talking about becomes irrelevant.

I am very detrmined about having the procedure(for both tibiae and femurs) but I want to figure out the best procedure, and I can't unless I ask the big hairy questions.

I will not answer any more replies written in the same tone and attitude as the last one.

Best,
El Greco

 Muscle tissue, nerve tissue or any other mesenchimal tissue cannot repair themselves completely... This is why there is a big concern regarding "soft tissue" (Although, I recently had a cup of coffee that exploded for some reason in my hand cutting part of my Tenar muscles groups which resulted in scar tissue in the muscle itself... Fortunately, I am happy to report that after the removal of all the stitches, the function of my thumb has almost returned to 100% almost 1 month after the incident. This has given me some relief in terms that muscle function can recover pretty good even if something like 20% of my muscle fibers according to the doc who operated my hand were completely cut).

 Now about the bone marrow stuff. Since it's not full of any pluripotent cells like young human marrow, the liquid is replenished (as far as I know... I might be wrong) which means that after nail removal, things go back to how they were... Post nail removal x-rays that were posted here and on old forum didnt seem to hint at a "hollow bone" so this is no concern as much as I believe.

Frankly, I dont really care what will happen to me when I will reach my 50's or 60's because (1) I want to do it as young as possible in order to "use" the advantages of being taller when they are mostly applied (everyone gets less and less superficial as they age... Especially women for which most of us do this surgery in the first place) (2) by that time I am pretty sure that medicine will be pretty advanced in order to fix any long term concequences.
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I learned some stuff during this time

goldenegg

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Re: What is the Long term effect of LL? Anyone know please answer. Thanks
« Reply #61 on: September 01, 2016, 08:56:46 PM »

Ok. I did expect that some people would lash back at me when I try to start a detailed scientific discussion, since details get people worried and consequently are not popular. But here is the thing: Refraining from thinking and researching will not make the consequeces and dangers go away. Just because you do not see something on somes doctor's website FAQ section does not mean it is not there. I say this with no hard feelings, and I can understand that you(I am assuming you did internals) do not want to think about this stuff.

Sorry El Greco, but I don't think you've magically discovered some big risk that the entire LL medical community has missed. the yellow marrow in an adult bone doesn't have any vital function which is why reaming and internal nails are acceptable in the first place not only for LL, but regular broken bones too. further, the marrow grows back after removal like others have pointed out.

I would be more concerned about real risks like PE from reaming. LL has plenty of important risks you should be worried about, but I think you're making a big deal out of a non-issue on this one. If still concerns you though, then I would go ahead and ask your surgeon before you do LL.
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