Topic: Dr Alex Monegal (Barcelona, Spain) Clinica Diagonal (Read 342467 times)

itzrammi · « **Reply #186 on:** January 30, 2015, 07:35:47 PM »

Quote from: Wazzup on January 30, 2015, 07:15:55 PM

Knowing that is awesome and i must say than IMHO nothing is better than having a doctor that is allways there to support us.

When it comes to the cuts in femurs the doctor said:
What is the advantages and disadvantages between boths? Can the "antegrade/9-10 cm" prevent us from knee pain? I am sure here it isn't inserted through the knees and the knee gets untouched, or am I wrong?

My consern is that I am planning to do this in 3 years time and then forget about leg lenghtening and just leave a healthy life style.I'm really concerned because saving 20k might not be worth it if you then have to leave the rest of your lives with pain and weak knees.

By the way I'm 19 and plan to do this with 22. As i said before my knees already look weak so... That is why i have all this obssession over knee pain. Whaiting to read some diaries I'm portuguese so spain is like if it was the same country.

I think yes , with any internal device there is a chance of Knee Pain coz after all Patellar Tendon is cut to insert nail into the tibia

Wazzup · « **Reply #187 on:** January 30, 2015, 07:39:56 PM »

Quote

I think yes , with any internal device there is a chance of Knee Pain coz after all Patellar Tendon is cut to insert nail into the tibia

You read my post? I was talking about femurs

Let me see if I got this straight...

Tibias -> through the knees
Femurs -> you have 2 options:
antegrade: 1,5 cm below lesser trochanter retrogade: 9-10 cm above knee joint retrograde

Now my question is what are the pros and cons of boths techniques for femurs. Am i safe of permanent knee pain in both? If so, my neighbour country here I go!

itzrammi · « **Reply #188 on:** January 30, 2015, 07:52:40 PM »

Quote from: Wazzup on January 30, 2015, 07:39:56 PM

You read my post? I was talking about femurs Can someone explain me like if I was a bit dump the pros and cons of both techniques to insert the fitzbone in femurs?

I dont know but probably it has no effect on knee according to the place of cut you described

and maybe this journal would be useful to you

http://www.boneandjoint.org.uk/highwire/filestream/40506/field_highwire_article_pdf/0/971.full-text.pdf

Dr Monegal · « **Reply #189 on:** January 31, 2015, 03:55:18 PM »

Thanks for your kind words guys.

You can avoid spreading of the patellar tendon using antegrade technique (when doing femur) and using a Suprapatellar approach (when doing tibia).
To decide which technique is better depends On allignment of the limb as retrograde allows axial correction.
Knee pain is an important issue, and happens in most techniques as patellar tendon is longitudinally cutted and protection while reaming is not the best. Fitbone instrumento provides special sleeves in which reamers are inserted and tendon is 100% protected. It is extremely important closure of the tendon and peritendon after the procedure very accurately, Otherwise this will be painful.

I have 2 procedures this week performing Suprapatellar approach for tibiae. Can t promise anything (it depends On patient s authorization) But maybe I can Show you How it goes.

Best regards

KrP1 · « **Reply #190 on:** January 31, 2015, 04:04:44 PM »

Could knee pain be avoided with LON metod too? Or is only 100x100 protected with fitbone?

Dr Monegal · « **Reply #191 on:** January 31, 2015, 04:38:09 PM »

There is a Suprapatellar set from Smith and Nephew regularly used for trauma fractures that might be usefull for tibiae. In femur You can perform antegrade technique

tallerbetter · « **Reply #192 on:** February 02, 2015, 02:36:00 PM »

This seems OK only if you do tibia and femur at once. But if you want to do only femurs or only tibias it seems that going to Spain isn't worth the effort. More surgeries mean a higher possibility of problems, more money... and a longer recovery period. More than one year for only 6-8 cm? No thanks. Only if tibia and femur are done together.

ForcedPuberty · « **Reply #193 on:** February 09, 2015, 04:02:07 AM »

Quote

Lol you telling me dr. G or Dr. Paley aren't good doctors because they don't have upper height limits?

I have to agree with read rothbard on this issue.

even though there is a very good reason why the great majority of people cant go past the safe limit, there are people who can. and so doctors cant really be judged by not having a lengthening limit.

instead a good doctor will strongly recommend that there is a very good chance for complications if you go above the safe limit and strongly advice against going further than this, but also maintaining that they will re examine whether further lengthening is advisable when you approach the safe limit for the individual.

heightangel · « **Reply #194 on:** February 28, 2015, 01:33:37 PM »

I am saying this because I'm remembering a guy from old forum who was operated by a surgeon in Barcelona and his knees were completely destroyed. I don't know if he was operated by this doctor or by another one in that city but this is making me worry. Well, I'm posting this just for you, to think twice before going to him, bcs I won't go to Spain. I don't know where I'll go. I would have chosen Russia, but the political crisis worries me.

heightangel · « **Reply #195 on:** March 16, 2015, 03:43:27 PM »

There're other more reknown doctors in Barcelona, as Ginebreda, and other doctors in Madrid who do ALbizzia and in other cities (Malaga,Pamplona). You should include their names in this forum.

Dr Monegal · « **Reply #196 on:** March 16, 2015, 09:54:50 PM »

Yes they are. i totally agree with you.

Dr Ginebreda is a world reference in Limb lengthening specially in All type of dwarfism. He has been my maestro during 9 years and he is an excellent limb lengthening Specialist. He deserves all my respect and admiration. He has done a marvellous carreer taking care of kids affected from growth disorders.

In Pamplona Dr Julio de Pablos is Another experienced doctor. I don t know if he is Doing internals. As far as I know he has performed some cases using Precice nail.

In Málaga Dr Felipe Luna. He is Also specialized in dwarfism and growth disorders.

Sorry I cannot tell you a name in Madrid. Maybe Dr Marti. He is a very experienced limb reconstruction surgeon.

I hope This information is helpfull for you guys.

just_me · « **Reply #197 on:** March 16, 2015, 10:33:07 PM »

@Dr Monegal do you offer leg deformity correction with Taylor spatial frame - If yes what is the price for such a surgery in one leg?

Freewill · « **Reply #198 on:** March 16, 2015, 11:12:49 PM »

Thankyou so much Dr.Monegal for always giving us your advice's and concerns. You are one of the most valuable resource of this forum.

crimsontide · « **Reply #199 on:** April 13, 2015, 03:51:32 PM »

dr monegal is easy to deal with

also answers every mail sent to him

paco1 · « **Reply #200 on:** April 22, 2015, 12:29:45 PM »

Hi to the forum.
I am a doctor Monegal patient. Tomorrow i lengthening 5cm in my left leg. My goal is 5,5 in this leg and 6 in the other because i have a little discrepancy.
I had my surgery on 18 in february, in clinica diagonal.
At the moment i am very happy with the surgery and the results. I have my leg more straight with the surgery too.
cheers, paco.

goodlucktomylegs · « **Reply #201 on:** April 22, 2015, 12:35:27 PM »

Hi Paco
I hope you doing well
Please share your experienced and create your diary.
Your diary will be first diary of Dr Monegal here

Uppland · « **Reply #202 on:** April 25, 2015, 01:13:23 AM »

I saw a doctor from Gothenburg and one from Stockholm in that video, damn I wish they accepted cosmetic patients. If I could be operated on in Stockholm I could live with my grandad and everything would just be so much easier.

Uppland · « **Reply #203 on:** April 25, 2015, 10:58:36 AM »

Quote from: Dr Monegal on April 25, 2015, 09:24:06 AM

Hahaha that s funny,

The main Point why I look short is that I AM currently 181 And probably people from north of Europe Are taller. The guys appearing beside me must bé 185-190. This Is quite disapointing but i cannot operate myself and none of my colleagues would operate me following their criteria.

Now being serious, must say That there are many reasons why as a surgeon I choosed fitbone among other systems. If I ever needed a LL procedure due to any cause, I would do Fitbone.

Glad to See mm is Not the only caring about me

Dr. Monegal what can you tell me about the Swedish doctors? I assume they don't accept cosmetic cases but I wanted to ask anyway.

Dr Monegal · « **Reply #204 on:** April 25, 2015, 11:13:24 AM »

Dear Uppland

Swedish doctor's are excellent LL specialists. As far as I know There are 2 Fitbone centers in Sweden. I cannot tell you if they do perform CLL But you will be able to find their details at www.fitbone.com
I think they do practice At Stokholm and Gotteborg

Kind Regards

Uppland · « **Reply #205 on:** April 25, 2015, 01:57:34 PM »

Thank you Dr. I sent an e-mail asking about cosmetic procedures.

Taller · « **Reply #206 on:** April 25, 2015, 05:51:02 PM »

Dear Dr. Monegal,

I hope that the fact that this video puts a face and character to your name will lead to people acting more respectfully towards you on this forum.

Regardinng limb lengthening, do you prefer to lengthen the femurs or the tibiae for cosmetic purposes? Which do you feel looks more aesthetic in men?

Dr Monegal · « **Reply #207 on:** April 25, 2015, 07:36:09 PM »

Dear Taller

It depends On biometrichal parameters of each patient. It is compulsory to perform radiological studies to measure each bone segment and calculate The fem/tibia ratio Of each individual.
In some cases We Migth See there Is a misproportion Between femur and tibia length, and it is adviceable to lengthen the hypometric bone maintaining a biomethrically viable limb after lengthening.

In other individuals we migth find nornal parameters preoperatively, and This means That Ideally they should be lengthenned in all 4 bones to preserve the original proportions. In case of lengthening only femur OR tibiae, the ammount of cm might be limited in order to keep the Limb in a viable ratio. Going beyond that limit migth cause a biomechanical conflict.

It Is very important to plan All Procedures so We can adjust Not only the biomechanical balance But Also allignment as well as a good cosmetic result. That is the main reason I prefer Fitbone rather than other LL internal implants or techniques.

Regards

Taller · « **Reply #208 on:** April 25, 2015, 07:40:23 PM »

Thank you for your detailed response. How much variation in natural tibia to femur ratio do you typically see between patients?

just_me · « **Reply #209 on:** April 25, 2015, 09:10:16 PM »

Which procedure fitbone procedure or external fixator procedure is the most minimal invasive surgery?

Dr Monegal · « **Reply #210 on:** April 25, 2015, 09:29:24 PM »

Hi Taller

It depends on every individual.i have recently had a few patient's with a ratio close to 1 which means Femur and tibia Are equal. In these cases It is better to Go for femur Otherwise tibiae Will be longer At the end of the lengthening procedure.
Femur shoud be 1.1 times longer than tibiae ideally. But There is a Range in which ratio remains safe and biomechanically correct.

I think there is a post somewhere which explains perfectly about these proportions.

Regards

Dr Monegal · « **Reply #211 on:** April 25, 2015, 09:37:53 PM »

Hi Just me

Referring to the operation itself nailing is more invasive for obvious reasons.
The advantage about using internals in my opinion are several.

1- no pins going throught the skin
2- no pinsite infection
3- less pain
4- better COSMETIC results: nitchy scars
5- less axial deviation
6- less delayed consolidation rates
7- early rehab of the knee joint
8- patients can start physical activities earlier (swimming pool/cycling)
9- Patient managing and handling
10- no need cures of the pinnsites
11- less surgical procedures (some of the LL using ex-fix or LON require
12- confort of the patient

So the surgical act might be More invasive as you ream the bone and stick in a nail, but in my opinion there are some factors 'non related' with the surgical act but with patient handling and post operative care, that really makes the system much safer and probably more easygoing.

Regards

just_me · « **Reply #212 on:** April 25, 2015, 09:43:16 PM »

@Dr Alex Monegal, Very informative answer - Thanks.

just_me · « **Reply #213 on:** April 25, 2015, 11:27:45 PM »

@musicmaker,
1) How long did you stay at the Hospital after surgery?

2) Did you stay at a Hotel after you left the Hospital before you went Home - if yes then for
how long did you stay at a Hotel?

3) Are there several Hotels close to the Hospital?

4) Is Barcelona/Spain an expensive country compared to other countries in Europe regarding Hotels, foods, Taxi etc.

Thanks.

Regards

just_me · « **Reply #214 on:** April 26, 2015, 01:27:26 PM »

Hi musicmaker,
Thank you kindly for your good answers. Thank you for offering your help - It's good to know. I wish you the very best with your legs journey.

Wazzup · « **Reply #215 on:** April 27, 2015, 04:33:46 AM »

Quote from: Dr Monegal on April 25, 2015, 09:29:24 PM

Femur shoud be 1.1 times longer than tibiae ideally. But There is a Range in which ratio remains safe and biomechanically correct.

Hello to u all,

To be honest I've allways read that tibias are normally 80% of femurs. But from what you just said, femurs should be 1.1 tibia wich leads to tibias beeing more a less 90% femur.

I am 1,66m and I was planning on lenghtening only 6cm femurs in the future. That beeing the case I would love to know what you doctors believe is the normal ratio and upper and lower limit in which the ratio remains biomechanicaly safe.

Why I am planning on doing femurs?
- I don't want to be tall I just don't want to be this short (I've lot of friend between 1,70-1,74 but almost none <1,70)
- Two segments would make my sitting height to height ratio look funny
- Tibia recovery time is scary

My dream is to get 6-6,5 in femurs so I would love to know what you have to say about the femur to tibia ratio

Thank you,

Dr Monegal · « **Reply #216 on:** April 27, 2015, 07:34:09 AM »

Hi wazzup

Probably I Did not express myself correctly.
I meant we need to keep ratio so It does not go underneath 1.1 at the end of lengthening.
Depending on the x rays, 6 cm femur in your case could be a good solution If This is a biomechanically correct procedure.

Regards

Limb Lengthening Forum

Author Topic: Dr Alex Monegal (Barcelona, Spain) Clinica Diagonal (Read 342467 times)

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