Quote from: Polycrates. on March 12, 2014, 07:15:02 PMDr. Birkholtz,
Should a length gained in the tibia by an Ilizarov apparatus correspond to the actual gain in height, or is it similar to the internal nail's mechanism? Thanks.
In tibias the mechanical and anatomic axes are parallel, thus it should correspond. There may be some subsidence after frame removal though.
Quote from: rickybobby on March 12, 2014, 08:09:43 PMdr franz,
thank you for all your valuable info,
I just want to do one surgery and want to gain 8 or 9 on my femurs and be done with LL, are you saying that the larger femur:tibia ratio will eventually cause arthritis or the malalignment?
so if i go all the way to 8cm with precice 2 on my femurs i will eventally get knee pain or arthritis? I am not worried about contracture because if I go with paley he will prob do itb and fb release.
thank you for all your info!!
It is not the femur to tibia ratio that changes alignment, but the fact that youre lengthening along a different axis. 8cm is a long distance and you should be worried. Remember paley is not the only surgeon doing releases. Contractures happen despite releases also.
Stick to safe distances if you can.
Quote from: paco1 on March 12, 2014, 08:12:16 PMhello doctor Frank,
what method do you prefer for lengthening 5,5 cm in tibias? LON or LATN.
I would prefer LON, but it is a personal preference.
Quote from: handy on March 12, 2014, 08:44:06 PMDr. Birkholtz- Why would lengthening 5-6cm be any safer than 6.1-8cm in terms of only malalignment? If lengthening along the anatomic axis with internal nails causes malalignment, since you're not lengthening along the mechanical axis, wouldn't any amount of lengthening then cause malalignment? What is it about lengthening 5-6cm and malalignment that makes it any safer than 6.1-8cm if all internal lengthening causes malalignment?
Thanks for all your information.
You are right. ANY lengthening along the anatomic axis will cause malalignment. As with most things in life, it is the magnitude that counts. Smaller distances will cause smaller malalignments and larger distances may lead to significant malalignments.
Quote from: Polycrates. on March 12, 2014, 08:58:48 PMThink I might answer my own question. Read online that in the tibia these axes are coincidental, so I assume height achieved is equal to height distracted.
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Yep absolutely right!
Quote from: Franz on March 14, 2014, 06:01:53 PMIt is not the femur to tibia ratio that changes alignment, but the fact that youre lengthening along a different axis. 8cm is a long distance and you should be worried. Remember paley is not the only surgeon doing releases. Contractures happen despite releases also.
Stick to safe distances if you can.
thanks for your repsonse dr. franz,
so your saying if anyone does 8cm on their femurs they WILL get knee pain and arthritis in the future?
Quote from: rickybobby on March 15, 2014, 12:01:40 AMthanks for your repsonse dr. franz,
so your saying if anyone does 8cm on their femurs they WILL get knee pain and arthritis in the future?
No, they will get a change in alignment. This may lead to knee pain and arthritis. It is very individual, but we cannot really predict who will and who wont.
Quote from: Franz on March 15, 2014, 12:36:34 AMNo, they will get a change in alignment. This may lead to knee pain and arthritis. It is very individual, but we cannot really predict who will and who wont.
Could this misalignment be corrected through a subsequent tibial LL with axis correction, on a later date after the femur LL?
Quote from: shawty on March 15, 2014, 10:34:28 PMHi Dr. B,
Does have muscular legs affect the lengthening process. For example is having muscular calves bad for tibia lengthening and strong muscles in the upper leg bad for femur lengthening. Not sure if others might know the answer to this.
Hey shawty this question was answered somewhere in the general limb lengthening section a while back I'm sure you'll be able to find it. The answer was along the lines of Pilates is an ideal exercise for those doing LL to give you an idea of the degree of muscularity and flexibility that is good for LL.
One thing I've noticed with people who want big distances like 9-10 cm is that their doctor doesn't seek to stop them going for it. Some even encourage them to go at least 7 cm.
Would you stop a patient from lengthening any further than 5-6 cm or let them continue at their own risk?
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