I find the good doctor's willingness to field such a torrent of questions without any compensation in return admirable. To you, I extend absolute graciousness. I see this thread hasn't been tended to in quite some time, so I hope doc Birkholtz is merely taking respite from the frenzied onslaught. If you are ever to return, I would be indebted to you if you would be willing to take a moment of your precious time to grant insight to the following questions I've been yearning to have answered. I'm currently undergoing LON in India, by the way.
There are many occurrences in our guest house that have not been given satisfactory answers by our doctor. Could you provide generalized answers to the following?
1) Many of us have noticed that the rings on our Ilizarov fixators have been installed with the centre of the rings heavily displaced to one particular side. ie. there is a gap of only a few cm. between the frame and the inner side of my knee but there exists a great many cm. gap on the outer part of the knee with the frame. Our doctor assured us that this will have no bearing on the distraction quality of the frame, but in my layman mind I would think, through simple application of force analysis, that this displacement would cause an outer/inner pressure on the bones, causing them to bend one particular way. I would have preferred to have had my leg centred in the frame, as would have everyone else, but is this something you take into consideration when installing a frame? Everyone's legs seem to keep straight, but some people have turned in ankles and others have what appear to resemble x-legs.
2) Ever since my initial surgery I've not been able to enact function on the big toe of the left foot. The doctor continually assures me its function will return. He seems unsure as to what the cause is, though. He says it is sometimes a nerve, and other times a muscle/tendon. Is it something that should ameliorate over time, as he assures?
3) This is perhaps too audacious a request, but I would like to know if I can send a picture of my legs to you after my frames are off to see if you can identify any occurrence of x-leg. Is there a particular angle and stance one can use to readily identify the symptom? The doctor tells everyone they do not have it, but I think some must.
Thank you in advance for whenever you have the time to resolve these enquiries. I would not hesitate in considering precise femoral lengthening in the distant future with you if you were ever to absolve your practice of the height limit contraindication. I reckon to be close to 183cm after this round, but would possibly do another 5-6cm on femur if the circumstances allowed for it.
Best regards,
Ashoka
Dr Franz Birkholtz (Pretoria, South Africa)
In case Dr. Franz doesn't respond:
1. A lot of people in Beijing ended up with their feet turned inward (pigeon toed) toward the end of lengthening. During the 2nd surgery, the doctors rotated the part of the leg below the break so the feet would be pointing straight.
3. The angles of the whole leg are checked while standing, and should look something like this:
Quote from: Arche on December 11, 2013, 12:44:08 AMDear Mr. Birkholtz,
Thank you so much for your participation on this forum! I was wondering if you would allow a patient to lengthen his femur one at a time? I understand that the Precise is not weight bearing, so to me it would make sense to do one femur and then the next using the Precise method. For a 5 CM gain I am sure it will take an entire year to complete, but would it perhaps enable a patient to work a desk job?
I was also wondering if you will use any other method of internal leg lengthening for femurs? I am considering pursuing this surgery with you primarily because of your active participation on this board.
Thank you,
Arche
Hi thanks for the kind words. It is certainly possible to do one at a time and would give better mobility during treatment.
It is more costly though, because hospitalisation cost is effectively double. Also, should you for some reason not complete the second phase, you are left with 5cm discrepancy. Not too cool.
Hi Dr. Birkholtz,
Will you take me on as a patient? I'm interested in completing 8cm with internal femur by the end of 2014.
Kind regards,
Quote from: inquisitivemind on December 18, 2013, 09:31:25 AMI've got a question that I have been googling and havent been able to get a solid answer for.
My height is 155cm with an armspan of 158cm. If I were to follow Dr Franz's advice (which is to lengthen 5 (or 6?) cm in each part as a maximum), then I would be 165/167 cm with a 158cm armspan.
Would this be painfully obvious? Obviously not Apo level of obvious, but still very obvious?
I think ultimately only you can answer this question. I would not go beyond 165 though
Hi Franz,
There has been a lot of talk about whether or not external fixation on femurs is really a feasible option. Most people on the forums say not to even consider external fixation on femurs due to the likelihood of a bad outcome, but recently there has been some discussion about whether the bad outcomes mentioned were because of the method or because of going to a surgeon who wasn't really qualified to be offering the surgery. If one were to go to a competent surgeon, do you think one could expect a positive outcome to happen with external femoral fixation (gaining back full range of motion, etc)? Or should external fixation on femurs be avoided in favor of internal methods for all cosmetic cases?
Quote from: Ashoka1 on February 02, 2014, 12:50:02 AMI find the good doctor's willingness to field such a torrent of questions without any compensation in return admirable. To you, I extend absolute graciousness. I see this thread hasn't been tended to in quite some time, so I hope doc Birkholtz is merely taking respite from the frenzied onslaught. If you are ever to return, I would be indebted to you if you would be willing to take a moment of your precious time to grant insight to the following questions I've been yearning to have answered. I'm currently undergoing LON in India, by the way.
There are many occurrences in our guest house that have not been given satisfactory answers by our doctor. Could you provide generalized answers to the following?
1) Many of us have noticed that the rings on our Ilizarov fixators have been installed with the centre of the rings heavily displaced to one particular side. ie. there is a gap of only a few cm. between the frame and the inner side of my knee but there exists a great many cm. gap on the outer part of the knee with the frame. Our doctor assured us that this will have no bearing on the distraction quality of the frame, but in my layman mind I would think, through simple application of force analysis, that this displacement would cause an outer/inner pressure on the bones, causing them to bend one particular way. I would have preferred to have had my leg centred in the frame, as would have everyone else, but is this something you take into consideration when installing a frame? Everyone's legs seem to keep straight, but some people have turned in ankles and others have what appear to resemble x-legs.
2) Ever since my initial surgery I've not been able to enact function on the big toe of the left foot. The doctor continually assures me its function will return. He seems unsure as to what the cause is, though. He says it is sometimes a nerve, and other times a muscle/tendon. Is it something that should ameliorate over time, as he assures?
3) This is perhaps too audacious a request, but I would like to know if I can send a picture of my legs to you after my frames are off to see if you can identify any occurrence of x-leg. Is there a particular angle and stance one can use to readily identify the symptom? The doctor tells everyone they do not have it, but I think some must.
Thank you in advance for whenever you have the time to resolve these enquiries. I would not hesitate in considering precise femoral lengthening in the distant future with you if you were ever to absolve your practice of the height limit contraindication. I reckon to be close to 183cm after this round, but would possibly do another 5-6cm on femur if the circumstances allowed for it.
Best regards,
Ashoka
Dear Ashoka,
Thanks for the kind words... No, I haven't been scared away, but have tremendous demands on my time, as have all of you. Also, we have our summer holidays in dec/jan, so I was also away. as always, I will try and respond as quickly and accurately as possible.
Point 1: whereas eccentric mounting of a ring might not neccessarily equate to a malaligned limb, it is certainly better biomechanically to center the limb in the frame.
Point 2: although loss of extension of the big toe may be due to a muscle injury, it is usually because of an injury to the nerve that supplies the extensor hallucis muscle. This phenomenon usually occurs at the time of osteotomy and is often (unfortunately) permanent.
Point 3: You are welcome to send your xrays for a no strings attached opinion. The xray you need is full weight bearing standing, with the patellae facing forward. Them we can meaure your normal alignment. Normally we accept malalignments of 5-10 degrees in orthopaedics in general. In cosmetic work these tolerances should probably be lower.
With regards to the height limitation: this is something I have full control over. I am more reluctant to lengthen people with an increased starting height, but every case is unique.
Quote from: Smallguy on February 02, 2014, 08:32:54 AMHi Dr. Birkholtz,
Will you take me on as a patient? I'm interested in completing 8cm with internal femur by the end of 2014.
Kind regards,
Dear Smallguy,
8cm in a single go is unrealistic and the most you will get from me on femurs (provided everything goes well) is 6cm.
Getting it before the end of the year is possible (6), but full consolidation of the bone may not be complete by then.
Quote from: Kilokahn on February 02, 2014, 10:00:58 AMHi Franz,
There has been a lot of talk about whether or not external fixation on femurs is really a feasible option. Most people on the forums say not to even consider external fixation on femurs due to the likelihood of a bad outcome, but recently there has been some discussion about whether the bad outcomes mentioned were because of the method or because of going to a surgeon who wasn't really qualified to be offering the surgery. If one were to go to a competent surgeon, do you think one could expect a positive outcome to happen with external femoral fixation (gaining back full range of motion, etc)? Or should external fixation on femurs be avoided in favor of internal methods for all cosmetic cases?
The two major issues with femoral exfix based lengthening are knee contractures and time in frame.
For every cm of length gained, an adult can expect to be wearing an exfix for 1.5 - 2 months. I.e. 6cm means 9-12 months in bilateral frames.
Almost all patients with femoral exfixes have some limitation of motion after frame removal. This may be acceptable in Trauma, but probably not in 'normal' people who need CLL.
Wooo, the king is back! 
Dr. Birkholtz, what is your opinion on releasing the ITB when lengthening femurs? Some doctors support it, but other doctors are strictly against it and mention that it can result in permanent athletic ability loss.
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