Dr. Monegal - Tibia and Femur - Fitbone - glenn

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Thanks Deutsch Mark and Musicmaker for your different viewpoints!

My belief is that there are pros and cons between one-stage and two-stage.

My personal opinion is that two-stage is "slightly safer, but takes slightly longer." I say safer because there are less variables to manage at one time, meaning less things can go wrong. Also, in terms of day-to-day mobility, if you lose your balance while moving on your crutches, or in the bathroom, you can always save yourself by putting your weight on your good leg. I'm on crutches now so I realize that this is a big plus.

For Fitbone, there's no need for a wheelchair when doing two-stages. That's not a trivial consideration. For G-nail there is no need for wheelchair either (I think), since it's full weight-bearing. But is the mobility really comparable to two-stage patients? I'm not sure that it would be. 

But the big disadvantage for two-stage is the time involved (both in terms of number of surgeries and recovery time) and more importantly the prolonged psychological stress for the patient. This too, is not something that is trivial.

I guess every patient's value system is different, and it just depends on what aspect is more important to them.

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Thanks Deutsch Mark and Musicmaker for your different viewpoints!

My belief is that there are pros and cons between one-stage and two-stage.

My personal opinion is that two-stage is "slightly safer, but takes slightly longer." I say safer because there are less variables to manage at one time, meaning less things can go wrong. Also, in terms of day-to-day mobility, if you lose your balance while moving on your crutches, or in the bathroom, you can always save yourself by putting your weight on your good leg. I'm on crutches now so I realize that this is a big plus.

For Fitbone, there's no need for a wheelchair when doing two-stages. That's not a trivial consideration. For G-nail there is no need for wheelchair either (I think), since it's full weight-bearing. But is the mobility really comparable to two-stage patients? I'm not sure that it would be. 

But the big disadvantage for two-stage is the time involved (both in terms of number of surgeries and recovery time) and more importantly the prolonged psychological stress for the patient. This too, is not something that is trivial.

I guess every patient's value system is different, and it just depends on what aspect is more important to them.

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Hi Goldenegg, thank you for the advice!

Yep, I think I will have to do the same and find a walk-in clinic. I wonder if I can get away with just telling them that it was to correct axis deviation or valgus?

btw, how's your recovery coming along?

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Hi Goldenegg, thank you for the advice!

Yep, I think I will have to do the same and find a walk-in clinic. I wonder if I can get away with just telling them that it was to correct axis deviation or valgus?

btw, how's your recovery coming along?

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Hi Yagen,

No problem at all, my pleasure! Feel free to let us all know how it turns out.

Good luck!

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Hi Yagen,

No problem at all, my pleasure! Feel free to let us all know how it turns out.

Good luck!

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Quote from: glenn on November 07, 2015, 01:28:07 AMHi Goldenegg, thank you for the advice!

Yep, I think I will have to do the same and find a walk-in clinic. I wonder if I can get away with just telling them that it was to correct axis deviation or valgus?

btw, how's your recovery coming along?

going well- I'm about 2 months into consolidation, but feeling impatient to be able to walk without crutches until the dr clears me hopefully soon.  at first I was so excited to be done with lengthening but didn't realize I I'd still have all the same physical limitations until my bones consolidated enough.  without the daily PT sessions and clicking, I'm really just bored these days since I'm not working and in hiding from my friends and family as long as I have crutches.  once I can walk again I feel like I'll be able to get on with the rest of my life. though, I suppose I should be grateful that's my only complaint right now haha

hope life back home is going smoothly for you.  also, I was wondering if there's been any notable differences in your experience with your femur vs tibia lengthening so far (other than ballerina)? was one more more difficult or painful?  do you expect your tibia to consolidate much sooner since you did less?

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Quote from: goldenegg on November 08, 2015, 04:19:26 AMgoing well- I'm about 2 months into consolidation, but feeling impatient to be able to walk without crutches until the dr clears me hopefully soon.  at first I was so excited to be done with lengthening but didn't realize I I'd still have all the same physical limitations until my bones consolidated enough.  without the daily PT sessions and clicking, I'm really just bored these days since I'm not working and in hiding from my friends and family as long as I have crutches.  once I can walk again I feel like I'll be able to get on with the rest of my life. though, I suppose I should be grateful that's my only complaint right now haha

hope life back home is going smoothly for you.  also, I was wondering if there's been any notable differences in your experience with your femur vs tibia lengthening so far (other than ballerina)? was one more more difficult or painful?  do you expect your tibia to consolidate much sooner since you did less?

isn't Guichet nail completely weight bearing?

what is your weight?

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Quote from: SAD on November 08, 2015, 06:18:36 PMisn't Guichet nail completely weight bearing?

what is your weight?

hey SAD, Im ~60kg and have the smaller diameter gnails.  yes the gnail is fully weight bearing in the sense that you can put your full weight when standing or walking with a walker or crutches like glenn pointed out earlier.  however, you can't walk too much unaided unless there's enough consolidation.  I don't believe there is any current nailing method that really lets you walk unaided from day 1. even if the nail was indestructible there are still other weak points in the screws or bone that can break. 

I dont wanna hijack glenn's diary, but if you have anymore questions about my experience with dr. G feel free to PM me

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Hi Goldenegg!

Quote from: goldenegg on November 08, 2015, 04:19:26 AMI'm really just bored these days since I'm not working and in hiding from my friends and family as long as I have crutches.
I was just thinking: why the need to hide from people when you're in crutches? In fact, I think it would be the perfect time to ease people into your new height, since their subconscious would link the height difference as having something to do with the crutches.

Sure, everybody's family and friends are different, but it might be something you want to ponder. I think a lot of guys just use the "ski accident" excuse or something anyway. And underarm crutches are commonly only used for temporary injuries so there's no stigma attached to it.

Quote from: goldenegg on November 08, 2015, 04:19:26 AMhope life back home is going smoothly for you.  also, I was wondering if there's been any notable differences in your experience with your femur vs tibia lengthening so far (other than ballerina)? was one more more difficult or painful?  do you expect your tibia to consolidate much sooner since you did less?

Life back at home is peaceful and lazy. I've been eating too well and sleeping too much. So much so that I've got to cut down on my carbs since I'm gaining weight. I was about 57kg before surgery, now I'm 61 kg. It's not much now, but percentage wise I'm sure that if I'm not careful it can get out of control very easily and really affect my recovery.

Since I'm doing cross-leg, I guess I have a better comparison between femur and tibia since I'm doing both methods at the same time and the experience of both are fresh in my mind. Here's a list of random observations, if anybody wants further clarification let me know:

- It's true what they say, femur is easier than tibia. Your leg is just that much stronger in that segment. I still haven't finished distracting my femurs yet, but even so, my femur side is still more powerful and stable than my tibia side.
- From about 1cm to 3cm, most of the stretching pain was on my femurs. I felt nothing on my tibia side and was loose and fully flexible.
- From about 4cm to 5cm, I hit the ballerina "wall" and my foot started dropping with each millimeter I lengthened and regardless of how hard I pushed myself to stretch it was a losing battle. I felt pretty much nothing on femur side at that time.
- From 6cm onwards, lengthening pains on femur were more noticeable, but nothing compared to the stress of what I endured on tibia.
- When moving around in bed or maneuvering to a certain position, it's more painful on femur side than tibia side. Although I'm not sure if this is because I've finished tibia distraction and the femur side is still lengthening. Or maybe because there is more muscle, nerves, ligaments etc rubbing up against the femur nail compared to tibia?
- For PT, the most painful thing by far is stretching the quadriceps (again, maybe there are more nerves in that area?). Stretching calves and hamstrings were comparatively less painful by far.
- From my experience, it's far easier to "power through" femur discomfort than tibia issues.
- Psychologically, I feel more "fragile" on my tibia side. Maybe because my calves are smaller than my thighs and they have to bear more mass than the femur side. (That is, my tibia segment has to bear the weight of everything above it, including the thighs and body, while my other femur segment on the other side bears less with only the weight of the body).
- With femurs, I have difficulty bending my leg at the knee. With tibia, I have difficulty bending my ankle. In terms of biometrics and gait, it's far easier to (try to) walk normally on femur side than tibia side.
- Going up and down stairs, I rely on the femur side as my strong leg. I honestly don't know if it would be possible for me to go up or down stairs if I had done both my tibia at the same time. Again, you have no idea how important ankle flex is to normal movement until you lose it.
- When I'm in the shower and I look down at my legs, aesthetically I prefer the longer tibia. The side with the longer femur makes me look "stumpy".  This feeling goes away when I put on my underwear. I suppose it's because optically, the underwear will "shorten" the visible length of the femur. When I stand up and look at myself in a full-length mirror, I have no aesthetic preference whatsoever on which side is better. They both look just fine and normal to me (even though the knees are at different heights).

And to answer your final question about whether I expect my tibia will consolidate sooner since I lengthened less... No. my current feeling is that my femur will catch up and recover quicker since tibs are so much weaker. (IMO)

Hope this helps!