Giotikas will use Gichet Nail

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Hey guys,
Giotikas told me today that Precise will be back in Europe in September, but he will also start using G-nail because it's weight bearing. My first thought is to wait for Precice and, if there are more delays, do G-Nail. However, I would like to know your opinions.
More info:


https://www.athensbjr.com/introduction-of-g-guichet-nail/

https://www.athensbjr.com/methods-of-bone-fixation-in-limb-lengthening/#1586804812044-2153da5a-68a1

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Quote from: Highest on July 31, 2021, 09:32:28 AMWasn't the issue with g nail runaway lengthening and the inability to reverse? Have these been corrected?

No, it can't reverse. It's obviously a clear disadvantage, but of course, I have also to consider weight bearing instead of being months on wheelchair. I don't know what runaway lengthening is. I apologize, as English is not my main language. I'm so conflicted right now.

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Quote from: Want-3-inches on July 31, 2021, 10:07:33 AMrunaway lengthening is when the clicks happen unintentionally and you keep lengthening even when you don't want to.

The biggest risk of Guichet nail is non-union.

If you don't want to use a wheelchair at all, you can do one leg at a time on Precice but you will need a long time to finish it.

But non union can be prevented by doing very regular x rays right? If there is bad bone growht, I can stop lenghtening. To be honest, my main worry is malfunction. It would be horrible to waste all this money and effort for the nail to suddenly stop working. However, Precise has also the risk of bending, so I don't reallt know what to do. I think I will wait to September for Precice and, if there are more delays, I would take G-nail. However, the weight bearing part is tempting.

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Quote from: Want-3-inches on July 31, 2021, 10:20:34 AMIf there is runaway lengthening then you can't stop. See Unicorn's diary.

Giotikas is new to the nail, so that is an extra problem.

I thought Unicorn's problems were because Guichet made her click too much? Regarding Giotikas being new to the nail, yeah, that's something to consider.
Anyway, would you choose Precice? I'm leaning to wait to September. After all, I just want 5.5 cm.

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Quote from: SirStretchAlot on July 31, 2021, 12:08:22 PMI'm on Betzbone, which is almost identical to the Guichet nail. Both derive from the Albizzia nail.

1) Guichet uses a similar knee rotational mechanism to lengthen the nail. The rotation angle is perpendicular to your walking stance and was chosen specifically because it is not used in day-to-day activity.  It cannot "runaway." I think some people are confusing it with ISKD.

2) Not reversing would only be an issue with tibias, where malunion is much more likely to occur. Femur malunion almost never happens in healthy young adults.

3) I agree with Want-3-inches that Giotikas being new to the nail may be the biggest problem. The operational procedure and aftercare may be different. I would want to see Giotikas perform at least 5 or so procedures before trying his Guichet nail.

Thanks for the insight. In your research about Betzbone, would you say that there is a higher malfunctioning rate compared to Precice? To be honest, my biggest fear is investing all this money and effort for the nail just to stop working mid lengthening. Of course, with Precise there is also risk of breaking the nail.

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Does anyone now how much weight can G-nail take? I can't find it, all places just say it's "full weightbearing", but no actual numbers are shown.

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Quote from: Arcon on August 01, 2021, 06:31:39 AMNo, you are wrong, the main problem with unicorn was that the nail penetrated the bone which was more of a surgeon's performance issue, not the uncontrolled lengthening.  ISKD nail was notorious for uncontrollable lengthening not guichet, betzbone or Albizzia.

Stryde failed in less than 3 years since its introduction and they now need 1.5-2 years to introduce a new "Stryde" (and probably another 2 years to see how it works in the real world). We should stop thinking of it as " the standard" because it has never been as good a nail as we all thought.

Precise-2 is good and proven, but it is non-weight bearing which means more physio and more limitation. So imo, frames may still be the best option in the tibia now but in the femur I think precise-2 , gichet nail and betzbone are all "sane" options if performed by a knowledgeable surgeon.

I agree with you. For now I think I will wait for Precice 2, specially if I can get the big nail, as I have quite a big frame for my height (I was 85 kg before dieting and getting to 74). I probably will do X rays soon to confirm that. However, if there are more delays with Nuvasive, I will consider G-Nail, and I don't think it's fair to call mechanical nails "crap" nails when there are so many recent success stories with them. I also don't think Giotikas would choose a crap nail, as he earns the same with Precice, the price changes are due to the nail itself.

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Quote from: KrP1 on August 01, 2021, 10:09:26 AMI sincerelly think that Precice 2 nail is the best option right now. It's a FDA approved nail , with reversal mechanism and most LL surgeons in the world use it.

Not approved in Europe though. They are hoping to get the CE mark back by September, but it would not be the first time there are delays.

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Quote from: Body Builder on August 01, 2021, 11:41:12 AMA nail that needs to paimfully rebreak your bone each time to lengthen is an obsolete crap and I am fully aware of what I am writing.
Stryde was a far superior nail in everything and yes, now it is not in market but if someome can't wait then of course precise 2 is a far better choice compared to these albizzia garbages.
With precise you lengthen almost painless, there is reverse lengthening to avoid any non union and the consolidation of the bone is much faster as you don't rebreak it every day for 2-3 months like albizzia. Also, for 2-3 months not walking unassisted is nothing of importance. I haven't walked for much more than that with my monorails and when I started walking again everything wen't fine so it is really not that important as the only reason to prefer albizzia than precise.
Maybe if albizzia had half the price of precise I would think of it as a choice (still not good). But with the same price I will keep writing that it is a joke.

And of course it has the problem of uncontrolled lengthening, and that haooened with Unicorn in contrast with what Arcon wrote.
And finally, it is not even that stable as some people want to believe. Many betzbones (the same as gnail) broke or bended.
But Giotikas probably found an easy way to earn more money, as gnail is much cheaper than precise and I am sure he will charge the same amount of money for both so it is an easy way for extra money. Simple as that.

It's not same price as Precice. It's around 7K more expensive, which is another disadvantage. However, I must consider it in case Precice keeps getting delayed. Hard to trust Nuvasive predictions at this point, and I need to do it on September at the very latest.

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I'm having a videocall with Giotikas this week and I will ask him a few doubts, I will update.