did parihar break the bones too high?

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penguinn's x-rays https://imgur.com/a/nYiru https://imgur.com/Tn2bn6O

most docs break the femurs much below

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here are some x-rays from US surgeons Dr M and Dr Paley

https://imgur.com/A4COg20

https://imgur.com/aYp9Brb

https://imgur.com/TqNLOlT

https://imgur.com/1WXNKZi

https://imgur.com/a/XXgTafU

https://i.imgur.com/nwR6ELIl.jpg

Where Dr Parihar has done the osteotomy is a very unusual place. What are the pros and cons of a more proximal osteotomy  vs a distal one?

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here are Dr Debiparshad's x-rays

https://i.imgur.com/9MiaaqR.jpg https://i.imgur.com/tdrGcBT.jpg

again far more distal

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Check out this thread by Ascending http://www.limblengtheningforum.com/index.php?topic=64696.msg170208

He and Mr Ian Bararese-Hamilton believe that the nail doesn't respond to proximal osteotomies that well. Interestingly, even Penguinn's nail did not work after surgery and they had to change it.

There has got to be a reason why every surgeon in the US does more distal osteotomies. It's science, not opinions.

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Quote from: KiloKAHN on May 17, 2021, 11:55:22 AMIf proximal osteotomy was something the Precice nail would have issue with, then that's something the Nuvasive rep who was in the OR for Penguinn's surgery would have mentioned to Dr Parihar, but nothing was said. All devices have a likelihood of having a mechanical error, which is why faulty nails are covered at no cost to the patient. It's a stretch to belive a nail failed because of the osteotomy site as opposed to the mechanics of the nail itself.

Also, 3 surgeons =/= every doctor in the US, and even listing every doctor on this site wouldn't be a fraction of that, but there are many surgeons who prefer more proximal femur osteotomies

What exactly are you worried about regarding the area chosen for osteotomy anyway?

No idea why Ellipse representative didn't say anything. Maybe this is a newly discovered problem?

The concern is really just that
a) the nail might not respond because the osteotomy is proximal. I don't have any official documentation stating this but only anecdotes
b) if it was decision taken because of lack of equipment in the OR

To quote Ascending about his surgeon

QuoteI suspect that the reason Dr E chose to do a high osteotomy in my case was because my femur was curved and he did not have a flexible drill to hand during the surgery and so he took whatever steps he could to continue the surgery.  I remember he told me after the surgery that it took 5 hours because he did not have a flexible drill for reaming which was needed because of femur curvature and so he had to go very slowly and carefully with the straight drill.

Then again, it's just strange that after going through 50 diaries I couldn't find one x-ray of such a proximal osteotomy. So I'm just looking for an explanation.

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Quote from: KiloKAHN on May 17, 2021, 11:55:22 AMbut there are many surgeons who prefer more proximal femur osteotomies

Do you have a source for this?

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Quote from: Tartar on May 17, 2021, 02:10:59 PMYou have a good eye. He performed an higher one. Giotikas too is used to do it sometimes.
Nuvasive recommends a lower osteotomy, some cms under the trochanter. Not a big deal anyway, but these are indications of the company.

Hi Tartar, are you a Giotikas patient? Did he change his ways now or does he still do proximal osteotomies? And do you have a source from nuvasive about this or did giotikas tell this to you?

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Quote from: KiloKAHN on May 18, 2021, 08:19:34 AMA shattered break during osteotomy is not uncommon, and patients with solid bone density will tend to shatter at the osteotomy site instead of being able to cut cleanly. This isn't a bad thing, and many surgeons will actually perform an osteotomy like this on purpose because it creates more surface area to promote bone growth.

While I agree I've read similar things before, I see no surgeon intentionally creating an osteotomy like this. Not Paley, not any of the US surgeons who are known for LL.

In Penguinn's case, it is understood that it unintentionally turned out this way because the nail had to be reinserted.

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Quote from: KiloKAHN on May 17, 2021, 10:19:53 PMEvery surgeon is going to have their own preference.

This is what Dr Franz Birkholtz (https://www.emedevents.com/speaker-profile/franz-friedrich-birkholtz) said about proximal osteotomies:

http://www.limblengtheningforum.com/index.php?topic=137.msg65429#msg65429

Maybe so, but if it's a Precice thing, it's something the surgeon should change his approach just for the nail.

The unknown now is whether Nuvasive officially recommends more distal osteotomies. I will see if I can get an answer somehow.

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Quote from: KiloKAHN on May 18, 2021, 10:36:05 AMDr Parihar's other Precice patients appear to be just fine. I think you're worrying too much, dude.

 

There is only one Dr Parihar Precice diary here. Are you sure these are his patients?

But yeah, it is done more distally in these.