Dr Alex Monegal (Barcelona, Spain) Clinica Diagonal

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Quote from: galaxy1 on December 28, 2014, 03:46:27 PMCorrect - he states single leg tib & femur is best suited for LLD (limb length discrepancy) patients, their physiology can handle single leg tib & femur method.

Not too sure that is what he is suggesting. He states clearly doing femur/tibia is a valid option. I bolded it for you on his email.  He just doesnt want to do it. He wants us to do 4 surgeries.

The German Doctor Baumgart does freely recommend the procedure and you can read here as he had a n interview with Daemon. He also insists on Fitbone for both uppers and lowers.

He is too damn expensive though 

http://www.limblengtheningforum.com/index.php?topic=735.0

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Quote from: TomD on December 28, 2014, 06:27:49 PMNot too sure that is what he is suggesting. He states clearly doing femur/tibia is a valid option. I bolded it for you on his email.  He just doesnt want to do it. He wants us to do 4 surgeries.

The German Doctor Baumgart does freely recommend the procedure and you can read here as he had a n interview with Daemon. He also insists on Fitbone for both uppers and lowers.

He is too damn expensive though 

http://www.limblengtheningforum.com/index.php?topic=735.0

I read darn fast sometimes! :0) Great information gathering though, I see this doctor being a viable option for some people.

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Ok I have send Dr Mongeal another email and he has clarified some things for us. Sending information through e-mail is often misunderstood or confused because we cannot see the other persons body language or the tone of their voice.

I have recieved another reply from him :

Here are my questions and his anwers

1) If pressed, will you do the 1 leg femur/tibia surgery using fitbone? It seems as though you think the procedure is fine but only for those who need correcting. Am I reading that Right?

 That s not what I said. I said simultaneous tibia and femur Was originally indicated in those comined femur/tibia LLD.
I said performing 4 surgeries (one segment at a time)  is safer but I cannot control TIME and MONEY. So simultaneous is Valid option for cosmetic LL. That s What I said.

All Fitbone users meet every year and we discuss cosmetic LL. You can read Prof Baumgart and he says exactly the same. I discussed with him the best procedure for cosmetic LL and he thinks exactly the same as me.

For those of us who are willing to do 2 surgeries, to lengthen femur/tibia is the best option compared to bilateral. I said that several times.
I have currently patients doing simultaneous femur/tibia.

I have said several times that this is a Valid method.


2) Are you willing to compromise? Do 1 femur, then the tibia a few months later like you prescribe, and once those are healed and 100% weight bearing then do the other leg femur / tibia at the same time? 

It s not that complicated. If you want to perform 4 segment you have 2 options:

1- 4 procedures
2- 2 procedures (simultaneous fem/tib one leg)

I do not perform simultaneous femur or simultaneous tibia (bilateral) because I do not want you to put patients in risk and wheelchair.

Probably I don t make myself clear but my mentality and system is exactly the same as other Fitbone users. You can read prof Baumgart s thread and it s very clearly explained.


Notes:

I hope this puts it all to rest (finally)


Now I am back on board. I want to send some emails to Dr Baumgart in Germany to see if he has any added imput on the 1 leg femur / tibia combination. Questions I would have for both doctors are the type of prosthesis used to prop up the shorter leg while the other one is lengthening , and the total time required before we can stand on the first lengthened leg and do the other one.

Thank you again to Dr Mongeal who has taken time from his very busy family life to make sure he answers all our questions.

 

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Hi TomD

Good job finding valid information.  I can see you are quite persistent   I am wondering what you do for a living. 

This time, the answers from Dr. Monegal are quite clear. 

If one want to do 4 segments surgery, there will be only 4 choices.

1. 1 segmet -> healing -> 2 segment -> healing -> -> -> 4 segment -> healing:  Safest, but most time cosuming and expensive, very unlikely that people would want to do this.
2. 2 segments at one surgery: bilateral (Femurs or Tibias) -> another bilateral: However, Dr. Monegal does not perform this due to the safty. If one wants to do this method not necessarily by fitbone, one can find other options like precise 2, Betzbone, or Guichet nail (improved version of Albizzia)
3. 2 segments at one surgery for one leg (femur + tibia) -> consolidation -> another 2 segments for one leg: This is a valid option that Dr. Monegal probably would do.
4. 2 segments at one surgery for two legs at cross positions (femur + tibia) -> another 2 segments: I heard that some Dr. may do this and of course Dr. Monegal wouldn't do.  It sounds very weird and very likely that most of people wouldn't consider this.
 
Considering possible aspects, most of people would go for 2 or 3.  However, if one want to do just 2 segments or only bilateral (femurs or tibias) without considering 4 segments, one may need to find a doctor who does bilateral surgery, since Dr. Monegal generally does not consider this.

Many Thanks to Dr. Monegal for your time and effort for answering many questions. 

TomD, I also have the same questions as you about the time, although Dr. Monegal mentioned about the time earlier, it seems still a little unclear to me. Or it could be depending on patients though.  Regarding prosthesis, I remember that Dr. Baumgart also can do one leg for 2 segments followed by another leg surgery and provides a special shoes that can be adjusted for the height.  His time schedule for this type of surgery seems longer than what Dr. Monegal said.  Anyway, once you have some answer from Dr. Baumgart, please post it here again.  I am very looking forward to seeing them.  Thanks a lot, TomD

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My name is Xavi, I'm 33 years old, I’ve got athletic build, my weight is 63 kg and my height was 166 cm.
For personal reasons, become taller, it was my life dream. My legs were slightly curved and they were quite short in compare with the trunk. Also, I've broad shoulders and they seemed disproportionate to my body.
I’ve been walking with shoe insoles until now, because I usually felt lumbar pain. However, I've always been a running lover, but for a long time, I couldn't run because always ended with contractures in the knees or plantar fasciitis.
In August from 2014, I was searching the Internet, when suddenly I found Dr. Alejandro Monegal expert and authorized by Wittenstein Intens in bone lengthening by Fitbone system. He is one of the 25 doctors in the world, who practice this type of surgery.
In September I had the first interview with him. He had empathy with me and he understood perfectly my problem and my complex.
The 16th of October, he made me the first intervention surgery of my left leg. He introduced the Fitbone system inside my femur. Before, we had been agree to do an elongation of 6 cm. At the end, my height is 172 cm. My dream was come true!
Eight days after the surgery, I began with two pulsations of Fitbone system (0.27 mm each pulsation) each day.
11 days after the surgery, I could start walking with crutches. I've been walking 45 minutes every day.
In October 30, I stopped taking painkillers. At that time, I was connected the Fitbone system three times every day.
November 3rd I started working. My life it was more or less normal with crutches limitations.
November 13th I'm connected the Fitbone four times each day. From the third centimetre, I begin to feel some tenderness in the fracture, when I connect the Fitbone system.
On December 19th I'm finished the treatment. I had grown 5 cm and my actual height is 172 cm. That was more than I’ve been expected. Dr. Alejandro Monegal had put my leg completely straight and with that I finally won an extra centimetre. Now, the ratio between the femur and tibia is perfect.
Today 4th January 2015 I can walk without crutches and my femur is consolidating well. So, If all goes well, at the end of February Dr. Alejandro Monegal will do the second surgery on my right leg.
The result is extremely spectacular, and I am very happy and pleased with the process and it seems impossible that my dream was becoming true.
I'm still doing leg stretches (hour and a half every day). It’s important that tendons and muscles have to stretched and is absolutely essential this type of stretching. It is very important to keep track of increases in footwear to adapting to the new height.
Slowly I'm breaking the leg adhesion, because I can’t bend more than 90 degrees. At the same time that the bone is consolidated is important to do some rehabilitation.
My assessment of the whole process is excellent, if you have enthusiasm, discipline and work hard every day, the lengthening process will be effective.
You can see the results from week to week. Dr. Alejandro Monegal has been an excellent surgeon for me. We talk frequently to monitor the whole process and I’m so thankful with him, because he made my dream come true.
My life is changing completely and this is a new beginning for me.
Now that's all. Once, I’ve finished the second surgery, I will write again telling my experience.
Bye and see you soon. 

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Is there any way that Dr. Monegal could do 7 cm on the tibias? Otherwise, everything looks great!

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Hi Xavi

Congrats on your progress!  Looks like your ll journey seems to go very well!
I have one question for you.  You said that Dr. Monegal also corrected your curved leg during lengthening.  How did he do that while you are lengthening your femur?  What if your tibia is curved not femur?  Is it possible to correct the curved tibia while lengthening femur?  My legs are also curved so I am very curious about it.  Can you tell me a little bit about it?

Thanks a lot!

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Quote from: musicmaker on January 09, 2015, 07:24:39 PMFor the tibias the maximum lengthening allowed by the Fitbone system is 6 cm. But ask Dr. Monegal. He will study your case and give you his opinion.

I am doing more research on internal tibias but if all goes well I am going to Dr Mongeal for my right leg then 10 months later for my left leg if there are no complications.

8cm femurs and 6 tibias. I have short femurs anyways.

I have seen the videos of his hospital, talked to some who have visited there and spoken with the Doctor on several occasions.

All I want is to talk to a patient who has done both the femur and tibia at the same time about the knee pain and drastic height gain . I want to know about the prosthetic lifts for the leg not being operated on.

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Hi Ghostfish

I am pleased to answer instead of Xavi.
All Fitbone users planify all cases as we are all trainned by Professor Baumgart and Wittenstein in Munchen Germany. We all use The Reverse Planning method (published by Rainer Baumgart) and it s a way to planify, NOT only LL But Also axial deformities and malrotation of limbs. That s one of the reasons I prefer Fitbone by far rather than others like Precice or Guichet systems. With Fitbone and Reverse planning method (Available when you use Traumacad 2.0) you can measure limbs, make allignment test and planify lengthenning and axial/rotational Correction.
It is a matter of reliabilty and Also to we in the safe zone not modifying the biomechanics of the limb. You might have seen x rays (mainly when using ex fix) where tibias finish with a terrific valgus deformity (I ve seen it in some of the x rays posted) which Will cause knee pain and early osteoarthritis.

Xavi had genu varus on his legs. We optimized his mechanical axis and lengthened his left limb. You obviously cannot modify tibia vara by operating a femur, you can improve the mechanical axis but not the tibia (if that s the origin of the deformity).
You can check Payley's malalignment test where you will find all the basics to understand How the Limb allignment works.

It is very important that patients understand that LL is not Just a matter of cm, a bad procedure can end up with a limb malalignment which might cause issues in the future.

I hope my reply Was helpful