Dr Alex Monegal (Barcelona, Spain) Clinica Diagonal

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I think you can finance the inplants fitbone. But it's better you speak with doctor Monegal.

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Quote from: Dr Monegal on December 21, 2014, 10:40:52 PMLet me say it this way..one patient died after bilateral simultaneous femur doing intramedullary device (fortunately not one of my patients) and it s not a matter of safety, it is a matter that if surgeons are aware of this, none of them will carry on doing bilateral because of legal issues.
Quote from: KiloKAHN on December 16, 2014, 08:21:55 PMI asked Dr Parihar's assistant Dr Ahuja (or Dr Divya as I always called him) about doing one leg at a time as opposed to bilaterial tibs or bilateral femurs to help prevent embolism and he responded "But you are still reaming two bones, how are you reducing the risk of embolism?"

I think the subject of fat embolism is interesting here. As Dr. Parihar's assistant suggests, you will still be doing both legs in the end. So the total risk of experiencing fat embolism will not be changed overall.

As I can imagine it, the advantage of doing it in two stages would be that if you are prone to fat embolism (or your surgeon is too aggressive in reaming), doing it in two stages would likely ensure the resulting embolism would be smaller as it would be coming from only one femur, and not possibly both femurs simultaneously.

A fat embolism from one femur would be damaging, but a fat embolism from both femurs simultaneously could be catastrophic.

But if this is the main concern regarding doing both femurs in the same operation, there is another solution. You could do one femur one day. Then one or two weeks later, he could do the second femur. You would still be spacing the operations apart. This provides the benefit of avoiding the possibility of bilateral femoral fat embolism. But it still allows you to get both legs lengthened over the same time frame.

The disadvantage of course is that you need to go under anesthesia twice, but I think could be worthwhile. Also, having both legs broken simultaneously means you can't be weight bearing on one leg during recovery. But for example, for myself, I don't think having one leg to hop around on would be that helpful anyway. I need to be able to stand and walk freely for my job. Personally, I would rather be in a wheelchair for 3 months than hopping around for 6-7 months.

I think Dr. Monegal raises a good point about avoiding reaming both femurs during the same operation. But as I have described, that does not necessitate letting one leg fully heal before doing the other. Even spacing the two operations a few days would be sufficient, providing the first operation goes without complication.

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On another note, I've been thinking more about Dr. Monegal's suggestion to consider doing femur & fibula simultaneously.

I think I may be sincerely considering it. The benefits are you maintain a better tib/femur ratio. In addition, because each bone has less to grow, the time for distraction/consolidation are both cut down.

Hypothetically, if you did 2.5" femur and 1.5" tibia with both legs (staggered 1-4 weeks), you'd be looking at:

- 63 days distraction (1mm/day femur)
- 6 months consolidation (based on consolidation index of 1.07 (0.75–1.62) months/cm)

In other words, it's a 8 month process for 4" balanced over all four segments. And since you're not stretching more than one segment very far, the contractures should be better spread around and less intense in any one spot. I am guessing you could start using crutches roughly half way through consolidation, so maybe 4-5 months in a wheelchair.

If you did each leg one at a time, you would be looking at a 1 year process.

I think this may be a valid option in particular because it maintains normal proportions. With Dr. Baumgart's Reverse Planning Method which Dr. Monegal uses, you also have the potential for perfectly aligned limbs after - likely better than they are before. I have a bit of tibial varus but my tibias are too long to be lengthened exclusively. So this appeals to me greatly.

It's a shame that the nail isn't full weight bearing. This would otherwise be an expensive but otherwise near perfect approach.

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Dr Monegal said I could go to Barcelona to watch one of his surgeries but he doesnt answer my emails nows. Dr Monegal, are you there? When can I go to watch one of your surgeries? Do you regret having offered this chance to me? Why don't you answer my pms?

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Dear GH

It is Not a straigth forward thing to do as you need both (Clinic and Patient) consent for you to se a procedure. As I told you you can come of course as soon as a patient gives me consent for you to watch his/her procedure.

Kind regards

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What is the price difference between bilateral femurs (1x2femurs) and unilateral femurs (2x1femur)?

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Dear Axel

Difference is basically hospital stay and anaesthetics. It is approximately 2000€.
As a cost is a bit higher but doing 2 stage allows patients to go back to a 'quite normal' activity much earlier. Most patients can go back to office work walking on crutches, si their productivity is not very much affected.
In my opinion It is worth to do it in 2 stage.

Kind regards

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Okay thanks,

next question haha.

A significant number of patients that lengthened their tibias complain about the loss of athletic ability.

If I try to imagine myself with lenthened tibias or lengthened femurs, I feel like lengthened tibias would be worse for my athletic ability. do you agree?

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Hi forum.
I had my other surgery with doctor Monegal, my right leg, the 11 on july. I was in clinica diagonal, with cooper, musicmaker, and other guy from spain too. Now i have lengthen 2cm more or less. I can walk with cructches in my home. The worst are the firsts two weeks, when i had more pain. The third week is better, and before this, the procedure is much more easy.
My goal is 6cm, and i hope finish in the second week of september.

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Quote from: paco1 on August 03, 2015, 07:05:49 PMHi forum.
I had my other surgery with doctor Monegal, my right leg, the 11 on july. I was in clinica diagonal, with cooper, musicmaker, and other guy from spain too. Now i have lengthen 2cm more or less. I can walk with cructches in my home. The worst are the firsts two weeks, when i had more pain. The third week is better, and before this, the procedure is much more easy.
My goal is 6cm, and i hope finish in the second week of september.
congrats bro. it seems others have been less lucky
keep well