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Dr. Alexander Kirienko (Milan, Italy) - Ilizarov Tibia

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Hobbit99
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Posted on Nov 29, 2023, 4:00 pm
#31
Quote from: Body Builder on November 29, 2023, 03:53:26 PMWhat else could he do? We are talking about pure externals here.

For 6cm you will need close to 9 months if you have a normal consolidation.  For 6.5cm you will need about 20 days more so closer to 10 months. 8 months is too optimistic especially for 6.5cm.

I don't exactly remember what he said but I think it was 2 months for lengthening + about 6 months for consolidation. For 6 cm. But I don't mind keeping my fixators on 1 or 2 months more.

What I care the most is start to walk better even with fixators on. He says the after lenghtening even if I need to correct the procurvatum I will have less pain and when the knee will be more straight I will be able to use crutches and later later on even walk without crutches.

For now just some little painful (but especially tiring) steps with a walker. Some day it's easier and I walk more, some day it's harder. I even climb up and dawn stairs with the help of the physiotherapist even if it's a bit painful but the doctor encourages me to weight bear because it stimulates bone growth.

EDIT: now at 4,3 cm I'm starting to have serious difficulties stretching the knee. It's painful and often stays flexed until I do a lot of painful stretching. I'll see what the doctor says next time. My physiotherapists told me I need to stretch more when I'm alone and probably in a week I'll be better.
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Hobbit99
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Posted on Nov 29, 2023, 4:04 pm
#32
Quote from: Beemer m3 on November 29, 2023, 01:49:34 PMare you going to bone consolidate with the frames on? i wonder why is that?

Of course. I don't have any intramedullary nail. This is not LON but classic ilizarov. My fixators act as an exoskeleton and bear my whole body weight.
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Hobbit99
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Posted on Nov 29, 2023, 4:42 pm
#33
I also read on this forum somewhere that after fixator removal you lose some millimeters. I asked his assistant and he said it doesn't happen if the bone if strong enough prior to removal. I will also ask him the same question next time just to be sure.
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limby101
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Posted on Nov 29, 2023, 8:45 pm
#34
Are you still on 1 mm/ day?
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Hobbit99
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Posted on Nov 29, 2023, 9:31 pm
#35
Quote from: limby101 on November 29, 2023, 08:45:26 PMAre you still on 1 mm/ day?

yes. Let's see if he will suggest me to slow down next time.
My next appointment is on december 9
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Body Builder
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Posted on Nov 29, 2023, 10:58 pm
#36
Quote from: Hobbit99 on November 29, 2023, 04:42:17 PMI also read on this forum somewhere that after fixator removal you lose some millimeters. I asked his assistant and he said it doesn't happen if the bone if strong enough prior to removal. I will also ask him the same question next time just to be sure.
No need to ask again, he is right. Most people remove the fixators too soon and they lose about 10% of the lengthened height. I had a very strong callus and didn't lose even 1mm after I removed my monorails.
Also you should slow down. Most llers can turn up to 0,66mm on tibias without any danger of premature consolidation after about 3cm with 1mm per day. If you continue with 1mm till the end then there is a risk of major equinus after 6cm. Even now you have some trouble with keeping.your knees straight as you said which is another reason why you should slow down the distraction rate. With 0,66 mm till 6.5 cm you will be fine.
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Hobbit99
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Posted on Nov 29, 2023, 11:02 pm
#37
Quote from: Body Builder on November 29, 2023, 10:58:14 PMNo need to ask again, he is right. Most people remove the fixators too soon amd they lose about 10% of the lengthened height. I had a very strong callus and didn't lose even 1mm.
Also after 3-4cm slow down. Most llers can turn up to 0,66mm on tibias without any danger of premature consolidation after about 3cm with 1mm per day. If you continue with 1mm till the end then there is a risk of major equinus after 6cm.

I don't think I can slow down if he doesn't tell me I should. I will ask. For now I don't have any equinus, just bent knee that it's painful to stretch. He said he was still okay alst time but now after another 4mm I feel it's worse. I'll try to stretch more. If it gets worse before the next appointment I will call him or send him an email.

So you did the lenghtening with a monorail fixator, not circular?
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limby101
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Posted on Nov 29, 2023, 11:23 pm
#38
Hey,
Can you describe your knee issue?
Is that a muscle pain when you straight your leg or is it a knee joint issue or some other thing?
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Hobbit99
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Posted on Nov 29, 2023, 11:33 pm
#39
Quote from: limby101 on November 29, 2023, 11:23:23 PMHey,
Can you describe your knee issue?
Is that a muscle pain when you straight your leg or is it a knee joint issue or some other thing?

I think it's the gastrocnemius proximal insertion. I have pain around the knee when I try to straighten the leg, especially the left one. After some stretching I can reach 180 degrees but today for some reason is more difficult. The calf is also bigger and sturdy. Usually after I walk a bit my legs gets straight, but today they were still slightly bent when walking. So my physiotherapist said I need to stretch my legs constantly during the day. Problem is that after a bit with straight leg laying down I get nerve pain, not around the knee but on the lower-anterior part of the leg. It's getting hard, but I knew it.

My feet are still straight with no equinus.
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Body Builder
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Posted on Nov 30, 2023, 4:27 am
#40
Quote from: Hobbit99 on November 29, 2023, 11:02:52 PMI don't think I can slow down if he doesn't tell me I should. I will ask. For now I don't have any equinus, just bent knee that it's painful to stretch. He said he was still okay alst time but now after another 4mm I feel it's worse. I'll try to stretch more. If it gets worse before the next appointment I will call him or send him an email.

So you did the lenghtening with a monorail fixator, not circular?
Of course you should speak with your doctor first but insist about it. You should not keep the 1mm rate till the end because it is gonna make your soft tissues too stiff and your rehabilitation will be way harder.
Yes I used monorails without any internal nail.
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