Dr Franz Birkholtz (Pretoria, South Africa)

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Quote from: drew on February 06, 2014, 08:26:51 AMHi Dr. Birkholtz,

Can the knee problem be solved in full by using this approach? Can you please clarified what this means?

Femoral lengthening with a rail external fixator:
 
“ Subtrochanteric femoral lengthening has the advantage of minimal interference with Knee ROM.”
The short answer is no. Because the osteotomy is further from the knee when doing it at the top of the femur (subtroch region), the risk of knee contracture is decreased but not eliminated. This area does not create good regenerates and as such, frame times can be longer.


“The cortical thickness of the femur rapidly increases distal to the lesser trochanter. This can sometimes make the osteotomy more difficult and predispose to a greater likelihood of crack propagation to the nearest pin. Due care and attention are needed, creating a ‘clean’ osteotomy…”


Thank you

What this means is that breaking the bone improperly in this region has a tendency to shatter the bone. This can break into the pins and cause the fixator to become unstable.

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Quote from: Smallguy on February 06, 2014, 03:32:27 AMHi Dr. Birkholtz,

Thanks for your reply. I already lengthen 8cm in the tibias and I'm looking to have the plates and rod remove in Canada in May. So what do you think would be the best time for me to start internal femur lengthening? And what method would you use? Can you purchase the precise 2?

The question is how well you have recovered from the tibial lengthenings. If you still have ballerina foot (equinus contracture) or knee flexion contracture (inability to fully straighten the knees), i would not proceed with the second phase.
My choice for femoral lengthening would be intramedullary lengthening.

We have Precice 2 available now.

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Quote from: rickybobby on February 08, 2014, 01:07:10 AMFINALLY,

We found a DR, that is generous enough to respond to our concerns.
Thank you so much for your time!!!

Dr. I have a couple of questions

1. On femoral lengthening how do you prevent valgar deformity and vulgus deformatiy from forming on our knees while lengthening?

2. Do you use forteo on patients that have a very small bone cloud or nonunion?

3. What do you think about the weight bearing ability of the alibizza nails for the 13mm diameter nail given that betz/guicet both allow weight bearing with crutches?

4. Do you use titanium nail replacements if the precice nail gets bend and can you get titanium screws in the proximal and distal portion for added support

5. The precice2 nail is 75 pounds weight capacity per leg is that for all the diamaters of the nails? Also if you weigh more than 150lbs are you in a wheelchair bound during the whole time of lengthening?

6. Is it possible to lengthening to lengthening at home and take the erc device with you?

Thank you so much for your time!!

For q4. I would like to add: "whats the price of titanium if I chose to have it right after lengthening?"

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Hey doc,

Thank you for the prompt responses. I can move my toe in circles and can feel it and everything, it just won't flex upwards. Would this minimal movement indicate that the nerve is still intact, or are the nerves for these movements separate? I really want to get my toe's function back, but I heavily appreciate your honesty. My doctor is never that forthcoming. He keeps saying it'll come back, but in the back of my mind I knew that it is something that seems like it might end up being permanent. If it never returns to normal function, should I be able to walk and function normally?

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Forgot to let you know, for when you answer, doc, that my username is now Polycrates (from Ashoka). To expound some more on what's happening, I told my physio about the nerve damage today and he tried telling me that if it were a nerve issue the whole foot would be dropped. He says proudly how he's studied over 6 years in physiology so I'd hope he know, but even from the little I've read, I know there exists several branching nerves supplied by the main tibial nerves. It would be one of these that would have been severed, correct?

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Video of paralysed toe:

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HI Dr. Birkholtz,

You are very smart and kind thank you!

5cm – femoral lengthening using monorail method what is the rate of time in most cases to regain full ROM after the device is removed?

(I’ve heard that it takes 5 months)

I look forward to hearing from you
Drew

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Dr. Franz,
Upfront question...how many precise rod have you implemented? Any way we can see the x-rays. It may be helpful for posterity.

Also, do you allow about 7.5 cm on femur if rehab is good.
Thanks

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Quote from: Polycrates. on February 10, 2014, 02:21:21 PMForgot to let you know, for when you answer, doc, that my username is now Polycrates (from Ashoka). To expound some more on what's happening, I told my physio about the nerve damage today and he tried telling me that if it were a nerve issue the whole foot would be dropped. He says proudly how he's studied over 6 years in physiology so I'd hope he know, but even from the little I've read, I know there exists several branching nerves supplied by the main tibial nerves. It would be one of these that would have been severed, correct?
Look, there is a possibility that it may return. If it is a nerve, it is the branch that supplies the muscle to the big toe and would certainly not give sensation loss in the whole foot.
Hope it returns!

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Quote from: drew on February 12, 2014, 04:20:37 AMHI Dr. Birkholtz,

You are very smart and kind thank you!

5cm – femoral lengthening using monorail method what is the rate of time in most cases to regain full ROM after the device is removed?

(I’ve heard that it takes 5 months)

I look forward to hearing from you
Drew

Jip, 5-6 months. This is the main advantage of precice. The rom returns sooner.