Dr Franz Birkholtz (Pretoria, South Africa)

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Quote from: applesandoranges on February 08, 2017, 05:06:54 PMHi Dr. Franz, thanks so much for answering our questions. I'm interested in your quote about the ITB release. What exactly is an ITB release? What happens to the band after? Does it go back to normal?

The iliotibial band (itb) is a connective tissue band on the outside of the thigh. It crosses over the knee as well. As opposed to tendons, the itb cannot really be stretched too much. Because of that, it is often a major resistive force to distraction and can cause nails to malfunction and also can cause a flexion contracture of the knee. This is the reason we advocate releasing it routinely. It is not really a very complicated procedure. A small slit is made in the itb. That allows it to stretch. It then heals up with a form of scar tissue. Interestingly scar tissue is made up mostly of collagen, a protein that also makes up most of the itb. Recovery is essentially complete.

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Quote from: TIBIKE200 on February 08, 2017, 06:58:24 PM So indeed we can safely say that LL is much more safer today than even 5 years ago?

Absolutely

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Hello Dr. Franz,

I really appreciate that you have offered to help us understand the limb lengthening process through your experience

I would like to ask about the prospects of a patient who chooses to undergone a 8.0 cm lengthening on both tibias using external fixators, followed by intramedullary nailing; LATN. For a person who does such an amount of lengthening:
1) How long would a he be needing to use a wheelchair after the surgery?
2) Is weight bearing possible right after the surgery?
3) How long would one have to use crutches after 'graduating' from the wheelchair

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Quote from: KiloKAHN on February 08, 2017, 07:03:49 PMHi Dr Birkholtz,

When you first obtained access to the Precice nail, was a representative from Ellipse sent by the company to be present during the surgeries? If so, how long does that continue until Ellipse decides that a representative doesn't need to be there for the surgery every time you use it on a patient?

Good question. This differs from country to country. Ellipse was bought out by Nuvasive, so they now distribute globally. In South Africa the company sells their products through a distributor. On initial launch there was an intensive training programme. Even now we have a representative in theatre with every case. Most importantly to ensure that there is optimal safety and attention to detail. It facilitates communciation and eliminates errors. I see everyone in the surgical team as equally important. The surgeon is strengthened by the team around him or her.

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Quote from: NeedForSpeed on February 08, 2017, 07:13:38 PMHello Dr. Franz,

I really appreciate that you have offered to help us understand the limb lengthening process through your experience

I would like to ask about the prospects of a patient who chooses to undergone a 8.0 cm lengthening using external fixators, followed by intramedullary nailing; LATN. For a person who does such an amount of lengthening:
1) How long would a he be needing to use a wheelchair after the surgery?
2) Is weight bearing possible right after the surgery?
3) How long would one have to use crutches after 'graduating' from the wheelchair

It depends a little on the segment, whether tibial or femoral. 8cm is an extreme distance, and would be something I would discourage greatly.
In principle crutch walking could start within days after surgery. As with any lengthening, consolidation takes around 1.5 months per cm lengthened. This is approximately the time till full unassisted weight bearing as well.

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Dr,

If I may ask about your record, how many CLL have you preformed? How many non-CLL surgeries have your preformed? Of those how many were using the Precice nail?

I see you don't offer Internal Tibia lengthening, is there a particular reason why? (Like lack of confidence to do so, perhaps you feel the alternatives are safer?)

Have you heard about about news relating to Ellipse's upgraded Precice 2 and when it's coming out? What are your views on it?

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Quote from: Franz on February 08, 2017, 01:50:51 PM50mm lengthening:
10 days lag period, 50 days distraction period. Ie 2 months till length is achieved. Bone consolidation typically takes another 4 months. Ie by six months full unaided weight bearing should be OK. Return to sport the six-nine months after that, depending on the type of sport.

Ballpark is around 18 months.

Thank you for responding Dr. All this information is so invaluable to us.

I guess my final question would be:

What would you say to the people that are considering you as an option but are afraid to do so because of the crime rate in South Africa? How concerned should we be?

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Some months ago some user here wrote about Precice3, they are creating a cobalt nail, which can be almost full Weight bearing, the question here is if P2 Will go Out of the market like Precice1?? Or just will be an option(mainly because there are very Slim people), also the cost!!

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Hi doctor.

do blood vessels get smaller in diameter after lengthening? have there been any studies regarding this?

also, do you know of research material we can go through to understand the impact of lengthening of nerves and blood vessels? Most of the papers I find on Google, decide the outcome of a surgery based on how a patient feels, but not quantitatively. Is there research done that quantitatively compares the before - after states of lengthening? (like an EMG test before and after)

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Quote from: Alu on February 08, 2017, 07:42:51 PMDr,

If I may ask about your record, how many CLL have you preformed? How many non-CLL surgeries have your preformed? Of those how many were using the Precice nail?

I see you don't offer Internal Tibia lengthening, is there a particular reason why? (Like lack of confidence to do so, perhaps you feel the alternatives are safer?)

Have you heard about about news relating to Ellipse's upgraded Precice 2 and when it's coming out? What are your views on it?

Hi,

I do not specifically count my numbers. Lengthening and limb reconstrction surgeries more than 2000. CLL with Precice around 10. Other non-CLL Precice around 20.

The imformation leaflet is somewhat misleading. Sorry about that. Tibial Precice is offered for the same package as femorals. Confidence is not an issue. Anterior knee pain risk with Precice still about the same as for LON. Weight bearing with LON better than Precice. COst significantly higher with Precice. Therefore I am probably a bit biased to prefer LON. :-)