Dr Franz Birkholtz (Pretoria, South Africa)

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Quote from: yyes on February 08, 2017, 08:00:17 PMThank 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?

Good question.
There are areas where it is really unsafe as in almost any country in the developing world. The hospitals an environments where I live and work are probably safer than a lot of big cities in the US. Be that as it may, the best would probably be to schedule a short holiday and combine that with a consultation and planning visit.

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Quote from: onemorefoot on February 08, 2017, 08:36:31 PMSome 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!!

In my experience products generally tend to take a lot longer to get to market than the rumour mill would suggest. Whether the company will kee the price similar and whether they will withdraw the 'older' models I don't know.

Remember that the Synoste Chrome Cobalt nail is also on the horison.

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Quote from: SAD on February 09, 2017, 06:13:23 AMHi 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)

Interesting question. I suspect that there are not many such studies as the groups per centre are relatively small. Also, proper assessment would require biopsy which is obviously too invasive. There are some studies on animals. In broad terms the muscle and vessels also grow with the bone and end up being of a similar structure than originally. Some of us are looking into getting better outcomes data through ongoing research.

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Quote from: Franz on February 09, 2017, 01:19:42 PMGood question.
There are areas where it is really unsafe as in almost any country in the developing world. The hospitals an environments where I live and work are probably safer than a lot of big cities in the US. Be that as it may, the best would probably be to schedule a short holiday and combine that with a consultation and planning visit.

What about staying in a hospital for lengthening phase?

Seriously i'm hearing tons of horrifying stories from SA...

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I have Been trying to figure Out if with LON method a monolateral fixators can be an option, can the nail inside help to prevent misalignments or the fixator is as important as the nail.

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Quote from: YourSpaceBoyfriend on February 09, 2017, 04:40:43 PMWhat about staying in a hospital for lengthening phase?

Seriously i'm hearing tons of horrifying stories from SA...

I mean in the hotel*

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Dr. Birkholtz, thank you for taking the time to diligently answer so many questions. It is incredibly appreciated.

One last question from me: how much blood loss do you generally see in operating theatre from CLL procedures (femoral) done with the Precise nail? In your experience, do they generally require blood transfusions? If so, how safe are the blood banks in SA relative to US/EU in terms of risk of infection/disease from blood transfusions?

TIA and best regards!

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Quote from: YourSpaceBoyfriend on February 09, 2017, 04:40:43 PMWhat about staying in a hospital for lengthening phase?

Seriously i'm hearing tons of horrifying stories from SA...

As the accommodation is not directly part of the package, it is your choice to decide where to stay during lengthning.
If it were me, I would consider the Irene Country Lodge. Excellent, safe, good food and amenities, beautiful gardens and centrally located close to shops, malls, hospitals etc. I think they have a reduced rate for extended stays.

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Quote from: onemorefoot on February 09, 2017, 08:25:02 PMI have Been trying to figure Out if with LON method a monolateral fixators can be an option, can the nail inside help to prevent misalignments or the fixator is as important as the nail.

It is definitely an option. To a large extent the nail will prevent malalignment. Cost in our setting for tibial lon with circular would be the same though, so probably better to go for circular.

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Quote from: jbc on February 09, 2017, 08:43:04 PMDr. Birkholtz, thank you for taking the time to diligently answer so many questions. It is incredibly appreciated.

One last question from me: how much blood loss do you generally see in operating theatre from CLL procedures (femoral) done with the Precise nail? In your experience, do they generally require blood transfusions? If so, how safe are the blood banks in SA relative to US/EU in terms of risk of infection/disease from blood transfusions?

TIA and best regards!

As a rule, because we use percutaneous techniques and have relatively low transfusion triggers, the need for blood transfusion is the exception.

You can visit the South African National Blood Transfusion Service's website for more info. It is one of the oldest blood bank services in the world and is regarded as exceptional in terms of international safety standards. www.sanbs.org.za

Intra-operative blood loss between 300 and 500 mls at the most. There can be further ongoing loss into the 'third space'. Most healthy adults can withstand losses of around three times this much without the need for transfusion.