Dear Dr Franz,
I'd like to ask a question regarding nerve sensations during limb lengthening:
1) If a patient feels a shooting pain, which is thought to be caused by a nerve, should lengthening be stopped or is it safe to continue?
2) If a patient feels numbness and a tingling sensations at places like the sole of the foot, should lengthening be stopped or is it safe to continue?
Hi,Dr. Franz
Would you operate one leg and some time after the second leg?? When you have a discrepancy of 6-7 cm, is Safe for the supone the use of some extra length on the shoe?
Quote from: NeedForSpeed on February 14, 2017, 09:28:11 PMDear Dr Franz,
I'd like to ask a question regarding nerve sensations during limb lengthening:
1) If a patient feels a shooting pain, which is thought to be caused by a nerve, should lengthening be stopped or is it safe to continue?
2) If a patient feels numbness and a tingling sensations at places like the sole of the foot, should lengthening be stopped or is it safe to continue?
This is a difficult question to answer, as I do not have the full context of the patient. In broad terms, if this were my patient, we would slow the rate of distraction down. It is extremely important that these symptoms be discussed with the treating surgeon as soon as possible.
Quote from: onemorefoot on February 14, 2017, 09:54:23 PMHi,Dr. Franz
Would you operate one leg and some time after the second leg?? When you have a discrepancy of 6-7 cm, is Safe for the supone the use of some extra length on the shoe?
I guess the question is whether one leg can be done and then the second leg later?
I am hesitant to do this, as this will leave the patient with a 6cm leg length discrepancy after the first surgery. If, for some reason the patient cannot return, it would be permanent.
It is also significantly more expensive than simultaneous bilateral surgery.
Another alternative would be cross-over surgery, where one femur and the opposite tibia are done at the same time. Once femur can take weight, the opposite combo of segments can be done. In this way, the LON leg becomes the stong one taking most of the weight.
Hello Dr Birkholtz, I hope you are having a good day in South Africa. Truly a beautiful country.
If you would humor me, I would like to ask some questions.
1) In your personal opinion and speaking very generally (every case is unique of course), if a man in peak physical fitness, young, flexible and dedicated to PT (Apologies, this sounds very odd) underwent the procedure, lengthened a reasonable amount of 3-4CM per segment for a total of 6-8CM gain and no complication arose, would you expect the patient to recover to a point where they were physically able to run/casually play sports to an acceptable standard?
2) I often see safety limits given as an absolute number. Would % not be more accurate, for example would 5CM on a short tibia be a much more difficult prospect than on a much larger tibia? Or are general safety limits just that, general and should be advised on a case by case situation? Do you have an upper limit you personally advise? Is it true plastic deformation occurs when the soft tissue cannot stretch anymore and is damaged more and more by further lengthening?
3) I see you stated that it is much safer to undergo cosmetic limb lengthening surgery now than 5 years ago, do you anticipate that such advancements in safety and results will carry on in the next decade? I assume this is because developments in orthopedic correction of deformity are technically the same developments that would be applied to cosmetic lengthening correct?
4) Is it true that the soft tissue isn't that much of an issue in deformity correction because the body has usually created the correct amount of soft tissue for a longer limb? I wouldn't think this is the case for Achondroplasia and the soft tissue would be relative to limb length, yet they seem to lengthen very high amounts and don't appear to run into major issues - why is this?
5) Do you like biltong?
Regards.
Quote from: Franz on February 16, 2017, 01:58:24 PMI guess the question is whether one leg can be done and then the second leg later?
I am hesitant to do this, as this will leave the patient with a 6cm leg length discrepancy after the first surgery. If, for some reason the patient cannot return, it would be permanent.
It is also significantly more expensive than simultaneous bilateral surgery.
Another alternative would be cross-over surgery, where one femur and the opposite tibia are done at the same time. Once femur can take weight, the opposite combo of segments can be done. In this way, the LON leg becomes the stong one taking most of the weight.
.
Very good option, I think 11-12 cm is still a safe amount doing this un Cross way. Would the price be exactly half of the original in each technique? More or less 35k USD.
I forgot to ask one thing: talking about subsidence, is it only a problem with pure external or there is still a chance using an hybrid method( LON, LATN)? I have read diaries of patients using pure external and lose like 1.5 cm, I hope this is not the case with hybrids.
Quote from: onemorefoot on February 17, 2017, 04:27:10 AMI forgot to ask one thing: talking about subsidence, is it only a problem with pure external or there is still a chance using an hybrid method( LON, LATN)? I have read diaries of patients using pure external and lose like 1.5 cm, I hope this is not the case with hybrids.
Conceivably, once the nail or plate is locked, the only way the bone can shorten is by the nail or plate bending or failing.
Quote from: 682 on February 16, 2017, 05:46:44 PMHello Dr Birkholtz, I hope you are having a good day in South Africa. Truly a beautiful country.
If you would humor me, I would like to ask some questions.
1) In your personal opinion and speaking very generally (every case is unique of course), if a man in peak physical fitness, young, flexible and dedicated to PT (Apologies, this sounds very odd) underwent the procedure, lengthened a reasonable amount of 3-4CM per segment for a total of 6-8CM gain and no complication arose, would you expect the patient to recover to a point where they were physically able to run/casually play sports to an acceptable standard?
2) I often see safety limits given as an absolute number. Would % not be more accurate, for example would 5CM on a short tibia be a much more difficult prospect than on a much larger tibia? Or are general safety limits just that, general and should be advised on a case by case situation? Do you have an upper limit you personally advise? Is it true plastic deformation occurs when the soft tissue cannot stretch anymore and is damaged more and more by further lengthening?
3) I see you stated that it is much safer to undergo cosmetic limb lengthening surgery now than 5 years ago, do you anticipate that such advancements in safety and results will carry on in the next decade? I assume this is because developments in orthopedic correction of deformity are technically the same developments that would be applied to cosmetic lengthening correct?
4) Is it true that the soft tissue isn't that much of an issue in deformity correction because the body has usually created the correct amount of soft tissue for a longer limb? I wouldn't think this is the case for Achondroplasia and the soft tissue would be relative to limb length, yet they seem to lengthen very high amounts and don't appear to run into major issues - why is this?
5) Do you like biltong?
Regards.
The short answer to all your questions, especially number five is YES. :-)
1) Yes, but it does depend on the individual circumstances.
2) Again, yes. To be 100% safe, the limit is 0cm lengthening. But life is not absolute and everything is a balancing act of benefit vs risk. My suggestion is to choose a good surgeon and then follwo his/her advice re safe limits. Personally I am comfortable with a risk-benefit ratio of around 5.5cm for femorals and 4.5-5cm for tibials. If the patient's starting height is more, maybe these numbers can be increased somewhat.
3) There is constant invention of new techniques and devices and development of existing ones. Technologies like Precice represent somewhat of a Revolution in thinking (disruption of the market). What will logically follow for the next few years will be gradual evolution of the system until the next revolution takes place.
4) Generally contractures in post-traumatic deformity is less of an issue. Achondroplasia is an interesting one. It is a condition that has its origins in abnormal collagen. You will recall that collagen also makes up most of the muscle and tendon structures. Because of this, these patients have much more supple soft tissues that allow tremendous amounts of lengthening quite safely.
5) Again Yes. Biltong is difficult to describe. It is a salt cured air dried meat, not dissimilar to Jerky or even Bresaola. But it needs to be experienced locally to really appreciate it. If you have gout, South Africa is maybe not the best place to visit! Barbecue, red meat, wine and beer is pretty much part of life down here.
Quote from: onemorefoot on February 16, 2017, 09:05:56 PM.
Very good option, I think 11-12 cm is still a safe amount doing this un Cross way. Would the price be exactly half of the original in each technique? More or less 35k USD.
Yes around there.
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