Early union

Edit Post

Quote from: Atomic on September 22, 2021, 02:33:02 PMWhat is the reason why you prefer to slow down the lengthening speed instead of increase lengthening speed to prevent premature union ?

my reasoning behind slowing down has nothing to do with avoiding premature consolidation.

The rationale is that premature consolidation is rare in adults.

What is not rare are : joint contractures and nerve pain and poor bone formation

slowing down avoids those 3 obstacles which can cause lifelong problems.

out of HUNDREDS of lengthenings i have done, I have seen a single premature consolidation in an adult. It happened because the lady was lengthening over a mole on her skin, rather than the purple thick mark drawn during surgery…. and she failed to show up to planned followup so it was too late to recover from after weeks of not lengthening (Weeks!)

Edit Post

"It happened because the lady was lengthening over a mole on her skin"

ty!!! Curious, what does this mean? Does the precise nail magnetic lengthener work on specific areas? Is it common for patients to accidentally lengthen over the wrong spot?

Edit Post

🤣 I know right!

Precice works by using a remote control(ERc) over the internal magnet.

My preferred method is to mark the magnet with a thick purple permanent marker line . There are other methods.

lengthening may not work if the ERC is used too far away.

It is extremely rare that this happens, but instead of aligning the ERc to the line, she aligned it to a nævus/mole/birthmark that was on her skin a few inches above.. that was when we still used ERC 1

oh well, that highlights the importance of proper patient post operative education

Edit Post

Quote from: Michael J. Assayag, MD on September 18, 2021, 07:35:33 PMit depends really on each patient and circumstances. for most adult one can start at 1mm per day and quickly slow down to 0.5mm per day without too much worry about premature consolidation.

most of my patients will tell you that “slow and steady wins the race”

When you say "...quickly slow down to 0.5 mm per day...", how quickly is this for tibia for an adult generally, is it after 1 cm, after 2 cm or.. ?

Edit Post

Quote from: Atomic on September 22, 2021, 02:33:02 PMWhat is the reason why you prefer to slow down the lengthening speed instead of increase lengthening speed to prevent premature union ?

Like dr explained, premature consolidation is not usual at least after 2-3 cm. But with fast lengthening soft tissues can't catch up and that leads to equinus, bad knee rom etc, things not easily fixed even after lengthening.
So always lengthen the slowest you can. With 1 x ray each month your doctor can see if you risk premature consolidation so if there is that risk you can always start lengthening faster to avoid it. But most of the time there is no need to.

Edit Post

Quote from: Michael J. Assayag, MD on September 23, 2021, 11:36:43 AM🤣 I know right!

Precice works by using a remote control(ERc) over the internal magnet.

My preferred method is to mark the magnet with a thick purple permanent marker line . There are other methods.

lengthening may not work if the ERC is used too far away.

It is extremely rare that this happens, but instead of aligning the ERc to the line, she aligned it to a nævus/mole/birthmark that was on her skin a few inches above.. that was when we still used ERC 1

oh well, that highlights the importance of proper patient post operative education

Sounds like Precise isn't very precise!

Jokes aside, I wanted to say I really appreciate that you contribute here, answer questions and offer your opinion. Thank you!