Quote from: cobalt on June 09, 2019, 07:40:39 PMHis issue arise from the surgeon's skill(cut too high, fragmented pt's bones, muscles pulling it out of alignment) and choice of method(monorail), which are poor in this case. The monorail cannot fix it like a TSF for instance can.
There will be be some varying degrees of misalignment with all internal nails the more one lengthens but Precice and Stryde are the top surgeons' choices for safety and results with least risks to patients. Precice and Stryde are engineered so that just about every competent surgeon can execute it the same. The surgeons are also vetted and initially supervised by Nuvasive team.
The misalignment will be very slight .. with the Precice and Stryde ... but safety results will be high
How fked am I? What to do about tibial misalignment?
You have the EXACT same complication that Cooper had in his tibia, done with Fitbone in Spain. This is PROCURVATUM. Cooper's was very bad according to Paley and Rozbruch. He couldn't extend his leg and thus he couldn't walk, even when his other leg hadn't been operated yet. Other patients had milder forms of procurvatum. Yagen had procurvatum too but he also had a very very bad fibula misalignment (he cropped out the xrays so that readers of his diary remained unaware of it).
You need to have PROCURVATUM corrected ASAP. When did you finish lengthening?
Hi again guys, thank you for all the input.
Now regarding Stryde and Precice2. FYI, this surgeon performs both of these as well. So if anyone thinks that the Nuvasive "quality" stamp somehow eliminates surgeons that make this type of elementary mistakes are sorely mistaken. Also, I have an internal nail, so I cannot see any reason why the situation would be any better had I chosen Stryde or Precice2. The problem is not the type of nail that is used, but the fact that there is not enough bone in the tibia above the cut to keep it in alignment with the nail itself. I do not see why using Stryde would eliminate this problem. But I may be wrong.
I am seeing at least one more doctor this week. But I do not expect him to state anything but the obvious. The doctor who performed this surgery did not apply enough force and/or used an inappropriate instrument (maybe a chisel that was unsharpened). Again, the doctor complimented me on my strong bones before surgery. Furthermore, due to my diet and exercise program, I have always known that I have a strong skeleton, period. I always thought this would be an advantage for LL surgery, but obviously not with this doctor.
I have never heard of procurvatum. But just to be clear, if I want to stand up without falling backward, I will have to keep my legs as the person to the right in the pic below, because I cannot fully extend my knee. I stopped lengthening a few days ago after a 2 month lengthening phase. Soon, I will remove the external frame and the internal nail will be locked. I am thinking that this might be a good time to somehow lock the internal nail in a way that aligns both tibias?
https://imgur.com/a/fm2iDK9
Please keep the comments coming.
Quote from: suddenurge on June 10, 2019, 12:01:25 AMHi again guys, thank you for all the input.
Now regarding Stryde and Precice2. FYI, this surgeon performs both of these as well. So if anyone thinks that the Nuvasive "quality" stamp somehow eliminates surgeons that make this type of elementary mistakes are sorely mistaken. Also, I have an internal nail, so I cannot see any reason why the situation would be any better had I chosen Stryde or Precice2. The problem is not the type of nail that is used, but the fact that there is not enough bone in the tibia above the cut to keep it in alignment with the nail itself. I do not see why using Stryde would eliminate this problem. But I may be wrong.
I am seeing at least one more doctor this week. But I do not expect him to state anything but the obvious. The doctor who performed this surgery did not apply enough force and/or used an inappropriate instrument (maybe a chisel that was unsharpened). Again, the doctor complimented me on my strong bones before surgery. Furthermore, due to my diet and exercise program, I have always known that I have a strong skeleton, period. I always thought this would be an advantage for LL surgery, but obviously not with this doctor.
I have never heard of procurvatum. But just to be clear, if I want to stand up without falling backward, I will have to keep my legs as the person to the right in the pic below, because I cannot fully extend my knee. I stopped lengthening a few days ago after a 2 month lengthening phase. Soon, I will remove the external frame and the internal nail will be locked. I am thinking that this might be a good time to somehow lock the internal nail in a way that aligns both tibias?
https://imgur.com/a/fm2iDK9
Please keep the comments coming.
What you have in that picture (person in the right) is a tale-telling sign of procurvatum. Sometimes people can't fully extend their legs because of their muscles being shortened due to lengthening. That's why stretching is recommended. However, when you have procurvatum, it's the bone that hinders you from putting your legs straight and walking. People who say this problem could have been avoided by using internals are mistaken. Cooper and other Monegal tibia patients suffered from procurvatum with the Fitbone nail. The surgeon didn't use a good technique. The surgery for correcting that misalignment isn't easy, no matter what the doctor says. Read Cooper's diary to know more.
Nuvasive wants to make sure the doctors that want to perform Precice and Stryde procedures do it correctly. You should not confuse that with greenlighting for other methods performed by these doctors. Surgeon skill does matter and their experience in handling complications that come up.
I dont know which is the biggest red flag: the fact that the doctor fked his leg or the fact that the doctor said everything is ok
can you please tell us the doctor or country?
Quote from: cobalt on June 10, 2019, 12:24:54 AMNuvasive wants to make sure the doctors that want to perform Precice and Stryde procedures do it correctly. You should not confuse that with greenlighting for other methods performed by these doctors. Surgeon skill does matter and their experience in handling complications that come up.
Oh no no no no
I know the worst doctor in the world performed precice surgery with Nuvasive techs and ended up bending bone...
Even with Stryde we must choose top notch doctors, otherwise those bad doctors will give us horrible results
Don’t go to inexperienced doctors
Quote from: suddenurge on June 09, 2019, 03:12:37 PMHi guys,
I had surgery only 2 months ago. I chose tibial lengthening with the LON method. I only wanted 5cm, so it seemed to be a fairly safe option with the internal nail supposedly preventing misalignment. I have just finished lengthening around 5 cm and had my tibias x-rayed (see below). Anyway, as you can see in the x-rays the cut of the left tibia was very poor and left me with very little posterior bone above the cut. On the right tibia, the cut was a little bit better but left me with a posterior fracture where the yellow arrow is. As a consequence, it seems that there is not enough strong posterior bone on either leg to guide the upper part of the tibia along the nail. I suppose, due to the tightness of muscles, ligaments, and lack of bone to force the tibia above the cut to stay in alignment with the nail, it has become misaligned with the tibia below the cut by about 10 degrees on both legs (the angle should be about 90 degrees, I assume). As a side-note, the misalignment is also clearly visible from the outside as big hard bumps in the skin (no pics, sorry). Also, the knees are sore all the time, especially the left knee. I think this has to do with how the external fixators were positioned on my legs. It is as if the angle between where the fixator is attached to my ankle and where it is attached to my knee is wrong. Especially on the left leg, it seems as if it hinders me to fully extend the leg.
x-rays:
https://imgur.com/sP3Rl3S
https://imgur.com/bS4g1C0
I don't understand how this could happen. The doctor told me before surgery, that I have very good and strong bones, so it must be that he did not apply enough force to break the tibias cleanly. Also, I think he cut the bone too high. What is the point of having an internal nail to avoid misalignment, when there is not enough bone around the nail to force the tibia in alignment? Of all the complications, I contemplated before surgery, this never ever crossed my mind, and I cannot seem to find something similar on this forum. I will not write the doctors name here at this point, because I am dependent on his care, and I am not sure he approves. I hope you understand.
Unbelievably, the doctor has told me that I do not need to worry, as the new bone will magically correct the align by itself. But I am not sure what he means by that. Sure new bone will connect the parts somehow. But I highly doubt that it can bring down the angle from 10 to 0 degrees because it seems that this would require some serious force to overcome the opposing forces that facilitated the misalignment in the first place. I am deeply worried that if this will heal with the 10-degree misalignment, as I cannot stand straight. After consulting with an orthopedist that is not a LL specialist, he expressed the same concern and said if the misalignment is not reversed, I will not be able to extend my lower leg fully and will, therefore, have a permanent slight bend in my knees. Also, I suppose, having a misalignment will lead to stress on joints and back because of improper load bearing?
Has anyone had a similar problem? What can be done to resolve this? How much time do I have to fix this before it consolidates with misalignment? I would really appreciate if the community would give me some solid advice that I can bring up when I talk to the doctor next week.
It seems that your doctor don’t know what he’s doing
Forget about this doctor and go see highly experienced doctors
If your doctor were competent, he wouldn’t have made such a bad mistake and never say such stupid things
It’s very obvious he cannot do anything now
You’ll probably need to change your frame to TSF to fix alignments
Some people think it’s easy to handle TSF because it’s computerized adjusting
But in fact with any kind of frames, doctors abilities and philosophy is very important to bring good outcomes
I would never trust your doctor
He can even worsen the complications you already have
Hi again guys,
Let me just say that I perfectly understand why so many sent me PM:s asking for the name of the doctor. However, I strongly feel that I should give the doctor a chance to change his mind first and come up with a solution. Even though it is hard to admit it, what is done is done, and all that matters now is how he deals with it. But, let me at least assure you that he is not one of the more common doctors that you so often read about in patient diaries. I am really thankful to the other doctor that I met last week who raised the alarm whilst it is still time to do something about it, without him, I would most likely never found out until the misalignment was a permanent disability.
I have another question for the forum. Let us say that he refuses to deal with it. What European doctor would you recommend to fix this?
Quote from: cobalt on June 10, 2019, 12:24:54 AMNuvasive wants to make sure the doctors that want to perform Precice and Stryde procedures do it correctly. You should not confuse that with greenlighting for other methods performed by these doctors. Surgeon skill does matter and their experience in handling complications that come up.
But my point is that the break of the bone is exactly the same procedure whether or not you are using LON or Stryde. It is the most basic and fundamental step which all lengthening processes with internal nails rest upon. So it is really not the question of being an expert in one method but not the other.
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