How LL (inevitably?) misaligns joints, creates x-legs, and causes joint pain

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QuoteThis is simply how growth occurs.

This ain't no proof. You didn't give me any links or studies regarding what you're claiming with 100% confidence.

Quote from: KiloKAHN on April 08, 2015, 08:28:10 PMI think risking some pains in the future due to misalignment from internal LL is probably better than dealing with the complications of external femur lengthening. Even Dr Birkholtz said that internal femur lengthening is preferable to external femur lengthening, even though the latter doesn't give you the misalignment problem.

To be fair, if you assume the misalignment problem is real and it causes long-term knee pain, external femurs would indeed be totally superior. Complications of external femur lengthening are the same as with internal lengthening, plus general complications of external fixation, but nothing specific to external femurs, expect temporary ROM limitations. The main problem of EFL I consider is discomfort. I'm talking about classic Ilizarov frames here, no monorail. But then again the 'misaligment problem' is highly speculative.

Also... I've heard Dr. Mongral talking about nail insertion and fixation under an angle, so actually you don't need externals anyway. It's just that we don't see surgeons (even the best ones) doing it. Must have something to do with them also viewing the 'misaligment problem' as speculative, idk.

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Quote from: exclide on April 08, 2015, 08:49:36 PMAlso... I've heard Dr. Mongral talking about nail insertion and fixation under an angle, so actually you don't need externals anyway. It's just that we don't see surgeons (even the best ones) doing it. Must have something to do with them also viewing the 'misaligment problem' as speculative, idk.

That's an interesting idea. Putting a nail in on an angle however wouldn't be sufficient to circumvent this issue for femurs, since femurs are on such a great angle already. But for tibias, theoretically it could work. Problems would be passing the nail through the tibia such that the nail is perfectly perpendicular to the ground when standing normally, while still having that nail confidently placed such that it's not deviating too far from one side of the bone to the other as it transits through the tibia.

Intramedullary rods are meant to be just that - intramedullary. Putting the lengthening rod through even a tibia on a perpendicular to the ground would require it to drill extensively through the cortical bone which would decrease confidence in ability to tolerate weight bearing and increase risk of the bone splintering/fracturing when weight bearing occurs.

In that case, you would lose most of the benefits of having the internal fixation in the first place. Though it might still be a valid option if the surgeons don't mind drilling it so that large portions are running through the cortex, with a more cautious protocol regarding weight bearing.

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itsmylife


yet again....


sigh

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yes i think its my life has come back...again

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I have no idea who that is. Nor do I understand what the problem would be with trying to identify and work through pros and cons of different surgical approaches on a site dedicated to discussing leg lengthening.

I had not seen anyone diagram this potential issue before or have a focussed discussion about it. I had some ideas I wanted to share and stimulate further thoughts about. If you don't think the discussion is useful, you don't need to participate.

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its my life, just give up, and give us a break now

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Quote from: endomorphisme on April 08, 2015, 09:20:20 PMyes i think its my life has come back...again

Don't be paranoid they write nothing alike, ItsMyLife lacks the emotional intelligence to fake a different personality.

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they have exactly the same personality


paranoid.. fixated on every possible worst case scenario and  also  overposting

this person just got here and  is on  pace to post over 20 times today...  this fits the pattern

the writing is somewhat different, and could be a different person... but theres very strong similarities

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Quote from: endomorphisme on April 08, 2015, 09:36:14 PMits my life, just give up, and give us a break now

Anyone want to give me the brief notes on who this is and why people are finding this discussion problematic?

I'm guessing it's because talking about possible negatives of different surgeries is considered a faux pas?

Is it better to never think about this stuff and then end up surprised you have x legs after 3 inch internal femurs are done?

As for my posting style, I'm posting a lot because I've been thinking about this a lot, and I'm sharing my thoughts as I go. I've contained all my posts to one thread so I don't see a problem, and I'm pretty much done talking now because I've said everything that I was wondering about.

Now I'm just curious if we can stop trying to analyze each other's personalities and actually discuss the alignment issue with external vs internal fixation. I'm still curious for any thoughts.

In particular I'm wondering if there are modern safe Ilizarov procedures that could be better long term alignment options than the current gold standard of Guichet internal femurs.

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come on guys. what kind of talk do you want to hear on this forum then?

rants? proportions? "how does it feel after LL?"? "new LL doctor in Antartica"?

being educated about what you're planning to go through is not a bad idea.

he's not trying to advertise anything you see...