I'll deal with the toe after frames are off. The neuro-consultant is a gold medallist (according to Harry-- apparently that's a medical accolade here) and he is of the opinion the nerve is intact. From your experience, do my x-rays look okay? Everyone's x-rays appear straight from the anterior but always misaligned in the lateral. Sringari always tells us this lateral misalignment won't be an issue, but I can't say I am content with that answer.
He has also been adamant all along that the nail will ensure the bones do not misalign, but Dr. Birkholtz reasoned that a nail does not possess the capacity to prevent this happening and a doctor should therefore remain prudent in combating deviations. This is in the x-leg thread under general. Sringari has never performed a single correct on any patient. Ever.
LON with the boys at Dr Sringari--India (Complete)
Quote from: Polycrates. on February 22, 2014, 08:59:15 PMI'll deal with the toe after frames are off. The neuro-consultant is a gold medallist (according to Harry-- apparently that's a medical accolade here) and he is of the opinion the nerve is intact. From your experience, do my x-rays look okay? Everyone's x-rays appear straight from the anterior but always misaligned in the lateral. Sringari always tells us this lateral misalignment won't be an issue, but I can't say I am content with that answer.
He has also been adamant all along that the nail will ensure the bones do not misalign, but Dr. Birkholtz reasoned that a nail does not possess the capacity to prevent this happening and a doctor should therefore remain prudent in combating deviations. This is in the x-leg thread under general. Sringari has never performed a single correct on any patient. Ever.
Yes, Dr. Sarin also told me that the nail will prevent the bones misalignment. I brought this up issue of x-leg many times to many people, including Modh, Harry, Dr. Sarin, his staff, and my roommate. They all assure me that once I start walking again, the x-leg on my right tibia will go away. And guess what, I now have x-leg on my right. So I think Dr. Franz is right. But if your doctor is so adamant and refuses to correct your problem, then there is nothing you can do about it... maybe harass him more? Now that you see this post and my result, I think you should try to get this corrected before your bone consolidate. Otherwise, when you come back to Canada, you'll have this problem to contend with.
If you have x-leg, you can visually see it externally without having to view the x-ray.
But if you turn out to have x-leg in the end, dont feel too bad about it. Even Dr. Dragoon patient has it (sick joke).
I think x-leg is cause by a misalignment in the longitudinal axis, but I honestly haven't a clue. The lateral shows deviation in the lateral axis.
This is what x-legs look like in an x-ray (attached image). All of our x-rays from the anterior have appeared straight.
Quote from: Polycrates. on February 22, 2014, 09:27:42 PMI think x-leg is cause by a misalignment in the longitudinal axis, but I honestly haven't a clue. The lateral shows deviation in the lateral axis.
I haven't got a clue neither.
Can you take a photo of your external tibias and post it? I'm not a doctor but if you have x-leg, then you can visually see it by now, externally.
I had the same frames on as you. Went through the whole ordeal. But x-leg only happens to my right. I spotted it visually when it was at 3cm. Don't worry about some theoretical concept. If you can't see your x-legs visually by now, then you won't have it.
I'll get Sukesh to take a pic tomorrow.
Quote from: Polycrates. on February 22, 2014, 06:54:37 PMThe doctor has never made a measurement on an x-ray himself. He just quickly peruses. I'll ask him of my plan and what he recommends on Monday. If I continue to turn equally I fear it'll exacerbate the growing discrepancy.
Quote from: Polycrates. on February 22, 2014, 05:51:46 PMThis is just a plan, of course. These x-rays have been so shoddy, I honestly am at a loss with what to do.... I have no idea what my actual distraction/discrepancy is, and the doctor doesn't seemed too concerned about it.
From a patient's advice about limb length discrepancy, quoting the message.
" The proper way to measures is from Hip to feet similar in fashion to Dr. Paley or Dr. Rozbruch, and the measurements are done by computer software.
Anyone who is thinking about taking off their frames and worries about limb length equality OR misalignment (Ex. X-Legs) and how to correct it (Frames are required BUT IM Nail/Rod need to be taken out) should go contact another, hopefully better Orthopedic Surgeon."
Pics of legs didn't come out very well. I'll get a standing shot tomorrow with a DSLR. Found an interesting case study by Dr. Chuadhary, who I know has a poor reputation among some. His article seems concise and well written though:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2739482/
I've been anxious over the possible consequence of my lateral misalignment in the right leg. From what I've gathered, this type of axial misalignment works to cause either a procurvatum or recurvatum condition (shown in attached picture). Sringari says it's fine, but as I've stated, he says most anything is fine. In Chaudhary's study, he states:
"In our series, we had 29.6% complications (eight in 27 lengthenings). There was one problem, three obstacles and three sequelae. We had to perform only four surgeries - two major (deformity correction with Taylor Spatial Frame (TSF)fixator, iliac crest bone grafting) and two minor (percutaneous TA Lengthening, repeat corticotomy). One of our sequelae was minor - a deformity of 10° tibial procurvatum, which did not interfere with function. One patient developed a premature consolidation of the femur, which left him 8 cm short. Most important, we did not have any deep medullary infection as compared to one out of 42 in Kocaoglu's series and three out of 20 in the series of Simpson (15%). However, two of the three infections in Simpson's series had shortening due to compound fractures and previous infection."
Feared Complications:
Procurvatum--
Valgus X-Legs (third legs)--
His statement would indicate that Sringari is correct in his assertion that an angular deviation within specific parameters will not cause a defect or malfunction of the leg. My deviation seems to be very subtle, so I am soothed by this. I turned my outer rods an extra two turns today, and it may be placebo, but I feel like so outward stresses have been relieved. I'll get an anterior x-ray if not tomorrow then by Wednesday to see how my alignment in that axis is doing. Haven't had an anterior x-rays in well over a month and I don't want x-legs!!!!!!!!!!!!
Anterior X-ray from 2 months ago with straight bone apparent. Haven't had anterior since.
---LL Forum Exclusive Content---
Standing:
Bearing weight awkwardly. Excuse the soiled shirt. Haven't stood in so long, and it felt very awkward:
Quote from: Polycrates. on February 23, 2014, 08:16:52 PM
Procurvatum--
Are you afraid of the above? (picture) I don't know what people call it. Ox leg? If you do, take a side-way photo, then we can tell whether you develop it or not.
Looking at your front, I think it looks fine. The metal frame mechanism makes your tibias lengthen outward, but I can see the lower part of your tibias are curving inward. So I can imagine when you put your knees together, your ankles will touch.
However, I think you should send these pictures to a qualified doctors for their opinion (maybe Dr. Franz or Paley?). But if it was me, I wouldn't be too worried about it.
And congratulation. Maybe no one comments on your photo so far because they are drooling over your 2 inches height increase. 2.5 by the time you finish.
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