Nomad fixing post monorail Valgus with Dr. Monegal

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Hi All,

I've recently finished distracting period of leg lengthening with external monorail device by a doctor and in country, which I don't want to disclose. Because I think very often LL doctors become subject to undeserved criticism in this or the other (old) forums and I am not going to blame my doctor of anything happened to me. And because long time before I had LL I made myself well aware what kind of risks LL represents generally and external monorail devices in particular.

I knew external monorails were prone to cause misalignments and were not capable to fix them. I hoped that I would be fortunate to avoid any serious issues during LL. After having read lot's of materials online and having understood excessive lengthening almost in every case end with some kind complications, I had from the very beginning decided to play safe and to aim for only 5 cm. However, unfortunately it didn't save me to end up with misalignment (and, probably as the result of this misalignment, valgus) in my left tibia, which you can see in the attached X-rays. Sorry for bad quality of pictures, but that's the best I could take with my phone.

http://i.imgur.com/wBlp9ui.jpg

As you see it is not that much of misalignment and that's the reason why my doctor keeps saying that misalignments less than 10 degrees are acceptable, and that he can fix valgus by replacing the device on my left leg, but for some reason after couple months when my legs get better. But I've learned that number of other patients of the same doctor had misalignments and he convinced them to accept their misalignments and not to do anything. I was not happy with my misalignment at all, I was not going to compromise, because of possible risks in the future, for example, of having early arthritis.

So, I've contacted Dr. Monegal about my case, he has been very much helpful so far answering all my questions and I have finally made my decision and going to have my left tibia alligned using intramedullary nail on October 15th, 2015 in Barcelona. So since I've finished distraction period this would be similar to do a LATN. I am pretty confident in Dr. Monegal's expertise, promise to stay positive and update my further progress here in this thread.

Meanwhile, I have couple concerns and would like to ask experienced LLers to elaborate on them.

1. Dr. Donghoon says about LATN on http://www.drdonghoon.com/index.php/archives/2414

QuoteDuring 1st stage surgery, future space needed for the internal rod needs to be considered when determining the positions for the external fixator pins. Also, the correction process before 2nd stage surgery requires much knowledge and care from the doctor. Rather than simply using the Ilizarov, computer assisted fixator systems  like the Hexapod or ORTHO SUV must be used for accurate correction.
In my case no such space had been considered. 1st operation was performed by different doctor with monorail external device 2nd operation will be performed by Dr. Monegal. Now I keep wondering will there be enough space for fixating the internal nail.

2. Another concern of mine is would inserting internal nail indeed correct not only the misalignment, but also correct valgus I have on my left leg?

I already asked the same questions to Dr. Monegal and know his answers, but would like to hear what collective consensus on these kind of problems on the forum. As a matter of fact very often experienced LL veterans form quite professional opinion on many things.

Thanks for your attention!

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Quote from: microman on October 02, 2015, 02:22:41 PMdr. mitkovic uses some aparatus to fix misalingments, maybe it's best you contact him?

Thanks for the suggestion, but I thought I made it obvious I am trying to fix problems caused by external monorail device, so recommending the external monorail doctor is just incongruous.

Besides, I've clearly stated that I've made my decision to get this fixed with Dr. Monegal, the date of operation is fixed, and was asking specific questions to experienced LL veterans.

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Quote from: Dr.Ruan on October 04, 2015, 07:28:25 AMThanks for  your case.Your xray  is  too short  to look .Would you  please  post  anterioposterior and lateral film?

Dr. Ruan, thanks for your feedback, but I don't have any other X-Ray and am not going to have any before the op on 15th. Anyway, I know my misalignment is not that big - my main concern is valgus, which you won't be able to see on X-ray anyway. However my valgus is clearly noticeable when looking at my left leg externally. So I am going to Dr. Monegal not as much for fixing the above misalignment as for getting my valgus straighten up.

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First day post op. Lying in my hospital room with moderate pain even after having some Tramadol. But it's ok taken into attention Dr.Monegal said it was one of the most complicated operation. It took around 5 hours to finish it. Doc says longer than it takes when he performs regular Fitbone operation. Because I had pretty much fked up case. You can see that by looking at the X-ray picture taken just before the op:

http://imgur.com/pqSwjPB

I can give more details in couple days when I have new X-rays. However already I can tell that I am extremely happy with the wonderful job done by Dr.Monegal just by looking at my left leg. Valgus, which bothered me most, is completely gone. As for misalignment IM nail has been inserted, so it also should be straighten up now.

And generally people, environment, the hospital staff, care, everything in Barcelona is superb. But above all Dr. Monegal himself is not only one of the best LL specialists in the world in my opinion, but also is a really cool guy with quite friendly personality.

I'll post more when I have X-rays.

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Quote from: maximize on October 16, 2015, 07:45:32 PMYou made the right decision in my opinion to get this fixed now. Hopefully the realignment process hasn't damaged your new consolidation bone.

You bet I did. As for new bone, of course the intervention disrupted it a bit, but the goal of getting my fked up valgus corrected had more priority than worrying about callus disruption. It will probably take longer for my left leg to get fully healed, however on the other side it has now IM nail, so I can start walking soon putting some weight on it.

I thought it would take couple days, but Doc decided to do X-rays today.



Look at the picture and you easily notice what kind of absolutely amazing job has Dr.Monegal done. Compare the misalignment and valgus before the op to the result on the right side of the picture. Hardly any other LL doctor could come so close to a nearly perfection result as Dr.Monegal achieved in this case. I couldn't indeed be any happier than I am now after seeing post op X-rays. Can't stop thanking Dr. Monegal for such a wonderful outcome.

Here is another one from different perspective:

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Quote from: Revenge on October 17, 2015, 10:38:48 AMI will use monarails too why you say its dangerous ?

Look at the pre-op picture to see obvious why you should not go with monorails. It is almost inevitable to develop some kind of misalignments/valgus/varus when distracting with monorails. And when it happens there is no possibility for doctor to fix it. He will just put you under MUA and try his best, but only to certain degree, 'coz there is only so much to fix with monorail device. And after that he will try to convince you to accept whatever harsh reality you have, saying "everything will be alright".

Moreover, I can confirm like EVERY single patient in a country where I was doing LL had some problems, usually misalignments. There are several patients in this forum whom I've seen in real life and who are sugarcoating their LL tales here, but in fact they have serious problems because of monorails. I won't name them but if you carefully read monorail diaries you will notice there are some pictures taken just after op, but there is none after couple months. Because of course there is no pride in posting fked up X-ray pictures.

People choose to go with monorails because they think they are more affordable, however in real life they end up spending twice as much as they initially planned because almost everybody goes through additional operations/interventions. So it's your decision what to do with your body, but based on the experience I have gone through I would never ever recommend monorails to anyone.

And guys in monorails countries, don't loose your hearts if you have misalignment/valgus/varus problems and if your doctor is trying to convince with "10% misalignment is acceptable, fked up bone will shave itself" bullcrap, because there is a solid solution - come to Dr. Monegal in Barcelona and he will fix even most complicated cases.

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Quote from: bluebarbie on October 17, 2015, 11:55:49 AMCongratulations on ur misalingnment fixed, Nomad. Did u lose any mms? How much weight can u put on ur legs at the moment? Wishing you fastest recovary.

Hi Bluebarbie,

I really can't tell visually right now, because my left leg is all wrapped up with bandages. However, according to Dr.Monegal's X-Ray calculations I didn't loose any - I have 5 cm lengthened on both legs. I can compare knee heights after bandages are taken off.

And I am only second day post-op, so lying in my bad all the time, haven't tried to put any weight on the operated leg yet. I think I'll try to stand one of these days, when Dr.Monegal gives his green light for me to walk.

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Quote from: Revenge on October 17, 2015, 03:31:07 PMI see your problem nomad and all my best wishes with you but ı see so many patients done with monorails any problem why it happened to you?Because of doctor?

I am telling you to find any good X-ray pictures of late consolidation period of monorail patients. You won't find many if any at all. Because they all have terrible misalignments which they have to compromise with. And I am not blaming a doctor, it's just nature of monorail devices to be prone to misalignments.

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Quote from: Taller on October 17, 2015, 04:57:20 PMHow much did it cost you to get your alignment corrected?

I paid 2450 euros for one week stay in Hospital Privado Universitari Sagrat Cor and another part to Dr.Monegal and his team for the operation, which only Dr.Monegal can disclose if he wants. All I can tell Dr. Monegal will have to see your case and give you a good deal. Of course, every case is different, so costs might vary.

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Important edit:

I somehow typed 3450, sorry. In fact, the hospital stay for one week costs 2450 euros.

That's 350 euros per day, which I believe is quite normal for state of the art hospital in the center of Barcelona. Staff, care, food by the way are excellent here.