I want to push back on some of the posts here saying that externals are inferior to Precice. I would disagree when it comes to tibias. Obviously, you DO NOT want to use externals on your femurs. However, when considering tibia surgery options, externals are not necessarily inferior to Precice. I had the option of using Precice or externals. I chose LATN with externals (over Precice) for several reasons-
1). Externals provide you the ability to fully weight bear, whereas Precice does not. This is huge during a lengthening experience. I was weight-bearing throughout my lengthening with LATN on my tibias. Precice patients were in a wheelchairs the whole time.
2). Going off of point 1, you are less likely to develop a ballerina foot (a common complication for tibias) if you use externals (versus Precice). Again, it is the weight bearing factor. Walking helps ward off ballerina foot. A patient who uses externals can walk with crutches (up to about 1 hour per day according to most surgeons), whereas Precice patients can only walk very small distances with their walkers. Even this is dangerous, the Precice nail can bend if you walk too much.
3). As a result of points 1-2, recovery after lenghtening is much quicker with externals. After I finished lengthening and began consolidation, I only used my crutches for about 2.5 months before I began walking unassisted. Precice patients take about twice as long as that to begin walking unassisted.
4). The scarring issue is over-exaggerated in my opinion. Yes, I have scars from my externals. But they are not really that visible due to me having a lot of hair on my calves. But yes, they are there. Most people probably don't notice my scars and how often do I really wear shorts outside of the swimming pool and/or gym? Honestly not that often. Finally, I can say with nearly 100% certainty that nobody who sees the scars thinks I had limb lengthening surgery done. It just doesn't cross anybody's mind, most people are simply not aware of limb-lengthening surgery and would not jump to that conclusion.
For femur CLL I absolutely agree that internal method is a better option. But based on the other posters in this thread, Precice Max is not fully weight bearing (like Stryde was), so please keep that in mind.
For tibias, externals are not as bad as some of you guys think. I say this as someone who went through both CLL with externals AND CLL with internals. So I have a reference point for comparison.
If you have any questions about my experience, feel free to send me a PM.
Quote from: CLLvet on January 19, 2024, 01:13:03 AMI want to push back on some of the posts here saying that externals are inferior to Precice. I would disagree when it comes to tibias. Obviously, you DO NOT want to use externals on your femurs. However, when considering tibia surgery options, externals are not necessarily inferior to Precice. I had the option of using Precice or externals. I chose LATN with externals (over Precice) for several reasons-
1). Externals provide you the ability to fully weight bear, whereas Precice does not. This is huge during a lengthening experience. I was weight-bearing throughout my lengthening with LATN on my tibias. Precice patients were in a wheelchairs the whole time.
2). Going off of point 1, you are less likely to develop a ballerina foot (a common complication for tibias) if you use externals (versus Precice). Again, it is the weight bearing factor. Walking helps ward off ballerina foot. A patient who uses externals can walk with crutches (up to about 1 hour per day according to most surgeons), whereas Precice patients can only walk very small distances with their walkers. Even this is dangerous, the Precice nail can bend if you walk too much.
3). As a result of points 1-2, recovery after lenghtening is much quicker with externals. After I finished lengthening and began consolidation, I only used my crutches for about 2.5 months before I began walking unassisted. Precice patients take about twice as long as that to begin walking unassisted.
4). The scarring issue is over-exaggerated in my opinion. Yes, I have scars from my externals. But they are not really that visible due to me having a lot of hair on my calves. But yes, they are there. Most people probably don't notice my scars and how often do I really wear shorts outside of the swimming pool and/or gym? Honestly not that often. Finally, I can say with nearly 100% certainty that nobody who sees the scars thinks I had limb lengthening surgery done. It just doesn't cross anybody's mind, most people are simply not aware of limb-lengthening surgery and would not jump to that conclusion.
For femur CLL I absolutely agree that internal method is a better option. But based on the other posters in this thread, Precice Max is not fully weight bearing (like Stryde was), so please keep that in mind.
For tibias, externals are not as bad as some of you guys think. I say this as someone who went through both CLL with externals AND CLL with internals. So I have a reference point for comparison.
If you have any questions about my experience, feel free to send me a PM.
Do you think the monorail is that bad for femurs? Of course, Ilizarov would be terrible for femurs. While externals for femurs do hurt more from what I've read not everybody can pay 100k USD or so for internals, current internals are mostly non-weight bearing, and femurs tend to recover faster. So, external femurs would probably be the fastest way to recover.
About the scarring, nobody wants scars but I think it falls in the same category as people complaining about proportions or not being able to squat 800 lbs.
It matters very little in the grand scheme of things. Being 2 or 3 inches taller is much more important than having scars that nobody will see when you're wearing pants or even shorts(femurs). You can also get revision surgery to make them less visible.
Personally if I had the money to do tibia as well I would only do externals only since they're weightbearing and minimizes the risk of chronic knee pain. The only downside is how long you have to wear the frames, and I have also heard that malalignment happens more often with them? Idk if its true.
By logic pmax must be full weight nail, (dependa of the person) otherwise why making another nail same as precice 2?
they made p 2.1 then p 2.2 . making little changes. so.. but at least this new one is weight bearing
Quote from: DanishViking on January 19, 2024, 04:52:41 PMPersonally if I had the money to do tibia as well I would only do externals only since they're weightbearing and minimizes the risk of chronic knee pain. The only downside is how long you have to wear the frames, and I have also heard that malalignment happens more often with them? Idk if its true.
I'm not sure of the misalignment issue. I don't think it necessarily happens more often with tibia externals, but I could be mistaken.
And time in frames can be greatly reduced if you do LATN (Lengthening and Then Nailing). This means that you only wear frames during your lengthening period (2-3 months) and then remove the frames as soon as you finish lengthening. The surgeon inserts an internal fracture nail into your tibias on the same day that he removes your external frames. Your recovery progresses fairly quickly after that due to the fracture nail (it is fully weight bearing). That is the method I used to reduce time in frames.
If you have any questions about my experience (with either internal femurs and/or external tibia LATN), please feel free to shoot me a PM.
I think donghoon will be great in your budget. He is also one of the finest surgions and have also worked under paley in the past
Quote from: CLLvet on January 19, 2024, 01:13:03 AMI want to push back on some of the posts here saying that externals are inferior to Precice. I would disagree when it comes to tibias. Obviously, you DO NOT want to use externals on your femurs. However, when considering tibia surgery options, externals are not necessarily inferior to Precice. I had the option of using Precice or externals. I chose LATN with externals (over Precice) for several reasons-
1). Externals provide you the ability to fully weight bear, whereas Precice does not. This is huge during a lengthening experience. I was weight-bearing throughout my lengthening with LATN on my tibias. Precice patients were in a wheelchairs the whole time.
2). Going off of point 1, you are less likely to develop a ballerina foot (a common complication for tibias) if you use externals (versus Precice). Again, it is the weight bearing factor. Walking helps ward off ballerina foot. A patient who uses externals can walk with crutches (up to about 1 hour per day according to most surgeons), whereas Precice patients can only walk very small distances with their walkers. Even this is dangerous, the Precice nail can bend if you walk too much.
3). As a result of points 1-2, recovery after lenghtening is much quicker with externals. After I finished lengthening and began consolidation, I only used my crutches for about 2.5 months before I began walking unassisted. Precice patients take about twice as long as that to begin walking unassisted.
4). The scarring issue is over-exaggerated in my opinion. Yes, I have scars from my externals. But they are not really that visible due to me having a lot of hair on my calves. But yes, they are there. Most people probably don't notice my scars and how often do I really wear shorts outside of the swimming pool and/or gym? Honestly not that often. Finally, I can say with nearly 100% certainty that nobody who sees the scars thinks I had limb lengthening surgery done. It just doesn't cross anybody's mind, most people are simply not aware of limb-lengthening surgery and would not jump to that conclusion.
For femur CLL I absolutely agree that internal method is a better option. But based on the other posters in this thread, Precice Max is not fully weight bearing (like Stryde was), so please keep that in mind.
For tibias, externals are not as bad as some of you guys think. I say this as someone who went through both CLL with externals AND CLL with internals. So I have a reference point for comparison.
If you have any questions about my experience, feel free to send me a PM.
Thank you for your sharing your thought. I appreciate it 
Quote from: wantingtobetaller on January 21, 2024, 02:23:20 AMThank you for your sharing your thought. I appreciate it
Glad I could be helpful. Please feel free to reach out to me (on this thread or over PM if you wish) if you have any more questions.
I asked Paley Institute about the price of the new PMax Nail. They said that the expected price increase in 5000usd PER NAIL. So, the price of femur lengthening will go from 95,500 -> 105,500. It’s kinda insane considering limbplastx increased their price by only 3000usd total.
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