Precise Nail vs Ilisarov

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Is it really worth it to pay more for the precise nail? I´ve been digging and I don´t find it more appealing to be crippled on a wheelchair more than have a huge apparatus on my tibias and be able to walk. What do you guys think?

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Quote from: Mzacr on December 11, 2018, 09:03:46 PMIs it really worth it to pay more for the precise nail? I´ve been digging and I don´t find it more appealing to be crippled on a wheelchair more than have a huge apparatus on my tibias and be able to walk. What do you guys think?

Precice is obsolete now unless your bone is too thin
With Stryde no wheelchair needed

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get pure ilazarov if ur going for tibias and nail if going for femurs

imo its a waste to pay extremely huge amounts to gain the same results in shorter time.

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I compare them because stryde is stupxdly expensive. I guess pure external is going to be a reality for many around here that don't have the privilege to pay that much.

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Precice 2.2 is not obsolete in today's reality. Yes Stryde is announced and already being used, but it is not widely available worldwide yet, and is unbelievably expensive.

It cannot be really justified if a person who has enough money for Precice (even better Stryde), goes with external methods. Because using an internal nail significantly eliminates the risk of infection. In internal methods, small cuts are performed, internal nails are inserted and the cuts are stitched, so it is nearly impossible for infection to penetrate easily. Since there are no pins and open pin sites, no need for regular dressing change and dealing with mess.

Yes, external devices allow you to walk while lengthening and recovering, and Precice doesn't, but believe me after operation, most patients want it end as soon as possible, which is not the case with Ilizarov method, which requires living with devices for up to 1 year.

I would prefer using the wheelchair for 2-3 months and leave everything behind, rather than being able to walk with difficulties for 1 year, always risking infection and other possible problems.

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Quote from: heightconsultant on December 12, 2018, 10:18:06 AMPrecice 2.2 is not obsolete in today's reality. Yes Stryde is announced and already being used, but it is not widely available worldwide yet, and is unbelievably expensive.

It cannot be really justified if a person who has enough money for Precice (even better Stryde), goes with external methods. Because using an internal nail significantly eliminates the risk of infection. In internal methods, small cuts are performed, internal nails are inserted and the cuts are stitched, so it is nearly impossible for infection to penetrate easily. Since there are no pins and open pin sites, no need for regular dressing change and dealing with mess.

Yes, external devices allow you to walk while lengthening and recovering, and Precice doesn't, but believe me after operation, most patients want it end as soon as possible, which is not the case with Ilizarov method, which requires living with devices for up to 1 year.

I would prefer using the wheelchair for 2-3 months and leave everything behind, rather than being able to walk with difficulties for 1 year, always risking infection and other possible problems.

Stryde is about $5000 more expensive than Precice 2 which is nothing when you consider that with Precice you will effectively be disabled for a good few months.  Even the recovery will be much faster with Stryde and you should also lose less muscle and retain more flexibility.

I think external methods are worth considering for Tibia for the reasons outlined in one of my previous posts and shown again below for convenience.  I have changed my mind with respect to Tibia lengthening with external methods and I now think they provide a better long term outcome at a fraction of the cost of internal methods:

Quote from: Ascending on September 25, 2018, 11:13:15 AMHi,

I have been researching and reading the opinions of posters about Tibia lengthening and I note that whilst there is consensus that Femur lengthening is best done using an internal distraction nail, such concensus doesn't exist for the Tibia.  My opinion is that a very good internal load bearing nail such as the Stryde trumps external methods mainly because it is more tolerable than external apparatus, has less infection risk and produces less scarring.  Interestingly nails are kept in the limb just as long as external fixators post lengthening - the difference being that the internal nail produces less discomfort/inconvenience for the patient and virtually no risk of infection.

Tibia Facts:

• There are two bones that must be broken and extended simultaneously - Tibia (Shin Bone), Fibula (Calf Bone).
• Complications of premature consolidation of one the two bones will lead to bow legs.
• The bones are thinner
• Greater resistance of soft tissue to lengthening when compared with Femurs
• Drop foot/Ballerina seems to be a frequent occurrence
• Blood supply is generally poorer than for the Femur

External Methods

Advantages:

• Load Bearing
• Can precisely control lengthening
• Can correct complex deformities
• Does not require reaming of bone
• Does not damage the knee
• Frame can be reused
• Much cheaper than internal methods
• Suitable for those with small diameter bones - adults and children
• Mechanically simpler than internal methods and problems can be fixed more easily
• Removal of apparatus has very little risk and is cheaper

Disadvantages:

• Pins fix the apparatus to the bones going through the skin and muscles - creating further resistence to muscle stretching.  This is more noticable for femural lengthening where the muscle mass is greater.
• Pin Site Infection - great care must be taken when showering
• Frame removal times are very long - removing too early risk fracture.  A nail can be inserted after lengthening but this will bring some of the disadvantages with internals methods
• Bulky frame make the surgery very noticeable and make it difficult to sleep - with the exception of Dr. Salameh's Salamehfix fixator
• Pins can and do break requiring replacement
• More scarring than internal methods

Internal Methods

Advantages:

• New nails such as the Stryde nail allow full Load Bearing
• Can precisely control lengthening if using Precice or Stryde
• Very low infection risk, negligible post surgery
• Soft tissue is lengthened without obstruction
• Nails can be kept in until consolidation fully completes without much inconvenience
• Much less scarring than external methods
• Much more comfortable experience for the patient - easier to disguise and easier to sleep

Disadvantages:

• Much more invasive than external methods - requires nail to be inserted through the knee and the bone to be reamed to make room for the nail
• Expensive
• Nails cannot be reused
• Bone marrow is lost from the bone
• Risk of fat embolism - caused by bone marrow being displaced by the nail and entering the bloodstream.
• Nails can bend and break requiring expensive surgery to replace
• The nail lengthening mechanism can break - leading to runaway lengthening or non lengthening
• Nail removal is an expensive and brutal process - nails are hammered out.
• Some nails such as Albizzia derivatives are extended using a very painful mechanical process - not true for Fitbone, Precice and Stryde nails.
• Not suitable for children or adults with thinner bones - more so with load bearing nails which are typically thicker.

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Which doctor you think is good for external?

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Quote from: TemakiSushi on December 12, 2018, 12:26:19 PMWhich doctor you think is good for external?

I would recommend Dr Salameh - his unique hinge based fixator (Salamehfix) is compact and much more tolereable - you can wear trousers over them.

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Quote from: Ascending on December 12, 2018, 12:29:13 PMI would recommend Dr Salameh - his unique hinge based fixator (Salamehfix) is compact and much more tolereable - you can wear trousers over them.

I see
Dr Salameh cost 25k euro and frames stays on for at least 6months or even more than a year depending on how much lengthened
Recent diary showed the pain and discomfort of Salameh frames prevented to work and earn money for whole lengthening period
Stryde in Greece will be around 45K euro, and with it I’ll probably be able to start working nomad after one month
I’ll earn much more than 20k in 6 months
So I think price difference is not much at all between Salameh and Stryde
I’d rather stay more comfortable while lengthening without much excruciating pain which can last for days and weeks with frames

I’ve actually met some precice patients and been talking with external patients, so I know how painful externals are. Generally Precice patients had much easier life even with wheelchairs
Stryde without wheelchair will really be so much easier than external
External frames can be a pure tourture for some people
I don’t wanna take that chance to save 20k

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Quote from: TemakiSushi on December 12, 2018, 01:33:26 PMI see
Dr Salameh cost 25k euro and frames stays on for at least 6months or even more than a year depending on how much lengthened
Recent diary showed the pain and discomfort of Salameh frames prevented to work and earn money for whole lengthening period
Stryde in Greece will be around 45K euro, and with it I’ll probably can start working nomad after one month
I’ll earn much more than 20k in 6 months
So I think price difference is not much at all between Salameh and Stryde
I’d rather stay more comfortable while lengthening without much excruciating pain which can last for days and weeks with frames

That's a good rational choice for you.  For others who are more price conscious it might not be.  There will also be patients with small diameter bones for which Stryde may not be an option.  There is also the potential long term problems of drilling through the knee - there has been much discussion about it on this forum.  As for the diary that you read - I think you need to read more than one diary to make a decision.  There are many more Salameh diaries on the old forum.  I met an ex-patient this year and his experience was much smoother.  But we must definitely not ignore the difficult cases and so you are right to point it out.  I would also suggest people go and see a few Drs before making their decision.  Does the Greece price include removal of the nail?