Q & A With Dr Franz Birkholtz

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Quote from: Rivers on December 03, 2013, 09:41:23 PMDr. Birkholtz are you aware of any prolonged pain in the hips, knees etc. after internal femur lengthening (5-6.5cm)?

I would also like to clarify the numbers you gave for tibia lengthening. Are you saying 50% of patients will experience knee pain throughout their life using LON, LATN or internal nail for tibia lengthening?

Thank you for your contribution to this forum.

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Quote from: Sweden on December 03, 2013, 09:52:19 PMI have to admit that I'm very impressed and happy to see an LL-doctor answering out questions.

I did LL on my tibias, LON - 7cm, in India with Dr Sarin and I am currently now 11 months post first surgery.
I can't run or jump. Only walk. My ankles are very stiff, especially the right.

1) Do you think I will be able to sprint and go for a 1 hour jog again? Very difficult to say. 7cm for tibias is a long distance which fundamentally changes the muscle function. In my practice recovery can occur up to 2 yrs after incident. Of course we deal more with trauma and nonunions, but it should be similar.

I exercise every day. Physical therapy, cycling, swimming, gym, Taekwondo and long power walks.

2) Have you seen patients recover so they can move very quick to the sides while running like American football/basketball players do to fool their opponents? Agility and proprioception are what you are talking about and this can form part of the recovery, but these are complex actions and may not recover fully.

3) Is it a bad idea to split the patellar tendon again when I want to remove the IM-nails?If they were split during insertion, it is better to go through the same approach for removal.

My doctor in Sweden says they don't remove IM-nails and it's no problem having them in your legs for the rest of your life.

4) What is your opinion about this? Remember, I am very active and would very much like to go back and compete in Taekwondo, a martial art. Generally the rods can stay in. The problem is that the locking screws are painful when making contact. Especially against a training bag, or when soemone blocks you. Fore these reasons it may be better to remove them.

Thank you for taking the time, very much appreciated!

/Sweden, now 180cm.

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Quote from: drew on December 09, 2013, 07:58:28 AMDear Dr. Franz Birkholtz,

Do you know if reaming of the bone will cause a fat embolism in the future years later from doing femurs with interal lengthening?
is this an issue only with internal femoral method?

rexdime:
"Even if a post LL patient doesn't get blood clots or thrombus or an embolism that can cause death, the more fat or bone marrow that is released from the operation, the higher chance that it will enter your blood stream.

You can look at 10 years later, this fat and bone marrow will still be in your blood stream and say it hasn't done any damage yet, and I don't think the body knows how to get rid of this from your blood stream either.

You will think that everything is perfectly fine, but I am guessing that your chance of having a heart attack or a stroke will be a lot higher than if you never had a broken bone before. I think you can say this is one of the Side effects of doing LL , but I doubt many doctors warn their patients before LL of this risk , I might be wrong since I never done it before.

I know this young lady who had a stroke about a year ago and she didn't know why, she had no high blood pressure and she was healthy, but today the left side of her body is paralyzed and needs to be on a wheel chair everywhere she goes"

thank you

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Quote from: handy on December 15, 2013, 04:16:42 PMHello Dr. Birkholtz, just to add to what masche is asking you. Here is what Dr. Paley says about bone healing. Please give us your opinion and thank you again for posting on this forum and answering all these questions. 

"Delayed or failure of consolidation: Slow or failed bone healing can occur with any lengthening surgery. This complication can usually be prevented by making drill holes at the level of the planned osteotomy before reaming the bone. This is a technique I introduced in 1990. Stable fixation is also important so the choice of nail length and diameter are important as well as the level of the osteotomy. Even the type of osteotomy affects the rate of bone healing. Cutting the bone with multiple drill holes and an osteotome is the most minimal invasive way while using an intramedullary saw or performing an open osteotomy have higher failure rates."

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