The first study is always rolled out in this site and is not useful. It identifies correlation, no causation and does not look at confounders.
Intramedullary tibial nailing is renowned as having long term complications, knee pain being the most obvious. If they are trauma, no lengthening will be happening. All that study has in common with this is that it is tibia surgery.
Quote from: HeightGain on February 26, 2019, 07:43:10 PMIntramedullary tibial nailing is renowned as having long term complications, knee pain being the most obvious. If they are trauma, no lengthening will be happening. All that study has in common with this is that it is tibia surgery.
Since intramedullary rods are used in internal lengthening, it's very relevant to look at complication and long-term studies regarding intramedullary rods. The complications (such as knee pain you mentioned) can occur after accidents and after LL surgery alike.
With respect, I do not agree with the above statements made by either IWannaBeTaller or HeightChange.
First "intramedullary rods" are the nails used in LON and LATN. They are usually left inside the bone for life although the screws are often removed once the bone heals.
Consequently, intramedullary rods are encountered in external lengthening; not internal.
Next, such rods are NOT renown for long-term complications. To the contrary, very few complications attributable to intramedullary rods are known to occur.
In fact, one of the studies referenced plainly concludes "At a median 14 years after tibial nailing of isolated tibial fractures, patients' function is comparable to population norms...".
A number of doctors have told me that about 50% of patients experience long term knee pain. Studies support this. For such key decisions that could potentially affect patients for the rest of their lives they need to be fully informed.
Earlier you mentioned about long leg films. These should be found in the majority of radiological departments in the US or Western Europe.
Quote from: HeightGain on February 27, 2019, 01:06:39 PMA number of doctors have told me that about 50% of patients experience long term knee pain. Studies support this. For such key decisions that could potentially affect patients for the rest of their lives they need to be fully informed.
If you believe reliable studies support your contention that use of intermedullary rods to treat tibia fractures causes long-tern knee pain; then, please present those studies.
I showed you using the study you discussed that just the opposite was concluded; namely, "At a median 14 years after tibial nailing of isolated tibial fractures, patients' function is comparable to population norms...".
I agree it is important to be informed; however, it is more important to be accurately informed.
Thanks for posting the x-rays California.
It doesn't seem to be happening extremely fast, but it does seem to be filling up!
A question that came across my mind, why don't LLers reduce distraction rate when it clear that there is no risk of preconsolidation? It seems to me that in your case, there was no risk of preconsolidation so could you have gone at 0.5mm per day or taken lots of breaks in between? One of the scary aspects of LL is the lengthening and logic seems to suggest that slower rate of lengthening would be friendlier to the body in all aspects.
This is just a general question that came to my mind looking at some patients' x-rays.
Cheers!
Quote from: ok on March 06, 2019, 07:56:47 PMThanks for posting the x-rays California.
It doesn't seem to be happening extremely fast, but it does seem to be filling up!
A question that came across my mind, why don't LLers reduce distraction rate when it clear that there is no risk of preconsolidation? It seems to me that in your case, there was no risk of preconsolidation so could you have gone at 0.5mm per day or taken lots of breaks in between? One of the scary aspects of LL is the lengthening and logic seems to suggest that slower rate of lengthening would be friendlier to the body in all aspects.
This is just a general question that came to my mind looking at some patients' x-rays.
Cheers!
Great question.
I think you are absolutely correct about slowing the distraction rate. So long as the fibula is captured, there is no pre-consolidation risk.
In fact, Dr. Kulesh shared the story of a patient who did just what you suggest with great success. That patient did pure-externals over the course of one year. He distracted .5 mm per day up to 9 mm.
For me, I set an arbitrary deadline by which I must stop distracting so that I could return home and to work. But for my self-imposed deadline, I could have gone more slowly, more safely, and more comfortably.
In hindsight, I probably should have reconsidered my deadline at the start. Unfortunately, once I learned that I could go more slowly with less risk, I already made commitments to others and had my distraction goal in mind so slowing down meant I had to either miss my goal or break commitments--I elected to push to hit my goal while keeping my promises to others.
Quote from: California2 on March 06, 2019, 08:11:19 PMI think you are absolutely correct about slowing the distraction rate. So long as the fibula is captured, there is no pre-consolidation risk.
In fact, Dr. Kulesh shared the story of a patient who did just what you suggest with great success. That patient did pure-externals over the course of one year. He distracted .5 mm per day up to 9 mm.
For me, I set an arbitrary deadline by which I must stop distracting so that I could return home and to work. But for my self-imposed deadline, I could have gone more slowly, more safely, and more comfortably.
In hindsight, I probably should have reconsidered my deadline at the start. Unfortunately, once I learned that I could go more slowly with less risk, I already made commitments to others and had my distraction goal in mind so slowing down meant I had to either miss my goal or break commitments--I elected to push to hit my goal while keeping my promises to others.
I am in similar situation, California. I want to be up and moving again by June, so do not want to delay to much. Thank you for your detailed updates.
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