Koehne Diary 21/22 | Unilateral Tibia + Femur

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Hi Siegfried, how was your surgery? Everything ok?

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Hey Siegfried,
do you know if it is true that Germany LL surgeons transfer from previous car accident injury surgeons to their jobs now?
I hope that can vouch for hwo skiLL Forumul Germany LL surgeons actually are.
Thanks!

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Hi Siegfriend,

Your approach of doing unilateral tibia + femur is quite interesting. One of the big pluses to this approach is that you gain length quite quickly. Your 8.5cm would have taken 90-100 days of lengthening and 6-10 months of consolidation if it was all done in the femurs. But by splitting it and simultaneously lengthening, you could lengthen 8.5cm in just 60 days (assuming that issue with nail availability had not happened in the beginning) and consolidate in just 5-6 months (even with a broken tibia). You also end up with better proportions and will be able to squat properly after recovery.

Did you discuss with your surgeon the risks of lengthening more than 1mm in total per day per limb? I do not know if there is any research on this. But my primary question is, from a nerve's perspective, does a single nerve feel a 2mm stretch or a 1mm stretch per day with this approach?

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Hey guys,

I know its been a while, since I have provided an update. So here we go.

Unfortunately, I have not been able to the the surgery on my second leg yet. Instead, I had to get a bone graft surgery, because my tibia was not healing 100%. So, in order to speed up the process, my surgeon and I decided to go forward with the hip graft surgery, which was done about a week ago.
Surgery for my second leg is scheduled in 6 weeks, about 9 months after my first surgery... Yes, things are taking longer than I anticipated. Be prepared for this, if you guys decide to the unilateral method.

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First of all, I am so sorry you are dealing with all this. Hopefully you are still in good spirits and staying strong brother . As someone doing unilateral tibias now and still lengthening leg #1, I know there is a real risk this could happen to me too. Is bone graft the standard procedure for a delayed Union like this or were you also offered exchange nailing?

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Quote from: 6CMFemurs on June 01, 2022, 05:01:32 AM Is bone graft the standard procedure for a delayed Union like this or were you also offered exchange nailing?

Im not sure how a nail-exchange would help this situation. Are normal titanium-nails full weight bearing? Furthermore, a nail-change would be far more invasive than a bone-graft.

To be fair, im pretty sure I would not have needed it, since I was basically 95% consolidated and I probably could have proceeded without the bone graft, but I didnt want to take the risk of the nail-breaking.

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Quote from: Siegfried on June 01, 2022, 02:15:08 PMIm not sure how a nail-exchange would help this situation. Are normal titanium-nails full weight bearing? Furthermore, a nail-change would be far more invasive than a bone-graft.

To be fair, im pretty sure I would not have needed it, since I was basically 95% consolidated and I probably could have proceeded without the bone graft, but I didnt want to take the risk of the nail-breaking.

That makes sense. So it sounds like you did this so you could speed things up to get onto your second leg. Best of luck man!

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Quote from: Siegfried on June 01, 2022, 02:15:08 PMIm not sure how a nail-exchange would help this situation. Are normal titanium-nails full weight bearing? Furthermore, a nail-change would be far more invasive than a bone-graft.

To be fair, im pretty sure I would not have needed it, since I was basically 95% consolidated and I probably could have proceeded without the bone graft, but I didnt want to take the risk of the nail-breaking.

Yes titanium trauma nails are fully weight bearing. But nail exchange means going in through the knee 2 more times. You have already avoided this once by doing hip insertion of the femur nails probably due to the same reason.

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Quote from: 6CMFemurs on June 01, 2022, 02:40:59 PMThat makes sense. So it sounds like you did this so you could speed things up to get onto your second leg. Best of luck man!
Thanks! All the best for you as well!

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https://imgur.com/a/QMfkThC?fbclid=IwAR0TRQiVo28EakjncGIAuBu6ddbvxaqAQkUnEBAGGULpVDP8SoOw0zJkluU

Here a picture of my proportions after 8.3cm. Im wearing my orthopedic shoe on the right side.