Nomad fixing post monorail Valgus with Dr. Monegal

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Hi All,

I've recently finished distracting period of leg lengthening with external monorail device by a doctor and in country, which I don't want to disclose. Because I think very often LL doctors become subject to undeserved criticism in this or the other (old) forums and I am not going to blame my doctor of anything happened to me. And because long time before I had LL I made myself well aware what kind of risks LL represents generally and external monorail devices in particular.

I knew external monorails were prone to cause misalignments and were not capable to fix them. I hoped that I would be fortunate to avoid any serious issues during LL. After having read lot's of materials online and having understood excessive lengthening almost in every case end with some kind complications, I had from the very beginning decided to play safe and to aim for only 5 cm. However, unfortunately it didn't save me to end up with misalignment (and, probably as the result of this misalignment, valgus) in my left tibia, which you can see in the attached X-rays. Sorry for bad quality of pictures, but that's the best I could take with my phone.

http://i.imgur.com/wBlp9ui.jpg

As you see it is not that much of misalignment and that's the reason why my doctor keeps saying that misalignments less than 10 degrees are acceptable, and that he can fix valgus by replacing the device on my left leg, but for some reason after couple months when my legs get better. But I've learned that number of other patients of the same doctor had misalignments and he convinced them to accept their misalignments and not to do anything. I was not happy with my misalignment at all, I was not going to compromise, because of possible risks in the future, for example, of having early arthritis.

So, I've contacted Dr. Monegal about my case, he has been very much helpful so far answering all my questions and I have finally made my decision and going to have my left tibia alligned using intramedullary nail on October 15th, 2015 in Barcelona. So since I've finished distraction period this would be similar to do a LATN. I am pretty confident in Dr. Monegal's expertise, promise to stay positive and update my further progress here in this thread.

Meanwhile, I have couple concerns and would like to ask experienced LLers to elaborate on them.

1. Dr. Donghoon says about LATN on http://www.drdonghoon.com/index.php/archives/2414

QuoteDuring 1st stage surgery, future space needed for the internal rod needs to be considered when determining the positions for the external fixator pins. Also, the correction process before 2nd stage surgery requires much knowledge and care from the doctor. Rather than simply using the Ilizarov, computer assisted fixator systems  like the Hexapod or ORTHO SUV must be used for accurate correction.
In my case no such space had been considered. 1st operation was performed by different doctor with monorail external device 2nd operation will be performed by Dr. Monegal. Now I keep wondering will there be enough space for fixating the internal nail.

2. Another concern of mine is would inserting internal nail indeed correct not only the misalignment, but also correct valgus I have on my left leg?

I already asked the same questions to Dr. Monegal and know his answers, but would like to hear what collective consensus on these kind of problems on the forum. As a matter of fact very often experienced LL veterans form quite professional opinion on many things.

Thanks for your attention!

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dr. mitkovic uses some aparatus to fix misalingments, maybe it's best you contact him?

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Quote from: microman on October 02, 2015, 02:22:41 PMdr. mitkovic uses some aparatus to fix misalingments, maybe it's best you contact him?

Thanks for the suggestion, but I thought I made it obvious I am trying to fix problems caused by external monorail device, so recommending the external monorail doctor is just incongruous.

Besides, I've clearly stated that I've made my decision to get this fixed with Dr. Monegal, the date of operation is fixed, and was asking specific questions to experienced LL veterans.

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Thanks for  your case.Your xray  is  too short  to look .Would you  please  post  anterioposterior and lateral film?

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Misalignment is not that big.

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Quote from: Dr.Ruan on October 04, 2015, 07:28:25 AMThanks for  your case.Your xray  is  too short  to look .Would you  please  post  anterioposterior and lateral film?

Dr. Ruan, thanks for your feedback, but I don't have any other X-Ray and am not going to have any before the op on 15th. Anyway, I know my misalignment is not that big - my main concern is valgus, which you won't be able to see on X-ray anyway. However my valgus is clearly noticeable when looking at my left leg externally. So I am going to Dr. Monegal not as much for fixing the above misalignment as for getting my valgus straighten up.

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Hope  that  you  will  be  safe and  correct  valgus  successfully  !  I wonder  how  many pins  are  there  on your  external device.From  your  xray just  one  pin  can  be seen  on  upper  portion   of  your  device.Thanks!

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First day post op. Lying in my hospital room with moderate pain even after having some Tramadol. But it's ok taken into attention Dr.Monegal said it was one of the most complicated operation. It took around 5 hours to finish it. Doc says longer than it takes when he performs regular Fitbone operation. Because I had pretty much fked up case. You can see that by looking at the X-ray picture taken just before the op:

http://imgur.com/pqSwjPB

I can give more details in couple days when I have new X-rays. However already I can tell that I am extremely happy with the wonderful job done by Dr.Monegal just by looking at my left leg. Valgus, which bothered me most, is completely gone. As for misalignment IM nail has been inserted, so it also should be straighten up now.

And generally people, environment, the hospital staff, care, everything in Barcelona is superb. But above all Dr. Monegal himself is not only one of the best LL specialists in the world in my opinion, but also is a really cool guy with quite friendly personality.

I'll post more when I have X-rays.

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Hey Nomad! Im happy that everything is going well

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Quote from: Nomad on October 16, 2015, 11:22:46 AMFirst day post op. Lying in my hospital room with moderate pain even after having some Tramadol. But it's ok taken into attention Dr.Monegal said it was one of the most complicated operation. It took around 5 hours to finish it. Doc says longer than it takes when he performs regular Fitbone operation. Because I had pretty much fked up case. You can see that by looking at the X-ray picture taken just before the op:

http://imgur.com/pqSwjPB

Holy crap! This is exactly why I try to talk everyone on this forum out of monorails. They are dangerous! What a misalignment! Looks like Bluebarbie's did during her distraction phase. Looks like she got it mostly straightened out during nailing but not perfectly, and I think part of the problem she's still having is due to that.

You made the right decision in my opinion to get this fixed now. Hopefully the realignment process hasn't damaged your new consolidation bone.