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Author Topic: Yardbird's Bilateral Tibia Lengthening w/ Dr. Shahab Mahboubian, D.O. CA, USA  (Read 26218 times)
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Yardbird
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« Reply #40 on: July 05, 2016, 09:46:17 PM »

Update:

Past 3 cm now. Nothing interesting to report. Same thing every day. Wake up, stretch, lengthen, eat something, exercise, go back to sleep, wake up, stretch, lengthen ... you get the picture. No complications, no significant knee bending or ballerina foot, no regrets. So far so good.
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Yardbird
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« Reply #41 on: July 09, 2016, 06:53:15 AM »

Update:

I had my second postoperative appointment with Dr. M today. The distraction gap measured on x-ray matched my calculations exactly. The precice is a very accurate and reliable device. However, my bone growth is very rapid, which is a bit of a concern. My tibias are regenerating at an ideal rate, but my fibulas are already forming a bridge. Dr. M advised me to increase the lengthening rate from 0.75 mm per day to 1 mm per day and to see him again in two weeks. Hopefully the increased rate of distraction will break up the callus forming on my fibulas and allow me to continue toward my goal of 6.5 cm. Only time will tell.  At present, I have reached 3.225 cm. I will also try to avoid walking as much as possible, since weight bearing stimulates callus formation.
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Yardbird
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« Reply #42 on: July 23, 2016, 04:54:46 AM »

Update:

I experienced a setback today. During my visit with Dr. M, the x-rays showed that my right fibula has fused. This stopped the lengthening of my right leg bones somewhere around 3 cm. My left leg continued to lengthen and is now over 4 cm. However, the fibula is quickly fusing on my left leg as well. This is very unusual and unexpected. Everyone I had spoken with prior to this surgery (doctors, patients, etc) told me that the lower leg bones heal more slowly than femurs, and that early consolidation is not a concern. Well ... that wasn't my experience at all. If anything, my lower leg bones are healing more rapidly than my femurs did. I have an additional surgery scheduled this coming Wednesday to re-break my fibulas and allow me to even out my leg lengths and continue toward my end goal. If there's any good news in all of this, it's that my consolidation should be very rapid when I finally finish lengthening ... and this will allow me to resume walking relatively quickly. I'm not looking forward to another surgery. Hopefully this will all be worth it in the end. At the moment, I'm giving serious thought as to whether I made the right decision in getting myself into this. Hope for the best, but be prepared for complications ...
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TIBIKE2002
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« Reply #43 on: July 23, 2016, 05:45:21 AM »

out of all possible complications, this is the "best" complication one should get if he has to get any. It's a sign of good regeneration. Maybe, in order to not risk it again, just even out the legs and call it a day?
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jwalk707
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« Reply #44 on: July 23, 2016, 07:21:35 AM »

Yardbird, your complication definitely has turned me off from wanting to do this, especially when combined with Dr.  M telling me via e-mail that I could expect to go back to work at a desk job two weeks after surgery, which every patient has told me is completely unrealistic.
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Yardbird
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« Reply #45 on: July 23, 2016, 08:30:00 AM »

Yardbird, your complication definitely has turned me off from wanting to do this, especially when combined with Dr.  M telling me via e-mail that I could expect to go back to work at a desk job two weeks after surgery, which every patient has told me is completely unrealistic.

I didn't mean to discourage you. I honestly feel that everything will be fine in the end. I am just in the process of dealing with this setback. More than anything, I regret causing my family stress and emotional pain. I did not involve my family and loved ones in my femur lengthening in France (during which I also experienced a complication that was later corrected). In hindsight, I think that was the most considerate thing to do. I weather setbacks and complications pretty well, but the realization that I've brought stress on others despite my best efforts causes me pain.  Sad
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Yardbird
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« Reply #46 on: July 24, 2016, 12:00:35 AM »

out of all possible complications, this is the "best" complication one should get if he has to get any. It's a sign of good regeneration. Maybe, in order to not risk it again, just even out the legs and call it a day?

Thanks for your post. I think my case is unusual. Everything was done right. We could not have predicted that the regeneration of the fibulae would be so strong. In fact, my tibiae are regenerating at an ideal rate. However, since the fibulae were fixated to the tibiae during the first surgery, they unfortunately limit any further lengthening if they consolidate prematurely. Because you are breaking four different bones when you lengthen your lower legs, the process is more complex and prone to complications. I would like to reiterate what others have said before ... if you are only going to do this once, lengthen your femurs with a ratcheting mechanism like the Guichet nail. Femurs heal quickly and, in the case of premature consolidation, you can always break up the callus in a clicking session. I do believe that the Precice device allows for quicker healing and better callus formation because it avoids twisting of the distraction zone. However, as mgibson77 has stated, the only way to tell whether whether your bones have consolidated is through x-ray ... and at that point it's too late. Luckily for mgibson77, he had already achieved a significant gain by the time he consolidated. If I had decided to equalize my legs in the manner he did, I would end up with only a 3 cm gain, which is not really worth the effort and expense. In the end, it's all individual. Others will have the opposite problem, and experience very slow consolidation. I will update again after I'm back on track. Whatever you decide, please be safe. With each complication, the realization that this procedure is not medically necessary becomes more acute ...
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TIBIKE2002
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« Reply #47 on: July 24, 2016, 12:26:39 AM »

I personally dont think that a ratcheting nail is better than a non ratcheting one in order to prevent pre consolidation... It's something you can't control. You either have it or dont.
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Yardbird
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« Reply #48 on: July 24, 2016, 01:13:29 AM »

I personally dont think that a ratcheting nail is better than a non ratcheting one in order to prevent pre consolidation... It's something you can't control. You either have it or dont.

I agree that consolidation rate is not something we can control. However, I know that it is possible to break up a callus with a ratcheting device to reestablish a gap. I know because I did it! The nice thing about the ratcheting device is that you can actually feel when the callus is forming because clicking becomes more difficult. It starts to feel sort of "sticky." I know of patients who took time off of lengthening, then broke up their calluses by clicking,then proceeding lengthening again. Of course, most people will find a ratcheting device to be much more uncomfortable during distraction. To each his own. I want to say that I still don't regret doing this. My left leg continues to lengthen and looks much better after gaining over 4.5. cm. Once I'm back on track, the end result will be well worth the extra effort.
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TIBIKE2002
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« Reply #49 on: July 24, 2016, 06:08:19 AM »

I wonder, since you lengthened both segments, aesthetically, which has more pronounced effect on how you look? The femurs or the tibs?
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Yardbird
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« Reply #50 on: July 24, 2016, 09:01:17 AM »

tibs, no doubt  Wink
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TIBIKE2002
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« Reply #51 on: July 24, 2016, 10:50:48 AM »

So if I want to "hide" that I did LL it's better to do femurs?

 I am asking because I have my femur doc and my tibs doc. Only thing left is to decide which one to go for
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Yardbird
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« Reply #52 on: July 24, 2016, 01:58:33 PM »

So if I want to "hide" that I did LL it's better to do femurs?

 I am asking because I have my femur doc and my tibs doc. Only thing left is to decide which one to go for

In my opinion, lengthening your femurs is less obvious. Long femurs sort of blend in with the midsection rather than your lower body. I did over 7 cm on my femurs and my legs did not look disproportionately long ... I probably could have done even more and been fine. Also remember that you can modify your appearance after lengthening through muscle building. The thicker and more muscular your legs are, the less long they will appear. Of course, you must also consider which segment is relatively long to begin with. In my case, I had relatively short femurs, so I lengthened them first. Who are you considering? I lengthened with Guichet and Mahboubian and I recommend them both!
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TIBIKE2002
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« Reply #53 on: July 24, 2016, 02:24:05 PM »

In my opinion, lengthening your femurs is less obvious. Long femurs sort of blend in with the midsection rather than your lower body. I did over 7 cm on my femurs and my legs did not look disproportionately long ... I probably could have done even more and been fine. Also remember that you can modify your appearance after lengthening through muscle building. The thicker and more muscular your legs are, the less long they will appear. Of course, you must also consider which segment is relatively long to begin with. In my case, I had relatively short femurs, so I lengthened them first. Who are you considering? I lengthened with Guichet and Mahboubian and I recommend them both!

One of the american docs for femurs (Dont want to specify which for a few reasons... Nothing related to you) and Catagni from Italy for tibs.
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TIBIKE2002
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« Reply #54 on: July 24, 2016, 02:27:12 PM »

I want to do 6cm max (I am already 171 so being 177 will be sufficient for me or even 176). So one go is enough for me. Planning on doing it in near January.

 Btw, thx for responding to my questions. I appriciate it
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mgibson77
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« Reply #55 on: July 28, 2016, 06:12:05 PM »

Yardbird,
sorry to hear you had complications before your goal. As is in life, sometimes things arent always the way we envision them but through your writings, I've come to notice that you're a tough and determined guy and that you'll get through this eventually.

In my femur consolidation, I thought about re-breaking but dr. Mahboubian told me that the amount of height left to gain was quite small and may not be worth the re-break: I was at 6.8cm. In your case, its easy to see why you'd want to re-break. Wish you all the best and we'll keep praying for you as well.
Hopefully in 2-3 years time, when I plan to do my tibias, there will be some way (other than x-ray alone) to tell if premature consolidation is happening so it can be corrected ahead of time.  I believe this is weakness with the PRECICE method.
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5ft9.5
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« Reply #56 on: July 28, 2016, 10:17:46 PM »

In my opinion, lengthening your femurs is less obvious. Long femurs sort of blend in with the midsection rather than your lower body. I did over 7 cm on my femurs and my legs did not look disproportionately long ... I probably could have done even more and been fine. Also remember that you can modify your appearance after lengthening through muscle building. The thicker and more muscular your legs are, the less long they will appear. Of course, you must also consider which segment is relatively long to begin with. In my case, I had relatively short femurs, so I lengthened them first. Who are you considering? I lengthened with Guichet and Mahboubian and I recommend them both!

Lets say though you start off with very short tibias like myself...would it not be more advisable to lengthen that segment first? Also, I wonder about the proportion with respect to my ethnic features. Without getting into this huge debate about proportions...I will just say that as a black man, I see more of us with long tibias (its hard to say if our femurs are long as well for me). At 5ft9 and 3/4 (as of yesterday), I think I would look weird with really long femurs and short tibias. What is your opinion yardbird?
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mgibson77
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« Reply #57 on: July 30, 2016, 12:55:16 AM »

I'm not sure whether you got the chance to read my diary. I'm a black male as well and added 2.5 inches to my femur without any awkwardness in my proportions. I'm walking now and wearing both shorts and long pants and tucking in - no abnormalities.
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Yardbird
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« Reply #58 on: July 31, 2016, 03:36:52 AM »

Hello all,

This past week was one of the most stressful periods I've experienced in a while, but now I'm back on track. We weren't certain whether the right fibula had solidified and caused the nail to stop distracting on that side - or if the nail itself had malfunctioned, leading to preconsolidation. After a repeat osteotomy on the right fibula, Dr. M. experimentally distracted the nail and found it still functioning properly. This was good news. If the nail had malfunctioned, my only option would be to replace it with a new one, which would require an additional waiting period for delivery and a third surgical procedure under general anesthesia. Now that my fibulas have been released, I'm cautiously optimistic that I will reach my lengthening goal. During the procedure Dr. M. also found that a couple of screws had bent and broken during the first half of the lengthening phase, and he replaced them with new ones. I will resume lengthening both legs 3 X per day beginning on Monday. 
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Yardbird
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« Reply #59 on: August 02, 2016, 02:01:54 AM »

Lets say though you start off with very short tibias like myself...would it not be more advisable to lengthen that segment first? Also, I wonder about the proportion with respect to my ethnic features. Without getting into this huge debate about proportions...I will just say that as a black man, I see more of us with long tibias (its hard to say if our femurs are long as well for me). At 5ft9 and 3/4 (as of yesterday), I think I would look weird with really long femurs and short tibias. What is your opinion yardbird?

Hello 5ft9.5,

Thanks for your post. Of course, everyone is different. You must decide which segment will look best for you. Both Dr. Guichet and Dr. Mahboubian were very clear with me upfront ... tibiae are more difficult to lengthen. You are breaking 4 bones as opposed to 2, and each bone heals at a slightly different rate. Everything must be orchestrated so that these 4 bones not only lengthen the desired amount, but also heal properly. Everything has to come together at the end. Among all the internal doctors I met with, the preference for femurs was evident. If you lengthen your tibiae, be prepared for a more lengthy and complex procedure (necessitating a follow up surgery for screw removal during the consolidation phase). However, it may be worth the effort if it's the particular look you're going for. Above all, be safe. You are already a fine height. At almost 5'10'', I don't imagine you experience any personal or professional difficulties due to your height. If you must do it, take your time and go with the best surgeon you can possibly afford. Remember that your health is precious ... and I'm sure that there are many people in your life who care about you ...
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