Is the internal ones really much safer? I've heard American doctors speak down a lot about overseas doctors, especially ones that use the external kind.
Internals are objectively better, especially newer nails like Precice. But that doesn't mean they're barbaric or even outdated; they're still being used today for more complex deformities that a telescoping rod can't fix.
It hasn't even been a decade since Precice hit the market, so methods like LATN and LON are relatively contemporary compared to classic Ilizarov. For instance, here's
Dr. Mahboubian treating a patient with an external fixator in 2011. Here's
a slide deck by Dr. Rozbruch in 2012, discussing the advantages of LATN and LON over classic Ilizarov.
FYI, LON was
introduced by Dr. Paley in 1997. LATN was
introduced by Dr. Rozbruch in 2007. Advanced hexapod frames like the
Taylor Spatial Frame (used by Dr. Mahboubian in video linked above) and
Ortho-SUV (created in conjunction with Dr. Solomin) improved on the Ilizarov apparatus with more degrees of control as well.
Of course, the advantages of external fixators don't mean as much for CLL patients, since what we need is relatively simple: lengthening in one direction. For that reason, doctors will recommend internals over externals if it's for cosmetic reasons. The experience is better through simplified lengthening process (push of a button on external controller), psychologically less taxing to not have frames, less socially isolating if patient is embarrassed about frames, less scarring, less infections, etc. Cosmetics patients are pickier and less forgiving, as they're seeking enhancement, not simply function -- so doctors prefer internals.
But externals still exist for CLL patients, and since it's less expensive, more doctors abroad still offer it. It's a strong association for sure. Some doctors are indeed worse than others, and this forum helps to find the right one for all budgets. As for Dr. Paley, he's all in on the Precice, since he helped to develop it; would be counter intuitive to trumpet another method when he can improve his own through consultation with the manufacturer.
Glad you're feeling a bit better!