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[GROWtalORdieTRYING1]

I too suspect that external femur lengthening is not as dangerous as old forum  pretends it is.

I looked at a dozen different external femur studies, and found an incredibly low contracture rate for monorail external femur, where the loss of range of motion ALWAYS in majority of cases went back to starting flexibility. I will try to post the studies.

I posted a bunch of studies on external femur medical studies on old forum . I cant remember the thread name.

if it is true and external femur is not dangerous and merely a temporary loss of range of motion followed by restoration of range of motion, then that would really put a dent in sysops/apothes earnings.

I AM NOT SAYING EXTERNAL IS SAFE FOR FEMUR,  I am saying we need to discuss weather it is all a lie to promote internal methods.

my studies have shown that a lot of the "supposed danger" is hype.

my studies do show that internal is the safest method though. I just want that to be clear.

[RGKEY]

I too suspect that external femur lengthening is not as dangerous as old forum  pretends it is.

I looked at a dozen different external femur studies, and found an incredibly low contracture rate for monorail external femur, where the loss of range of motion ALWAYS in majority of cases went back to starting flexibility. I will try to post the studies.

I posted a bunch of studies on external femur medical studies on old forum . I cant remember the thread name.

if it is true and external femur is not dangerous and merely a temporary loss of range of motion followed by restoration of range of motion, then that would really put a dent in sysops/apothes earnings.

I AM NOT SAYING EXTERNAL IS SAFE FOR FEMUR,  I am saying we need to discuss weather it is all a lie to promote internal methods.

my studies have shown that a lot of the "supposed danger" is hype.

my studies do show that internal is the safest method though. I just want that to be clear.

the only negative about external/monorail is that if there is a misalignment of the bone due to a contraction of the muscle, it is hard to fix the problem with this device alone. This is the only real problem. It is only one problem but it is a big problem! Internals will always be more convenient and wont have misalignment issues for the most part, but it has its risks too. the biggest risk is internal infection of the bone and if the bone rejects the rods. Most likely it wont happen but it can and it is also a big bad situation if it happens.

[GROWtalORdieTRYING1]

hello gys.

I guess it is time to have a discussion about external femurs. is it safe, or is it dangerous. is the danger being hyped to scare people into paying exorbitant prices for internals which will result in sysop/Apotheosis receiving income for his internal investments.

we have already seen how sysop/Apotheosis admitted in e-mails to sarin that he deliberately coerced people on old forum  into making sarin the forefront in the world for cheap external, and sysop admitted that he did so by making people not choose other doctors who are also cheap and qualified for LL.

my proposal is simple, given that sysop/Apotheosis has a habit of manipulating people into seeing specific doctors for monetary gain, and we know he has an investment in internal LL, then it is highly likely that sysop also lied about externals so he could make massive profits of internal LL.

if word got out that people could do external LL for femur then internal LL would significantly decrease in price or become obsolete. 

I once emailed sysop about external femurs and asked for specifics on why it was so dangerous according to him and his statements. all I ever got was a vague don't ever do it response or I will ruin myself for my life. this is not informative. this is only a fear based coercion tactic.

NOW LET ME BE CLEAR!
I am not saying external femur is safe.
I am saying that it needs to be discussed.
from my research internals is safer. but the danger of externals is so overhyped it is not funny.
the only reason that statistical analysis for external femur in a clinical setting could be so different from old forum 's opinion on external femur LL, is because of the investment sysop/Apotheosis has with internal LL.

I intend to get external femur as my doctor said it is safe. it is not without risk but the danger is over exaggerated.

I will attach some studies.

[GROWtalORdieTRYING1]

this is for Ilizarov cages. Ilizarov cages are by far the most dangerous external femur method due to their size and the subsequent range of motion issues it causes.

 We have encountered the usual complications com- mon with the Ilizarov external fixator, including pin site infections, decreased knee range of motion, deep infections (osteomyelitis), neurological complications, and new defor- mities. In the lengthening group, the most common compli- cations were knee contractures, with 7 cases or 30%, requir- ing quadricepsplasty. This complication has been noted by multiple authors [1, 4, 5, 15, 20, 24, 25], with rates ranging from 0% to 100%. Quadricepsplasty rates ranged from 0% to 18% in series utilizing external fixation ± intramedullary nail [1, 5, 15, 20] and 0% in series using intramedullary nails only [4, 24, 25]. This is consistent with the rates reported in the literature

so 30% of people who use cages get knee contracture. this statistic is too high to warrant being called safe. however quadroplasty does fix it from other research I have looked into.


it would appear that 30% seem to get enough scar tissue to limit knee range of motion in which a Quadricepsplasty is needed.

[GROWtalORdieTRYING1]

We retrospectively reviewed the charts of 66 patients

Of these 66 patients, 16 (24%) had an extension
contracture of the knee develop (Table 1). These patients
were not able to bend their knee greater than 60 despite
aggressive physical therapy.

Extension contracture of the knee is a common complication of femoral lengthening. Knee flexion exercises to stretch the contracture with physical therapy can be effective but take a prolonged amount of time to work and place increased stress across the patellofemoral joint. We developed a minimal-incision limited quadricepsplasty surgical technique to treat knee extension contracture secondary to femoral lengthening and retrospectively reviewed 16 patients treated with this procedure.

Range of motion of the knee and quadriceps strength were recorded preoperatively, after femur lengthening but before additional surgery, after quadricepsplasty, and at each followup. The mean femoral lengthening performed was 4.4 cm. We compared range of motion and time to regain knee flexion with those of historical controls. The minimum follow up after quadricepsplasty was 6 months (mean, 38 months; range, 6–84 months). The mean range of motion was 129 preoperatively, 29 after the distraction phase of femoral lengthening, and 108 after limited quadricepsplasty, and at final followup, the mean knee flexion was 125. There were no major complications. Limited quadricepsplasty improved knee flexion after a knee extension contracture developed secondary to femoral lengthening. In comparison to historical controls who did not have quadricepsplasty, the patients with limited quadricepsplasty had quicker return of knee flexion, although there was no difference in knee flexion achieved ultimately.

http://www.limblengthening.com/LimitedQuad.pdf

so range of motion comes back even if you don't do a quadroplasty. it takes longer to reach full ROM though.

this was in cages also so monorail would have less scar tissue I imagine.

this scar tissue and subsequent range of motion issue seems to be the only draw back to external femur long term damage.
with the new lon monorail technique I imagine even less scar tissue. and a much greater chance of recovery.

I guess my point is why is everyone so scared of doing external femur?Huh?Huh?? obviously there is a higher chance to develop knee contractures and limited ROM however all my study shows that is due to scar tissue and increased for a larger cage frame and is also increased for a longer duration of external frames.

[GROWtalORdieTRYING1]

129 preoperatively, 29 after the distraction phase of femoral lengthening, and 108 after limited quadricepsplasty, and at final followup, the mean knee flexion was 125.

as you can see. 125 from 129 after 6 months is a full recovery of range of motion.

 

the patients with limited quadricepsplasty had quicker return of knee flexion, although there was no difference in knee flexion achieved ultimately.

as you can see even those who did not have quadricepsplasty still had a full recovery of range of motion.

[GROWtalORdieTRYING1]

control

Herzenberg et al. [7] reported followup ROM of 25 patients with extension contractures after femoral lengthening treated nonoperatively. The mean age of their patients was 20.2 years. Fifteen patients underwent femoral lengthening for atraumatic (congenital or developmental) and 10 for posttraumatic shortening. The mean femoral lengthening was 6 cm (range, 3–15 cm). ROM decreased from 127 ± 16 to 37 ± 15 after femoral lengthening. All patients underwent daily aggressive physiotherapy. All but one patient achieved 90 knee flexion by 6 months after frame removal and full recovery was seen during the course of 1 year after frame removal. Patients required very aggressive physical therapy during the course of 1 year to recover ROM of the knee. At final followup, knee flexion was 122 ± 23.

as you can see range of motion always drastically reduces during the external femur surgery, but comes back after. this was for LON.

[GROWtalORdieTRYING1]

now we have discussed a 30% knee contracture rate in external femur cages, however it would seem the knee contracture rate goes down to 5% from 30% when you use monorail LON.

http://www.bjj.boneandjoint.org.uk/content/81-B/6/1041.full.pdf

20 cases of femur lengthening with lon. including all complications for each patient time for both lengthening and consolidation and length attained.

only 1 person needed quadricepsplasty (and this patient used lizarov not monorail).

5% only for quadricepsplasty for external femur .

patient 2,
age 22,
Post-traumatic,
open fracture Yes,
amount lengthened= 7.0cm, 
Femur Drill Ilizarov,
Duration of lengthening=  85 (12.1)
Duration of external fixation (days)= 93 (13.3)
Required osteotome quadricepsplasty

see link for full details.

[GROWtalORdieTRYING1]

also I will note that this text was in the above link. which comments on mechanical and anatomical axis.

(just a side not out of curiosity)

In recent clinical studies, successful lengthening over a nail has been achieved without compromising the quality of the regenerate and subsequent consolidation.7-12,21 This technique allows lengthening only in the anatomical and not in the mechanical axis. Theoretically, in the treatment of congenital shortening, it could create abnormal mechanical axes but neither we nor Paley et al7 encountered this problem.

http://www.bjj.boneandjoint.org.uk/content/81-B/6/1041.full.pdf

[123]

It's not dangerous. But just be realistic for a moment. Imagine having these frames on your femurs. You won't be able to sit, you won't be able to straighten your legs and they will hurt like hell because the pins will go through so many muscles (unlike if you would do it on the tibia). Imagine this for AT LEAST 6 months/180 days/4320 hours. Go for it if you want but that's just torture. 

[GROWtalORdieTRYING1]

pay careful attention to what I posted.

I stated that Ilizarov cages are a bad idea. due to 30% contracture rate and cumbersome frame.

only LON monorail is a safe alternative with a 5% contracture rate (which can be cured by quadroplasty).

LON monorail is not nearly as cumbersome. and is only going to be on you for 10 days per centimeter (guideline) for lengthening only.

[123]

pay careful attention to what I posted.

I stated that Ilizarov cages are a bad idea. due to 30% contracture rate and cumbersome frame.

only LON monorail is a safe alternative with a 5% contracture rate (which can be cured by quadroplasty).

LON monorail is not nearly as cumbersome. and is only going to be on you for 10 days per centimeter (guideline) for lengthening only.

Stop with this studies. No one here is a doctor, you don't even understand them. If you think external femurs is good then do it. Like anybody here cares how much you will suffer.

[crimsontide]

i'd be willing to try lon with femurs...possibly.... if certain questions were answered.... i would not do external femur

[Taller]

Thanks for the input RGKEY! Can you tell us a bit more about just how inconvenient Ilizarov femoral fixators are to wear? Can one sit, sleep, or walk normally while wearing them? What are the biggest limitations from wearing them?

[crimsontide]

internal is overhyped and overpriced


i don't believe internals are safer at all


the reason most get internals is for ease of use... now with the cost of internals being exponentially higher than externals, i'd expect and want a smooth as care free as possible time  if i went for internals... that is after a lll why   internals are so much more expensive... they are supposed to make ll easier... but  time after time, i read stories about nails bending, malfunctioning, etc etc....   to me, internals are overhyped...

[GROWtalORdieTRYING1]

Stop with this studies. No one here is a doctor, you don't even understand them

I honestly hope your not being serious........... how stupid would a person have to be not to be able to read a basic study.......... as for a matter of fact I am qualified to assess peer reviewed articles.

but honestly in my opinion I don't need my fancy degree to understand something so basic. this is not rocket science.

i'd be willing to try lon with femurs...possibly.... if certain questions were answered.... i would not do external femur

im confused, lon is external. 

either way if you have any doubts then a close to 0% contracture rate exists with internals. you are welcome to do internals as it is a safer method. however the difference in contracture rate is 5%(externals) as opposed to 0%. and for that extra solace you spend big dollars. its your choice.

if you wish to refute my claims then post some peer reviewed articles please.

[GROWtalORdieTRYING1]

well there are 3 options.

-Ilizarov femoral fixators,
-LON (external, monorail),
-Pure internal.

internal does offer the lowest knee contracture rate at close to 0%,
LON is statistically consistent with 5% contracture,
Ilizarov femoral fixators are consistent with 30% contracture rate.

contracture can be fixed with quadroplasty.

so internals do offer an advantage. the question becomes how much of an advantage. and is that advantage worth the price.

however 30% is not acceptable. Ilizarov femoral fixators are not acceptable in my opinion.

[RGKEY]

Thanks for the input RGKEY! Can you tell us a bit more about just how inconvenient Ilizarov femoral fixators are to wear? Can one sit, sleep, or walk normally while wearing them? What are the biggest limitations from wearing them?

all is fine, painful and uncomfortable but i was able to sleep and survive. i think it is pretty obvious what the inconveniences, they are big metals, can take off and put on your pants as fast. cant walk as if you had nothing, etc...definitely not convenient but the pros are more that the cons in my opinion.

[Medium Drink Of Water]

The pins don't go directly through the muscles, they go between the muscles.  I think it is getting overblown over on old forum .  Jungle did it in Serbia and Mummy did it in China.  Their complaints were "excruciating pain" and "agony" but the job got done.

[crimsontide]

again.... i don't think internals are any safer


you post 1 measure... contracture...  in 5% of lon patients, which can then be corrected...how about  serious deep infection which is more of a possibility with internal

medium is right... it gets the job done... i would never pay the price for internals

[Greek-Semidget]

Wow!If Lon monorail, is actually a good option I will definately go for it my tibias are almost same length with people who are 178-180, but my femurs are always shorter, this will be fantastic for me, please recommend some doctors

[Sweden]

My roommate did LON in one leg and LATP in the other. A total of 4cm.

He said it was total nightmare. The worse thing was the IMnail in his first leg. The pain in his knee was excruciating.
Then the scar in his other leg, from the plate, was horrific.

This is strongly advised against for many reason.

ROM in the knees almost always get back to normal. All it takes is time.
It took me 1 full year to fully kneel.

Just these past two weeks I've been recovering a lot I can tell. Barely any stiffness pain or such things. I guess it'll take one more year.

[Greek-Semidget]

My roommate did LON in one leg and LATP in the other. A total of 4cm.

He said it was total nightmare. The worse thing was the IMnail in his first leg. The pain in his knee was excruciating.
Then the scar in his other leg, from the plate, was horrific.

This is strongly advised against for many reason.

ROM in the knees almost always get back to normal. All it takes is time.
It took me 1 full year to fully kneel.

Just these past two weeks I've been recovering a lot I can tell. Barely any stiffness pain or such things. I guess it'll take one more year.

Intersting Sweden, how about latn on femurs?

[Taller]

Work done by Amar Sarin should never be used as an example of what proper lengthening might feel or look like.

[GROWtalORdieTRYING1]

this is a study to help people who are researching external monorail (LON) femur surgery.

We present a retrospective review of a single-surgeon series of 30 consecutive lengthenings in 27 patients with congenital short femur using the Ilizarov technique performed between 1994 and 2005.

The mean increase in length was 5.8 cm/18.65% (3.3 to 10.4, 9.7% to 48.8%), with a mean time in the frame of 223 days (75 to 363). By changing from a distal to a proximal osteotomy for lengthening, the mean range of knee movement was significantly increased from 98.1° to 124.2°

http://www.bjj.boneandjoint.org.uk/content/91-B/7/962

this is important information. if you are going to risk a 5% contracture rate then this kind of knowledge is important.