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[BullSurfer]

Let me hijack this post for a sec to ask all of veteran LLers and prospective LLers with lots o knowledge. Of the three economical methods namely LON LATN and MONORAIL, which one of these is the best way to go?

This is my understand of these methods:
LON - cut back time, but risk of nail infection also since one begins with the intramedullary nail your bone will not come back as strong. Then you have to get another operation to remove nails.
LATN - save time but need extra 2 opertions, after lengthening and removal of nails. Lengthening period with external only.
Monorail - no bulky frames, no correction while lengthening (unless I'm wrong), consolidation period times 2 of lengthening period. The good thing is, no need for extra surgery to remove nails.

Please help add on or deduct pros and cons so I can pick a method to suit my needs.

* Above Post moved from Disobedient's diary, easier to track replies with a new thread.

[Medium Drink Of Water]

You can also get Ilizarov without internals in Russia, so monorail is not your only option for external-only.

LON and LATN are almost exactly the same.  So close I'd barely consider them different LL methods.  Both involve 3 surgeries.  The only difference is with LON, the 1st surgery is really big with 2 smaller surgeries later, and LATN has two big surgeries and one smaller surgery later.  You will get the same result with either of them.

Pick the right doctor first and just go with whatever method he uses.

[KiloKAHN]

An advantage I see with LATN over LON is that the intramedullary nail put inside after lengthening can be of a larger diameter than the one put inside the bone canal during lengthening with LON. I know Dr. Rozbruch published something saying that LATN has a shorter recovery time compared to LON or external also.

[BullSurfer]

Thank you MDW and Kilokahn for weighing in.
 
I forgot to include the original Ilizarov which probably really safe but time in bulky frames after lengthening can be exhausting for anyone to bear especially in our time, also the cheapest from what I've heard.

Lately I've heard so many bad things regard Monorail, such as, one can not bear weight for the entire lengthening period but the weight bearing is allowed once the lengthening period is over. I don't like the hassle of getting extra surgery, I just might join Disobedient in India (Diso if you're reading this let me know what you think).

I also heard bad things about LON, like deep nail infections and bent nails.

Although I have not heard much bad things about LATN but finding a doctor who willing to perform this method is rare and patient who had undergo this method is rarer.

Guys, if you have to choose one method and let say all methods are available, which method would you choose? Give additional proves and evidences or story you have heard at least.

Thank you.

[Medium Drink Of Water]

External only was my first choice.  Least invasive, least traumatic, fastest to completely finish.

If you really want LATN but can't find a doctor you might ask a LON doctor to do it.

[KiloKAHN]

LATN for me.

I wouldn't be able to stand being in frames for so long with purely external methods, even though they're the cheapest. I want to go for 5cm on my tibias, and most orthopedic surgeons say adults need up to 2 months in frames per centimeter lengthened. That means a potential 10 months or longer wearing the Ilizarov fixators. To hell with that.

[BilateralDamage]

I think external only would be my preference as well.  Once you're done, you're done!  No drilling or reaming into your bones, etc.  But the frames are going to be on for a very long time which is the only thing holding me back from doing that on my tibias.  Who knows, when I finally come around to it, that may be my ultimate choice.

[BullSurfer]

Thanks guys. Any suggestion if I joined Disobedient? She's doing quad with Monorail, I'm just interested in 2 for tibias.

Btw, how can I pm Disobedient? I'm serious about LL now, this is my year.

[Medium Drink Of Water]

My suggestion is not to join her.

[KiloKAHN]

Thanks guys. Any suggestion if I joined Disobedient? She's doing quad with Monorail, I'm just interested in 2 for tibias.

Btw, how can I pm Disobedient? I'm serious about LL now, this is my year.

There's a white balloon under every user's username (or avatar if they have one) that you click on and it will take you to the message box to write that specific person a PM.

As far as joining Disobedient, I'm not sure that's the best idea (imo). Most qualified orthopedic surgeons would not even agree to do external only quadrilateral lengthening with monorail fixators. It's that dangerous. Yet her doctor did it anyway. Probably not a doctor you would want doing your surgery. If it were me, I'd look for other options. If you plan on going ahead with it, be very very careful and don't let the doctor ignore potential complications.

[BullSurfer]

I'm here to learn more so I can make proper decision so that I don't go into LL blindly. Disobedient seems fine to me, why hasn't she posted some news.

Ok guys, are suggestion on Dr. choice? I'm willing to listen if you're in India and have heard or consulted with some reputable doctors. If I'm rich I would do the internal nail or at least with Rozbruch since he's close to where I live. But karma dealt me a short hand, I'm gonna make do with what I can.

[KiloKAHN]

I'm here to learn more so I can make proper decision so that I don't go into LL blindly. Disobedient seems fine to me, why hasn't she posted some news.

Ok guys, are suggestion on Dr. choice? I'm willing to listen if you're in India and have heard or consulted with some reputable doctors. If I'm rich I would do the internal nail or at least with Rozbruch since he's close to where I live. But karma dealt me a short hand, I'm gonna make do with what I can.

Is India your only option? How much money have you saved up?

[BullSurfer]

Is India your only option? How much money have you saved up?
[/quote

Yes, at the moment.]

[Disobedient]

(Diso if you're reading this let me know what you think).
 

I said it before I can't recommend my Dr till I see the final result..
but so far I'm doing well...

[jerry]

Getting the external device off the legs after 3-4 months sounds alot more appealing than 9-10 months. 

It is often said that doing just one surgery with external device is less invasive than LON/LATN,  but how much difference does it ultimately make to full recovery of a normal condition? 

So  my question is this:  Which method give the best possibility of full recovery to previous sporting and functional abilities?  Please give your thoughts, thank you.

I'm thinking about doing Monorails because of the possible knee pain problem with LON/LATN mentioned in another thread here 
http://www.limblengtheningforum.com/index.php?topic=342.0

[Wannabegiant]

Getting the external device off the legs after 3-4 months sounds alot more appealing than 9-10 months. 

It is often said that doing just one surgery with external device is less invasive than LON/LATN,  but how much difference does it ultimately make to full recovery of a normal condition? 

So  my question is this:  Which method give the best possibility of full recovery to previous sporting and functional abilities?  Please give your thoughts, thank you.

I'm thinking about doing Monorails because of the possible knee pain problem with LON/LATN mentioned in another thread here 
http://www.limblengtheningforum.com/index.php?topic=342.0

External only definitely has the best possibility of full recovery, its the least invasive. Particulary the knee pain problems you mention seem to be quite common with internal methods.

[ChrisIsaak]

I agree with Kilokahn. There's no sense to do externals if you can afford LON/LATN. Frames around your legs for 8-9 months? Forget about it, I'd never do that.

When saying this, I'm assuming that someone who asks "Intramedullary methods or external ilizarov?" is able to afford LON/LATN.

I did internals, I do have a little knee pain here and there. Who cares when you're taller?

[Adriano]

There is a good reason NOT to do internals for tibia LL. KNEE PAIN.

with external only, you are on frames for an additional 5-6 months.

surely that is better than having knee pain for the rest of your life. pain wears you down. it ages you faster so avoid it if you can.

I am not doing my tibia until methods improve or I can afford (time wise) to do external only. I am seriously considering the salmefix.

The best option atm is internal femur.

[TRS]

There is the option of LATP which reduces the external fixation time and avoids the insertion of an IM rod, therefore no risk of permanent knee pain.

[ChrisIsaak]

I'll ask my doctor about this tibiae LON knee pain. I wonder what Dr.Franz thinks about this? Maybe he could give us an insight.

[Cyber]

I did internals, I do have a little knee pain here and there. Who cares when you're taller?

Hi ChrisIsaak,

Could you please elaborate on the little knee pain from your internal femur experience?
Is it on the lateral (outside), anterior (top), or medial (inside) portion of the knee?
Does the area feel pain, tender or numb?
What about hip area?

Your input would be greatly appreciated!

[ChrisIsaak]

Hi ChrisIsaak,

Could you please elaborate on the little knee pain from your internal femur experience?
Is it on the lateral (outside), anterior (top), or medial (inside) portion of the knee?
Does the area feel pain, tender or numb?
What about hip area?

Your input would be greatly appreciated!

Hi Cyber,

I only have knee pain when I walk/stand up without leg braces for a very long time. Which is natural, because I'm actually not allowed to walk without leg braces yet (still 3 more weeks to go). But yesterday night I began to walk without wearing them at home, simply not to wake others up with zipping and unzipping the braces at night several times. I know I shouldn't do this, but I feel fine. I don't have knee pain when I sit, lie down, or walk with support. In my case knee pain is also natural since the Fitbone nails were inserted from my knees. I would say it's medial (inside). I'm sure it'll go away in a few weeks 

There's no numbness, and no hip pain either. Hope that was helpful!

[Cyber]

Hi Cyber,

I only have knee pain when I walk/stand up without leg braces for a very long time. Which is natural, because I'm actually not allowed to walk without leg braces yet (still 3 more weeks to go). But yesterday night I began to walk without wearing them at home, simply not to wake others up with zipping and unzipping the braces at night several times. I know I shouldn't do this, but I feel fine. I don't have knee pain when I sit, lie down, or walk with support. In my case knee pain is also natural since the Fitbone nails were inserted from my knees. I would say it's medial (inside). I'm sure it'll go away in a few weeks 

There's no numbness, and no hip pain either. Hope that was helpful!

Yes, your answer was very helpful. Thanks ChrisIsaak!

[Muse]

I discussed this topic with a LL patient who did LON and agree to share his views about the additional risks of LON/LATN.   

Updated with more information.
 
____________

"  feel free to share more of my experiences if it helps others post it.   it could be one of those things that can save future LL patients from  or at the very least minimize their risks associated with internal methods.

LON, when performed correctly, with proper fixation of both bones (Tibs and fibs) at the Proximal, Medial, and distal ends and if high proximal tibia osteomy is avoided (can also lead to malalighnment according to my docs - actually there's some articles or vids available as well such as this one: http://www.wheelessonline.com/ortho/im_nailing_of_proximal_tibial_fractures.)

the risk of knee pain is not worth it. It's very, very, very annoying. And sometimes debilitating. Some days the are mild, other days the are more severe. I would recommend you stay the hell away from any internal tibia methods.

Before this site, I did not even know about the risks associated with Internal nailing for Tibias because those fkers on old forum  downplayed everything. And whenever someone did bring that concern up, it was quickly shot down or censored such as the one brought up by a patient from Dr. Paley I believe. Who knows, maybe scum bags like Apo and Tall have persistent knee and hip pain but are not telling us so they can continue their marketing to naive people.

I am not sure why the knee pains happens. Some Docs say it is because of weak quad muscles, others mention damage to the infrapettelar nerve branch of the sapheous nerve. Others mention damage to the fat pad on the knee, or the lateral retraction of the petella tendon. Others mention damage on the patella tendon itself from either the splitting process, OR the other method of just moving it.

 
if I could redo my experience again, I would definitely, without a doubt, choose Externals only. I don't care about waiting in the frames for an extra 4-5, 6 months, 1 yr, I don't care. At least with externals only, I would have avoided the knee pain issues, AND able to do precise deformity correction to correct malalighnment associated with Lengthening.

My legs would be totally straight, bones perfect anatomically aligned. No knee pains, no extra trauma from Nail insertion, less scars associated with the Nail insertion etc.

And most importantly, what I've noticed is that people who op with LON or LATN are people who think they are saving time by not being in frames for a few extra months. But from what I've witness and learned from prior patients and from myself, is that even though you don't have the frames on, you are still suffering and basically semi-disabled because you still are experiencing pain, muscle contracture, nerve damage, bone migration from improper fixation, malalighnment, and IM Nail trauma and the requirement to remove it later on.

So I would choose to be in frames and suffer for 9-12 months, and then be done with LL forever. Rather then be free by taking the easier way out (by removing frames early and putting in internal rod or plate) and be stuck in a state of purgatory because of complications and having to wait longer before your journey is complete (2-3 years or more).

If you want, and waiting is out of the questions, LATP is also viable options if waiting is 100% out of the questions. From my experience, and other patients, I noticed that the more cuts and the more invasive a surgery is, the higher risk of developing nerve problems like potentially permanent numbness, or tenderness and nerve sensitivity from the cutting, insertion, and trauma. "

Humans cannot "fully Regenerate" like other animals. They can only "heal" where it is NOT 100% like it was prior to injury. Humans tissues repair itself and leave scar tissue behind which can cause interference with other tissues. Scar tissues are unsitely, and for all intensive purpose, cannot be completely, 100% removed - only the appearance to be improve.
And scar tissues are not like the surrounding tissues in that they do not have nerves etc in them, so yes, the area on the scar is numb.

One more thing regarding Externals, and it is pretty a flook or just semi-dumb luck: There is an issue with compartment Sydrome and nerve damage, especially with Internal methods. Externals have pins and wires going through your legs which provides "vents" to help minimize / release pressure.

Internals do not. I know this because a Doctor who wants to fix me up gave me ways in which he would fix me. The internal method method all required fasocitomy and decompression, whereas, the externals only did not.
 

[Adriano]

I were lifts and last week when i was climbing up stairs i felt sharp but mild pains on my right knee.

I knoew right there and then that i would never do internal tibia. I took my lifts off and now i dont use them when walking on non flat surfaces.

I cant imagine living with that pain for the rest of my life. no way. if you want to do an internal LL do your femurs.

I is better to put up with frames and struggle an extra 6 months in frames than leave with the knee pain.

Its very obvious that only a few if any will walk away without knee pain doing LATN or other internal Tibia LL.

They cut your knee open
drill the top of your bone
remove the liquide inside your bone (bone marrow)
then they force a a metal rod insude your bone.
the rod stayes there for 18+ moths!!
then they stich your knee back together

then when you knee has tried to heel back to normal,

they CUT your knee open AGAIN
drill ur bone
forceble remove the metal nail inside your bone (tibia)
then they say your knee back together

if your chances of developing knee pain is around 50% when ever your knee is cut open and bones are drilled is 50%.

then the probability that you DONT develop knee pain after 2 operations (on one leg) is 25%.

The probability that you dont deleop knee pain from BOTH of your 2 legs is only 6%.

if you do LL and dont develop Knee pain after the firstoperation (insertion of the nail) then there is still a 75% chance that you will develop knee pain from the nail removal surgery.
Assuming independency of the process or outcome.

Maybe we should thread about previous patients and there experience.

Did u have knee pain after nail insertion.
did the pain go away after frame removal or did it stay.

did you get kne pain after nail removal...etc?

This would help put actual experience to the random numbers we get from doctors.
Assuming our population wont be a selected group.
 

[TRS]

This is a study showing the incidence of anterior knee pain from IM nailing. Anterior knee pain was present in patients regardless where the IM nail was inserted (femur/tibia). It is noted that anterior knee pain is more frequently related to tibial nailing.

    http://www.bjj.boneandjoint.org.uk/content/88-B/5/576

[crimsontide]

 ... i wanted to latn, but after reading this thread... horror movie

[alps]

Why don't people who do internal femur lengthening get hip pain? After all the nail is inserted through the hip if I'm right.

[ChrisIsaak]

Why don't people who do internal femur lengthening get hip pain? After all the nail is inserted through the hip if I'm right.

I did internal femur lengthening and the nails were inserted through my knees. Maybe that's why I don't see LON/LATN as problematic; I have very little and infrequent knee pain and it'll obviously go away in a while, it's not a permanent thing. It's not bad at all.

If I ever do a second LL I'l do LON/LATN without a single doubt. Wearing external fixators for months and months sounds like hell.

[Wannabegiant]

I did internal femur lengthening and the nails were inserted through my knees. Maybe that's why I don't see LON/LATN as problematic; I have very little and infrequent knee pain and it'll obviously go away in a while, it's not a permanent thing. It's not bad at all.

If I ever do a second LL I'l do LON/LATN without a single doubt. Wearing external fixators for months and months sounds like hell.

Possibly because you did femurs they cut the knee open in a different spot which didnt cause permanent knee pain. However there is evidence that LON and LATN can cause permanent knee pain with a relatively high probability, however it seems more likely to happen with tibia lengthening.

[ChrisIsaak]

I understand the risk, as documented by all the research shared here. Still, the psychological burden of wearing the frames for a longer period is a costlier trade-off in my case. I have to serve in the military as well, so I need more time for other things; work, setting up a business, leisure, etc.