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[Sudheer]

Hi Everyone

I'm new to this forum, so apologies in advance if this is a silly question. I couldn't find answer anywhere, therefore posting it here. Please weigh in and provide your feedback. Thank you!

I'm planning for LL surgery and inclined towards going with Femural lengthening instead of Tibia, using Monorail fixator with Nailing (to avoid wearing frames during consolidation). Here are my reasons why I think this is best for me -

Pros-
- Femur lengthening heals faster than Tibia.
- Can tolerate more lengthening compared to Tibia - I'm aiming for 7 cms.
- Tibial bone only has muscle on top (Achilles Tendon). Therefore, it cannot take severe lengthening. Femur however is covered by muscles all around it, and therefore muscle stiffness is less prevalent here, as there is enough muscle.
- No chance of ballerina as my Tibia and ankle bones/muscles are untouched.
- Comfortable than Illizarov as it doesn't restrict my movements as much as Illizarov frame. So I think I can sleep well

Cons -
- I read on lot of forums that external femur is extremely painful. However, because I'm choosing to go with Nails instead of pure External, I think I only have to tolerate this during distraction.
- Large pins cause more pain than Illizarov rings.
- Cannot rectify angular corrections (like bone bending) if needed during distraction. I'm not sure how likely this is to occur in case of Femural lengthening, as I've rarely seen curved bones in Femur, unlike Tibia where curved bones is quite prolific.

My Physique -
Height - 162 cms
Weight - 80 Kgs (Yes, I'm a fat b**tard )
Wing span - 173 cms

Please weigh in on the pros and cons and let me know if my decision is right. Feel free to add in any pro/con that I have missed.

Thank you all.

[TIBIKE200]

Hi Everyone

I'm new to this forum, so apologies in advance if this is a silly question. I couldn't find answer anywhere, therefore posting it here. Please weigh in and provide your feedback. Thank you!

I'm planning for LL surgery and inclined towards going with Femural lengthening instead of Tibia, using Monorail fixator with Nailing (to avoid wearing frames during consolidation). Here are my reasons why I think this is best for me -

Pros-
- Femur lengthening heals faster than Tibia.
- Can tolerate more lengthening compared to Tibia - I'm aiming for 7 cms.
- Tibial bone only has muscle on top (Achilles Tendon). Therefore, it cannot take severe lengthening. Femur however is covered by muscles all around it, and therefore muscle stiffness is less prevalent here, as there is enough muscle.
- No chance of ballerina as my Tibia and ankle bones/muscles are untouched.
- Comfortable than Illizarov as it doesn't restrict my movements as much as Illizarov frame. So I think I can sleep well

Cons -
- I read on lot of forums that external femur is extremely painful. However, because I'm choosing to go with Nails instead of pure External, I think I only have to tolerate this during distraction.
- Large pins cause more pain than Illizarov rings.
- Cannot rectify angular corrections (like bone bending) if needed during distraction. I'm not sure how likely this is to occur in case of Femural lengthening, as I've rarely seen curved bones in Femur, unlike Tibia where curved bones is quite prolific.

My Physique -
Height - 162 cms
Weight - 80 Kgs (Yes, I'm a fat b**tard )
Wing span - 173 cms

Please weigh in on the pros and cons and let me know if my decision is right. Feel free to add in any pro/con that I have missed.

Thank you all.

 Femurs might not have the achiles tendon but they do have the hip flexors (And especially the notorious Ileopsoas) which causes Lordosis (also known as duckass). Femur lengthening also has the problem with the knee (just as tibias) because of the rectus femoralis.
 About externals for femurs: NO NO NO! ONLY INTERNAL!

[KiloKAHN]

- Tibial bone only has muscle on top (Achilles Tendon). Therefore, it cannot take severe lengthening. Femur however is covered by muscles all around it, and therefore muscle stiffness is less prevalent here, as there is enough muscle.

Muscle stiffness is a much bigger issue in external femur lengthening because there is more muscle around the femur.

"External lengthening on the femur tends to cause more problems with muscle scarring and consequent stiffness, compared to the tibia, precisely because the femur is surrounded by muscle. So what one gains in length, one may lose in terms of function. This is the primary reason why most surgeons would not do external femoral lengthening for CLL."
- Dr Mangal Parihar

[Sudheer]

Thank you for your responses. Looks like I was ignorant about complications of external femural lengthening.

What is your opinion about HLN for femur ? This is an internal method but I'm scared to go to Sarin after all the bad news that I heard from him. Most of the HLN diaries I read either sound too good to be true or end abruptly. Are there any other doctors who would implant HLN nail apart from Sarin in India ?