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[talldarkandhandsome]

In 2 months I am getting my LL procedure done in Russia. The doctor I will most likely be going with told me the lengthening period can take 2-3 months and the consolidation period takes another 6-9 months. I plan on returning home for the consolidation period. From what I understand LON doesn't require frames during the consolidation period opposed to LATN, so I think that would be my best option if I plan on returning home for this phase.

However, after doing some research many patients report permanent knee pain with the LON method when used on the tibias. My goal is to lengthen 4-9 cm and I understand I will be sacrificing some motor movement if I go past 5 cm but I would like to know the extent of the pain being described by some patients...

[Chris]

In regards to consolidation without frames, LON and LATN are basically the same thing. If you do LATN, the nail will be inserted after the lengthening phase and requires a second surgery.
Chances for permanent knee pain are the same.

[talldarkandhandsome]

Thanks for clarifying that.

[fujitora]

In 2 months I am getting my LL procedure done in Russia. The doctor I will most likely be going with told me the lengthening period can take 2-3 months and the consolidation period takes another 6-9 months. I plan on returning home for the consolidation period. From what I understand LON doesn't require frames during the consolidation period opposed to LATN, so I think that would be my best option if I plan on returning home for this phase.

However, after doing some research many patients report permanent knee pain with the LON method when used on the tibias. My goal is to lengthen 4-9 cm and I understand I will be sacrificing some motor movement if I go past 5 cm but I would like to know the extent of the pain being described by some patients...

Inserting a Nail after lengthening [LATN] can have few risks over LON -
1)Risk of damaging the callus formed during the lengthening phase.
2)Risk of causing misalignment during Nailing.

[talldarkandhandsome]

LATN seems like the better option from what I've read so far.

[fujitora]

LATN seems like the better option from what I've read so far.

Have you considered plate fixation using locking plates [LATP] ? They don't have the risk of permanent knee pain like nailing, and can be fixated by protecting periosteum to not deter your recovery rate. They also have significantly less chance of bone infection when compared to nailing. They can be fixated with minimally invasive approach to minimize scars, as compared to the conventional approach where you'd have scars along the length of your tibia.

[talldarkandhandsome]

Have you considered plate fixation using locking plates [LATP] ? They don't have the risk of permanent knee pain like nailing, and can be fixated by protecting periosteum to not deter your recovery rate. They also have significantly less chance of bone infection when compared to nailing. They can be fixated with minimally invasive approach to minimize scars, as compared to the conventional approach where you'd have scars along the length of your tibia.

The doctors I've been in contact with haven't mentioned LATP but I will ask about it. Unfortunately I don't have wide variety of choice considering my tight budget.

[fujitora]

The doctors I've been in contact with haven't mentioned LATP but I will ask about it. Unfortunately I don't have wide variety of choice considering my tight budget.

Sure, take your doctors opinion on this.

Locking plates are cheap - In India, they cost about 30,000 Rupees for both the legs, which is about 430 USD [I'm talking just about the plates and not the surgical or other costs].

[Bander72]

I would do lon as you dont have to do another surgery to have the nail put in and as mention it can make the callous harder making the journey longer.

[talldarkandhandsome]

I would do lon as you dont have to do another surgery to have the nail put in and as mention it can make the callous harder making the journey longer.

I think I miss read the earlier post then, so LON has less chance of complications and the recovery is faster?

[TheLichKing]

I'm curious to know the better option between these two as well. LATP sounds really interesting...

[onemorefoot]

Most of the doctors prefer LON, becuase is easier than LATN and has fewer risks. Good luck.

[TheLichKing]

Most of the doctors prefer LON, becuase is easier than LATN and has fewer risks. Good luck.

Looking at the different methods of LL, the pros and cons of both seem to be the following:-

LON (Lengthening Over Nail)

Advantages: Requires only 1/3 of the time wearing an external fixator as compared to the purely external method. Intramedullary nail helps prevent misalignment in regenerate bone. Fewer complications than external method overall.

Disadvantages:  Higher rate of pin site infection due to presence of intramedullary nail during lengthening. Requires acute deformity correction which compromises bone healing potential during subsequent lengthening. Comparatively high incidence of deep intramedullary infection. Additional surgery required to remove intramedullary nails years later. Need to be careful of impact on intramedullary nails during consolidation due to risk of re-fracture. Doesn’t appear to reduce the duration needed for bones to heal compared to purely external method. Unlike LATN, LON uses a small diameter nail so bone can regenerate over it, allowing less stability than LATN method. Discomfort and soft tissue tethering due to pin sites.

LATN (Lengthening and then Nailing)

Advantages: Requires only 1/3 of the time wearing an external fixator as compared to the purely external method. Quicker bone healing rate than pure external method. Lower rate of infection than LON. Infections can be treated more easily and gradually during lengthening due to absence of intramedullary nail present in LON method during lengthening phase. Larger diameter nail than the one used in LON method is inserted into bone cavity during consolidation, allowing greater stability and increased protection against re-fracture.

Disadvantages:  May require repeated adjustments to avoid bone misalignment due to lack of IM nail during lengthening phase. Need to be careful of impact on intramedullary nails during consolidation due to risk of re-fracture. Discomfort and soft tissue tethering due to pin sites.

The disadvantages of LON do seem to outweigh those of LATN though.

[TheLichKing]

Good info I found here by Dr. Donghoon: http://www.drdonghoon.com/index.php/archives/2414?ckattempt=3

[0184946]

the only method that has reported knee pain after consolidation is internal tibia which is why people prefer external tibia but as far as im concerned unless they lived all their life even the ones that went thru it dont know if its permanent . never heard of lon causing permanent knee pain infact people decide on external over internal to prevent knee pain