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[NewGuy1]

What i know if you want both start for internal femur first, as best doctors advice.

Is it possible to lengthen both tibias and femurs in the same time? I mean inserting nail in one femur, then in other, and while femur nails are still in, install external frames on tibias?
And will lengthening all in the same time increase risk of fat embolism or knee pain?

[The Kaiser]

Is it possible to lengthen both tibias and femurs in the same time? I mean inserting nail in one femur, then in other, and while femur nails are still in, install external frames on tibias?
And will lengthening all in the same time increase risk of fat embolism or knee pain?

what i know that their should be at least if you insist 3 months for the second surgery, its advisable 1 year because its reduce the risk

[NewGuy1]

what i know that their should be at least if you insist 3 months for the second surgery, its advisable 1 year because its reduce the risk

Do you mean 3 month between tibias and femurs sergery? Or do you mean 3 month interval before EVERY surgery?

[Chris]

Is it possible to lengthen both tibias and femurs in the same time? I mean inserting nail in one femur, then in other, and while femur nails are still in, install external frames on tibias?
And will lengthening all in the same time increase risk of fat embolism or knee pain?

I was very desperate and wanted to lengthen all four segments at the same time, but Dr. Deepak told me the following:

When you're lengthening femur and tibia at the same time and the combined speed of lengthening exceeds 2mm per day, chances are very, very high that you will get a severe and permanent nerve damage in one or both of your legs.
This means a repeating stinging pain, convulsions and the loss of your full mobility for the rest of your life.
When lengthening femur and tibia simultaneously, 2mm per day are easily hit and many patients can't stay below that rate, because of pre-consolidation.
This is the biggest (and somehow less known) reason why quadrilateral lengthening is so dangerous.

Regarding the risks of fat embolism:

Almost everyone gets fat embolism from broken bones, but our bodies can absorb the fats reaching the lung and so nothing happens.
The issues CAN start to arise when we suddenly have many broken bones and have a poly-trauma like after a severe car accident. Breaking all six bones in our legs is comparable to it.
This can lead to fat embolism syndrome (FES), which means that the much higher amount of fats reaching the lung can not be absorbed quickly enough and then we start to suffocate.
It can take up to five days till FES happens.
However, nobody should have to die from it anymore these days IF you go to a proper clinic/doctor for your LL-surgery, because they can help you if anything happens.

Having explained all this, you now can probably imagine that when you want quadrilateral LON or internals, the additional reaming of four of the six broken bones (which is necessary for it) is even more dangerous.

If you do femurs first, you should at least wait for 5 to 7 days before the second surgery on tibia in order to reduce the risk of FES.
But you would still have the very, very high risk of nerve damage from lengthening simultaneously.
So in conclusion, you should wait at least until you have finished lengthening the first segment.

[NewGuy1]

When lengthening femur and tibia simultaneously, 2mm per day are easily hit and many patients can't stay below that rate, because of pre-consolidation.

No! I didn't mean 2mm per day! What I meant is lenghtening one segment AFTER you've already lenghthened another, but your frames/nails are still in you for consolidation.
Lengthening itself(1mm per day) lasts for a month or so(in case of 3cm, for example), but you will still be in frames for a year after lengthening itself is over, right?
I mean lengthening every segment 1mm per day, but when one is already lenghthened enough and consolidating, do another surgery(with first surgery's frames/nails still in you) and start lengthening second segment 1mm per day.
Is it possible?

[Chris]

No! I didn't mean 2mm per day! What I meant is lenghtening one segment AFTER you've already lenghthened another, but your frames/nails are still in you for consolidation.
Lengthening itself(1mm per day) lasts for a month or so(in case of 3cm, for example), but you will still be in frames for a year after lengthening itself is over, right?
I mean lengthening every segment 1mm per day, but when one is already lenghthened enough and consolidating, do another surgery(with first surgery's frames/nails still in you) and start lengthening second segment 1mm per day.
Is it possible?

Like I have stated in my last sentence: "So in conclusion, you should wait [for your second surgery] at least until you have finished lengthening the first segment."
Yes, it is possible. Even with the other frames still on or the nails still inside you respectively.
Just be aware that you will most likely need a wheelchair for the time of the second lengthening phase due to even more muscle degradation.

[NewGuy1]

Like I have stated in my last sentence: "So in conclusion, you should wait [for your second surgery] at least until you have finished lengthening the first segment."
Yes, it is possible. Even with the other frames still on or the nails still inside you respectively.
Just be aware that you will most likely need a wheelchair for the time of the second lengthening phase due to even more muscle degradation.

Wheelchair is not a problem for me.
What i worry about is fat embolism or permanent leg pain or something like that after surgery.

[The Kaiser]

Do you mean 3 month between tibias and femurs sergery? Or do you mean 3 month interval before EVERY surgery?

Dr Paley prefer one year between each surgery so the body can realize the amount of nails, but he made this surgery for patient insist to do both, so he did the second one after 3 months "or before if am not wrong" but the longer the better outcome. Plus there is discount for doing both segment.