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[MirinHeight]

I know that amputation is a risk when going under the leg lengthening procedure.
What risks or factors lead to amputation. What is the reason the leg has to be amputated.
I'm sure it has to do with some serious infection.

And if it does, this is another reason in my opinion why external fixation> LON/LATN and precise techniques when it comes to risks.
Highly unlikely that you will develop a serious infection with external fixation (only pin site infections). But when you use intramedullary rods, you can develop some serious infections that can cause loss of limbs whereas the only infections seen with external fixators are pin site infections which are easy to catch and take care of.

Also a lot more unlikely for one to develop fat embolism when going through with the external fixation which can lead to coma/death.

I have done a lot of research on this procedure, and nailing of the long bones carries a lot more risk than the "external fixation only" approach did.

Doctors have developed this precise nail and it is a great piece of technology that has the potential for you to gain significant height, but it carries much more risk than external fixation procedures. Furthermore, doctors are getting paid a lot more for using the precise nail, so do not believe everything that they say.


My advice is to do external fixation ONLY on tibias for 5 cm or less (only go up to 5 cm for externals) first,
And if you really still don't like the height you are at, and would like to do the nailing techniques,  knowing there are more and bigger risks, then do up to 5-7 cm via precise on femurs.
But I highly advise against internal-medullary reaming techniques due to the risks it carries

[alps]

I think it's worth finding out how often infections occur in general orthopaedics (not just in LL) because nailing is a common procedure in fractures too.

I think it's uncommon at reasonably hygienic centers, but I really don't know.

If the risk of infection is minuscule, it's probably not a good idea to dismiss internal methods because the risks of other problems like joint contractures, CECS, nerve damage are probably higher in external tibias.

[MirinHeight]

I think it's worth finding out how often infections occur in general orthopaedics (not just in LL) because nailing is a common procedure in fractures too.

I think it's uncommon at reasonably hygienic centers, but I really don't know.

If the risk of infection is minuscule, it's probably not a good idea to dismiss internal methods because the risks of other problems like joint contractures, CECS, nerve damage are probably higher in external tibias.

The risk of infection might not be that huge BUT

if infection does occur when using an intramedullary nail, it can be very serious and very hard to take care of,  and has the possibility to lead to catastrophic outcomes such as amputation

[MirinHeight]

Furthermore Deep vein Thrombosis that leads to pulmonary embolism and can kill you is also a big risk when doing surgery on femurs...


"Deep vein thrombosis (throm-BO-sis), or DVT, is a blood clot that forms in a vein deep in the body. Blood clots occur when blood thickens and clumps together.

Most deep vein blood clots occur in the lower leg or thigh. They also can occur in other parts of the body.

A blood clot in a deep vein can break off and travel through the bloodstream. The loose clot is called an embolus (EM-bo-lus). It can travel to an artery in the lungs and block blood flow. This condition is called pulmonary embolism (PULL-mun-ary EM-bo-lizm), or PE.

PE is a very serious condition. It can damage the lungs and other organs in the body and cause death.

Blood clots in the thighs are more likely to break off and cause PE than blood clots in the lower legs or other parts of the body. "

[MirinHeight]

My messages with Dr. Divya Ahuja who works very close with Dr. Parihar in India:


Me:
Hello Dr. Ahuja,
    Thank you for your response. I have another question: What is your protocol in case of a patient developing fat embolism or pulmonary embolism.

Dr::
The best thing is to take measures to prevent the embolism to happen - lots of steps to take care of that - vents to prevent intramedullary pressure to build up, sharp reamer heads, not too aggressive reaming, proper hydration during and after surgery.

Me:
Hello Dr. Ahuja,
    I am only considering external tibia lengthening for 3.5-4 cm, so intramedullary pressure due to reaming wouldn't be applicable here right? I have heard External tibia lengthening is generally safer than internal femurs/tibias in regards to fat embolism. Is this correct as well?

Dr:
 In externals only there is no reaming so intramedullary pressures don't change.

In terms of fat embolism the externals have no chance of embolism.

[MirinHeight]

I think it's worth finding out how often infections occur in general orthopaedics (not just in LL) because nailing is a common procedure in fractures too.

I think it's uncommon at reasonably hygienic centers, but I really don't know.

If the risk of infection is minuscule, it's probably not a good idea to dismiss internal methods because the risks of other problems like joint contractures, CECS, nerve damage are probably higher in external tibias.

None of those risks would be higher for external tibias. You are still lengthening muscles and irritating nerves in both cases.

These risks you describe are higher if you do more than 5 cm per segment. That is why I advise only up to 5 cm on external tibias.

[Body Builder]

The risk of infection might not be that huge BUT

if infection does occur when using an intramedullary nail, it can be very serious and very hard to take care of,  and has the possibility to lead to catastrophic outcomes such as amputation

Yes, risk of infections is true and could lead in very extreme cases in amputation.
But the risks of dying due to anaesthesia is much more than a disastrous infection so in reality noone should avoid internal methods for that reasons.
I never heard of an amputation due to infection from LL.
It is possible but the possibilities are so small that it is more probable to be hit by a car or dying from anaesthesia than that.

[MirinHeight]

The risks for

External fixation vs Intramedullary nailing techniques

needs to be a topic of discussion so patients can make the best safe decision for themselves. A lot of doctors are money hungry when it comes to precise and disregard many risks discussed. Dr. Paley on his site says that

"Dr. Paley has only seen fat embolism twice in his career. Both occurred more than 10 years ago before he developed a special venting method to prevent this complication."

This is a flat out lie. Dr Paley might be a phenomenal orthopedic surgeon, BUT he needs to be transparent about the risks that the precise nailing technique carries for his future patients, instead of marketing his technique as a low risk procedure.

This is from a diary from 2014:

My stay on this floor was for a long time.  Too many bad things happened for me to care to recount.  One good thing that stands out to me was when Servando told me I would have to pay for my extended stay in the hospital.  This worried me of course, because he didn't know how much it would be and I had no idea how long I would have to stay in this s**t-hole.  I emailed Dr. Paley and expressed that I was worried about the costs.  Dr. Paley immediately emailed me back and told me not to worry about the costs, he would take care of them, and all he wanted was for me to recover.  He gave me a private meeting in my room a few days later, also confirming this while checking up on me.  Then the news was confirmed- I had gotten a fatty emboli in my lungs.  For those unaware, this is when your fat being reamed out of your femoral canals goes into your bloodstream which then travels up to your lungs.

Dr. Paley in this private meeting also confirms to me that I'm only his 2nd patient ever to have a severe case of fat embolism in the past 3 years, and that I'm the worst case he's ever had of it.  What an honor, huh?  We talk for a few more minutes and he leaves.  There's not much left to say in this meeting because my condition is improving and he's already done his job, the rest was up to me to heal.



Fat embolism might not be as rare as we think it is, and well respected surgeons might be hiding some facts about the risk of fat embolism with nailing techniques. This is just one proof.

[alps]

Yes, risk of infections is true and could lead in very extreme cases in amputation.
But the risks of dying due to anaesthesia is much more than a disastrous infection so in reality noone should avoid internal methods for that reasons.
I never heard of an amputation due to infection from LL.
It is possible but the possibilities are so small that it is more probable to be hit by a car or dying from anaesthesia than that.

Do you have proof that anaesthesia deaths are more probable than bone infections? Otherwise it's just your opinion

[Body Builder]

Do you have proof that anaesthesia deaths are more probable than bone infections? Otherwise it's just your opinion

I didn't said just bone infections but amputations due to bone infections.
No I don't have exact numbers but I never saw anyone get amputated from internal nails (not for LL only but generally) while everyday people day from anaesthesia (older people most of the times).
Embolism is something more possible but a serious infection that leads to amputation is really rare and noone should consider it as a really possible risk when doing LL, although it could happen theoretically.
There are many more probable risks of LL, osteomyelitis infection, at least not in a third world country's hospital, is not one of them.

[LLSouthAmerica]

The risk of deep infections with pure internal method is very low and I don't think there has been a case of amputation due to LL in all the recent case series I've read. With a pure internal method, the only way for an infection to occur in during implantation of the lengthening rod or due to a severe infection of the wounds which had to go all the way to the bone. Of course, when it DOES happens the rod can be colonised with bacteria. What happens more frequently is that these bacteria inhibit the growth of the new bone and leads to delayed/mal union rather than osteomyelitis.

With an external device, infections are much more common both superficial and deep, but the fact that there is no foreign object inserted makes the treatment of the infection much easier.

However, the bigger risk comes from combining these 2 methods such as LON and LATN techniques because you have both an intramedullary rod and a permanent opened window from which bacteria can enter (pin wounds).

[alps]

So what would take for a rod to be not sterile? Would it get intention capable by simply leaving out in the air for some time, or washed in hard water, or wiped with an unwashed towel?

No doctor would do any of these, but I'm just wondering how bad a doctor would need to be to manage to get you an infection from the nail.

[LLSouthAmerica]

So what would take for a rod to be not sterile? Would it get intention capable by simply leaving out in the air for some time, or washed in hard water, or wiped with an unwashed towel?

No doctor would do any of these, but I'm just wondering how bad a doctor would need to be to manage to get you an infection from the nail.

Impossible to know. In medicine nothing is ever absolute. Normally the rod would be sterile until the surgeon opens its container. After that the surgical technique is important, the cleaning of the room, whether all the surgical team follows  all precautions. Imagine a drop of sweat drops from the surgeon. Etc.

In the classification of wounds, LL would be "clean" because there is no contact with a mucous membrane. Even so, my doctor prescribed me antibiotics after surgery for 3 days.

In order to get an infection a number of factor must be happen at the same time: From a break of the sterility of the procedure, the agressiveness of the pathogen, inadequate defense of the host, resistance to antibiotics.

[IwannaBeTaller]

I assume that in the case of non-consolidation (the bones refuse to grow back together), amputation would be the last resort if no other methods achieve success. I'm not aware of any LL procedure that has resulted in an amputation. Is anyone else aware of a specific case?

[LLSouthAmerica]

I assume that in the case of non-consolidation (the bones refuse to grow back together), amputation would be the last resort if no other methods achieve success. I'm not aware of any LL procedure that has resulted in an amputation. Is anyone else aware of a specific case?

I doubt it. In cases of non-consolidation, first, they would try to stimulate growth with bone marrow, HGH, etc. If not they would do a bone graft. Even if that doesn't work I guess they would try to compress the gap to produce healing and if not use metal plates/pins.

The only possibilities for amputations I can think of are severe bone infection which does not respond to antibiotics and is causing sepsis/gangrene or a compartmental syndrome in which there is already necrosis of the lower limb.