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[farmerjohn1324]

The painful recovery period is the only thing holding me back at this point. I've heard that breaking your femur is the worst pain a person can endure, but obviously you're under anaesthetic when that happens.

How long does the pain last and how bad is it? Do the painkillers help reduce it to tolerable levels?

[lldude]

Have you read the testimonial threads? Everyone single one has the op talking about his/her pain right after surgery, during lengthening and consolidation.

[farmerjohn1324]

Have you read the testimonial threads? Everyone single one has the op talking about his/her pain right after surgery, during lengthening and consolidation.

Several of them say the pain has gone away shortly.

What was your experience? What was the worst part and how long did it last for?

[MirinHeight]

no pain, no gain


Honestly if you can't handle a little pain to get to where you want to be, cll isn't for you.

There are kids undergoing this procedure for leg length discrepancies that are doing fine, and you scared bout a little pain. cmon man.


"breaking the femur is worst pain one can endure"
Yeah but thats if it gets broken during an accident and fractures unevenly causing an open fracture. This is a surgery where the surgeon will make a precision cut while you are under anesthesia.

[farmerjohn1324]

no pain, no gain


Honestly if you can't handle a little pain to get to where you want to be, cll isn't for you.

There are kids undergoing this procedure for leg length discrepancies that are doing fine, and you scared bout a little pain. cmon man.


"breaking the femur is worst pain one can endure"
Yeah but thats if it gets broken during an accident and fractures unevenly causing an open fracture. This is a surgery where the surgeon will make a precision cut while you are under anesthesia.

I can handle A LITTLE. But if it's agonizing pain for 3-4 months that even painkillers can't control, that's different.

When I was younger, I broke 2 bones in my neck and 4 in my back and bruised the spinal cord in my neck. By the time I regained consciousness, it was 4 days later and I don't remember much pain. There was months of physical therapy, however.

I've also had several other surgeries that were comparitively minor and the pain resulted just from the site of the surgery. Like having to lie on my back after back surgery.

[Android]

Some patients experience little pain while some experience excruciating pain. The duration also varies quite a bit. Everyone's experience is different since there are many factors, so you really won't know until you wake up after the surgery's over.

Prepare for the worst and you'll be ready for anything. If it hurts, just say so and they'll do the best they can to help.

[TRS]

Pain most days were manageable with pain killers, however there were several occasions when the painkillers did not work and I would be in severe pain for hours. Pain varies with each patient, but always be prepared for the worst!

[Body Builder]

For me it was almost painless.
Only the first 2-3 days the pain was about 5/10 and then the max it has been was 2/10.

Internals with obsolete nails like Guichet's are very painful due to the way they are clicking to lengthen but other methods/nails are usually not very painful.

[0184946]

There are kids undergoing this procedure for leg length discrepancies that are doing fine, and you scared bout a little pain. cmon man.

this. grow sum balls

[LLSouthAmerica]

Pain most days were manageable with pain killers, however there were several occasions when the painkillers did not work and I would be in severe pain for hours. Pain varies with each patient, but always be prepared for the worst!

In my case it was moderate at best and completely manageable with pain killers, though I sometimes took the pain so as to not take too many pills.

[farmerjohn1324]

Does the amount of pain depend on the individual, the doctor, or the method?

[Android]

Does the amount of pain depend on the individual, the doctor, or the method?

All of the above just like any surgery.

[Winterishere]

For me there was no pain during my hospital stay as the intravenous pain meds were very effective, but I would say the first 2 weeks after the surgery were the most difficult, mostly due to discomfort and lack of sleep rather than physical pain (which was very manageable mostly through taking prescribed oral oxycodone). After about the 3 week mark I was completely off any pain medications and was using crutches full time and the experience became rather mundane. Again this is probably useless information to you as your experience will change dramatically based on where, who and what procedure you choose to go with. Good luck!

PS: Try not to get too caught up on the pain aspect of the procedure, as if this is something you are serious about the pain is only temporary. Children with leg discrepancies come every few years to lengthen their limbs until adulthood through more surgeries, so if they can do it you can!

[lldude]

PS: Try not to get too caught up on the pain aspect of the procedure, as if this is something you are serious about the pain is only temporary. Children with leg discrepancies come every few years to lengthen their limbs until adulthood through more surgeries, so if they can do it you can!

fk, my mind was blown right now. I cringe at the worst aspects post-surgery as a 30 year old men while kids are going through this surgery

[Android]

fk, my mind was blown right now. I cringe at the worst aspects post-surgery as a 30 year old men while kids are going through this surgery

It makes a difference that most of us are here for cosmetic purposes, breaking perfectly working legs that are subjectively imperfect.

The kids are also encouraged by their parents; it's most likely their idea, they're telling their kids that they have to do it to carry on a normal life.

For us it's a choice. We're choosing to take a risk. We're often paying it ourselves. We also do a lot more homework on the subject beforehand which can scare us.

But I think that's also what makes it so rewarding. It's not something we take for granted, this is why we often say that it's our journey.

[MirinHeight]

It makes a difference that most of us are here for cosmetic purposes, breaking perfectly working legs that are subjectively imperfect.

The kids are also encouraged by their parents; it's most likely their idea, they're telling their kids that they have to do it to carry on a normal life.

For us it's a choice. We're choosing to take a risk. We're often paying it ourselves. We also do a lot more homework on the subject beforehand which can scare us.

But I think that's also what makes it so rewarding. It's not something we take for granted, this is why we often say that it's our journey.

After doing a lot of research, not that big of a risk at all if:
1. you choose a highly respected surgeon
2. you go with external approach instead of internal
3. You don't go over 5 cm per segment

it risky when people have done surgeries with Dr. Sringari, Sarin etc
or when they over lengthen a segment using a intermedullary rod that can cause a lot of complications which I have listed in recent postings.

[Winterishere]

After doing a lot of research, not that big of a risk at all if:
1. you choose a highly respected surgeon
2. you go with external approach instead of internal
3. You don't go over 5 cm per segment

it risky when people have done surgeries with Dr. Sringari, Sarin etc
or when they over lengthen a segment using a intermedullary rod that can cause a lot of complications which I have listed in recent postings.

Hi MirinHeight,
I completely agree that everyone should take the time to acquire the appropriate finances to do this safely, and do their research when it comes to finding a reputable surgeon. I fail to see why an external approach would be more beneficial to an internal one, when to me the benefits to an internal device are far surpassed. I would love to hear your thoughts!
In terms of the length of lengthening it really does come down to the individual, there is no set number. Some people feel no difference after 7cm when it comes to mobility and others feel a huge difference after only 3. It really is a personal thing in everyones experience to know when is the right time to stop which is why I think its important for people not to go into this with a set number in mind. Instead set realistic goals and see how your body adjusts over the experience. Thanks!

[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 (even seen with Dr. Paley) when going through with the internal 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

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. (different from fat embolism!)

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. "

if one develops valgus/valus deformity during ll, it can also be fixed with external fixator. These deformities (such as x legs) cannot be fixed via internal methods.

Keeping the complications in mind, external ll is best if you want to do <5cm. If you do 6+ cm, you can do internal method keeping the complications in mind, so that you wont have to wear the external fixator for 1 year+

Problems with Traditional Internal Femur Lengthening

Internal femur lengthening devices will by their nature lengthen along the femur's anatomic axis. This can lead to shifts in the mechanical axis towards a valgus (x legs) position. Such shifts in the mechanical axis have been documented by Dr. Paley. Paley demonstrated that in normally aligned limbs, lengthening along the anatomical axis of the femur with internal Precise nails led to a lateral shift of the mechanical axis by 1 mm for each 1 cm of lengthening.

The following diagram from Paley's article demonstrates how this shift happens. Internal lengthening is compared in this picture with external lengthening, which can theoretically maintain the mechanical axis. In practice, however, we know that external monorails for femurs can lead to distortion and misalignments, as the monorail devices and pins can be subject to surgeon error and bending/warping with muscular forces and weight bearing.



Internal lengthening of the femurs is considered an ideal method of leg lengthening for most because it is fast, safe, predictable, and effective. However, this expected shift of the mechanical axis is a concern for many of us, because any degree of varus/valgus can predispose joints to arthritis. If internal femoral lengthening is then to be considered a good method of lengthening, a solution is needed to maintain the mechanical axis in normal alignment.

Cliff Notes:
I have done my own research on this topic, and made some threads/messages explaining each point I make below:

intramedullary femur lengthening risks:
- fat embolism due to intramedullary reaming
- DVT; femurs having higher risk of developing DVT than tibias
- serious infection that can lead to amputation. Only infections seen in external fixator lengthening are pin-site infections
-The nail can break and fracture the femur as seen in cases here (such as programdude by Dr. Paley)

More advantages of external lengthening:
-adjustments can be made to prevent malunion, x legs, etc
-biomechanics altered a lot more when lengthening femurs

SO YEAH, ILL RATHER WEAR A CAGE FOR 6 MONTHS THAN GO UNDER A MUCH MORE INVASIVE SURGERY. To each their own.

[biggerdreams]

Not to hijack the thread, but if someone can relate, please speak to this question. Does anyone here have a high tolerance to drugs and have undergone this? I have a high tolerance to most drugs so even when going to the dentist they have to numb me extra, or wait longer periods for it to kick in, for me to have the normal dosage effects.

I'm worried this will translate to me being in a lot of pain after surgery.

[Winterishere]

The majority of these complications occur in both techniques, and infections are more common in external devices in almost all studies I have read. Internal devices are universally considered by most surgeons to be safer and more practical. If you personally prefer the external approach that is entirely your opinion and I hope it worked/works out for you!

[Winterishere]

Hi Biggerdreams,
After your surgery, most of the time (depending on your anaesthesiologist, which should discuss with you your pain management) you will be attached to an intravenous drip which will distill your pain medications. If you are in pain you can vocalise that with the nursing team who will most likely increase your dosage. After your hospital stay you will most likely be managing your pain with oral medications which you can take at your own comfort. Just be vocal with your doctors!

[MirinHeight]

The majority of these complications occur in both techniques, and infections are more common in external devices in almost all studies I have read. Internal devices are universally considered by most surgeons to be safer and more practical. If you personally prefer the external approach that is entirely your opinion and I hope it worked/works out for you!

yes infections occur in both techniques, but you can't be naive and say that infections within the bone canal is the same as pin site infections lol

All surgeons in every other country says that the external approach is much safer.
Even US surgeons do not say that internal is "safer" for the patient. They say that it is more practical and the pt will have less pain and will not have to wear an external fixator for a long time + faster recovery.

This does not take away from the complications listed that can occur.

[MirinHeight]

Getting a rod reamed inside your femur bone canal is not less invasive than an external approach


Why do majority of orthopedic surgeons use an external device on children when dealing with leg length discrepancies?

[Winterishere]

I never stated it was less invasive, just preferable to many people including myself. Infections can occur at the site of the bone in an external approach just the same as an internal one. When your bone is 'caved' in preparation for the insertion of the rod the area is highly sterilised and therefore with a reputable surgeon infections are remarkably rare. External devices are used on children because they are still growing, and therefore an internal device is not preferable since the bone has not fully developed. Internal devices would only ever be used on children for periods of shorter than 30 days to repair sustained injuries, along with other considerably rare circumstances. Hope this helped!

[MirinHeight]

I never stated it was less invasive, just preferable to many people including myself. Infections can occur at the site of the bone in an external approach just the same as an internal one. When your bone is 'caved' in preparation for the insertion of the rod the area is highly sterilised and therefore with a reputable surgeon infections are remarkably rare. External devices are used on children because they are still growing, and therefore an internal device is not preferable since the bone has not fully developed. Internal devices would only ever be used on children for periods of shorter than 30 days to repair sustained injuries, along with other considerably rare circumstances. Hope this helped!

If it is not less invasive, how can it possibly be safer? And not using the intramedullary rod on kids because they are still growing should tell you a lot about how invasive the internal surgery really is and the damage it can do.

Infections that can occur with internal approach (rare if rod is perfectly sterilised but can still happen). These infections can lead to amputations...
On the other hand, pin site infections are common and easy to take care of.

You cannot compare the two lol.

Also, what will you do if you develop x legs? You can't do anything if you're undergoing an internal method of lengthening. But you can fix misalignments with external fixators..

[Winterishere]

Creating a linear comparison between the invasive nature of each procedure with safety probably isn't accurate. If an external device is what you believe is safer then I completely respect that opinion. Good luck!

[MirinHeight]

Creating a linear comparison between the invasive nature of each procedure with safety probably isn't accurate. If an external device is what you believe is safer then I completely respect that opinion. Good luck!

Thanks. I just wanted to put some evidence out there of why I believe external approach is a lot safer and less invasive so pts can make the best decisions for themselves knowing the facts.

[Winterishere]

Yes thats a great idea! Everyone should voice their opinions in healthy arguments and it was actually a very informative read for me so thank-you

[farmerjohn1324]

Thanks. I just wanted to put some evidence out there of why I believe external approach is a lot safer and less invasive so pts can make the best decisions for themselves knowing the facts.

Do you think LON or LATN are just as safe as standard Ilizarov?

[MirinHeight]

Do you think LON or LATN are just as safe as standard Ilizarov?

no; they involve intra-medullary reaming of the bone canal too, which carries the same risk as standard internal precise lengthening.

[farmerjohn1324]

no; they involve intra-medullary reaming of the bone canal too, which carries the same risk as standard internal precise lengthening.

So I guess it's Ilizarov or nothing for me.

Sure sucks to have to wear those frames for so long.

I'm still trying to figure out if my proportions would be weird afterwards. I wish there was an easy way to tell.