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[myloginacct]

how are the odds of a car crash 1:5000?  most people drive 10 times a week. so in 10-15 years everyone should have been involved in a car crash? think of third world countries like Vietnam where traffic is very chaotic.

Yeah, I'm not sure where Bruce got his numbers from.

https://www.thrillist.com/cars/nation/how-likely-you-are-to-die-in-a-car-accident-in-every-us-state-the-most-dangerous-roads-in-america

It seems it can vary drastically.

I'm not sure if Bruce's numbers refer to normal city traffic or road traffic, either. I'd say that's an important distinction to make.

Either way, it really puts driving into perspective.

https://www.iii.org/fact-statistic/facts-statistics-mortality-risk

(Lifetime chance of dying in a car accident, as the occupant, being 0.15% according to this last link.)

[myloginacct]

Do keep in mind that we travel a lot more often than we get operated on. I'd take the 1-2% risk. Again, my opinion.

Correct, he has never had a person die from FES. Risk of death by FES is 10-20% if you get it at all, so mortality is fraction of a percent (20% of 2% is 0.004%). It is not a death sentence.

Isn't it 0.4%?

That is comparatively much higher than the car crash scenario (0.02%), but given that it'd be just once or twice in our whole lives... (I'm assuming removing the IM nails can also trigger FE, but I'm not sure.)

So that's about a 1 in 250 chance of dying to FES.
                         (0.4%)

[..]

So that's about a 1 in 250 chance of dying to FES.
                         (0.4%)

Oh  , really need to consider 2-stage then. How different do you think between a month apart and 6 months apart?

[myloginacct]

Oh  , really need to consider 2-stage then. How different do you think between a month apart and 6 months apart?

I'm not a LL vet or a medical doctor. I'd rather just not comment on this.

E-mail Paley about your concerns, and use your own critical thinking to weigh the costs and benefits of unilateral/bilateral femur procedures with Paley/Rozbruch, given all the data and related issues we know about those.

[short2tall]

Oh  , really need to consider 2-stage then. How different do you think between a month apart and 6 months apart?

I think you're reading too deeply into the issue. I'm going to agree with Android here and say undergoing 2 separate surgeries is far riskier than doing both legs at the same time. Even Dr. Paley is saying it is more advantageous to just do both legs at the same time. I think your chances of just some general complication from one of 2 different surgeries is far greater than the risk of getting FES. Not to mention the extra cost and recovery time.

[MirinHeight]

wont the doctors look for fat embolism anyway and make sure you are okay regardless?

lol people in here just talk nonsense when they don't know anything about fat embolism syndrome to begin with.

there is no specific therapy for fat embolism syndrome once you get it. All you get is supportive treatment (oxygen) and even with the supportive treatment you can still die or go into an induced coma. If it leads to cerebral fat embolism, you will be brain dead almost immediately. But since there are so many research scholars in here who just want to talk without actually reading up on these things, I will leave it up to them to decide what is best.

[MirinHeight]

people think that a 2% chance of getting fat embolism syndrome that can lead to death or coma is insignificant.
or that a 0.4% chance of death from fat embolism syndrome is insignificant.

ask yourself this: Do you really want to be the unlucky 1/200 that dies from this surgery?? Or the 2 in 100 who actually get fat embolism syndrome? Or would you rather avoid it all together and make it almost nonexistent by doing a unilateral LL?

[Android]

I have a heart defect from birth that I need repaired before I'm too old (before 50), and the operative mortality rate is 1.5-5.5%. I'm not thinking twice about it, definitely doing it. I wouldn't be able to leave the house if my decisions demanded zero risk.

But hey, that's just my two cents!

[myloginacct]

lol people in here just talk nonsense when they don't know anything about fat embolism syndrome to begin with.

there is no specific therapy for fat embolism syndrome once you get it. All you get is supportive treatment (oxygen) and even with the supportive treatment you can still die or go into an induced coma. If it leads to cerebral fat embolism, you will be brain dead almost immediately. But since there are so many research scholars in here who just want to talk without actually reading up on these things, I will leave it up to them to decide what is best.

This is why I am very cautious when I make my posts. But it's been too long and the forum won't let me edit my post about FE on the first page.

Paley has never had a patient death AFAIK, but I shouldn't have made a post that kind of downplayed the severity of FE & FES just because they've been able to manage the cases they have had under their hands.

[Johnson1111]

So what is it about unilateral that prevents the FE?

[MirinHeight]

So what is it about unilateral that prevents the FE?

50% less fat globules get reamed out of the bone canal, and subsequently your body's mechanism for dissolving these fat globules is faster/more efficient. This decreases your chances of fat globules getting dislodged in your lungs, brain or brain stem. Even by very very rare chance, fat embolism syndrome does occur in unilateral lengthening, it will also most likely have low incidence of mortality due to less fat globules that are dislodged or are in your blood stream

Look at how many unilateral deformity corrections/leg length discrepancy surgeries are done around the united states and the incidence of fat embolism syndrome and compare that to the ~2% chance from cosmetic bilateral femoral lengthening.

It should also be noted that femurs have higher chance of getting fat embolism than tibias. Dr. Paley has never seen a fat embolism syndrome from bilateral tibia lengthening. Also research papers have shown that femurs trauma has a higher incidence of FES than tibias. Bilateral internal tibias should be generally safe when it comes to fat embolism syndrome if anyone is considering that. However internal tibias can cause permanent knee pain due to the rod going through the knee joint.

Thus, my own research has shown that external tibias are the safest and least invasive form of lengthening, although recovery will take longer and must wear frames for long time. Also I can only advise a max of 5 cm for tibias due to biomechanical and proportion issues. And if you want to do internal lengthening, you should do unilateral femurs.

[..]

50% less fat globules get reamed out of the bone canal, and subsequently your body's mechanism for dissolving these fat globules is faster/more efficient. This decreases your chances of fat globules getting dislodged in your lungs, brain or brain stem. Even by very very rare chance, fat embolism syndrome does occur in unilateral lengthening, it will also most likely have low incidence of mortality due to less fat globules that are dislodged or are in your blood stream

Look at how many unilateral deformity corrections/leg length discrepancy surgeries are done around the united states and the incidence of fat embolism syndrome and compare that to the ~2% chance from cosmetic bilateral femoral lengthening.

It should also be noted that femurs have higher chance of getting fat embolism than tibias. Dr. Paley has never seen a fat embolism syndrome from bilateral tibia lengthening. Also research papers have shown that femurs trauma has a higher incidence of FES than tibias. Bilateral internal tibias should be generally safe when it comes to fat embolism syndrome if anyone is considering that. However internal tibias can cause permanent knee pain due to the rod going through the knee joint.

Thus, my own research has shown that external tibias are the safest and least invasive form of lengthening, although recovery will take longer and must wear frames for long time. Also I can only advise a max of 5 cm for tibias due to biomechanical and proportion issues. And if you want to do internal lengthening, you should do unilateral femurs.

MirinHeight, is it even better to have 6-month gap between unilateral surgeries than 1-month?

And are you sure that that external tibias is the safest and least invasive? Maybe less chance for FE, but what about knee pain, possible requirement of ATL, etc? Also doctors told me that in general femur is less complex than tibia. "Tibias have a risk of equinus contracture and (although small) of compartment syndrome." says Dr Franz Birkholtz

Even if external tibias is the safest, the best doctor who can give the most guaranteed outcome (aka Dr. Paley) don't perform external tibias no more.

I'm not a LL vet or a medical doctor. I'd rather just not comment on this.

E-mail Paley about your concerns, and use your own critical thinking to weigh the costs and benefits of unilateral/bilateral femur procedures with Paley/Rozbruch, given all the data and related issues we know about those.

All these doctors have their own personal interest and can be bias at times. There must be a reason why Paley doesn't encourage unilateral and not necessarily for the patients' own good. It may be dangerous to the surgery's reputation if everyone knows that bilateral isn't as safe and everyone does unilateral. And more time spent for him, he waste more time that could be spent for taking another case. Just possibility, but we don't know.

[Body Builder]

1% possibility of major complication in LL is really not much if you consider how unvasive this surgery is with internals.
Only full externals are not so risky, anything else is. Thats why I believe that LON or LATN are truly stupid, cause you risk so much only to save 3-4 months max from your consolidation.

Anyway, embolism is not so frequent as deep infection but still both problems can be treated in the vast majority of cases, if you go to a good doctor in a good hospital and not in india or places like that.
If someone is not willing to take those risks then he should forget about LL.
After all this surgery is not for anyone, you must be really brave or crazy to do it.

[..]

1% possibility of major complication in LL is really not much if you consider how unvasive this surgery is with internals.
Only full externals are not so risky, anything else is. Thats why I believe that LON or LATN are truly stupid, cause you risk so much only to save 3-4 months max from your consolidation.

Anyway, embolism is not so frequent as deep infection but still both problems can be treated in the vast majority of cases, if you go to a good doctor in a good hospital and not in india or places like that.
If someone is not willing to take those risks then he should forget about LL.
After all this surgery is not for anyone, you must be really brave or crazy to do it.

Risks are always there. But we can minimize it as much as possible.

[FormerKidd]

I believe you are referring to the point in the video he talks about Guichet. It's because Guichet gets his patients to muscle up before surgery. Paley essentially called that worthless.

Whether it's a positive, a negative, or even completely irrelevant how built your legs are, I can't tell. I haven't looked up any published material on this subject.

I'd like to note that if you talk to the Physical Therapists who work for Paley, they will all tell you that stretching beforehand can make a big difference.  I would highly advise it, personally.

[myloginacct]

I'd like to note that if you talk to the Physical Therapists who work for Paley, they will all tell you that stretching beforehand can make a big difference.  I would highly advise it, personally.

Thank you for the information.

Starting to stretch beforehand definitely seems like a good idea. The body takes some time to build flexibility. I have some personal experience with spine stretching exercises.

I was just not sure about "muscling/bulking up" thing Guichet requires of his patients. That definitely seems like it makes no difference (at best).

[myloginacct]

Thus, my own research has shown that external tibias are the safest and least invasive form of lengthening, although recovery will take longer and must wear frames for long time. Also I can only advise a max of 5 cm for tibias due to biomechanical and proportion issues. And if you want to do internal lengthening, you should do unilateral femurs.

And also because increasing T/F ratio is associated with hip and knee arthritis. (If only you only lengthen the tibias.)

https://www.ncbi.nlm.nih.gov/pubmed/26398436

[Body Builder]

Risks are always there. But we can minimize it as much as possible.

Only with going to a good doctor. You cant do anything else!

[..]

Only with going to a good doctor. You cant do anything else!

The methods are not all equal. You said it yourself externals are safer.