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[programdude]

Say lengthening 2-3 inches. Is internal femurs the method with the least complications? Does it have the knee pain that is associated with LON on tibia?

[TRS]

Say lengthening 2-3 inches. Is internal femurs the method with the least complications? Does it have the knee pain that is associated with LON on tibia?

Yes, internal femur with antegrade nail insertion seems to circumvent the risk of permanent knee pain which is usually associated with tibia nailing and retrograde femur nailing.

[programdude]

is there a catch? Other than the price that is.

From what I read it also seemed like recovery time was best.

[TRS]

is there a catch? Other than the price that is.

From what I read it also seemed like recovery time was best.

The recovery time is a bit faster than tibias. The downsides of doing internals that come to my mind is the price of the nail and the possibility of nail malfunction due to various factors e.g. weight bearing issues, nail bending, motor problem and also the possibility of getting additional release surgeries such as the ITB release.
You can also risk deep infection with any nail insertion and malalignment but these risks are also associated with externals.

[programdude]

Ok thanks! And one thing I've wondered is why people say you cant recover from two surgerys, say 3 inches tibias, 2 inches femurs? I know apo and others are references as having questionable recoveries, and obviously its unrealistic to ever exactly match your old athleticism 100%, but assuming you did one operation, then allowed for recovery, then the other, wouldnt it not make much of a difference that you did two?

[TRS]

The recovery time is a bit faster than tibias. The downsides of doing internals that come to my mind is the price of the nail and the possibility of nail malfunction due to various factors e.g. weight bearing issues, nail bending, motor problem and also the possibility of getting additional release surgeries such as the ITB release.
You can also risk deep infection with any nail insertion and malalignment but these risks are also associated with externals.

I'd also add the risk of pulmonary embolism from reaming the bone during nail insertion


 

[TRS]

Ok thanks! And one thing I've wondered is why people say you cant recover from two surgerys, say 3 inches tibias, 2 inches femurs? I know apo and others are references as having questionable recoveries, and obviously its unrealistic to ever exactly match your old athleticism 100%, but assuming you did one operation, then allowed for recovery, then the other, wouldnt it not make much of a difference that you did two?

Well I guess it's because you are doing double trauma to your legs but that doesn't mean you won't recover. If you are within the safe limits of lenghtening, which most doctors recommend doing no more than 5 cm tibias and 6 cm femurs, then you should be able to recover provided you have no major complications during lengthening. APO/Crazy went WAY beyond the recommended safe levels and I know for sure that crazy is having alot of problems at the moment with walking and getting back to normal routine while APO's recovery is quite obscure. But then again, some people may be able to lengthen to that extent and have normal recovery while others may not.
So I would choose a good surgeon and lengthen within the safe limits and follow my doctors advice and hope for the best recovery! And yes it is unrealistic to match your old athleticism from changing your normal leg anatomy and physiology!

[Cyber]

Yes, internal femur with antegrade nail insertion seems to circumvent the risk of permanent knee pain which is usually associated with tibia nailing and retrograde femur nailing.

Hey, you should look into that more before making such a bold statement, preferably with 3rd party, credible LL Ortho surgeons who have no conflict of interest...Medical treatment and business intentions should never go together because it could have bad consequences for the patients.

I mean, no one on the old forum, or this forum, knew anything for YEARS about the sequelae associated with Tibial nailing until some random person asked one day AND why was it that NO ONE Before from Paley, Beijing, Betz, Mahboubian, India, other LL Vets (Apo, Tall, LON patients) or anyone else doing Internal Tibias or LON ever mention it as a possible complication for YEARS Before?
Why it it that none of those Docs / Institutions / vets are mentioning it as possible complication NOW?
Maybe because it has to do with a conflict of interest?...How do we know 100% that Internal Femur Antigrade Nailing has no such effect??

Knowing this, are there other important, health related things that we should know about? Maybe longterm effects or other things that are vitally important, but is being withheld due to business conflict of Interest?

I've read and heard other opinions that contradicts Internal Femoral Antigrade Nailing as "safest."
Maybe people should do more research and contact qualified Docs regarding this matter as well so other perspective pateints don't risk getting screwed as well with either knee pains, or other sequelae that they might not know about until many months/years later when it's too late.

[TRS]

Hey Cyber,
You have a valid point and since this is an open forum it is common sense for prospective patients to seek professional medical advice from credible orthopaedic surgeons and this should not be replaced by any advice given by me or any other non-MD member in this forum. I am not a medical doctor but from my research relating to this matter, studies have shown that antegrade femur nailing does seem to have lower incidence of anterior knee pain and better knee function compared to retrograde nailing. http://www.bjj.boneandjoint.org.uk/content/88-B/5/576
Well, since you have heard and read the contrary, it will be great if you post the studies and information on this forum as it will certainly benefit me and the other members by broadening our knowledge and putting us into a better position into making proper informed decisions!
As for doctors and LL vets not knowing or mentioning about this complication, I wish I had an answer but I don't