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[ReadRothbard]

I've been considering 6-7 cm of tibial lengthening with Dr. Leonid Solomin in late 2022/early 2023, and I was previously of doing LON, but I've since learned about the possibility of chronic knee pain doing that. So, I'm now thinking about pure externals. The question is, of course, how long do you have to stay in frames with pure externals? I've heard the rule of thumb that 1 cm of lengthening is equal to 1-1.5 months in the frames, but I want to know how accurate that is from people's experiences. Thank you.

[KiloKAHN]

1 month per cm is more common for children. Realistically it's more like 1.5 - 2 months in frames per cm.

[ReadRothbard]

1 month per cm is more common for children. Realistically it's more like 1.5 - 2 months in frames per cm.

Yeah, there’s just no way I’m going to sit in frames for 1+ years. I’d rather just do LON or internals if necessary.

[Thehighest]

For more than 5 cm better take risk of knee pain.

[zaozari]

With external frames (Ilizarov's or adapted franes)  in tibias there is generally an average (it may have to be adapted to each one situation, response, exerience if surgeon, physiotherapy, etc.) of: 1 day for each mm lenghtening and the double for its consolidation, so to sum up, 3 days in frames per 1 mm, or 6 months (180 days) for 60 mm (6 cm). This is just a generally indicative timetable.

[zaozari]

For more than 5 cm better take risk of knee pain.

Chronic knee pain in nail systems in tibias is largely not yet fully understood and not only due to manipulation of patellar tendon but of multifactorial origin. It may be atenuated with time and physiotherapy...or not. It has no proper, directed, therapy.
Why do you say it's a good idea to risk forever pain just to save 2 or 3 months with frames? Sorry, but in my modest personal opinion it seems not to make any sense! Would you do that?

[zaozari]

Yeah, there’s just no way I’m going to sit in frames for 1+ years. I’d rather just do LON or internals if necessary.

But beware that all nails (not only LON) for tibias are inserted in the knee region (except some "creative" doctors) touching or manipulating the pattellar tendon, generate huge blood loss) more risk of clots, etc) and don't provide means of correction (for rotations, deviations, etc), reversion for consolidation improvment, etc. Internals are more suitable for the anatomy, practice of surgeons, etc, for femurs.Besides tibias are more curved, fragile bones.

I am in a similar boat as you. For tibias I chose ideally Ilizarov done preferably by one among the more reputable clinical and LL surgeons. But altough, ideally, money shouldn't guide the decison, my 3rd choice may be LON after a bit more of further investigation.

[Thehighest]

Chronic knee pain in nail systems in tibias is largely not yet fully understood and not only due to manipulation of patellar tendon but ofvmultifactorial origin. It may be atenuanted with time and physiotherapy...or not. It has no proper therapy. Why do you say it's a good idea to risk forever pain just to save 2 or 3 months with frames? Sorry, but in my modest personal opinion it seems not to make any sense! Would you do that?

Time in frames for 6 cm is almost 1 year, uisng LON not more than 2.5 months so is not 2 months is more than 6 months more with pure external

[Medium Drink Of Water]

Dr. Mitkovic told me nine months for 7.5 cm.

[Thehighest]

Dr. Mitkovic told me nine months for 7.5 cm.

I think that can be possible but in the worst case it would take more than a year.

[zaozari]

For more than 5 cm better take risk of knee pain.

Risk pain is chronic, possibly forever! Are you serious? You can use pure or adaped Ilizarov in the hands of a good, experienced surgeon with a very reduced risk of that kind of problem, according to sources as Pubmed when you make a directed search. Chronic knee pain strarted to ocur mailly after nail systems for tibias were introduced. And Ilizarov framesare are also overall saffer  (better stabilization and eventual corrections, etc.).
Anyway, not only you can more safely lenghten more (with more time) as you are rid of externals in 6 months (for 6 cm in tibias) if everything goes ok (not 1 year!!) . If you refer or include complications, you should include it also for LON, for example deep infection of nails and having to substitute them in another surgery (already included in costs or not) if antibiotics are late or infection is not detected quickly enough.
HOWEVER IT'S TRUE that according to x-rays your doctor may prefer a bit more time in frames.

[Thehighest]

Risk pain is chronic, possibly forever! Are you serious? You can use pure or adaped Ilizarov in the hands of a good, experienced surgeon with a very reduced risk of that kind of problem, according to sources as Pubmed when you make a directed search. Chronic knee pain strarted to ocur mailly after nail systems for tibias were introduced.
Anyway, not only you can more safely lenghten more as you are rid of frames in 6 months (for 6 cm in tibias) if everything goes ok.
HOWEVER IT'S TRUE that according to x-rays your doctor may prefer a bit more time in frames.

There is serious risk using puré external which is collapse of the regenerate that happen after they removal of the fixator I read that can be as high as 10 per cent.

[zaozari]

It's wortless keep this discussion. Have you compared that rate with other, nail methods, in tibias (SOURCES?)?
However one thing is sure. Ilizarov methods success depend absolutely on the skills and experience of the surgeon to insert the pins in the ideally places (not reaming the medula for example) its ability to plan, install, monitor and change set up of pins and frames, as well as the qualityof the alloy. But it's still clearly the saffest method also on that aspect so far.

[zaozari]

so is not 2 months is more than 6 months more with pure external
[/quote]
Where the heck have I said it was 2 months for pure externals in total? That is only for elongation of 60 mm (1mm/day), doesn't include consolidation

[zaozari]

Time in frames for 6 cm is almost 1 year, uisng LON not more than 2.5 months so is not 2 months is more than 6 months more with pure external

"Allmost one year in frames" for 6 cm ?! 
I hate free speculation and misinformation presented as true facts. This only lowers forum quality and harms people's best choices and peace of mind. Thant's why I am reacting so much on this topic.
What are your sources, not counting on cases of complications ? (that is also interesting, to compare type of complication and methods of LL used).

[zaozari]

_mistake

[zaozari]

I think that can be possible but in the worst case it would take more than a year.
[/quote

And there you have again, "Thehighest": 3,6 days for 1mm elongation (7,5 cm in 9 months) including consolidation, according to one more doctor. And now you "think it could be possible"!! (3,6 is not 3 but we have to look at each patient consolidation, age, etc). Never one year!
Just try maybe to be more attentive and rigorous when giving "advice" , not  when making questions and learning more, here or elsewhere. Some people try to rely on this forum already for serious stuff. Free speech in a forum like this maybe could come with some responsibility attached,  in my humble opinion.

[Thehighest]

"Allmost one year in frames" for 6 cm ?! 
I hate free speculation and misinformation presented as true facts. This only lowers forum quality and harms people's best choices and peace of mind. Thant's why I am reacting so much on this topic.
What are your sources, not counting on cases of complications ? (that is also interesting, to compare type of complication and methods of LL used).

1.5 -2 months per centímeter for adults, just do the maths 9-12 months

[zaozari]

But that's " Kilokhan" time only (it's only ,1 patient, we would have to consider his bone density, intensity of physiotherapy recovery,etc.), not eg Dr.Solomin. The total time tends to be the same (3 days for 1 mm).  The thing is that according to some here in the forum, life with LON nails is far from being "normal", not business as usual (mobility, pain, etc), as well as with Ilizarov EF (maybe worse). Let them speak. Is it worth loosing all advantages of Ilizarov?
If you go with Kilokhan figures (and not Dr. Solomin for example) yes you get  that timing....and yes it can happen duration for each mm to be different. That's why we should save time for possible delays, complications, etc.
But the classic rule of thumb is still, for an average yough, complying and healthy patient, 3 days with Ilizarov's EF. Some report a bit more for of consolidation problems and earlier stop of lenghtening with LON.

[KiloKAHN]

My experience is typical for external fixation. 1 month per cm is more of a thing with adolescents.

Once the patient has reached their desired length, they enter the consolidation phase. No further adjustments are made to the fixator. The fixator will remain until the end of the consolidation phase to allow the newly-formed bone to harden. The total time in the external fixator can be estimated to be approximately 1 month for each centimeter of lengthening in children and 1.5 to 2 months (or longer) per centimeter for adults. Total fixator time is divided evenly between the distraction and consolidation phases.

https://paleyinstitute.org/centers-of-excellence/limb-lengthening-world-renowned-surgeons/how-does-limb-lengthening-work/#/

[ReadRothbard]

Okay, so after a lot of research, I found a study looking at about 800 cosmetic leg lengthening patients, and the average was 42 days/cm detracted. That's fairly in-line with the 1-1.5 months per cm. Of course, LON/LATN is about a quarter of this.

[zaozari]

[\quote]
Okay, so after a lot of research, I found a study looking at about 800 cosmetic leg lengthening patients, and the average was 42 days/cm detracted. That's fairly in-line with the 1-1.5 months per cm. Of course, LON/LATN is about a quarter of this.
[/quote]
First of all thanks for your additional research because my dilemma now (reasons elsewhere in the forum) is also pure EF vs LON.
I will avoid any solution based on speed or confort but I understand some people can't just stop their lives for long.
It seems realistic 42 days/cm ("detracted"=lenghtening plus consolidation?). Until 2000 serious doctors only performed CLL to patients until 35 years old average, but now more and more people do it. There are cases up to more than 60 years old, not to speak about 40/45 years old women already in the phase of bone loss and reabsorption. The time of lenghtening and consolidation crucial depends on that so it's natural that average time of lenghtening and  consolidation keeps increasing.
But I don't understand how than can come to a year or more.
So, for 6cm with EF, time for both lenghtening and consolidation is around 8 months and 12 days. This is far from "one year or more".
And thus time with frames (elongation time) can be (it's never linear) 84 days with LON. (Allmost 3 months to preserve minimal safety of weight bearing in crutches).
Am I right?
Regarding observations in Paley's handbook, of course 1,5 and 2 days are safer, but this is not the average in industry and historically, weight bearing and light exercise has been promoted precisely to better stimulate natural hardening.If process was normal and there was a good follow up, bone quality is enough for that at the classic rate of 3 days/mm. You can check multiple sources if they are rid of commercial misinformation. Take also into account that Paley doesn't perform CLL since decades and he is an active commercial promoter of the nails he conceived AND has royalties to receive from and discounts for (which nevertheless never benefiting clients...) like Stryde. At the same time he naturally "tends to (di)promote" alternatives. He only uses allmost pure Ilizarov for complications and malformations, which ironically demonstrate its multiversatility and physical stability when done by those  among the best surgeons (like him).

[zaozari]

QUOTE: There is serious risk using puré external which is collapse of the regenerate that happen after they removal of the fixator I read that can be as high as 10 per cent.

Have you compared that rate with other, nail methods, in tibias (SOURCES?)? I remember the tragic case of "Unicorn", a nail insertion performed by a 30 year experienced doctor in which halves of the femurs poped up to internal skin surface? The  truth is: pure or adapted (Taylor) Ilizarov EF is the saffest in this aspect, if performed with state of the art alloy, an experienced surgeon, with permanent Rx and other (densitometry,  etc) follow-up and a totally compliant, carefull patient.

[zaozari]

But that's " Kilokhan" time only (it's only ,1 patient, we would have to consider his bone density, intensity of physiotherapy recovery,etc.), Dr.Solomin and others. The total time tends to be the same (3 days for 1 mm).  The thing is that according to some here in the forum, life with LON nails is far from being "normal", not business as usual (mobility, pain, etc), as well as with Ilizarov EF (maybe worse). Let them speak. Is it worth loosing all advantages of Ilizarov?
If you go with Kilokhan figures (and not a real orthopaedic doctor like Dr. Solomin for example) yes you get  that timing....and yes it can happen duration for each mm to be different. That's why we should save time for possible delays, complications, etc.
But the classic rule of thumb is still, for an average yough, complying and healthy patient, 3 days with Ilizarov's EF. Some report a bit more for of consolidation problems and earlier stop of lenghtening with LON.

[zaozari]

(Sorry, my mistake)

[zaozari]

(Sorry everybody, another mistaken post. I am ill in bed, already fever, it seems covid, will stop now using phone)

[zaozari]

so is not 2 months is more than 6 months more with pure external

Where the heck have I said it was 2 months for pure externals in total? That is only for elongation of 60 mm (1mm/day), doesn't include consolidation

Here it was my mistake. It's not only 2 months more, it would be theoretically around 4 monthsor slighty more, additionally.