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[Lennys]

We would think that if there was an advanced method, it would be something safer and less invasive.

But no, LL used to be a rather simple external method, just separate the the bones in a controlled manner and put the fixators on. Sadly, it's followed up by something a lot of more invasive that would only increase the chance of embolism complications where not only you have to break the bones, but also drill the fukc out of them.

I mean why on earth would you want to do that? (Except for femurs) The original LL (external method) is already dangerous and painful enough that most people won't even do it, the last thing we need is taking more unnecessary risks by doing it internally.

I wish that instead of them being so busy marketing PRECICE or Stryde or what ever the fukc it is called, more efforts and resources are allocated at the perfection of the already existing and superior external method to make it even safer that it has ever been.

More read on this: http://www.limblengtheningforum.com/index.php?topic=84060.msg265525

[NailedLegs]

I think I made a pretty good argument for why internals are better, citing all of my sources.

The #1 factor that determines your success when it comes to Limb Lengthening is your Doctor. Your Doctor has far more control over if the surgery will be a success or not than what method you use. If you're going to do externals, please make sure you pick a reputable Doctor. Most people doing externals are doing it solely because it's cheaper, and butchers in Turkey like Buldu offer it.

[Lennys]

I think I made a pretty good argument for why internals are better, citing all of my sources.

No, but Body Builder and Medium Drink Of Water did for externals.

If you're going to do externals, please make sure you pick a reputable Doctor.

Yeah, absolutely. That applies to whatever method you choose.

[NailedLegs]

No, but Body Builder and Medium Drink Of Water did for externals.

Yeah, absolutely. That applies to whatever method you choose.

Bodybuilder and Medium Drink of Water didn't cite a single source. I'm not sure why you said no.

If you took anecdotes and random strangers online over peer reviewed studies and Doctor's statements, I don't know what to tell you. It was a great thread that had differing viewpoints--iron sharpens iron. It sounds like you already made up your mind with doing externals. I wish you good luck. There are reputable surgeons that do externals like Dr. Parihar, and he is probably the most inexpensive option. I understand you want a cheap option, as thats the #1 reason why people do externals. Perhaps you should research him?

I've said it before. I would rather do externals will a skilled and reputable Doctor than doing internal with a butcher like Buldu. Doctor > Method.

[Lennys]

Bodybuilder and Medium Drink of Water didn't cite a single source. I'm not sure why you said no.

If you took anecdotes and random strangers online over peer reviewed studies and Doctor's statements, I don't know what to tell you. It was a great thread that had differing viewpoints--iron sharpens iron. It sounds like you already made up your mind with doing externals. I wish you good luck. There are reputable surgeons that do externals like Dr. Parihar, and he is probably the most inexpensive option. I understand you want a cheap option, as thats the #1 reason why people do externals. Perhaps you should research him?

I've said it before. I would rather do externals will a skilled and reputable Doctor than doing internal with a butcher like Buldu. Doctor > Method.

As the others have pointed out in that thread, none of your sources are relevant. Minor complications don't mean much, it's only the serious ones that matter.

Even if the prices were the same, I'd still choose external mainly because I prefer the low-invasiveness of externals compared to the shudder-inducing brutality of not one but two major surgeries for internals.

As for the reputable doctors, I believe we have different standards for what qualifies as good doctors. Like I wouldn't do this surgery in India with Dr. Parihar or with an unknown doctor like Dr. Kucukkaya or with a surgeon who has killed a patient like Dr. Giotikas.

[NailedLegs]

As the others have pointed out in that thread, none of your sources are relevant. Minor complications don't mean much, it's only the serious ones that matter.

Even if the prices were the same, I'd still choose external mainly because I prefer the low-invasiveness of externals compared to the shudder-inducing brutality of not one but two major surgeries for internals.

As for the reputable doctors, I believe we have different standards for what qualifies as good doctors. Like I wouldn't do this surgery in India with Dr. Parihar or with an unknown doctor like Dr. Kucukkaya or with a surgeon who has killed a patient like Dr. Giotikas.

You have no sources or evidence to back up your claims that externals are objectively better. Nor did they. Saying "Erm, well actually I don't like your sources" isn't valid.

Show proof.

But you, like them, can't. Show me a single statement from any orthopedic surgeon that externals are safer than internals. I'm not even asking for a study. Give me somebody. Can you even find a PA or nurse that holds that view? Does any medical professional? I haven't seen a single one.

You don't have the $ for internals. Don't lie. It's OK you don't have the funds. If your height dysphoria is that bad and causes you that much pain, but you don't have the money, then I understand doing externals even with their risk profile. Height dysphoria can be debilitating. Doing anything to increase you height might be worth it to some individuals, and might be worth the risks. I won't argue against that.

You are trying to justify your bad decisions to make yourself feel better. That's a common thing humans do. I get it. But your coping. Your coping over the fact that you cannot afford an internal nail, so now you are ranting on this forum to make yourself feel better.

I don't want to see more people get butchered. There's nothing in it for me. I simply want to help people. Seeing internet strangers give bad advice to people who don't know any better is bad. There are real life implications of posting on this forum.

[Lennys]

You are trying to justify your bad decisions to make yourself feel better. That's a common thing humans do. I get it.

Sounds more like you're trying to justify your bad decisions of doing QLL in Early 2025 with the PRECICE nail with a bunch of shady surgeons as candidates.

[JustineCollins]

Well. I think internals are better because they have less risk of infection and have a limit of few inches to not fall for ballerina syndrome due to more lengthening. thereby internals are easy to manage etc.

[Body Builder]

We would think that if there was an advanced method, it would be something safer and less invasive.

But no, LL used to be a rather simple external method, just separate the the bones in a controlled manner and put the fixators on. Sadly, it's followed up by something a lot of more invasive that would only increase the chance of embolism complications where not only you have to break the bones, but also drill the fukc out of them.

I mean why on earth would you want to do that? (Except for femurs) The original LL (external method) is already dangerous and painful enough that most people won't even do it, the last thing we need is taking more unnecessary risks by doing it internally.

I wish that instead of them being so busy marketing PRECICE or Stryde or what ever the fukc it is called, more efforts and resources are allocated at the perfection of the already existing and superior external method to make it even safer that it has ever been.

More read on this: http://www.limblengtheningforum.com/index.php?topic=84060.msg265525

Well said.
Externals only for tibias with hexapod is definitely the safest, most painless and cheap method. The only reason that many famous doctors don't do it is that they have way less profit than using magnetic nails or mechanic cr*ps. Still, respectable doctors like Giotikas and Pili use it.

[Body Builder]

Well. I think internals are better because they have less risk of infection and have a limit of few inches to not fall for ballerina syndrome due to more lengthening. thereby internals are easy to manage etc.

Internals have a limit of 8+cm which is way more than the max length you should do on tibias, so what you wrote is not true.
Also, if.internals.stop working or bemd you need a new big surgery to replace them while with externals, if a pin is bend it is a much easier procedure to change it.

For infections, yes they are much more frequent in externals but in 99% of.cases they just go away with a week of oral antibiotics.
With internals if you have a deep tissue infection it can lead to amputation. So even in this sector internals are not superior to externals.

[jbfjbj4]

The vast majority of those who do internals do them on femur, and you're in a very small minority if you're arguing externals are safer on femurs.

[Lennys]

Well said.
Externals only for tibias with hexapod is definitely the safest, most painless and cheap method. The only reason that many famous doctors don't do it is that they have way less profit than using magnetic nails or mechanic cr*ps. Still, respectable doctors like Giotikas and Pili use it.

Also, another reason is that external method is harder to perform requiring the surgeon to be way more skilled. It is basically more work for them so internal is less headache for them.

[TheDream]

One thing I’ve wondered about with internals tibia is how they can control the axis of the fibular bone, because it’s only the tibia that has the device inside of it. I guess the nails keep the fibular in place as well? Maybe this only becomes an issue for larger lengthening amounts on tibia >3-4 cm?

But overall not having the pins that connect the outside world with the bone through the muscles surely makes internals better than externals. I mean sure the internals is a larger initial procedure but if the surgeon is good at what he does then there shouldn’t be an issue and the chance of complications after the surgery will be less.

Also increased mobility of internals.

[Lennys]

One thing I’ve wondered about with internals tibia is how they can control the axis of the fibular bone, because it’s only the tibia that has the device inside of it. I guess the nails keep the fibular in place as well? Maybe this only becomes an issue for larger lengthening amounts on tibia >3-4 cm?

But overall not having the pins that connect the outside world with the bone through the muscles surely makes internals better than externals. I mean sure the internals is a larger initial procedure but if the surgeon is good at what he does then there shouldn’t be an issue and the chance of complications after the surgery will be less.

Also increased mobility of internals.

It doesn't matter how good the surgeon is. The point is with internals, your body takes a lot more damages than necessary so the risks are inherently higher.

[erlang]

Sadly, it's followed up by something a lot of more invasive that would only increase the chance of embolism complications where not only you have to break the bones, but also drill the fukc out of them.

Could you please refer to some source that states that the internal method has a higher risk of embolism than the external method?
The only comment I have seen on this forum about embolism is from Dr. Assayag and it is quite positive
http://www.limblengtheningforum.com/index.php?topic=65693.msg182778#msg182778

In addition, I am also ready to question the statement that the external method is safer than the internal one.
On this forum there are not many actual diaries about the external method, but here is a similar Russian-language forum(https://legscorrection.ru/forum/forumdisplay.php?f=61), where 99% of the diaries are about the external method on tibia and there are quite a lot of terrible stories about the dysarthrosis (false joint), damaged nerve (which can lead to paralysis and amputation), hallux valgus, and much more. Of course, you can argue that in general the level of medicine in Russia is not the same as in Europe, but they invented this method and have been practicing it for decades, I think they should understand something about it.

[CLLvet]

It doesn't matter how good the surgeon is. The point is with internals, your body takes a lot more damages than necessary so the risks are inherently higher.

I did internals with my femur (Stryde) and then externals on my tibia (Taylor Spatial Frames LATN) a few years later. Both surgeries with Giotikas.

 I will say that externals were challenging, but not as bad as I thought they would be. The physical pain was minimal (in fact it was less painful than internal Stryde femurs). I remember when I did Stryde on my femurs I would wake up in the middle of the night due to actual physical pain inside my femur bones. Whereas with the externals, I rarely (if ever) felt any physical pain in my tibias.  The main challenge with the externals is the discomfort because your body never truly gets used to having frames on your legs, especially at night while you sleep. However, I did eventually adjust and found myself being able to fall asleep. My sleep quality was not dramatically different when comparing my experience with externals versus internals. As mentioned earlier, pain awakened me at night during my femur CLL. Whereas it was physical discomfort that awakened me at night during tibia CLL. So different issues, but both disrupt your sleep quality. And I dealt with both by standing up, doing some quick stretches, adjusting my body position, and laying back down in bed.  I should also caveat that I am not good at sleeping and have always struggled with sleep to an extent (regardless of CLL or not) 

Finally, having a surgeon who KNOWS how to properly attach the pins/ rods is critical if you do externals. Your doctor can put the pins/ fixators on in such a way that it minimizes the discomfort and pain to the patient. This is something that Giotikas actually knows how to do quite well due to his experience with treating orthopedic trauma patients. 

Perhaps I am one of the few veterans on this forum who has experience with BOTH internal and external. I can speak to the differences in my experience with the two methods if that is something you are interested in. Feel free to post your specific questions here on this thread or reach out to me via DM. 

 

[Hobbit99]

Also, another reason is that external method is harder to perform requiring the surgeon to be way more skilled. It is basically more work for them so internal is less headache for them.

Interesting. Why do you think external is harder to perform for the surgeon?

[Kintaeryos]

omg everytime I think I've understood the labyrinthine theory and factors involved in this complex surgery some new curveball comes up. I thought it was fully established that internal is superior to external in every way except the cost. I guess I still have a lot of research left to do.

[Lennys]

Could you please refer to some source that states that the internal method has a higher risk of embolism than the external method?
The only comment I have seen on this forum about embolism is from Dr. Assayag and it is quite positive
http://www.limblengtheningforum.com/index.php?topic=65693.msg182778#msg182778

For starters, Dr. Paley the GOAT had 2 embolism cases who almost died through internal method and he's the best in the world. Let that sink in. Now feel free to find us an embolism case through external method.

It's a common knowledge that the internal method has a higher risk of embolisms. The reason you don't see it mentioned often enough is the very reason that I made this thread. Most of the surgeons aren't very open about it but if you ask them this specifically and corner them enough, they'd have no choice but to admit it.

I did internals with my femur (Stryde) and then externals on my tibia (Taylor Spatial Frames LATN) a few years later. Both surgeries with Giotikas.

 I will say that externals were challenging, but not as bad as I thought they would be. The physical pain was minimal (in fact it was less painful than internal Stryde femurs). I remember when I did Stryde on my femurs I would wake up in the middle of the night due to actual physical pain inside my femur bones. Whereas with the externals, I rarely (if ever) felt any physical pain in my tibias.  The main challenge with the externals is the discomfort because your body never truly gets used to having frames on your legs, especially at night while you sleep. However, I did eventually adjust and found myself being able to fall asleep. My sleep quality was not dramatically different when comparing my experience with externals versus internals. As mentioned earlier, pain awakened me at night during my femur CLL. Whereas it was physical discomfort that awakened me at night during tibia CLL. So different issues, but both disrupt your sleep quality. And I dealt with both by standing up, doing some quick stretches, adjusting my body position, and laying back down in bed.  I should also caveat that I am not good at sleeping and have always struggled with sleep to an extent (regardless of CLL or not) 

Finally, having a surgeon who KNOWS how to properly attach the pins/ rods is critical if you do externals. Your doctor can put the pins/ fixators on in such a way that it minimizes the discomfort and pain to the patient. This is something that Giotikas actually knows how to do quite well due to his experience with treating orthopedic trauma patients. 

Perhaps I am one of the few veterans on this forum who has experience with BOTH internal and external. I can speak to the differences in my experience with the two methods if that is something you are interested in. Feel free to post your specific questions here on this thread or reach out to me via DM.

That's wonderful! Thanks for sharing man. Here's the type of answers that people are looking for coming to this thread.

The physical pain inside the femur does sound quite scary but unfortunately, still the only way for femoral lengthening.

Interesting. Why do you think external is harder to perform for the surgeon?

It's not what I think. I'm not a surgeon but that's what the surgeons I spoke with told me. But one of the reasons might be the one that the poster above me has pointed out "Finally, having a surgeon who KNOWS how to properly attach the pins/ rods is critical if you do externals."

omg everytime I think I've understood the labyrinthine theory and factors involved in this complex surgery some new curveball comes up. I thought it was fully established that internal is superior to external in every way except the cost. I guess I still have a lot of research left to do.

Yeah, been there, done that.

[Kintaeryos]

For starters, Dr. Paley the GOAT had 2 embolism cases who almost died through internal method and he's the best in the world. Let that sink in. Now feel free to find us an embolism case through external method.

It's a common knowledge that the internal method has a higher risk of embolisms. The reason you don't see it mentioned often enough is the very reason that I made this thread. Most of the surgeons aren't very open about it but if you ask them this specifically and corner them enough, they'd have no choice but to admit it.

That's wonderful! Thanks for sharing man. Here's the type of answers that people are looking for coming to this thread.

The physical pain inside the femur does sound quite scary but unfortunately, still the only way for femoral lengthening.

It's not what I think. I'm not a surgeon but that's what the surgeons I spoke with told me. But one of the reasons might be the one that the poster above me has pointed out "Finally, having a surgeon who KNOWS how to properly attach the pins/ rods is critical if you do externals."

Yeah, been there, done that.

So if I want an extra 7 cm of height, external femurs is the best way?

[Body Builder]

The vast majority of those who do internals do them on femur, and you're in a very small minority if you're arguing externals are safer on femurs.

Nobody talked.about femurs though.

And yes externals on tibias need a much more capable doctor than an internal nail. That's another reason many surgeons stick with internals.
More and easier money, thats all.

[Lennys]

So if I want an extra 7 cm of height, external femurs is the best way?

Femurs have to be done via internal but none guarantees that much height for you. It depends on the your initial bone length. Also, because femurs are curve, it means you might not get the full height increase.

[Kintaeryos]

Femurs have to be done via internal but none guarantees that much height for you. It depends on the your initial bone length. Also, because femurs are curve, it means you might not get the full height increase.

Oh, so your comparison only applies to tibial lengthening?

[Kintaeryos]

Well said.
Externals only for tibias with hexapod is definitely the safest, most painless and cheap method. The only reason that many famous doctors don't do it is that they have way less profit than using magnetic nails or mechanic cr*ps. Still, respectable doctors like Giotikas and Pili use it.

Is externals for tibias safer and less painful than internal femurs? Assuming only 5-6 cm since more than that usually isn't possible with tibias (correct me if I'm wrong but your 7.5 cm tibial increase is a rare case).

[Lennys]

Oh, so your comparison only applies to tibial lengthening?

Yes.

Is externals for tibias safer and less painful than internal femurs? Assuming only 5-6 cm since more than that usually isn't possible with tibias.

Yes, I believe that externals for tibias is superior to internal femurs.

[Kintaeryos]

Yes.

Yes, I believe that externals for tibias is superior to internal femurs.

Interesting, I've never heard this opinion before, will have to do some reading. Do you think even if someone went to the best doctors they wouldn't be able to get an accurate answer to this cause the doctor might have an incentive to recommend internal so they make more money?

[Lennys]

Interesting, I've never heard this opinion before, will have to do some reading. Do you think even if someone went to the best doctors they wouldn't be able to get an accurate answer to this cause the doctor might have an incentive to recommend internal so they make more money?

Yes, as the other veteran has said above, it's more and easier money for them. That's all.

[Kintaeryos]

Yes, as the other veteran has said above, it's more and easier money for them. That's all.

Damn, so even Paley couldn't be trusted? I have to 100% do my own research?

[Lennys]

Damn, so even Paley couldn't be trusted? I have to 100% do my own research?

Paley is the inventor of internal lengthening. He's the last person you'd want to ask about this.

[Kintaeryos]

Paley is the inventor of internal lengthening. He's the last person you'd want to ask about this.

So I guess it comes down to finding the best doctors who do externals, or both (preferably the latter since the formed might be biased too but the other way). Do you have any recommendations?

[Acemace86]

Have you done LL?