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[JJ299]

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.

There's a relatively famous case in Korea where someone died from fat embolism doing externals like 8 years ago.



Right now lot of the popular surgeons here in Korea still offer externals but many of them recommend internals like most of the western Doctors. They are still doing externals mostly because it's lower cost and something more people can afford - a reason why there are still lot of people going to India/Egypt/Turkey for their surgery.

[Staystrong]

He is not, inventor of Internal method is Bliskunov who lived Ukraine!
Don't get confused and do not confuse people!

I would say - Paley improved that method and made it popular but not invented.
Interesting fact - fathers of LL, external and internal methods are from USSR.

[Lennys]

I found an article about it: https://www.allkpop.com/buzz/2018/06/musical-actor-trainee-suddenly-dies-after-limb-lengthening-surgery and if it's the right one, it says "pulmonary thromboembolism" which is different from "fat embolism". A surgeon told me that the risks for PE are the same for both, the difference is the risks for FE.

That's why it's always important to go to the right clinic. No one says that external lengthening is risk-free. But safer? Hell, yes.

I found an interesting thread about a possible solution to PE: http://www.limblengtheningforum.com/index.php?topic=83522.msg262082#msg262082

[HateLAPELoveSTEM]

Well, I gotta agree with NailedLegs. Indeed studies beat anecdotes and whatever the forumers here say, even if they are LL veterans.
But yeah there is nothing wrong with doing exteral tibias, and I don't think it is not a bad decision to trade a lot of expenses for marginally higher risks.   

[jbfjbj4]

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.

Seems to me in the thread no one was distinguishing between femurs and tibias.

I agree externals on tibias is 'safer', albeit it's much more uncomfortable and inconvenient, with a fair bit more scarring. These aren't just small things to be handwaved away though - patient comfort is going to be a big predicator for adherence to stretching and good mental health during the lengthening process and so will directly affect outcomes. Given we all do this surgery to 'look better', the scars from externals are of course another issue, particularly if you live in a warm climate where you'll be wearing shorts a lot.

On the flip side, yes safety is better in terms of major complications and it is of course cheaper.

[Kintaeryos]

Seems to me in the thread no one was distinguishing between femurs and tibias.

I agree externals on tibias is 'safer', albeit it's much more uncomfortable and inconvenient, with a fair bit more scarring. These aren't just small things to be handwaved away though - patient comfort is going to be a big predicator for adherence to stretching and good mental health during the lengthening process and so will directly affect outcomes. Given we all do this surgery to 'look better', the scars from externals are of course another issue, particularly if you live in a warm climate where you'll be wearing shorts a lot.

On the flip side, yes safety is better in terms of major complications and it is of course cheaper.

So this isn't some subjective opinion? External tibias is the safest form of LL when looking at the science?

[jbfjbj4]

So this isn't some subjective opinion? External tibias is the safest form of LL when looking at the science?

Yes if we're talking about tibias only. But 'risk' and 'safety' are overused words. The vast majority of patients, both internal and external, have no serious complications. Whereas the discomfort from wearing fixators is guaranteed. As is the higher cost of internals. Those are the main factors to look at.

You've significantly more lifetime risk of dying in a car accident than getting a serious fat embolism with either method, and yet I bet you still drive your car and don't worry about it.

[Lennys]

Seems to me in the thread no one was distinguishing between femurs and tibias.

I agree externals on tibias is 'safer', albeit it's much more uncomfortable and inconvenient, with a fair bit more scarring. These aren't just small things to be handwaved away though - patient comfort is going to be a big predicator for adherence to stretching and good mental health during the lengthening process and so will directly affect outcomes. Given we all do this surgery to 'look better', the scars from externals are of course another issue, particularly if you live in a warm climate where you'll be wearing shorts a lot.

On the flip side, yes safety is better in terms of major complications and it is of course cheaper.

You might consider getting tattooed on them or look into some laser therapy, but I haven't thought that far.

However, speaking of looking better, longer tibias definitely look more aesthetic than longer femurs. In fact, you would most probably end up looking weird after femur lengthening. Imagine, that your knee lines stay the same height.

It's another worthy advantage of tibia lengthening that is often overlooked.

Whereas the discomfort from wearing fixators is guaranteed.

Well, I imagine what the other LL veteran above has pointed out that the discomfort from internal nail would be the physical pain of having the nail inside your bones. I actually feel discomfort already just by reading it.

[Rockstarz5]

 
 At some point is stupid this discution, LL is not safe and it never willl be, period. You can have a better chance if is a good doctor, but still paley had patients with embolism, and halil had excellent results , so at this point is a matter of luck

[jbfjbj4]

You might consider getting tattooed on them or look into some laser therapy, but I haven't thought that far.

However, speaking of looking better, longer tibias definitely look more aesthetic than longer femurs. In fact, you would most probably end up looking weird after femur lengthening. Imagine, that your knee lines stay the same height.

It's another worthy advantage of tibia lengthening that is often overlooked.

Well, I imagine what the other LL veteran above has pointed out that the discomfort from internal nail would be the physical pain of having the nail inside your bones. I actually feel discomfort already just by reading it.

I don't really have to imagine any of this as I've done femur lengthening.

Agree tibias are more aesthetic (although femurs get you more height which I'd say is much more important). Regarding the pain of an internal nail, to be honest I didn't feel much pain at all post-surgery. Certainly not any pain from the nail being in the bone canal. The main pain came towards the the of lengthening where I was trying to grind out those extra few millimetres, and I was using a gnail so the twisting of the leg was quite painful towards the end (last couple of weeks). That wouldn't apply with Precise. I recognise everyone's experience is different though.

[LG1816]

Indeed studies beat anecdotes

Theoretically, though as has been evidenced multiple times over, people here rarely have the skill set required to interpret them correctly.

[Rockstarz5]

 
   How was your experience with giotikas and gnail?.. want it for the next year

[Body Builder]

I don't really have to imagine any of this as I've done femur lengthening.

Agree tibias are more aesthetic (although femurs get you more height which I'd say is much more important). Regarding the pain of an internal nail, to be honest I didn't feel much pain at all post-surgery. Certainly not any pain from the nail being in the bone canal. The main pain came towards the the of lengthening where I was trying to grind out those extra few millimetres, and I was using a gnail so the twisting of the leg was quite painful towards the end (last couple of weeks). That wouldn't apply with Precise. I recognise everyone's experience is different though.

You don't get much more height in reality with femurs.
For 8cm, which is the upper safety limit, you get about 7.2cm in reality due.to the curvature of femur bone. With tibias you can get all the 6.5cm (which is the upper safety limit).
Ok 0,7 cm is a difference but not so.significant compared to how cheaper are external tibias and with a relatively very good safety profile for LL which of course is a not a safety cosmetic surgery compared to almost any other one.

[JON SNOW]

with 8cm lengthened most people “lose” 2 to 3 mm, although this may depend on the angle at which the surgeon inserts the nail

[JON SNOW]

there are cons and pros of external vs internals, but imo internals are overall better because

cons: with external the psychological and social aspect of having bulky frame for 9 or up to 12 months is underestimated. superficial infection almost guaranteed and a lot more scars

pros: cheaper and easier to correct deformities

Replying to op: the logic of most suregons is the risk of serious infection with externals, it is unacceptable for aesthetic purposes, at least in the US and most of Europe

[Beemer m3]

im currently watching game of thrones. season 5 rn haha about to finish it then onto my next series. alot of tv series during LL

[Hobbit99]

there are cons and pros of external vs internals, but imo internals are overall better because

cons: with external the psychological and social aspect of having bulky frame for 9 or up to 12 months is underestimated. superficial infection almost guaranteed and a lot more scars

pros: cheaper and easier to correct deformities

Replying to op: the logic of most suregons is the risk of serious infection with externals, it is unacceptable for aesthetic purposes, at least in the US and most of Europe

People seems to forget that one usually doesnt have 60k or more to go internals or don’t want to travel to a third world country for months.
A big pros of externals that’s a lot understimated on this forum is that is a lot cheaper so you can afford it whill still staying in your country.

[GrowGrow123]

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

The premise of this entire thread is false.

Internals are safer, more convenient, leave less scarring, and have an overall faster recovery. ESPECIALLY for femurs.

For tibias and tibias only, there is an argument to be made that external is good enough. But, as I'm sure you already know by reading everything on this forum, it is recommended to do femurs over tibias. The only time one should really be doing tibias is if they are doing quad LL.

[CLLvet]

there are cons and pros of external vs internals, but imo internals are overall better because

cons: with external the psychological and social aspect of having bulky frame for 9 or up to 12 months is underestimated. superficial infection almost guaranteed and a lot more scars

pros: cheaper and easier to correct deformities

Replying to op: the logic of most suregons is the risk of serious infection with externals, it is unacceptable for aesthetic purposes, at least in the US and most of Europe

I would disagree and push back a little bit with some of the cons you referenced regarding externals. First of all, it is not necessary to wear the frames for 9-12 months. If you do LATN (Lengthening and Then Nailing) method, which is the one that I used, you remove the frames and insert an intramedullary internal fracture nail into your tibias immediately once you finish lengthening. That means you will only wear the frames for the lengthening period (approximately 3 months) rather than the 9-12-month period that you reference. I agree with you 100% that wearing frames for 9 months would be unbearable. I would not be able to do that. However, 3 months in frames is much easier to endure. Honestly, there was very little pain and I eventually got fairly used to the discomfort of the frames. The discomfort never fully goes away, but like with anything in life, the human spirit is remarkably resilient and we become accustomed to conditions that initially may appear quite unpleasant.

Regarding your 2nd point, infection is NOT guaranteed. It is certainly a risk, but you can reduce the risk if you are careful and follow the treatment protocol. I never had an infection once throughout my time in frames. I was very meticulous and systematic in keeping my pin sites clean. That is how I was personally able to avoid infections. Another patient who was in Athens with me and using external frames DID get an infection. However, he only got it once throughout his lengthening period and it was a relatively minor infection that the doctor immediately treated with oral antibiotics. It went away after a few days and I don't think it even disrupted his lengthening (although perhaps he stopped lengthening for 2-3 days while the infection was being treated).

So yes, wearing externals is psychologically difficult. I agree with you there! it certainly took me a while to get used to them. And I was counting down the days until I finished lengthening and would have them removed. But in my opinion, 3-4 months with externals is highly manageable assuming you follow some basic guidelines:

-Develop a good daily routine that keeps your mind off your frames
-Follow a good eating and physical therapy protocol
-Keep the pin sites clean by always having gauze and antiseptic in your apartment
-Be disciplined about cleaning your pinsites at least 3 times per week. I usually cleaned my pinsities immediately after a shower. I would shower and get water on my frames/ pinsites. Then immediately after the shower, I dried my pinsites with a hair dryer and cleaned them up nicely and reapplied the gauzes and antiseptic. The nursing team in Athens taught me how to do this and they personally came over to my hotel room and cleaned my pinsites for me at first until I was 100% comfortable doing this myself and I no longer needed them. 
-I also still showered every day, even on days I did not want to get the pinsites wet. You can also still take showers and not get your pinsites wet by wrapping a thick towel around your metal frames. That is what I did on the days that I still wanted to shower my upper body, but avoid having to clean my pinsites
-Finally, do consider an LATN method so you do not have to endure external frames for more than 3-4 months

For anyone who has additional questions on external frames (and/or internal femur lengthening), please feel free to respond to this thread. Or send me a DM if you have personal questions regarding your specific situation. I will try to help as best as I can.