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[AnotherLLer]

Since I've seen one of Betz / Becker patient's diary here who lengthened 11 or 12 cm on his femurs where he posted his post lengthening photo in undies I changed my mind doing femur for my first LL. It looks very bad when nked, albeit in clothes it's not that bad (but still looks weird). Even 8 cm would look odd IMO.

Basically, one has to have a really long tibia compared to femur in order to look acceptable post femur lengthening. Unfortunately, my tibia:femur ratio is very close to 0.80 so I can't look normal after huge amounts of femur LL.

I compared the photo of one of the famous tibia LL-er and he looks much more acceptable nked (even though he did almost 10 cm on tibia).

I'm thinking of 6-6.5 cm or whatever the upper safe limit for tibia there is.

My budget is for Russia only, either with Kulesh or with Bagirov.

Kulesh uses full-ring Ilizarov frames (huge ones) whilst Bagirov uses modified Ilizarov frames (half-ring ones that are much smaller and lighter).

I'm not going to insert nails (neither LON nor LATN). Since I'll be living with external frames till full consolidation, the stability of the device is very important to me. I don't want it to malfunction during the lengthy consolidation phase since my bones will be dependent on the device's stability. Any kind of deformation on the device will result in bowed legs and lost height.

Now, the way I see their pros and cons are following:

Full-ring device

Pros:

Very sturdy
More weight bearing capacity
More doctors are using it

Cons:

Huge and uncomfortable
Heavy (AFAIK it weighs 3.5 kg each)
Very hard to hide in pants

Half-ring device

Pros:

Smaller comfortable
Light
Easier to hide in pants

Cons:

Less sturdy than full-ring frames
Less weight bearing capacity (Requires sufficient bone bridge for unassisted walk)
Less doctors are using it

Basically, that's it. Both are capable of correcting misaligned bones during lengthening phase but after the frames are locked, it's all about the time until bones become hard enough. Until then, the device has to be strong and rigid in order to support broken and distracted bones to hold in place.

Do you think I'll be fine with half-ring frames till the end of the process?

[Beemer m3]

is there a reason why u dont want the nail ? u can recover much quicker. its such a pain being in frames too. if theres complication like nerve damage the frame will hurt alot. if u call it quits u can remove the frames n the nerve damage will lessen. being in frames u risk having nerve damage and being on precice u rarely get nerve damage. because there are pins through the bones that can damage if u over lengthen. is ur living space big enough for u to walk in frames? i had an apartment and i didnt do anywalking with frames . kinda embarrassing to go out wiht it.

[AnotherLLer]

The main reasons I'm contemplating doing pure external on tibia are it's least invasive nature and less costs. With LON, I will need 2 major surgeries and with LATN - 3. Additional surgeries is a hassle and costs add up significantly.

With 6 cm tibia, I will be in frames for about a year. My mother will take care of me. I won't need to hire a cleaner, a caretaker, a cook, a nurse or any other person that might become necessary during that period. She can do all of these things for me. I plan to take her with me in a country where I will get operated at so during the distraction phase she will be there supporting me.

I understand that doing pure external means about a year being disabled and dependent on someone else for many things like washing, cleaning, cooking, shopping for groceries and meds and even for movement in first few months post-op. If I didn't have a supportive person like my mother, I would have never considered pure external and do LON tibia instead.

I can save tons of money this way and won't need additional surgeries for nail insertion and removal.

[financialadvisor]

Think about the mental, physical work you are putting on your mother shoulders too..

I think Paley told in one of the pods that he prefers internal femus rather than tibias. Less infections, faster healing, you don't have to brake 2 bones, longer femus = more cms.

External tibias, long, painful but reliable approach.

How about LATN permanent knee pain problem, did you reseach that? 

[AnotherLLer]

Yeah, I understand that it won't be easy for her but she's ready to support me throughout the whole journey.

Of course internal femurs is superior and I would do that in a heartbeat if I had the money but I won't be able to do that for many years unfortunately.

I'm not going to exceed 4 cm on tibia and 5 cm on femur.

I'm aware of LATN risks but I don't think I'll need it since 4 cm on tibia is 8 months in frames max.

I'm researching LON femur because I need to lengthen that segment for max height gain and better proportions. 5 cm is all I need since 9 cm total will put me at 174 cm which is my limit in terms of arm length and I will have ideal leg-to-body ratio after 9 cm LL.

[financialadvisor]

If your only going for 4 cm on tibia, you should be good to go in 8 months. Check your bone density, vitamin d levels. Here's one summary of the study with 27 patients.

LATN Technique: The LATN group had a BHI of 0.8 months/cm. This implies that for every centimeter of bone lengthened, it took approximately 0.8 months (or about 24 days) for the bone to heal fully after lengthening.

Classic Method: In contrast, the classic method showed a BHI of 1.9 months/cm. Therefore, for every centimeter of lengthening, the bone took approximately 1.9 months (or about 57 days) to heal.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628243/

[AnotherLLer]

Yeah, but LATN is good for more than 5 cm lengthening. I don't think it's a good idea to put nails for 4 cm tibia. It can be healed in 6 months in good scenario so it doesn't worth additional surgeries for nail insertion / removal.