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[Kafka]

Hi,

this is my first post, though I‘ve been following the forum intensely for several months. First of all a great compliment from my side to this forum and all members!

I would like to know what the LL Forum Community thinks of the general decision between internal femur vs. external tibias (vs. internal tibias). Given that money wouldn’t matter.

My question is mainly targeted on which procedure is safer, i.e. leads to less serious complications and less problems also years after the surgery. By serious complication I don’t mean pain or pin infection but rather long lasting complications/inconveniences or those which can only be solved by additional surgery.

I hope this question does not sound to shallow. I intensively researched this issue but still am not sure about which method is safer.
Thanks for all answers, I appreciate it!

Cheers

[G-Man]

Tibs, external only.

[Uppland]

I have also been wondering this, temporary pain I can deal with but not life long complications.

[Medium Drink Of Water]

External tibiae is the least invasive method, and that's why I like it best.  It's just a few pins going through the legs.  That was my first choice for lengthening, but it didn't work out so I had to go to my 2nd choice (China) where LON was the standard practice and I didn't question it like I should have.

[Metanoia]

Internal femurs are very risky. Possible complications are e.g. dangerous fractures, chronical bone infection and hip joint necrosis. Also bone healing problems are very likely due to the reaming of the bone marrow.
External tibiae are much safer.

[KiloKAHN]

I like externals simply because you aren't getting anything shoved into your bone canal.

[GROWtalORdieTRYING1]

LON causes knee pain at the patella in 50% of LON patients(according to some doctors)for LON external tibia, and in 50% of those patients 50% get chronic long term knee pain. so overall 25% of LON patients get chronic long term knee pain at the patella.

to answer your original question. the safest method is tibia externals full not LON.

in my opinion, full external for tibia and full internal for femur are as safe as each other.
I know you stated you don't want to worry about cost, but really that is the only real issue between the 2.

full externals are probably safer technically but both have very little side effects that it is negligible. this is based on probability of side effects.

please people don't swamp me with bone infections and other things like that because that is like saying you could get an amputation for external tibia, its just not a high enough probability to warrant in the comparison.

[Kafka]

Thanks a lot for the feedback!!!

Maybe a few words about what I think and researched so far about the topic ...

From the diaries and other posts and also other stuff on youtube or the internet one can get the general impression that internal femurs are safer. At least from what I've read, patients who did tibs appeared to have had much more complications than internal femur patients. So I thought that there would be some kind of general consensus that internal femurs are safer, so is that the case (patients doing tibs on grounds of proportions or money)?

However recently I talked to both, people being sure that internal femurs are safer and people being sure that externals are safer.

The things I am concerned about internal femurs (and please correct me if I'm write, I don't claim the things to be 100% percent true):

- possible reaming of the bone canal
- inserting the nail to stay for 1-2 years and thus having to extract the bone marrow, bone infection ?
- the inserting of the nail through the hip (possible hip joint problems ??), nevertheless the knee joint is not directly involved in the operation, so you can say "it's hip against knee" ?!
- higher probability of fat emboly due to the larger amount of fat in the femur than in the tibia (although fat emboly seems to be veeery rare, although also quite dangerous)

What do you think about those (some were already mentioned in the comments, I know)? Are there any special internal femur risks to be added (which would not occur in purely external tibs)? And another important question: From what I know there are only few options to go purely externally on the tibs. Thus possibly one could end up with a doc who might not be as well qualified as a doc who does LON/LATN. Above isn't it that with LON/LATN I would sort of combine all the risks of external AND internal methods (except e.g. the hip insertion which would be done via the knee in LON/LATN)?

Finally at least in my opinion I think it's mostly about the long term well-being. So I would totally do externals (although recovery itself takes longer and there seems to be more pain involved) if it would provide me with a higher probability of being complication/problem free in the long term than internal femurs. (for example regarding my walk, the joints, chronic pain ...).

[Medium Drink Of Water]

If you want to get external-only from one of the more expensive/1st world doctors, they can oblige.  You might get cool high-tech TSF frames instead of the old fashioned Ilizarovs also.

[Kafka]

I didn't know that ... good to know!! Thanks !