Limb Lengthening Forum
Limb Lengthening Surgery => Limb Lengthening Discussions => Topic started by: Lennys on December 21, 2023, 10:59:10 PM
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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
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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) :D
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.
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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?
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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.
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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) :D
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.
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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?
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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.
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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.
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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?
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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).
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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.
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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?
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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.
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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?
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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.
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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?
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Have you done LL?
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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.
https://www.youtube.com/watch?v=2dvyNQbVw2I&ab_channel=%EB%B3%80%ED%98%B8%EC%82%AC%EC%9D%B4%EC%9A%A9%ED%99%98
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.
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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.
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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
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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.
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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.
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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?
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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.
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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.
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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
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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.
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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.
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How was your experience with giotikas and gnail?.. want it for the next year
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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.
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with 8cm lengthened most people “lose” 2 to 3 mm, although this may depend on the angle at which the surgeon inserts the nail
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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
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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
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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.
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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.
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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.