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[NewGuy1]

After reading this forum for some time, i understand that:
"All external" method has the smallest risk of fat embolism.
LATN/LON methods have less fat embolism risk than any other methods with internal nail.
Monorail method is bad because of big ugly scars.
Legthening both femurs at the same time is dangerous with any method, and almost impossible with Illizarov because of discomfort.

Things i still don't understand:
1.Will any internal method(including LON/LATN) give you permanent knee pain?? Is there a method with internal nail but without any risk of knee pain problem?
2.Are there "All External" methods except llizarov and Monorail, and are there different kinds of Ilizarov? Which Dr has the best all external Ilizarov?
3.Which is the safest method of LL(in terms of avoiding fat embolism): Both tibias, then both femurs. Or tibia+femur on first leg, and then fibia+femur on the second leg?
4.Is it possible to combine different LL methods in order to make it safer? For example, 1st surgery - All external Ilizarov on both tibia, LON on first femur. 2nd surgery - LON on the second femur?

[The Kaiser]

After reading this forum for some time, i understand that:
"All external" method has the smallest risk of fat embolism.
LATN/LON methods have less fat embolism risk than any other methods with internal nail.
Monorail method is bad because of big ugly scars.
Legthening both femurs at the same time is dangerous with any method, and almost impossible with Illizarov because of discomfort.

Things i still don't understand:
1.Will any internal method(including LON/LATN) give you permanent knee pain?? Is there a method with internal nail but without any risk of knee pain problem?

Permanent knee pain mostly came from internal tibia, Internal femur should lower the risk of knee pain if they insert it from the hip side not the knee.

2.Are there "All External" methods except llizarov and Monorail, and are there different kinds of Ilizarov? Which Dr has the best all external Ilizarov?

There is no best doctor for these thing, but i would say rozbruch for externals, visit their website he will give you a great details about cleaning pins, not swimming in the beach for the first month and many many.

3.Which is the safest method of LL(in terms of avoiding fat embolism): Both tibias, then both femurs. Or tibia+femur on first leg, and then fibia+femur on the second leg?
[/color]
Fat embolism is very rare, stop thinking about it. Its like you will die during travel, be optimistic. Safest method is internal femur but it have its own risk "complication", the surgery itself is risky

4.Is it possible to combine different LL methods in order to make it safer? For example, 1st surgery - All external Ilizarov on both tibia, LON on first femur. 2nd surgery - LON on the second femur?
[/color]
If you want to be this first one and test yourself like a laboratory rat, its possible, I advice you to stick with basic surgery and don't try something new

[NewGuy1]

Thanks a lot for detailed reply!

Can you also explain difference between classic Illizarov of Russian doctors and Taylor Spatial Frame(TSF)? Which one is better for just simple limb lenghthening? Does TSF give some advantages in bone alignment, complication risks, safety, saving time?
I want to do both tibias external and i dont know if I should find doctor with TSF and pay more or just go with cheap classic Illizarov...?

[notimportant]

Internal methods are the worst methods for fat embolism.
It hardly ever happens but when it happens... it can happen even with Dr Paley. You can find some cases in old forum and other internet sites. It's quite dramatic.

[The Kaiser]

Internal methods are the worst methods for fat embolism.
It hardly ever happens but when it happens... it can happen even with Dr Paley. You can find some cases in old forum and other internet sites. It's quite dramatic.

First of all whoever say a   about internal method thats mean he can't afford it. the surgery itself is  , fat embolism is rare maybe one of 1000. Its rare as hell and when it happens its only because of two operations at the sometime, like put devices in your femur and tibia at the same time with no time difference, even if its occurred, its very easy to fix. so forget about fat embolism and think about different complication that are very common. 

[The Kaiser]

Thanks a lot for detailed reply!

Can you also explain difference between classic Illizarov of Russian doctors and Taylor Spatial Frame(TSF)? Which one is better for just simple limb lenghthening? Does TSF give some advantages in bone alignment, complication risks, safety, saving time?
I want to do both tibias external and i dont know if I should find doctor with TSF and pay more or just go with cheap classic Illizarov...?

I don't know TSF or whatever, but trust me do the basic surgery and don't look for something new, I prefer to do internal if you couldn't then do external with so expert doctor, i could help you with their name, Good luck.

[NewGuy1]

I don't know TSF or whatever, but trust me do the basic surgery and don't look for something new, I prefer to do internal if you couldn't then do external with so expert doctor, i could help you with their name, Good luck.

Can you please explain what "basic surgery" means? Just classic Illizarov?
I read this and other LL-forums, and there are so many messages that classic external Illizarov frame is outdated and used only in Russia and India. All other doctors are using TSF(Taylor Spatial Frame) or other hexapod frame, which makes right bone alignment...

Its rare as hell and when it happens its only because of two operations at the sometime, like put devices in your femur and tibia at the same time with no time difference,

What about two simultaneous operations on both legs TIBIAS(all external)?
So if i want to lengthen tibias and femurs on both legs, its gonna be 4 operations for every bone of every leg and will take about 2 years of time?

even if its occurred, its very easy to fix. so forget about fat embolism and think about different complication

Lots of messages on many forums and just Google'ing "fat embolism" tells that fat embolism is very dangerous and hard to fix thing, which often ends dramatically... Are you sure fat embolism is not so important with LL?

[ub40]

I don't know TSF or whatever, but trust me do the basic surgery and don't look for something new, I prefer to do internal if you couldn't then do external with so expert doctor, i could help you with their name, Good luck.

No offence dude but you're hardly an expert yet you give out more advice than anyone else here. Internals are a more invasive method. They just happen to be more convenient, to say they're better outright is doing a disservice to people that are here looking for real advice.

As for TSF, it's a device that allows a lot of options to correct misalignments or complications. It's not necessarily required for lengthening

[ub40]

As for fat embolism it's only a concern a few days after surgery. You get a shot once in the morning and you're fine.

Edit: the shot is preventive

[NewGuy1]

Internals are a more invasive method. They just happen to be more convenient, to say they're better outright is doing a disservice to people that are here looking for real advice.

So "all external" method is anyway safer in terms of avoiding embolism and other complications, right?

As for TSF, it's a device that allows a lot of options to correct misalignments or complications. It's not necessarily required for lengthening

Isn't bone alignment important when you lengthening a leg? I've read something about bone anatomical/mechanical axis and that lengthening can possibly damage it, so therefore TSF is better. Or did i just misunderstood something?

[Auron]

So "all external" method is anyway safer in terms of avoiding embolism and other complications, right?

I wouldn't say so. Some doctors even stopped using external methods and only do internals now a days. I don't know much about externals but you're more prone to getting an infection that way.

I think that it's safe to say that most people would go for internals if money wasn't an issue.

[ub40]

So "all external" method is anyway safer in terms of avoiding embolism and other complications, right?
Isn't bone alignment important when you lengthening a leg? I've read something about bone anatomical/mechanical axis and that lengthening can possibly damage it, so therefore TSF is better. Or did i just misunderstood something?

There are pro's and cons. You are more likely to get minor infection with externals but you may have serious bone infections with internals. You will have more scars with externals but internals are much more invasive and there are potential permanent knee pain issues.

Misalignments are less likely with internals but if they occur they could be because of device malfunction which would require another surgery whereas with externals they can easily be fixed with device adjustments.

It's not simple enough to say one is better. Make your decisions based on doctor reputation and stop freaking out about fat embolism. When I had my surgery for 3 days after I got a shot as a preventative measure, it's a non issue

[ub40]

I wouldn't say so. Some doctors even stopped using external methods and only do internals now a days. I don't know much about externals but you're more prone to getting an infection that way.

I think that it's safe to say that most people would go for internals if money wasn't an issue.

That's simply not true, some of the best doctors in the world still do externals. Which doctors are you talking about that have stopped, Paley?

[Auron]

That's simply not true, some of the best doctors in the world still do externals. Which doctors are you talking about that have stopped, Paley?

Uh? I never said that the best doctors stopped using externals.

[ub40]

Uh? I never said that the best doctors stopped using externals.

Well I didn't say that you did. You were implying that doctors were abandoning externals because of some shortcomings, I was merely pointing out that some of the best doctors provide externals to counter that.

I had the money to do internals and chose the external route because I was worried about certain complications

[Auron]

Well I didn't say that you did. You were implying that doctors were abandoning externals because of some shortcomings, I was merely pointing out that some of the best doctors provide externals to counter that.

I had the money to do internals and chose the external route because I was worried about certain complications

Just so you know, what I said is indeed simply true. Some doctors did give up on externals and you even mentioned one of the doctors.

A quote from Guichet:

I offer the strongest nailing technique with the fastest recovery in the world, the Guichet V2 Nail. I can also offer others, including external fixators, but when you have a Porsche, why would you like to get a Yaris?

I stand by what I said, if money wasn't an issue, most of the people would pick a Porsche over an Yaris.

I don't know what you on about but I'vent said anything wrong. And for the record, I respect alot who ever has surgery with externals, they're definitely tougher than me.

[YourSpaceBoyfriend]

I wouldn't go with an internal method to lengthen tibias, the risk of getting permanent knee pain is too high.

[ub40]

Just so you know, what I said is indeed simply true. Some doctors did give up on externals and you even mentioned one of the doctors.

A quote from Guichet:

I offer the strongest nailing technique with the fastest recovery in the world, the Guichet V2 Nail. I can also offer others, including external fixators, but when you have a Porsche, why would you like to get a Yaris?

I stand by what I said, if money wasn't an issue, most of the people would pick a Porsche over an Yaris.

I don't know what you on about but I'vent said anything wrong. And for the record, I respect alot who ever has surgery with externals, they're definitely tougher than me.

There's a conflict of interest in this scenario because Dr Guichet provides his own personal nail at a much higher price. I'm not saying anything negative about him rather than saying that he has a vested interest against externals.

While I concede that internals are more convenient and discreet, the potential for permanent knee pain as well as damage during thr reaming of the inside of the bone are not to be taken lightly. Externals for tibias are less invasive than internals and the potential for more serious complications are less as well.

For a person to say one method is better than the other they would have to be better in most criteria which in this case that's not the case.

For femurs without a doubt internals win, but it's debatable in the case of tibias

[Auron]

There's a conflict of interest in this scenario because Dr Guichet provides his own personal nail at a much higher price. I'm not saying anything negative about him rather than saying that he has a vested interest against externals.

While I concede that internals are more convenient and discreet, the potential for permanent knee pain as well as damage during thr reaming of the inside of the bone are not to be taken lightly. Externals for tibias are less invasive than internals and the potential for more serious complications are less as well.

For a person to say one method is better than the other they would have to be better in most criteria which in this case that's not the case.

For femurs without a doubt internals win, but it's debatable in the case of tibias

I would like to point out that I've never said above that externals are better than internals, even if I think so. I merely quoted a doctor saying basically that. I don't have the knowledge to say what methods are the best.

But I do agree with your conclusion.

[notimportant]

I haven't said internals are a bad deal. I have only said that there is a greater risk of fat embolism with them.

[The Kaiser]

That's simply not true, some of the best doctors in the world still do externals. Which doctors are you talking about that have stopped, Paley?

but most of them prefer Internals, Guichet said it once, doing externals like riding a horse while theres car. Externals is old method

[EndGame]

I wouldn't go with an internal method to lengthen tibias, the risk of getting permanent knee pain is too high.

Could you share more on the risks. I've heard people mention this risk of knee pain with tibias a few times. I'm not sure but don't some external methods also involve insertion of a nail (LON?) too and also risk knee pain? Any studies on the frequency of knee pain with different methods? I'm not sure how much this risk really is. I'd wanted to do internals with new nail with Paley for tibias. Avoid risk of fibula migrating and full weight bearing and Paley all seem string draws but permanent knee pain sounds scary. Would love any info you could share to help me learn more. Thanks!

[NewGuy1]

but most of them prefer Internals, Guichet said it once, doing externals like riding a horse while theres car. Externals is old method

But ALL external tibias (without nails) is the best way to avoid permanent knee pain, right?

[Whereintheworld?]

First of all whoever say a crap about internal method thats mean he can't afford it.

Nonsense. I could have gone with Paley and internals if I wanted to but I preferred externals for a number of reasons.
Interestingly enough, a while back someone posted their consultation experience with Paley and mentioned that he uses externals with children.

[Whereintheworld?]

But ALL external tibias (without nails) is the best way to avoid permanent knee pain, right?

In theory, but there are many people who went to Russia and now have various issues as a result. Since externals allow for an easy fix with regard to misalignment, I assume there are other factors that come into play with the older external techniques.

The major downside to externals, even the newer versions, is the longer consolidation/recovery period and of course the fact that you have frames on your legs for several months (sometimes longer).

[The Kaiser]

But ALL external tibias (without nails) is the best way to avoid permanent knee pain, right?

yes, if you insist for tibia, but the safest is internal femur

[onemorefoot]

If you have not problems with sleeping, go for only externals. Sleeping on your side should be a nightmare, I dont know how our llers are able to do that.

[NewGuy1]

yes, if you insist for tibia, but the safest is internal femur

What if I want both tibias and femurs lengthened? Externals for tibia and internals for femurs are the safest ways, right?

[The Kaiser]

What if I want both tibias and femurs lengthened? Externals for tibia and internals for femurs are the safest ways, right?

What i know if you want both start for internal femur first, as best doctors advice.

[NewGuy1]

What i know if you want both start for internal femur first, as best doctors advice.

Is it possible to lengthen both tibias and femurs in the same time? I mean inserting nail in one femur, then in other, and while femur nails are still in, install external frames on tibias?
And will lengthening all in the same time increase risk of fat embolism or knee pain?

[The Kaiser]

Is it possible to lengthen both tibias and femurs in the same time? I mean inserting nail in one femur, then in other, and while femur nails are still in, install external frames on tibias?
And will lengthening all in the same time increase risk of fat embolism or knee pain?

what i know that their should be at least if you insist 3 months for the second surgery, its advisable 1 year because its reduce the risk