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[Stryde2021]

It looks like of all the possible complications this is by far the scariest one. To LL vets, how did you overcome this fear? 

[Mule]

I guess I didn’t really think about it. I think the odds of it happening are extremely low...it’s like how come you get in a car every day even though there’s a chance you could die in a crash?

[Stryde2021]

Paley's current "Risks" page says even with "precautions our incidence of symptomatic fat embolism requiring treatment is 4%."   A 4% incidence rate for something that can kill you is scarier than getting in a car

[BelowTheMean]

It's not as low as the likelihood of a car crash though, right?

I'll be honest I bought an Apple Watch even though it's probably not that accurate, but being able to check blood O2 on a whim is better than nothing.

[Movie]

Paley's current "Risks" page says even with "precautions our incidence of symptomatic fat embolism requiring treatment is 4%."   A 4% incidence rate for something that can kill you is scarier than getting in a car

is that current data? I think that might've been old probabilities, today it's lower, and I agree with Mule, although I knew about Fat embolism I just put negative thoughts out of my head and thought positively, prayed everything would turn out fine and thankfully it did. No risk no gain, simple as that.

[Stryde2021]

is that current data? I think that might've been old probabilities, today it's lower, and I agree with Mule, although I knew about Fat embolism I just put negative thoughts out of my head and thought positively, prayed everything would turn out fine and thankfully it did. No risk no gain, simple as that.

Thanks, legend.  Did Dr. M say anything about it beforehand?

[GenralizedAnxietyDisorder]

Deep bone infection leading to amputation above the knee is more scary to me.

This fear makes me want to do one leg at a time. Also doing one leg at a time reduces chances of fat embo by half.

Regarding fat embolism I've still not found one source clearly telling how long after surgery you are completely safe. There are docs who don't even prescribe blood thinners and there are those that prescribe them till even after lengthening.

[exceeding2meters]

Can embolism happen even long after the surgery and the lengthening? Like years down the line?

Sorry completely ignorant on biology, just I remeber reading somewhere something that I understood like that

[Stryde2021]

Deep bone infection leading to amputation above the knee is more scary to me.

This fear makes me want to do one leg at a time. Also doing one leg at a time reduces chances of fat embo by half.

Regarding fat embolism I've still not found one source clearly telling how long after surgery you are completely safe. There are docs who don't even prescribe blood thinners and there are those that prescribe them till even after lengthening.

Where have you heard of a case of infection nearly that bad in CLL?

[Body Builder]

Can embolism happen even long after the surgery and the lengthening? Like years down the line?

Sorry completely ignorant on biology, just I remeber reading somewhere something that I understood like that

No it can't. And if you do antithrombotic injections against it is is very rare.
I did them for 1 month after surgery. External tibias are safer than internals though.
Maybe with internals they would give me blood thinners for more time.

[Medium Drink Of Water]

Where have you heard of a case of infection nearly that bad in CLL?

A Beijing patient had a bad deep bone infection.  She'd had a botched surgery elsewhere and came to them to fix it and continue lengthening.  They drilled a hole in her leg and kept irrigating it with some kind of solution, flowing through her canal for several days straight.  She finished but had a lot of scars.

[Michael J. Assayag, MD]

Alright! It is time to shed some light on the difference between fat embolism and pulmonary embolism.

Fat embolism is a clinical syndrome consisting of a rash in the trunk, shortness of breath and confusion. It is usually related to unstable fractures, and can occur during insertion of a rod through a bone.It happens when droplets of fat go into the bloodstream and lodge into the small circulatory vessels. after surgery, when bones are fixed, the risk is virtually non existant.

It is extremely  rare (i have never seen a clinically significant one in 10 years of doing a LOT of intramedullary rods) and is usually treated with oxygen therapy. Don’t forget that the 4% number quoted includes patients with all type of other medical problems, mostly elderly. Interestingly enough, fat embolism is the most quoted complication by patients inquiring about CLL. However, it is likely the complications surgeons fear the Least.

Pulmonary embolism(PE)  is when a blood clot goes into the circulation and lodges itself in the lung vessels. It can be easily recognized intraoperatively. It is rarely fatal. It is uncommon in healthy individuals. It can also happen post operatively due to prolonged immobilization, or plane flights . Blood thinners should be given for 3 to 4 weeks to mitigate that risk.


As for infection, it has to be promptly recognized and treated. Deep infection during limb lengthening is not nearly as worrisome as prosthetic joint infection after hip or knee replacement.
It can usually be treated by a simple washout of the surgical site, and antibiotics. In the worst cases, it may require exchange of the lengthening rod with an antibiotic coated trauma rod when the lengthening is done

I hope this helps dispel some fear related to ft embolism and PE.

[Stryde2021]

Alright! It is time to shed some light on the difference between fat embolism and pulmonary embolism.

Fat embolism is a clinical syndrome consisting of a rash in the trunk, shortness of breath and confusion. It is usually related to unstable fractures, and can occur during insertion of a rod through a bone.It happens when droplets of fat go into the bloodstream and lodge into the small circulatory vessels. after surgery, when bones are fixed, the risk is virtually non existant.

It is extremely  rare (i have never seen a clinically significant one in 10 years of doing a LOT of intramedullary rods) and is usually treated with oxygen therapy. Don’t forget that the 4% number quoted includes patients with all type of other medical problems, mostly elderly. Interestingly enough, fat embolism is the most quoted complication by patients inquiring about CLL. However, it is likely the complications surgeons fear the Least.

Pulmonary embolism(PE)  is when a blood clot goes into the circulation and lodges itself in the lung vessels. It can be easily recognized intraoperatively. It is rarely fatal. It is uncommon in healthy individuals. It can also happen post operatively due to prolonged immobilization, or plane flights . Blood thinners should be given for 3 to 4 weeks to mitigate that risk.


As for infection, it has to be promptly recognized and treated. Deep infection during limb lengthening is not nearly as worrisome as prosthetic joint infection after hip or knee replacement.
It can usually be treated by a simple washout of the surgical site, and antibiotics. In the worst cases, it may require exchange of the lengthening rod with an antibiotic coated trauma rod when the lengthening is done

I hope this helps dispel some fear related to ft embolism and PE.

You're a hero Dr. Assayag.  Thanks for this most-informative post; this forum was sorely lacking something that contextualizes these fears appropriately

[GenralizedAnxietyDisorder]

Yeah that's super helpful!

But more than the internal biology, for a patient, what would matter most is the impact on him. Like which one can cause death, which one can lead to an amputation, which would need expensive medical care, etc. And how long these risks exist.

Like even I now I'm confused:

- how long does the risk of pulmonary embolism exist after surgery? till lengthening? even beyond?
- what is the worst case side effect and impact if you survive a pulmonary embolism episode? loss of limb? brain damage?
- what is the worst case side effect and impact if you survive a fat embolism episode? loss of limb? brain damage?
- how long is the risk of infection? If your doc doesn't see any infection before discharging you, are you good? Or can it happen anytime?

[AnotherShorty]

Many thanks, Dr Michael Assayag for being there for us despite having a tight schedule...
Could you please throw some light on the possibility of amputation, because that's my greatest fear... I watched your entire interview on Victor's Channel but that part was not discussed.

Best regards and thank you !!!

[Body Builder]

Alright! It is time to shed some light on the difference between fat embolism and pulmonary embolism.

Fat embolism is a clinical syndrome consisting of a rash in the trunk, shortness of breath and confusion. It is usually related to unstable fractures, and can occur during insertion of a rod through a bone.It happens when droplets of fat go into the bloodstream and lodge into the small circulatory vessels. after surgery, when bones are fixed, the risk is virtually non existant.

It is extremely  rare (i have never seen a clinically significant one in 10 years of doing a LOT of intramedullary rods) and is usually treated with oxygen therapy. Don’t forget that the 4% number quoted includes patients with all type of other medical problems, mostly elderly. Interestingly enough, fat embolism is the most quoted complication by patients inquiring about CLL. However, it is likely the complications surgeons fear the Least.

Pulmonary embolism(PE)  is when a blood clot goes into the circulation and lodges itself in the lung vessels. It can be easily recognized intraoperatively. It is rarely fatal. It is uncommon in healthy individuals. It can also happen post operatively due to prolonged immobilization, or plane flights . Blood thinners should be given for 3 to 4 weeks to mitigate that risk.


As for infection, it has to be promptly recognized and treated. Deep infection during limb lengthening is not nearly as worrisome as prosthetic joint infection after hip or knee replacement.
It can usually be treated by a simple washout of the surgical site, and antibiotics. In the worst cases, it may require exchange of the lengthening rod with an antibiotic coated trauma rod when the lengthening is done

I hope this helps dispel some fear related to ft embolism and PE.

Very informative post, like all of yours Dr.
Your scientific opinion in a forum that some member believe even that they can become taller by hitting their legs with a hammer is more than important and appreciated.

Keep up and thank you for your time.

[Stryde2021]

Many thanks, Dr Michael Assayag for being there for us despite having a tight schedule...
Could you please throw some light on the possibility of amputation, because that's my greatest fear... I watched your entire interview on Victor's Channel but that part was not discussed.

Best regards and thank you !!!

Where is this amputation fear coming from?  Unicorn's story seems to be the worst example of crippling throughout this forum (or anywhere else).  And even she hasn't had her legs amputated.

[AnotherShorty]

Where is this amputation fear coming from?  Unicorn's story seems to be the worst example of crippling throughout this forum (or anywhere else).  And even she hasn't had her legs amputated.

Hi,
in the below video at 15:30 mins, you will see the possibility of amputation. So I am seeking expert advice... I agree unicorn’s case is one of the worst cases we all know about but
there must be many disaster cases we are not aware of bcz they were not discussed on this forum.

[financialadvisor]

I don't believe that modern medicine could not deal with the swelling caused by vascular trauma on the surgery. See some videos on how illizarov is attached to the leg, there is minimal intervention in terms of cutting the soft tissues.

[ghkid2019]

They don't let you sit on your áss post op for days for a very good reason

[Dirona]

This is really scary..

[10cmOnTibiaOrGTFO]

if your leg gone you still win because money from government 

[overandover]

You can decrease fat in your bone marrow by leg workout/exercising/running. There is a paper published on this topic which you'll find if you google. I think one way to decrease fat embolism risk is just working out your legs. It's better to be in a really good shape before the surgery.

[MakeMeTallAF]

Working out your legs may make the distraction process more difficult though because muscular legs means there is more tissue to stretch and grow.

I think just being lean is good enough, not muscular. You can build muscle after the LL surgery.

[Vibes]

Alright! It is time to shed some light on the difference between fat embolism and pulmonary embolism.

Fat embolism is a clinical syndrome consisting of a rash in the trunk, shortness of breath and confusion. It is usually related to unstable fractures, and can occur during insertion of a rod through a bone.It happens when droplets of fat go into the bloodstream and lodge into the small circulatory vessels. after surgery, when bones are fixed, the risk is virtually non existant.

It is extremely  rare (i have never seen a clinically significant one in 10 years of doing a LOT of intramedullary rods) and is usually treated with oxygen therapy. Don’t forget that the 4% number quoted includes patients with all type of other medical problems, mostly elderly. Interestingly enough, fat embolism is the most quoted complication by patients inquiring about CLL. However, it is likely the complications surgeons fear the Least.

Pulmonary embolism(PE)  is when a blood clot goes into the circulation and lodges itself in the lung vessels. It can be easily recognized intraoperatively. It is rarely fatal. It is uncommon in healthy individuals. It can also happen post operatively due to prolonged immobilization, or plane flights . Blood thinners should be given for 3 to 4 weeks to mitigate that risk.


As for infection, it has to be promptly recognized and treated. Deep infection during limb lengthening is not nearly as worrisome as prosthetic joint infection after hip or knee replacement.
It can usually be treated by a simple washout of the surgical site, and antibiotics. In the worst cases, it may require exchange of the lengthening rod with an antibiotic coated trauma rod when the lengthening is done

I hope this helps dispel some fear related to ft embolism and PE.

So glad I saw this! Very informative and puts a lot of my own fears to rest.