I know that amputation is a risk when going under the leg lengthening procedure.
What risks or factors lead to amputation. What is the reason the leg has to be amputated.
I'm sure it has to do with some serious infection.
And if it does, this is another reason in my opinion why external fixation> LON/LATN and precise techniques when it comes to risks.
Highly unlikely that you will develop a serious infection with external fixation (only pin site infections). But when you use intramedullary rods, you can develop some serious infections that can cause loss of limbs whereas the only infections seen with external fixators are pin site infections which are easy to catch and take care of.
Also a lot more unlikely for one to develop fat embolism when going through with the external fixation which can lead to coma/death.
I have done a lot of research on this procedure, and nailing of the long bones carries a lot more risk than the "external fixation only" approach did.
Doctors have developed this precise nail and it is a great piece of technology that has the potential for you to gain significant height, but it carries much more risk than external fixation procedures. Furthermore, doctors are getting paid a lot more for using the precise nail, so do not believe everything that they say.
My advice is to do external fixation ONLY on tibias for 5 cm or less (only go up to 5 cm for externals) first,
And if you really still don't like the height you are at, and would like to do the nailing techniques, knowing there are more and bigger risks, then do up to 5-7 cm via precise on femurs.
But I highly advise against internal-medullary reaming techniques due to the risks it carries
leg lengthening risk (amputation and more)
I think it's worth finding out how often infections occur in general orthopaedics (not just in LL) because nailing is a common procedure in fractures too.
I think it's uncommon at reasonably hygienic centers, but I really don't know.
If the risk of infection is minuscule, it's probably not a good idea to dismiss internal methods because the risks of other problems like joint contractures, CECS, nerve damage are probably higher in external tibias.
Quote from: alps on July 15, 2017, 07:50:39 AMI think it's worth finding out how often infections occur in general orthopaedics (not just in LL) because nailing is a common procedure in fractures too.
I think it's uncommon at reasonably hygienic centers, but I really don't know.
If the risk of infection is minuscule, it's probably not a good idea to dismiss internal methods because the risks of other problems like joint contractures, CECS, nerve damage are probably higher in external tibias.
The risk of infection might not be that huge BUT
if infection does occur when using an intramedullary nail, it can be very serious and very hard to take care of, and has the possibility to lead to catastrophic outcomes such as amputation
Furthermore Deep vein Thrombosis that leads to pulmonary embolism and can kill you is also a big risk when doing surgery on femurs...
"Deep vein thrombosis (throm-BO-sis), or DVT, is a blood clot that forms in a vein deep in the body. Blood clots occur when blood thickens and clumps together.
Most deep vein blood clots occur in the lower leg or thigh. They also can occur in other parts of the body.
A blood clot in a deep vein can break off and travel through the bloodstream. The loose clot is called an embolus (EM-bo-lus). It can travel to an artery in the lungs and block blood flow. This condition is called pulmonary embolism (PULL-mun-ary EM-bo-lizm), or PE.
PE is a very serious condition. It can damage the lungs and other organs in the body and cause death.
Blood clots in the thighs are more likely to break off and cause PE than blood clots in the lower legs or other parts of the body. "
My messages with Dr. Divya Ahuja who works very close with Dr. Parihar in India:
Me:
Hello Dr. Ahuja,
Thank you for your response. I have another question: What is your protocol in case of a patient developing fat embolism or pulmonary embolism.
Dr::
The best thing is to take measures to prevent the embolism to happen - lots of steps to take care of that - vents to prevent intramedullary pressure to build up, sharp reamer heads, not too aggressive reaming, proper hydration during and after surgery.
Me:
Hello Dr. Ahuja,
I am only considering external tibia lengthening for 3.5-4 cm, so intramedullary pressure due to reaming wouldn't be applicable here right? I have heard External tibia lengthening is generally safer than internal femurs/tibias in regards to fat embolism. Is this correct as well?
Dr:
In externals only there is no reaming so intramedullary pressures don't change.
In terms of fat embolism the externals have no chance of embolism.
Quote from: alps on July 15, 2017, 07:50:39 AMI think it's worth finding out how often infections occur in general orthopaedics (not just in LL) because nailing is a common procedure in fractures too.
I think it's uncommon at reasonably hygienic centers, but I really don't know.
If the risk of infection is minuscule, it's probably not a good idea to dismiss internal methods because the risks of other problems like joint contractures, CECS, nerve damage are probably higher in external tibias.
None of those risks would be higher for external tibias. You are still lengthening muscles and irritating nerves in both cases.
These risks you describe are higher if you do more than 5 cm per segment. That is why I advise only up to 5 cm on external tibias.
Quote from: MirinHeight on July 15, 2017, 07:53:44 AM
The risk of infection might not be that huge BUT
if infection does occur when using an intramedullary nail, it can be very serious and very hard to take care of, and has the possibility to lead to catastrophic outcomes such as amputation
Yes, risk of infections is true and could lead in very extreme cases in amputation.
But the risks of dying due to anaesthesia is much more than a disastrous infection so in reality noone should avoid internal methods for that reasons.
I never heard of an amputation due to infection from LL.
It is possible but the possibilities are so small that it is more probable to be hit by a car or dying from anaesthesia than that.
The risks for
External fixation vs Intramedullary nailing techniques
needs to be a topic of discussion so patients can make the best safe decision for themselves. A lot of doctors are money hungry when it comes to precise and disregard many risks discussed. Dr. Paley on his site says that
"Dr. Paley has only seen fat embolism twice in his career. Both occurred more than 10 years ago before he developed a special venting method to prevent this complication."
This is a flat out lie. Dr Paley might be a phenomenal orthopedic surgeon, BUT he needs to be transparent about the risks that the precise nailing technique carries for his future patients, instead of marketing his technique as a low risk procedure.
This is from a diary from 2014:
My stay on this floor was for a long time. Too many bad things happened for me to care to recount. One good thing that stands out to me was when Servando told me I would have to pay for my extended stay in the hospital. This worried me of course, because he didn't know how much it would be and I had no idea how long I would have to stay in this s**t-hole. I emailed Dr. Paley and expressed that I was worried about the costs. Dr. Paley immediately emailed me back and told me not to worry about the costs, he would take care of them, and all he wanted was for me to recover. He gave me a private meeting in my room a few days later, also confirming this while checking up on me. Then the news was confirmed- I had gotten a fatty emboli in my lungs. For those unaware, this is when your fat being reamed out of your femoral canals goes into your bloodstream which then travels up to your lungs.
Dr. Paley in this private meeting also confirms to me that I'm only his 2nd patient ever to have a severe case of fat embolism in the past 3 years, and that I'm the worst case he's ever had of it. What an honor, huh? We talk for a few more minutes and he leaves. There's not much left to say in this meeting because my condition is improving and he's already done his job, the rest was up to me to heal.
Fat embolism might not be as rare as we think it is, and well respected surgeons might be hiding some facts about the risk of fat embolism with nailing techniques. This is just one proof.
Quote from: Body Builder on July 15, 2017, 08:14:45 AMYes, risk of infections is true and could lead in very extreme cases in amputation.
But the risks of dying due to anaesthesia is much more than a disastrous infection so in reality noone should avoid internal methods for that reasons.
I never heard of an amputation due to infection from LL.
It is possible but the possibilities are so small that it is more probable to be hit by a car or dying from anaesthesia than that.
Do you have proof that anaesthesia deaths are more probable than bone infections? Otherwise it's just your opinion 
Quote from: alps on July 15, 2017, 12:45:08 PMDo you have proof that anaesthesia deaths are more probable than bone infections? Otherwise it's just your opinion
I didn't said just bone infections but amputations due to bone infections.
No I don't have exact numbers but I never saw anyone get amputated from internal nails (not for LL only but generally) while everyday people day from anaesthesia (older people most of the times).
Embolism is something more possible but a serious infection that leads to amputation is really rare and noone should consider it as a really possible risk when doing LL, although it could happen theoretically.
There are many more probable risks of LL, osteomyelitis infection, at least not in a third world country's hospital, is not one of them.
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