How do LL methods rank in terms of non-union / nonunion risks?

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Basically, what the title says.

What LL methods (LON, LATN, pure external, internal nails, etc) carry the most and the least risk of non-union? I know age, nutrition and genetics are huge factors, but still, despite that, how do the LL methods rank among themselves? Also, if you know, how does pure external tibial lengthening fares? I was looking into doing that in the future, but I may just give up and opt for whichever is a safer method instead, if any are.

Thanks for any help.

Edit: I also did search the forums, but there was no thread individually covering this topic like this.

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The only answers you'll get are subjective opinions of non-medically trained individuals.

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Quote from: 0184946 on November 25, 2017, 09:59:12 PMThe only answers you'll get are subjective opinions of non-medically trained individuals.

Even that answer already helps a bit.

If nonunion after LL is a total coin flip, I'm thinking no one should ever do LL. If there's no way to predict it before it becomes worse or to stop before total nonunion (i.e. as opposed to delayed union), no one should do LL. One could argue nonunion shouldn't be that scary of a prospect due to all the documented evidence posted in these forums, but I'm guessing the sample is biased, as most of the nonunion cases probably didn't exactly feel like telling a bunch of strangers and everyone else on the internet how they just spent thousands of dollars in savings to lose their legs.

Edit: Though I'm looking at some CLL papers and the numbers of suspect nonunions seem to form a low enough percentage. I need to research this further, in any case.

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Also, I believe we should be discouraging (even more than usual) people over 40 of doing LL, and should actually think twice before going to doctors that perform LL too freely in old patients. People over 50 shouldn't even think about it. The risks of nonunion are significantly higher in older patients. Why risk ruining your last years of life? Unless you are fully aware of the risks and are the type that prefers to go out with a bang, you shouldn't even consider LL in your 50s. You'll just end up losing all function in your legs. You need to be fine with that being a very real possibility for you if you're gonna pay for LL in an advanced age. Older people need to be aware of their risks.

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See the compendium of results thread to get some idea.

http://www.limblengtheningforum.com/index.php?topic=3069.0

You could also go through each diary & search for something like "union" to get a rough idea of how many people have had that particular complication.

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Thanks a lot for the link. I'll try to find the amount lengthened and method used by each patient to see if I notice any patterns in regards to method or amount lengthened. Just from a quick glance, though, the picture looks pretty bad.

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Depends also on the technique done for the osteotomy, if the technique is poor, then pray. I dont know if there is s serious study, but if you are very worried, then get only external frames, if you have a bad regeneration, then the gap could be compressed And fix it, if you have that with Guitchet Nail or Betzbone or fitbone, then you are ver fk;;.

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Quote from: onemorefoot on November 26, 2017, 04:59:17 AMDepends also on the technique done for the osteotomy, if the technique is poor, then pray. I dont know if there is s serious study, but if you are very worried, then get only external frames, if you have a bad regeneration, then the gap could be compressed And fix it, if you have that with Guitchet Nail or Betzbone or fitbone, then you are ver fk;;.

Thanks a lot, onemorefoot. My plan is to do 5cm tibias on purely external Ilizarov sometime in the next 2~4 years. However, nothing is worth risking nonunion. If I have no way of fixing it before a total nonunion after I have already started lengthening, then I'd just give up on LL.

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Quote from: myloginacct on November 26, 2017, 02:14:22 PMThanks a lot, onemorefoot. My plan is to do 5cm tibias on purely external Ilizarov sometime in the next 2~4 years. However, nothing is worth risking nonunion. If I have no way of fixing it before a total nonunion after I have already started lengthening, then I'd just give up on LL.

With pure Ilizarov, if the doctor sees the beginning of that problem, he can compress It, also if there is a misalignment he can correct It, I see Many advantages un this method, except comfort, but Will be just like 7 months.

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Quote from: onemorefoot on November 26, 2017, 05:22:21 PMWith pure Ilizarov, if the doctor sees the beginning of that problem, he can compress It, also if there is a misalignment he can correct It, I see Many advantages un this method, except comfort, but Will be just like 7 months.

I've heard of a few patients here having fibula non-union even after doing external tibias (not sure if they did LON/LATN, though). Maybe precice is the only LL method that can really deal with nonunion.

Also, about 11% (6) of patients had serious complications in this study by Catagni, although probably only 2 (3.7%) are not walking again - that is, if the bone grafting didn't work ("autologous cancellous bone grafting from the iliac crest was undertaken for atrophy of the new bone at the distal distraction site in two patients"). It seems most people on here have no idea what they're getting into. These are the percentages using HEF in Europe.