Quote from: JON SNOW on December 25, 2023, 10:35:50 PMthere 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.