Major complications with LATN/LON

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Hi,

I have been reading medical articles about LATN/LON and I am very concerned about severe complications. To my knowledge, CLL has the following severe complications:
1. Pulmonary Embolism
2. Deep Vein Thrombosis
3. Deep Infection

I initially wanted to do STRYDE, but decided against it due to the greater risk of PE (4% have symptons, according to Paley). I am deciding on tibial methods, but not pure externals due to time (I have 4-5 months, looking to gain 4-4.5cm MAX, and understand that this could be 8 months in frames). As of now, I am looking at Donghoon Lee, who I understand is very experienced in LATN/LON+Tibias.

Have these questions:
1. Tibias is safer than Femur for PE (and DVT, I think? Might be mixing up). But LATN/LON still involves reaming and internal nail. Would their risk be lower compared to something like pure tibias internal (maybe due to holes already being created due to externals?). Does LATN/LON have a difference in safety wrt to PE and DVT? And IF it occurs, how can they fix it?
2. In a good hospital, like Dr Lee's, is deep infection a serious risk? And IF it occurs, how can they fix it?

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Quote from: tacoma94 on December 03, 2019, 04:12:28 AMHi,

I have been reading medical articles about LATN/LON and I am very concerned about severe complications. To my knowledge, CLL has the following severe complications:
1. Pulmonary Embolism
2. Deep Vein Thrombosis
3. Deep Infection

I initially wanted to do STRYDE, but decided against it due to the greater risk of PE (4% have symptons, according to Paley). I am deciding on tibial methods, but not pure externals due to time (I have 4-5 months, looking to gain 4-4.5cm MAX, and understand that this could be 8 months in frames). As of now, I am looking at Donghoon Lee, who I understand is very experienced in LATN/LON+Tibias.

Have these questions:
1. Tibias is safer than Femur for PE (and DVT, I think? Might be mixing up). But LATN/LON still involves reaming and internal nail. Would their risk be lower compared to something like pure tibias internal (maybe due to holes already being created due to externals?). Does LATN/LON have a difference in safety wrt to PE and DVT? And IF it occurs, how can they fix it?
2. In a good hospital, like Dr Lee's, is deep infection a serious risk? And IF it occurs, how can they fix it?

Is this Dr. Lee himself ?

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If you are doing tibias with Donghoon, no worries about PE and DVT
Even if you get those you’ll be fine as long as you are monitored by medical staff staying at hospital
You’ll be at the hospital for at least 120 day
Even with tibias they put tubes post surgery to control down the pressure in the compartment of calf muscle and this can reduce edema afterward
With external tibias, it’s very common to get superficial pin site infections, possibly you’ll get it a few times during that 120 days
But they claim they never had deep bone infection. I never heard of such cases from their veterans
Still I recommend you to do the surgery during winter so that you’ll lower the chance of infections
They will actually recommend you to do LON than LATN
Long ago it was considered LATN has faster bone consolidation, but then with Donghoon method, LON bone consolidation became faster.  BMAC is included during the surgery.
You are still young so don’t worry too much about slow consolidation

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Hi TemakiSushi,

Thank you so much for replying! See you on a lot of posts here. Wanted to check, why do I need 120 days at least? I'm only doing 4-4.5cm. 9 days surgery and post op + 45 days lengthening + rest time and frames removal maybe 21 days + 15 days recovery is only 90 days in hospital.

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Oh I see if it’s only 4cm, average is 90days, it’s confirmed
But I don’t know if they have 90 days package price for LON
In the price list there is only 120 days package is listed for LON
You will not be lengthening 1 mm a day unless you have very fast consolidation
Average actual lengthening amount is 0.5mm a day
They let you turn the bolts 1 mm a day but actual lengthening in X-rays will be much less since muscles will pull back at the beginning when lengthening amount is less than 3cm
Also after finish lengthening you’ll need around 1 to 2 weeks to adjust bone alignment precisely especially if you have bowlegs or xlegs

BTW Many people are fooled by turning amount and cheated by doctors in other countries


Stryde should come out soon

Price list of Precice and LON in KRW and USD
https://imgur.com/J98CdRY

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Quote from: TemakiSushi on December 03, 2019, 11:43:03 AMThey will actually recommend you to do LON than LATN
Long ago it was considered LATN has faster bone consolidation, but then with Donghoon method, LON bone consolidation became faster. 

What other method do they use to make consolidation faster with LON? Does their new method also reduce the deep infection risk that comes with LON? Because with LATN the infection risk is a bit lower.

QuoteWith the LATN technique, there is no concomitant use of internal and external fixation, and this should lower the risk of infection. In the lengthening over a nail procedure, if a pin tract infection occurs during the distraction phase, the presence of the nail increases the chances that the infection will spread to become a deep infection.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628243/

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Quote from: Great321 on December 04, 2019, 12:25:26 PMWhat other method do they use to make consolidation faster with LON? Does their new method also reduce the deep infection risk that comes with LON? Because with LATN the infection risk is a bit lower.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628243/

BMAC helps consolidation
Also alignment is very important for faster consolidation
There are a few cases of misalignment I’ve known from other doctor who does only unilateral. 
The consolidation was very slow or even got  non union case.
Then they went to Donghoon to do the other leg.  Consolidation was much faster like twice as fast as the first misaligned legs
His aighment technique is superb.  very meticulous adjustment he makes upon the completion of lengthening.  Sometimes it takes a few weeks to adjust well with External frames
If slight knee contracture is present, alignment will not be good, so he waits till the slight knee contracture is overcomed by stretching

he doesn’t use regular frames as it is and modified LON frames to get better adjustment

Also they give lots food at hospital such as beef, chicken, pork, soy beans, milk, fish, shells etc..
Supplements aren’t really needed with their food

After seeing lots cases, I’m worried about the dent on the front side of the shins like yours and Jolien

They never have deep bone infections
So there’s no merit of doing LATN unless there’s severe deformity

The inputs from their site
—————-
However, there are some potential weaknesses of LATN. After the lengthening period, a correction period is added. Hence, an external fixator needs to be maintained for an additional 2-4 weeks, compared to LON. Also, one or two more external fixator pins are inserted than in LON. The LATN method was established by Dr. Rozbruch. (https://www.ncbi.nlm.nih.gov/pubmed/18800209), Before he solved the disadvantages of conventional LON (valgus change and bone formation – this is explained in the LON section.), Dr. Donghoon Lee used LATN more than LON.

However, since he has now solved these two problems, he uses the LON method more often for general stature lengthening; it is simpler and less expensive than LATN. In some cases, such as small bone canals, short bone length, and when the intramedullary nail cannot be inserted because of severe deformation, LATN is still the best option. LATN is also very useful in treating many rare diseases that are otherwise difficult to cure.

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Quote from: TemakiSushi on December 04, 2019, 03:30:55 PM

After seeing lots cases, I’m worried about the dent on the front side of the shins like yours and Jolien

Thanks for the information! Sure it'll help other future LLers. Let's see. I might try "extracorporeal shockwave therapy" if it won't look better in the next X-rays. Have you heard of it?

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Quote from: Great321 on December 04, 2019, 04:16:12 PMThanks for the information! Sure it'll help other future LLers. Let's see. I might try "extracorporeal shockwave therapy" if it won't look better in the next X-rays. Have you heard of it?

Also for faster consolidation they use ultrasound treatment for some patients.

Paley use Forteo teriparatide
But be careful with this medicine since it’s prohibited to use for more than 2 years in ones life
Considered it may leave some damage in brain if used for a long period

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Quote from: TemakiSushi on December 04, 2019, 04:28:24 PMAlso for faster consolidation they use ultrasound treatment for some patients.

Paley use Forteo teriparatide
But be careful with this medicine since it’s prohibited to use for more than 2 years in ones life
Considered it may leave some damage in brain if used for a long period

In this German newspaper for doctors, it says that ultrasound has no effect for consolidation. https://www.aerztezeitung.de/Medizin/Ultraschall-bei-Fraktur-ohne-Nutzen-299777.html

I found the study in English: https://www.ncbi.nlm.nih.gov/pubmed/27797787

Conclusion:
QuotePostoperative use of LIPUS (low intensity pulsed ultrasound) after tibial fracture fixation does not accelerate radiographic healing and fails to improve functional recovery

QuoteLetztlich, so die Forscher, lässt sich relativ sicher sagen, dass der Ultraschall die Patienten weder schneller arbeitsfähig macht noch Folgeoperationen verhindert oder die radiologische Heilung beschleunigt. Auch werden Schmerzen nicht signifikant gelindert, und die Zeit bis zur vollen Belastbarkeit wird nicht verkürzt – für diese beiden Schlussfolgerungen sehen die Forscher auf Basis der wenigen qualitativ hochwertigen Studien sogar eine sehr gute Evidenz.

--> This basically says that the scientist say that it is very certain that ultrasound doesn't help because of the qualitative studies which are very good evidence.