Quote from: NailedLegs on June 27, 2023, 07:17:59 PMI want to make my final point clear. If you disagree, tell me why. This sums up my entire argument:
We are cosmetic patients wanting to increase our height. The most effective and safest way to do so is not with external fixators. Intramedullary nails, such as PRECICE 2.2, come with risks. No surgery is 100% safe. All prospective patients should understand what they are about to put their body through, all the pros and the cons.
You're doing God's work with all the facts! It baffles me that there are people on this forum who legitimately believe external methods are better than internal methods or that tibia's are safer than femurs despite the litany of evidence to the contrary.
I think some people are just looking for any justification for why they are opting for a riskier method instead of just being honest with themselves that price is the only reason. Nothing wrong with choosing a certain method because it's the only financially feasible option, but people should definitely be aware of the risks and not go in with eyes blind.
What method of Limb Lengthening is best? Internal Nail vs LON vs External Frames
What's the coefficient of determination? Is one even provided? I'm using statistics too here; knowledge of the science of statistics to be precise. Studies with sigma 3 confidence frequently get debunked, and this one can't even hold a candle to that. This is only a small step up from anecdotal stories.
I've personally met more than 39 LL patients. The reason I'm using anecdotes is because they're what I have. I'm offering them up as a way of illustrating an important point to consider: patient and doctor behavior matter A LOT. That idiot patient you mentioned in the OP is a perfect example. The method isn't to blame for what he did. What other stupid stuff happened that the study's authors didn't know about? I personally witnessed a lot of ridiculous patient behavior, and that was IN THE HOSPITAL. 
I have lots of anecdotal observations of recklessness and malfeasance which is why I don't trust the numbers.
QuoteWhere in the literature do we see IMN nails causing fractures at the same rate of externals, besides patients not following their Doctor's instructions?
The literature is inadequate to use as a tool for making a judgment about that. A broken leg after LL (in cases in which the LL was even a factor) is due to insufficient regenerate. Does the literature tell us why the quality of internal patients' regenerate is so much better than that of external patients'? No; it doesn't even make the claim that there is a difference. That's you taking the ball and running out of the stadium and past the city limits with it. The study only covers three instances of fractures with no information about what caused them. Did the doctors take the devices off before there was enough regenerate? Did the patients do something stupid?
Quotebut why did you ignore everything else?
I didn't have anything else add about them specifically that wasn't covered by the other stuff I was saying in general.
QuoteThat is correct.
Dr. Paley created the modern day LON method.
Sorry, I thought you were conflating monorail and LON. You have three instances of specific devices and methods separated by slashes here:
QuoteIntra-Medullary Nail/PRECICE is superior to the Modular Rail System/LON and to the Taylor Spatial Frames/external frames.
hence my incorrect assumption.
QuoteSo the creator of the modern day LON method states that the LON is outdated, and that the PRECICE nail is the most advanced in the world. Should we give any credibility to the Doctor that created the modern LON method? Should we say he's wrong, and that we should continue to use LON?
Paley of course has lots and lots of credibility and I agree with those statements.
But external-only is by far the least invasive method of LL and that should count for something, based on nothing more than conjecture from my own common sense. I'd rather have broken legs and some serious body jewelry for several months than have my legs cut wide open and my bone marrow reamed out by a giant nail, and then cut back open again to take the nail out, with the bone marrow never coming back. Especially after the entire process is long over with and the frames are gone but the marrow isn't.
Problems that occurred more frequently (or exclusively) with externals in this tiny study but could occur with internals shouldn't be attributed to externals in general based on such a weak correlation and with zero causal linkage established.
Infection of course is a bigger worry with externals. But I think these "odds" are not what they appear to be. Based on anecdotal observations and basic knowledge of microbiology I further conject that environment and behavior affect the risk of infection occuring and that if you have the time and can take care of yourself properly, externals are the best.
If you don't, but have plenty of money, internals is the second best choice.
LON is a last resort but it's all there is for some peope.
QuoteSo what evidence do you have to support the contrary? NONE. That's the point of this thread. You have no evidence to support your claims, and I'm revealing the lies and falsities spewed on this forum.
I don't have evidence to support the contrary. But non-robust, non-experimental correlational studies aren't strong evidence and are barely a blip on the weak evidence radar. We're still in the "use your common sense to figure it out" phase in the process of achieving enlightenment about CLL, and this topic doesn't advance us out of it in any appreciable way. We need real experiments or at the very least massive amounts of correlational datapoints to start generalizing.
Making big, sweeping proclamations about what is better and why, and saying any divergenet proposition is a lie, based on this dearth of evidence is arguably misinformation too.
Quote from: NailedLegs on June 27, 2023, 07:31:04 PM
What do you disagree with?
Thank you for posting this study.
The part about method affecting maximum length achievable.
Dr. Paley, the world's most famous cosmetic limb lengthening surgeon, already has only PRECICE on his surgical menu now.
https://limblengthening.org/lengthening-strategies/
In my opinion, PECICE is the best choice if your budget is sufficient, except for the following cases
(1) When you need to lengthen the limb by more than 8 cm in one segment.
(2) When there is a severe deformity before the surgery.
(3) When the doctor's skill is poor and there is concern about postoperative bone deformity.
In the case of a poorly skilled doctor, knock-knees are likely to occur in the tibia.
With circle-type external fixation, even if bone deformity occurs during limb lengthening, it can be corrected by adjusting the external fixator.
The term best is a very subjective one.
I don't know what is considered as best for every single LLer, but the safest and cheapest way is objectively the external tibias.
Lon is the worst way imo because it combines both the cons of externals.and internals without being better than both the other methods in anything.
The classic Ilizarov procedure is not safer than PRECICE because of the risk of osteomyelitis due to exacerbation of pinsite infection.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7342054/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7342054/table/T3/?report=objectonly
There are only three cases of osteomyelitis in these statistics, all of which occurred with the classic Ilizarov procedure.
Quote from: Maison on June 29, 2023, 07:55:46 AMThe classic Ilizarov procedure is not safer than PRECICE because of the risk of osteomyelitis due to exacerbation of pinsite infection.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7342054/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7342054/table/T3/?report=objectonly
There are only three cases of osteomyelitis in these statistics, all of which occurred with the classic Ilizarov procedure.
Don't write the same again and again. With ilizarovs it is way too rare to have osteomyelitis from pin site infections because you should left an infection for too many days untreated and with terrible pains and swelling to come in deep inside the skin and then inside the bone.
If someome does LL in India or Turkey or any other third world country that left you without any assistance after LL to rot with the first complication then yes it may happen. In ANY other case, when there is redness and a little.pain in the pin site the doctor will simply prescribe otan antibiotics for a few days and you have ZERO risk of a further complication like bone infection. Simple as that.
Even in the second link you refered there was no case of osteomyelitis even with some Egyptian butchers that used ilizarov fixators.
So don't mention again and again the same things about some imaginary risks with external LL that doesn't exist, at least more than the internal one. And by far the most important risk of LL is embolism which is fatal in many cases and it is almost completely linked to internal methods, not externals.
Quote from: Body Builder on June 29, 2023, 08:10:12 AMDon't write the same again and again. With ilizarovs it is way too rare to have osteomyelitis from pin site infections because you should left an infection for too many days untreated and with terrible pains and swelling to come in deep inside the skin and then inside the bone.
If someome does LL in India or Turkey or any other third world country that left you without any assistance after LL to rot with the first complication then yes it may happen. In ANY other case, when there is redness and a little.pain in the pin site the doctor will simply prescribe otan antibiotics for a few days and you have ZERO risk of a further complication like bone infection. Simple as that.
Even in the second link you refered there was no case of osteomyelitis even with some Egyptian butchers that used ilizarov fixators.
So don't mention again and again the same things about some imaginary risks with external LL that doesn't exist, at least more than the internal one. And by far the most important risk of LL is embolism which is fatal in many cases and it is almost completely linked to internal methods, not externals.
Yes, you are right, there is a risk of embolism with intramedullary nail surgery. Paley says fat emboli are about 5%.
However, as far as I can tell from this forum, most of the doctors who offer external techniques in cosmetic limb lengthening are surgeons from Turkey, India, and other less developed countries.
Thus, the dilemma is that when a patient chooses Ilizarov in favor of low price and embolism risk management, choosing a country that is too cheap will increase the risk of osteomyelitis.
Generally speaking, the risk of osteomyelitis is higher than the chance of dying from embolism. There have been several osteomyelitis patients on this forum, and I think most of them were external.
Furthermore, Rozbruch, one of the top physicians, also stated
Internal limb lengthening devices are associated with fewer complications than alternative methods of limb lengthening.
https://journals.lww.com/jbjsoa/Fulltext/2020/12000/Motorized_Internal_Limb_Lengthening__MILL_.22.aspx
If the risk of embolism in nail insertion were significant, no physician in the world would perform internal procedures. In reality, however, the internal technique is still widely practiced. With "bent," surgeons can reduce the risk of fat embolization.
Which doctors in which countries do you think are reliable for the Ilizarov procedure, for example?
I too believe that Ilizarov surgery by a good doctor is safe.
Albizzia nail
Sorry, bent is a misspelling, correct is vent.
A vent is a procedure in which several holes are made in the bone before reaming to create exits for the bone marrow fat.
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