What method of Limb Lengthening is best? Internal Nail vs LON vs External Frames

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Would it be fair to summarize the main risks as:

Purely internal method: Risk of fat embolism due to the bone marrow. Requires reamers to prevent this and is entirely up to the surgeon.

Purely external method: Risk of osteomyelitis due to pinsite infections. Requires a lot of hygiene and maintenance to prevent along with antibiotics if an infection is spotted. Is depended on surgeon, nurses and the patient.

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Quote from: TheDream on July 10, 2023, 09:20:13 AMWould it be fair to summarize the main risks as:

Purely internal method: Risk of fat embolism due to the bone marrow. Requires reamers to prevent this and is entirely up to the surgeon.

Purely external method: Risk of osteomyelitis due to pinsite infections. Requires a lot of hygiene and maintenance to prevent along with antibiotics if an infection is spotted. Is depended on surgeon, nurses and the patient.

I will make a few corrections to your summary.
In the intramedullary method, reaming is essentially always performed.
During reaming, fat embolization is said to be more likely to occur due to increased intramedullary pressure.
There are several strategies to reduce the risk of fat embolization associated with reaming.
These include techniques such as VENT (pre-drilling holes in the bone) and the use of the Reamer-Irrigator-Aspirator system.

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Damn, I've been researching LL for months now. I had no idea there's debate as to whether external vs internal is more dangerous. I though it was settled and agreed on that external is much riskier than internal. Guess I've got way more reading than I thought left.