Whats the chance of me ending up on a wheel chair after a failed LL?

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Quote from: Life on April 30, 2018, 12:10:41 AMPermanent wheelchair occurs usually after spinal injuries but some LL patients can't walk normally after nerve damage or lack of callus formation as BB said. This is a real possibility as well as amputation and death although they aren't common side effects.

Amputation and death? I suppose from extreme infection? How would that even develop under supervision of a doctor?

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Quote from: Life on April 30, 2018, 12:10:41 AMPermanent wheelchair occurs usually after spinal injuries but some LL patients can't walk normally after nerve damage or lack of callus formation as BB said. This is a real possibility as well as amputation and death although they aren't common side effects.

This is why you go to doctors who specialize in LL/limb reconstruction in children and adults with congenital or external causes for their limb discrepancies, misalignment cases, etc, and cosmetic LL is not their focus.

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Some doctors don't monitor adequately. Patients develop compartimental syndrome and get amputation. Other patients get fat embolism and die. One case is described in Catagni's article.

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compartment syndrome or a serious infection can lead to amputation if not caught early.


A way to help prevent compartment syndrome is to raise the legs above the heart level post surgery to decrease the swelling.
If compartment syndrome does occur, the surgeon must do a fasciotomy. This is where the skill of the surgeon comes into play. A good surgeon will diagnose, manage and treat complications ASAP. 

Infections rarely occur. Most common infections seen are pin site infections when using external fixator. These are normal and you should treat clean pinsites daily.

A very bad internal infection can occur when using the internal nail. This is very rare, especially in the US where the nails and hospital rooms are sanitized very well before the procedure.


overall, to prevent these types of infections you want first class care with a great surgical team.

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Quote from: Life on April 30, 2018, 12:50:48 AMSome doctors don't monitor adequately. Patients develop compartimental syndrome and get amputation. Other patients get fat embolism and die. One case is described in Catagni's article.

Dr. Paley has seen 4 fat embolism syndromes while doing internal femurs on normal cll patients.
Dr. Catagni's pt had achondroplasia, which can lead to an array of extra complications when doing an osteopathic procedure due to diff sizes of organs and pre-health concerns in a full grown adult.

overall, tibias are safer when it comes to fat embolism syndrome. Dr. Paley has confirmed this (he has never seen fat embolism syndrome when doing tibias). Furthermore, the external LL is safer than the internal LL due to no reaming of the bone canal, which pushes out the fat emboli.

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Quote from: MirinHeight on April 30, 2018, 07:26:47 AMDr. Paley has seen 4 fat embolism syndromes while doing internal femurs on normal cll patients.
Dr. Catagni's pt had achondroplasia, which can lead to an array of extra complications when doing an osteopathic procedure due to diff sizes of organs and pre-health concerns in a full grown adult.

overall, tibias are safer when it comes to fat embolism syndrome. Dr. Paley has confirmed this (he has never seen fat embolism syndrome when doing tibias). Furthermore, the external LL is safer than the internal LL due to no reaming of the bone canal, which pushes out the fat emboli.

It should be noted, too, that Catagni's dwarf patient died due to the ATL, not the initial LL itself.

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Hi guys, after exploring this site more, I got confused in determining the safest possible method and doctor. Basically here's what I got.

Tibia is safer than femur.

Only use external for tibia.

Dr. Paley is the best surgeon in the world but doesn't even practice external.

So Catagni who is believed by some to be the best surgeon for external comes to mind. Or anybody else?

Price is a lot cheaper with Catagni and if it also means safer then why the heck not?

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I mean Dr. Paley does externals although I don't know about it for CLL. I'm assuming there's an assumption being made that if people care that much about their appearance they probably also care about their leg looking normal and externals leave a lot of scars. I've been told externals are more painful as well.

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Quote from: Bruce Wayne on May 03, 2018, 07:39:00 AMTibia is safer than femur.

Only use external for tibia.

Dr. Paley is the best surgeon in the world but doesn't even practice external.

So Catagni who is believed by some to be the best surgeon for external comes to mind. Or anybody else?

Price is a lot cheaper with Catagni and if it also means safer then why the heck not?

I'm not quite sure if tibias is necessarily safer, but they're well tolerated with externals, and therefore cheaper. This makes it easier to recommend to those who want around 6 cm of ;lengthening. Femurs are recommended for those who want a little more lengthening, more comfort, and/or more stealth.

The drawback with Dr. Catagni and Dr. Pili is that you'll be in frames for a long time, lengthening time plus 5 to 6 months for consolidation. That's the price you pay. If you have time to spare, go for it.

Quote from: olivine on May 07, 2018, 12:08:58 AMI mean Dr. Paley does externals although I don't know about it for CLL. I'm assuming there's an assumption being made that if people care that much about their appearance they probably also care about their leg looking normal and externals leave a lot of scars. I've been told externals are more painful as well.

Bingo. He still uses externals, just not for CLL patients.

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Quote from: Android on May 07, 2018, 03:28:38 AMI'm not quite sure if tibias is necessarily safer, but they're well tolerated with externals, and therefore cheaper. This makes it easier to recommend to those who want around 6 cm of ;lengthening. Femurs are recommended for those who want a little more lengthening, more comfort, and/or more stealth.

The drawback with Dr. Catagni and Dr. Pili is that you'll be in frames for a long time, lengthening time plus 5 to 6 months for consolidation. That's the price you pay. If you have time to spare, go for it.

Bingo. He still uses externals, just not for CLL patients.

So which one do you think is the the safest, less long-term complications, the best athletic recovery and the most guaranteed outcome: femur with Precice by Dr. Paley or tibia with Dr. Catagni?