Which is the safest, internal femur with Paley or external tibia with other Dr?

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It's a question that's been bothering me lately. Everyone here likes to point out that external tibia is the safest and least invasive form of LL. BUT the best LL doctor in the world doesn't even do that.

So what would be a safer move to do overall between internal femur with Paley and external tibia with other respectable doctor and good with the method, says Giotikas/Parihar/Catagni?

Safer = less likely to die, lose a leg, get other serious complications, better athletic recovery.

I'm beginning to question the advantages of being in Paley's hands. He's got some FE cases where other mediocre doctors haven't.

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Quote from: RaaX on June 07, 2018, 03:38:19 PMWhat does FE mean and elaborate his cases please.

Fat embolism. Out of 250 cases. 4 patients got it. 1 almost died.

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Quote from: Body Builder on June 07, 2018, 06:55:52 PMSafer are always externals only in terms of very serious complications, so external tibias are safer than internal femurs.

So in which department would you say the internal is safer?

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Quote from: Body Builder on June 08, 2018, 04:59:48 PMBone and soft tissue healing, less chances of malunion and no pin site infections. However if you have an infection with internals it is far more dangerous than externals. But very unlikely to happen.

Less chances of malunion really? I thought the anatomic axis of the femur is more likely to causes malunion and secondly external fixator is capable of fixing it whereas internal nail isn't.

And when you said bone and soft tissue healing, do you mean it's simply faster with femur or with tibia, it will be permanently more crippled?

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Quote from: Body Builder on June 08, 2018, 09:36:23 PMI meant non union, not malunion. My mistaktle. Femur heals better and faster than tibias thats why non union is harder.
Malunion with internals are harder too but with good hexapod frames malunions can be easily treated so there is no problem with that even in tibias.

Soft tissues is a big problem with tibias. Most people cant go more than 6-6.5 cm or they risk oversttetching of gastrocnemius-soleus which leads to permanent weakening. I dont even mention atl to fix equinus which is a madness.
On the other hand, on femurs most people can lengthen more than 6 cm without much problems as it band release is not significant and can fix most of problems that femur LL causes (duck ass mainly).

Anyway, if you want to lengthen up to 6cm, tibia LL with an hexapod and a good doctor is the way to go.
For more than that, Stryde on femurs is the best.

I think 6cm might be a little too much for tibs.

The problem with tibia lengthening is I believe it will lead to inferior stability and athleticsm compared to femur lengthening. But it's very confusing, long femurs simply don't look aesthetic, besides being much more expensive and more dangerous. And I'm not sure how the feeling of heavy thighs is gonna affect.

If I do tibs, I'm probably gonna settle for TSF.