Is external tibias safer than internal femurs?

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If we're comparing the same amount of lengthening, I would choose internal femurs all day.  5-6cm in the femurs seems to be within a very safe limit and patients who lengthen that much seem to have really good recoveries.  whereas the same amount in the tibias is pushing it since the safe limit for tibias is less.  especially if you have to get ATL, which you may not fully recover from and Paley and Guichet seem to agree. 

Lastly, I wouldn't want to spend almost a year of my life in frames.  Externals are a much better price though compared to internals I'll give it that. 

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Quote from: goldenegg on February 15, 2016, 05:33:12 PMIf we're comparing the same amount of lengthening, I would choose internal femurs all day.  5-6cm in the femurs seems to be within a very safe limit and patients who lengthen that much seem to have really good recoveries.  whereas the same amount in the tibias is pushing it since the safe limit for tibias is less.  especially if you have to get ATL, which you may not fully recover from and Paley and Guichet seem to agree. 

Lastly, I wouldn't want to spend almost a year of my life in frames.  Externals are a much better price though compared to internals I'll give it that. 

Yes I agree that femurs can manage a greater amount of length, but at what cost? If you lengthen the femur too much, say by 5cm, there will be a mechanical acis shift of 5mm which to me is a lot. For tibias, there doesn't seem to be an issue with the anatomical axis since tibias are straight.

Other doctors seem to be okay with Achilles lengthening so it might be a debataeble issue. If you keep it to 4cm or less you may not need Achilles lengthening either

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Quote from: applesandoranges on February 15, 2016, 05:55:50 PMYes I agree that femurs can manage a greater amount of length, but at what cost? If you lengthen the femur too much, say by 5cm, there will be a mechanical acis shift of 5mm which to me is a lot. For tibias, there doesn't seem to be an issue with the anatomical axis since tibias are straight.

Other doctors seem to be okay with Achilles lengthening so it might be a debataeble issue. If you keep it to 4cm or less you may not need Achilles lengthening either

Agree. You can have a bigger lengthening on femur but still it is same for the soft tissues. You might appear to recover well but that is because your muscles are compensating the damage to the soft tissue.

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Quote from: goldenegg on February 15, 2016, 05:33:12 PMLastly, I wouldn't want to spend almost a year of my life in frames.  Externals are a much better price though compared to internals I'll give it that.

For many successful people, externals are more expensive than internals.

With externals, you'd want to hide from the general public for a year. Whereas with internals, you can probably go back to work in crutches at months 4-6, which represents a 6-8 months difference in lost wages.

Thats why I encourage all the young people to stop feeling sorry for themselves and work hard to advance your career and be in this position where externals are more expensive. Don't blindly go to a 3rd world country just cuz you have enough money.

Cheers