The risk of deep infections with pure internal method is very low and I don't think there has been a case of amputation due to LL in all the recent case series I've read. With a pure internal method, the only way for an infection to occur in during implantation of the lengthening rod or due to a severe infection of the wounds which had to go all the way to the bone. Of course, when it DOES happens the rod can be colonised with bacteria. What happens more frequently is that these bacteria inhibit the growth of the new bone and leads to delayed/mal union rather than osteomyelitis.
With an external device, infections are much more common both superficial and deep, but the fact that there is no foreign object inserted makes the treatment of the infection much easier.
However, the bigger risk comes from combining these 2 methods such as LON and LATN techniques because you have both an intramedullary rod and a permanent opened window from which bacteria can enter (pin wounds).
leg lengthening risk (amputation and more)
So what would take for a rod to be not sterile? Would it get intention capable by simply leaving out in the air for some time, or washed in hard water, or wiped with an unwashed towel?
No doctor would do any of these, but I'm just wondering how bad a doctor would need to be to manage to get you an infection from the nail.
Quote from: alps on July 15, 2017, 05:55:21 PMSo what would take for a rod to be not sterile? Would it get intention capable by simply leaving out in the air for some time, or washed in hard water, or wiped with an unwashed towel?
No doctor would do any of these, but I'm just wondering how bad a doctor would need to be to manage to get you an infection from the nail.
Impossible to know. In medicine nothing is ever absolute. Normally the rod would be sterile until the surgeon opens its container. After that the surgical technique is important, the cleaning of the room, whether all the surgical team follows all precautions. Imagine a drop of sweat drops from the surgeon. Etc.
In the classification of wounds, LL would be "clean" because there is no contact with a mucous membrane. Even so, my doctor prescribed me antibiotics after surgery for 3 days.
In order to get an infection a number of factor must be happen at the same time: From a break of the sterility of the procedure, the agressiveness of the pathogen, inadequate defense of the host, resistance to antibiotics.
I assume that in the case of non-consolidation (the bones refuse to grow back together), amputation would be the last resort if no other methods achieve success. I'm not aware of any LL procedure that has resulted in an amputation. Is anyone else aware of a specific case?
Quote from: IwannaBeTaller on July 15, 2017, 11:31:48 PMI assume that in the case of non-consolidation (the bones refuse to grow back together), amputation would be the last resort if no other methods achieve success. I'm not aware of any LL procedure that has resulted in an amputation. Is anyone else aware of a specific case?
I doubt it. In cases of non-consolidation, first, they would try to stimulate growth with bone marrow, HGH, etc. If not they would do a bone graft. Even if that doesn't work I guess they would try to compress the gap to produce healing and if not use metal plates/pins.
The only possibilities for amputations I can think of are severe bone infection which does not respond to antibiotics and is causing sepsis/gangrene or a compartmental syndrome in which there is already necrosis of the lower limb.
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