Comparison of femurs vs tibias(pros and cons)

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From what I gathered and read up on these topics, correct me if im wrong
Tibias:
Pros
Better sleep(lower legs less affected by bed movement)
Less pain(?)
More recommended for externals and LON(lower budget)
Cons:
Lengthening limit lower compared to Femurs(6 compared to 8?)
Tighter stretching
Higher risk of fibula and tibias not aligned completely

Femurs:
Pros
Higher lengthening limit(8cm)
Better recovery rate(?)
Better proportions femurs to tibia ratio
Cons:
Usually additional procedure(IT band release, required)
Considerably more painful
Lengthening around soft tissues area on thigh could make it harder to sleep
More expensive due to only being recommended on internals

Is that more or less accurate?

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Quote from: LengtheningDream on November 09, 2022, 03:54:07 AMFrom what I gathered and read up on these topics, correct me if im wrong
Tibias:
Pros
Better sleep(lower legs less affected by bed movement)
Less pain(?)
More recommended for externals and LON(lower budget)
Cons:
Lengthening limit lower compared to Femurs(6 compared to 8?)
Tighter stretching
Higher risk of fibula and tibias not aligned completely

Femurs:
Pros
Higher lengthening limit(8cm)
Better recovery rate(?)
Better proportions femurs to tibia ratio
Cons:
Usually additional procedure(IT band release, required)
Considerably more painful
Lengthening around soft tissues area on thigh could make it harder to sleep
More expensive due to only being recommended on internals

Is that more or less accurate?

I agree w/ the above

I'll add something about the sleep:

I'm doing internal femurs now (about 5cm so far) and am getting knee pain waking me up a few times a night. I'm experimenting with various pillow/blanket positions etc to force the knees to be bent to prevent the knee pain/knee tightness that wakes me up. Any LL veteran out there has any tips for this?

I have found that a big pillow under the knee helps somewhat but doesn't remove completely the instances of being woken up by knee pain. I'm experimenting with other positions like lying on back, knees bent, heavy-ish blanket on the feet and other pillows on the side to hold the legs in place in a knees bent position. Also tried putting feet (with knees bent) on my travel roller bag on a pillow which helped at first then I woke up with left knee pain

So I believe (not sure if this is true) that the quads tightening during sleep may contribute to the knee pain and it is good to keep the legs in a knees bent position to decrease this knee pain. I know the nurses often say to put something under your lower leg for circulation but if knee pain is keeping someone awake at night..


"Higher risk of fibula and tibias not aligned completely"

I think Dr. Asssayag also made a list of some other complications that are also more common in tibias but I can't seem to find his post

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I've heard that compartment syndrome is more common in tibias than femurs but am not sure if this is true / what the reason might be

Anyone understand how compartment syndrome works?

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Quote from: SpeedDialer on November 09, 2022, 04:11:10 AMI agree w/ the above

I'll add something about the sleep:

I'm doing internal femurs now (about 5cm so far) and am getting knee pain waking me up a few times a night. I'm experimenting with various pillow/blanket positions etc to force the knees to be bent to prevent the knee pain/knee tightness that wakes me up. Any LL veteran out there has any tips for this?

I have found that a big pillow under the knee helps somewhat but doesn't remove completely the instances of being woken up by knee pain. I'm experimenting with other positions like lying on back, knees bent, heavy-ish blanket on the feet and other pillows on the side to hold the legs in place in a knees bent position. Also tried putting feet (with knees bent) on my travel roller bag on a pillow which helped at first then I woke up with left knee pain

So I believe (not sure if this is true) that the quads tightening during sleep may contribute to the knee pain and it is good to keep the legs in a knees bent position to decrease this knee pain. I know the nurses often say to put something under your lower leg for circulation but if knee pain is keeping someone awake at night..

Had knee pain for a few days at around 4cm too. If it’s like mine it comes from the quads being too tight and pulling on it’s insertion. Only solution is to stretch more. And stretch hard. Especially before you sleep and after clicking. It will disappear after some time entirely though if you do it.


For OP list is more or less accurate. Risks with alignment and nonunion and nerve damage is much higher in tibia. Also the surgery is tougher and longer and the fibula can make problems.
Pros: it’s much smoother At least until like 5 or 6cm. And walking is much better and quicker off crutches if you choose a weightbearing nail.

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Quote from: SpeedDialer on November 09, 2022, 09:57:57 AMI've heard that compartment syndrome is more common in tibias than femurs but am not sure if this is true / what the reason might be

Anyone understand how compartment syndrome works?

It's when there's too much blood in a muscle and the pressure gets too high.  The cause is the muscle getting maxed out in terms of what it can handle.  The small muscles of the lower leg have a lower limit to what they can handle.  This is why you can see even huge bodybuilders with small calves.

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Quote from: Medium Drink Of Water on November 09, 2022, 05:15:49 PMIt's when there's too much blood in a muscle and the pressure gets too high.  The cause is the muscle getting maxed out in terms of what it can handle.  The small muscles of the lower leg have a lower limit to what they can handle.  This is why you can see even huge bodybuilders with small calves.

Yes. The consequence of compartment syndrome is extreme pain and fasciotomy (very big ugly scar) or if left untreated necrotic leg and amputation. Basically never happens in femur.

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The size and ugliness of the scar depends on the severity of the compartment syndrome.  I tried to take a picture of my fasciotomy scars just now and they don't  even show up because of the flash.  They're 2.5 inch straight white lines down the tibialis anterior muscles and have not had any plastic surgery.

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Quote from: Medium Drink Of Water on November 09, 2022, 05:15:49 PMIt's when there's too much blood in a muscle and the pressure gets too high.  The cause is the muscle getting maxed out in terms of what it can handle.  The small muscles of the lower leg have a lower limit to what they can handle.  This is why you can see even huge bodybuilders with small calves.

ty!!! Are there any mistakes some patients make that increase the chance of compartment syndrome happening? 'handle' like too much stretching or too much exercise or something?

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You missed the most important pro for tibia and con for femur:

Long tibias will always look better and natural compared to long femurs.

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Quote from: Medium Drink Of Water on November 09, 2022, 06:06:57 PMThe size and ugliness of the scar depends on the severity of the compartment syndrome.  I tried to take a picture of my fasciotomy scars just now and they don't  even show up because of the flash.  They're 2.5 inch straight white lines down the tibialis anterior muscles and have not had any plastic surgery.

You probably refer to the prophylactic fasciotomy. Every responsible doctor does an inch incision to preemptively vent the muscles to avoid this with tibia LL. This is one of the reasons  why calves do get thicker with tibia ll. If you like a masculine strong look it’s positive, if you like a skinny look it’s negative. But Becker told me the leg optically slims down if you lengthen it so idk. I would not like that calf hypertrophy tbh. 

Quote from: SpeedDialer on November 09, 2022, 07:38:37 PMty!!! Are there any mistakes some patients make that increase the chance of compartment syndrome happening? 'handle' like too much stretching or too much exercise or something?

No nothing to do with that. It’s comparable to fat embolism as in that happens in the beginning when you are in the hospital and it’s not patients fault. Perhaps the more precise and less invasive the surgery the better. Blood drainage helps prevents it. Prophylactic fasciotomy helps prevent it.

For the legs I have the feeling they want to be stretched all the time. If you stretch 12h a day which is impossible it would be theoretically great for the lengthening (at my stage, the tightness starts at about 2.5-3cm for femurs). So can’t overdo stretching and can’t overdo exercise (well considering you do normal stuff like walking and biking and swimming and not stupid   like running or jumping or weightlifting)