Femur lengthening surgery before and after results with internal nails versus external fixators

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I'm considering femur lengthening surgery and I'm torn between internal nails and external fixators. Has anyone had experience with both? What are the pros and cons of each?

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Honestly, I've had a terrible experience with external fixators. The pain was manageable, but the frame was so bulky and uncomfortable. I had to take 3 months off work and the rehab was grueling. I paid around $20,000 for the procedure and the frame. If I had to do it again, I'd opt for internal nails, specifically the Precice nail. It's more expensive, but from what I've read, the recovery time is shorter and there's less risk of complications.

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I'm not sure I agree with you, @mike_t. I've read that internal nails can cause more damage to the bone and surrounding tissue, especially if the distraction rate is too high. And what about the risk of non-union or delayed union? Isn't that higher with internal nails?

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Physiological Mechanisms of Distraction Osteogenesis

From my deep dive into the literature and consultations with orthopedic surgeons, it's clear that the choice between internal nails and external fixators depends on the individual case. The key to successful distraction osteogenesis is maintaining a balance between the distraction rate and the body's ability to form new bone. This process, also known as callus formation, is crucial for the consolidation phase. Intramedullary nails, such as the Precice nail, can provide internal stability while allowing for gradual distraction, which can reduce the risk of complications associated with external fixators, such as pin-site infection and joint stiffness. However, it's essential to carefully monitor the distraction rate to avoid premature consolidation or delayed union.

• The latency period before starting distraction is critical, typically ranging from 5-7 days.
• The distraction rate should be carefully controlled, usually at 1 mm/day, divided into 0.25 mm increments four times daily.
• The consolidation phase can last several months, depending on the length gain and the individual's healing process.

Ultimately, the decision between internal nails and external fixators should be based on a thorough evaluation of the patient's specific needs and circumstances, including the desired length gain, bone quality, and overall health.

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@bone_expert23, that's really helpful information. I've been considering the Precice nail, but I'm still unsure about the cost. Can you provide more information on the cost implications of each option?

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@mike_t, thanks for sharing your experience. I'm definitely going to look into the Precice nail. @sarah_m, I understand your concerns, but I think the benefits outweigh the risks. @bone_expert23, your analysis is really comprehensive, thanks for breaking it down for us.

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I still have concerns about the risks, but I appreciate the discussion. @bone_expert23, can you provide more information on the complications associated with internal nails, specifically the risk of non-union or delayed union?

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Complications Associated with Internal Nails

The risk of non-union or delayed union is a significant concern with internal nails. However, studies have shown that the intramedullary nail can provide internal stability while allowing for gradual distraction, which can reduce the risk of complications. The key is to carefully monitor the distraction rate and adjust as needed to avoid premature consolidation or delayed union. It's also essential to preserve periosteal integrity during osteotomy, as this tissue is crucial for callus formation and bone healing.