Limb Lengthening by Lengthening Over Nail (LON) – The Combined Method

Classical methods with an external fixator such as Ilizarov and Holyfix require a long period of external fixation until the full consolidation of bones. Patients must keep the device attached to their legs once the bones are completely strengthened. However, a shorter duration of external fixation has led to the development of new techniques such as Lengthening Over Nail (LON, also known as ) the combined method. This brings out a huge advantage in terms of removing the external fixator earlier. For instance, patients only spend around 2 or 3 months with external devices of LON on their legs compared to 9 or 12 months in completely external methods such as Ilizarov and Holyfix. When compared to traditional lengthening treatments, a technique focused on offering better comfort and internal bracing for the regenerated bone should have a lower complication rate, as well as simplicity of application and cost-effectiveness. In addition to all of these, Holyfix and LON (The Combined Method) apparatus have such a superior design allowing the accelerated bone formation and transferring the burden from the bone without any shortening (Dynamization).

Components of Lengthening Over Nail (LON) – The Combined Method

External Fixator;

Its role is to be scaffolding outside of the leg. Stated in other words, it is a stabilizing frame made of strong metal to keep the bone stable during the lengthening period. Metal bars are attached to the bones with pins as can be seen from the picture below. The device is kept between two to three months depending on the desired height.

Intramedullary Nail;

Intramedullary nail or rod is used as internal fixation and is made of titanium alloy. The doctor decides the size of the nail by reviewing the X-ray images. (8,5 mm, 10,7 mm, 11,5 mm or 12,5 mm) During the operation, it is surgically embedded into the bone cavity. As the nail is biocompatible, it does not contain any elements that will cause harm to the body.

Limb Lengthening Surgery Lon Method Scar
Limb Lengthening Surgery Lon Method X-Ray

2 + 1 Surgeries with LON (the Combined Method)

If LON is chosen as a surgery method for limb lengthening, there are three operations that are performed;

  1. First Surgery; An intramedullary nail is inserted into the medullar cavity of the bone, and then, an external fixator is attached to the leg. Patients lengthen the bone gradually by 1 mm per day by turning the screws. (Every 6 hours the screw is turned by a metal key / 0,25 mm x 4)
  2. Removal Surgery for External Fixator; Once the desired height is achieved, the nail is locked with screws in order to preserve the achieved length. After that, the external fixator is removed. The remaining nail in the bone’s canal will move on to provide stability while the newer bone matures and hardens.
  3. Removal Surgery for Intramedullary Nails; Intramedullary nails can be removed upon the patient’s request after the full bone consolidation is completed. It can take a year or one and half years to get rid of the nail with a short procedure. Yet, some patients prefer not to remove it.

Advantages and Disadvantages of LON Method

Advantages;

  • It allows the external fixator to be removed much earlier compared to classical methods. (e.g Holyfix)
  • It is more cost-friendly than internal methods such as Precice and Stryde.

Disadvantages;

  • The surgery cost is higher than classical methods because of the usage of the intramedullary nail.
  • There is a high risk of getting an infection unless the dressing is changed properly.
  • Patients’ comfort zone may be spoiled since there are external fixators attached to the legs compared to internal methods.

The ‘LON’ methodology is highly preferred by our patients for these simple reasons:

  • High reliability in LON comparison to classical external methods due to the fact that Intramedullary nails add more stabilization to the bone.
  • Early removal of external devices allows earlier return to regular daily life activities. To compare, in the Holyfix method, patients have to walk, sleep, and live with external devices for 9 to 12 months or more.
  • Most importantly, reasonable costs in comparison to other latest systems such as PRECICE or STRYDE.

For the reasons listed above, around 70-80% of our patients choose the LON method.

It is equivalent to the conventional methods ( Ilizarov or Holyfix ) in terms of postoperative scars. While some people may find the scars disturbing, others may find them too insignificant to notice and worry about. The surgical wounds are stitched with dissolvable sutures and covered with waterproof dressings. Nevertheless, the scar marks will fade away as time passes by, and will not be eyeful. Especially, our surgeon ties off stitches aesthetically. If you think you may have sensitive skin against scar marks, you may find out some useful tips for the ways of minimizing the scar marks by watching the video below.

Wanna Be Taller Patient's Lon Scar Mark Wanna Be Taller Patient's Lon Scar Mark
Wanna Be Taller Patient's Lon Scar Mark Wanna Be Taller Patient's Lon Scar Mark

As in any other surgery, there are always risks and complications that might occur. As long as the doctor applies the right technique, the hygienic environment is established at the hospital, and proper post-operative care is provided, the risks and the complications are preventable and treatable. As Wannabtaller Team, the first priority is always patients’ safety for us. Yet, every person has a unique physiology and some unpredictable conditions might occur such as non-bone union or slow bone union. You may visit our blog writing to find out more information related to this issue;  "Limb lengthening Side effects, Complications and Risks"

  • Op.Dr. Yunus Öç(Istanbul, TURKEY) – 19,850 $ LON method, 47,850 $ intramedullary nail (PRECICE 2.2), Precice Stryde, 16,500 $ limb shortening surgery,
  • Dr. Paley (the USA) – Bilateral femur lengthening (up to 8 cm of height; cost $97,500 USD,PRECICE-Stryde) / Bilateral tibia lengthening (up to 5 cm of height; cost $109,000 USD, PRECICE-Stryde)
  • Dr. Jacob Rozbruch (the USA) – $125,000 (Femur or Tibia) / Nail Removal Fee: $20,000 (Femur or Tibia)
  • Dr. Shahab Mahboubian (Hollywood CA, the USA) – Bilateral femur lengthening (Precise nail) – $75,000, Bilateral tibia lengthening (Precise nail) – $85,000 & Combined tibia and femur lengthening 3-4 weeks apart – $155,000

You can visit our post for more detail.

How many months should I stay for this procedure?

Limb lengthening is not a simple procedure to go through. Considering broken bones and the recovery process, patients should spare a considerable amount of time for it. Notably, the first 3 months are a crucial period for patients in order to get through the process healthily as much as possible. The lengthening period needs to be observed closely by the doctor apart from the recovery, the functionality, and the health condition of the patient. Besides all these, patients must take a proper physiotherapy session from a physiotherapist who is well familiar with the post-operative process of limb lengthening. Patients desiring to have limb lengthening surgery need to stay here for at least 3/4 months by taking into account all these factors.

We provide patient accommodation, post-operative care, and physiotherapy services at Hampton by Hilton Istanbul. For other accommodation facilities and prices, please visit Accommodation services page.

  • Accommodation + 3 meals/day
  • Personalized Physical Therapy
  • X-rays, tests & examinations
  • Medications
  • Psychologic Counselling Service (Twice a month)
  • Dietitian Services (Twice a month)
  • Fitness, Free WI-FI internet, daily room cleaning, clean towels, and linen changes
  • 24/7 business center use for those who continue their work remotely
  • Activities outside the hotel and special tours for the patients to relax, breathe, and increase their motivation once a month

All inclusive: 3,350 $  2,450 $/ per month

(3 month-package: 7,150$)

Step by step guide from the beginning to the end with LON (the Combined Method)

Wanna Be Taller Step by Step Lon Surgery

Leave a Reply

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darya2023-01-27 15:35:46

Hello, How much does the LON method cost + including the accommodation? and do you offer financing?

Reply

WannaBeTaller - Makbule2023-01-27 17:20

Hello, thanks for your comment. The current LON surgery cost is 19 850 USD. The current 3-month accommodation is 7 150 USD. When it comes to financing, we don't provide such a service. Please feel free to get in touch with us. WhatsApp/Telegram +90 531 988 30 90 or e-mail [email protected] Regards, Wannabetaller Team Regards, Wannabetaller Team

Ath2023-01-02 00:44:40

Hi, I want to ask if how much for all expenses including the surgery via ion method? Thank you

Reply

WannaBeTaller - Makbule2023-01-02 18:02

Hello, thanks for your comment. The current LON surgery fee is 23 850 USD (external device removal surgery is included.) Adding a 3-month accommodation package, the price would be 35 400 USD. Please feel free to get in touch with us. WhatsApp/Telegram +90 531 988 30 90 or e-mail [email protected] Regards, Wannabetaller Team Regards, Wannabetaller Team

Joshua2022-12-22 20:12:48

Hi i would like to ask if how much for all expenses including the accommodation? Thank you!

Reply

WannaBeTaller - Makbule2022-12-23 11:29

Hello, thanks for your comment. Based on the current prices, the total cost would be 24 000 USD (including the main surgery, external device removal surgery, and 3-month accommodation) Please feel free to get in touch with us. WhatsApp/Telegram +90 531 988 30 90 or e-mail [email protected] Regards, Wannabetaller Team

canon2022-12-18 14:02:35

我想了解双腿延长13cm的条件自己以及费用,以及需要在国外待的时间,和复查时间。

Reply

WannaBeTaller - Makbule2022-12-21 13:57

您好,請用中文聯繫我們的患者代表以獲取更多詳細資訊。 電郵位址: [email protected] 電話號碼:+90 533 193 6500

Donovan Cage2022-12-10 17:38:13

Do you offer financing for the LON and accommodation package?

Reply

WannaBeTaller - Makbule2022-12-13 11:50

Hello, thanks for your comment. An installment plan can be offered only for the surgery cost, but for the other expenses, it is not. Please feel free to get in touch with us. WhatsApp/Telegram +90 531 988 30 90 or e-mail [email protected] Regards, WannaBeTaller Team

Almo2022-11-27 09:53:30

Merhaba, ameliyat ücreti ne kadar? Ve size yakın yaşıyorum, bu yüzden bir otele ihtiyacım, ortak bir oteliniz var mı yoksa tek başıma mı aramalıyım?

Reply

WannaBeTaller - Makbule2022-11-28 10:21

Hello, thanks for your comment. Please contact our Turkis patient consultation expert to get more details regarding the surgery and the process. PN: +90 505 091 66 09 Regards, Wannabetaller Team

Marty2022-11-27 09:09:26

Hello, I would be interested in LON surgery. What does it cost? And what is the waiting time for it? Thank you Marty

Reply

WannaBeTaller - Makbule2022-11-28 10:27

Hello, thanks for your comment. Patients need to give us notice at least a month ago, and in order to reserve the surgery date, they need to send a 10 percent deposit payment. For the quotes, the information has been sent to your email address. Regards, Wannabetaller Team

Anonymous 2022-11-07 17:40:01

Does the cost of the surgery cover both limbs, or is it a individual fee

Reply

WannaBeTaller - Makbule2022-11-08 11:59

Hello, thanks for your comment. A single surgery fee covers both legs (either femurs or tibias) Regards, Wannabetaller Team

D. Powers2022-11-06 01:45:56

Can the LON method be performed on femur? And what the is total cost including 3 months stay and removal?

Reply

WannaBeTaller - Makbule2022-11-07 10:38

Hello, thanks for your comment. Yes, the LON method can be applied to the femurs. Though it can be challenging compared to Precice 2, most patients go for it and achieve their desired height. With current prices, the quote for a single LON surgery and 3-month accommodation is 24 000 United States Dollars. Please feel free to get in touch with us. WhatsApp/Telegram +90 531 988 30 90 or e-mail [email protected] Regards, WannaBeTaller Team

Ahmad 2022-10-27 13:19:55

What is the cost of all 3 surgeries

Reply

WannaBeTaller - Makbule2022-10-28 12:40

Hello, all the necessary details regarding your inquiry have been sent to your email address. Regards, Wannabetaller Team

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