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.
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;
- 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)
- 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.
- 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.
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"
- Assoc. Prof. 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 limb lengthening surgery price post for more detail.
Wanna Be Taller - Makbule2023-06-02 13:14
Hello, first of all, with a single surgery, you can gain up to 8 cm (3 inches) from Femur, and 7 cm (2.76 inches) from Tibia. These are the maximum safe limits and it is not advised to exceed them in terms of health and proportionality. Quadrilateral surgery is not performed by our doctor because it is too risky. For example, there is a high risk of embolism, and long duration of anesthesia and there can be multitrauma in the legs. Thus, the second limb lengthening surgery can be done ideally 6/12 months after the first surgery. The amount of lengthening that can be safely achieved in a single surgery depends on various factors, such as the age and overall health of the patient, the location of the bone that needs to be lengthened, and the surgical technique used. It's important to note that pushing the limits of safe lengthening can increase the risk of complications, such as nerve damage, joint stiffness, infection, muscle contracture, and bone healing problems. It's essential to consult with a qualified and experienced orthopedic surgeon who can assess your individual case and provide guidance on the safe and realistic limits of lengthening for you. The minimum time to achieve between 12-15 cm is 6 months and the maximum is 12 moths. Regards, Jana