Limb Lengthening surgery by LON Method

“LON” stands for ” lengthening over nails “, which literally means that the bones are distracted or lengthened with an internal nail; however the bones are lengthened using a mono-lateral type external fixator device; similar to the one used in the Holyfix method. The main difference between the LON method and Holyfix is ​​the presence of the internal intramedullary nails over which the bones are lengthened over. This provides some important advantages over other fully external methods like Holyfix or Illizarov; that the patients are enabled to have the external fixators removed much earlier than with fully external methods. Usually, with LON, external devices can be removed approx. 3-4 months, after the surgery. The intramedullary nails stay inside the bone cavity until, the bones fully consolidate, heal, and recovery; which can usually happen, approximately, after 1-1.5 years of the surgery. After which the patient’s bones should have fully strengthened, the internal nails can also be removed by a minor surgical operation.

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

  • High reliability, in comparison to classical external methods. Intramedullary nails add more stabilization to the bone.
  • Early removal of external devices, which 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 9-12 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.

What is an Intramedullary Nail?

An Intramedullary Nail or Rod, is generally a metallic nail type rod device which is surgically embedded within the bone cavity, during a Limb Lengthening Surgery by LON Methodology. In the past, this technique had been employed by medical practitioners in order to treat fractures of the long bones in the human body. The medical pioneer, Gerhard Kuntscher, who was born in 1939, had to treat soldiers who were returning from World War 2 with femur fractures. But the treatment available at that time was limited to traction or plaster; both systems required long periods of inactivity and hence prolonged recovery periods. His invention of the intramedullary nail had enabled his patients to return to the activity within a week, as well as having faster bone healing.

How does this method work?

Now, the limb lengthening mechanism in LON methodology works with two devices, an internal intramedullary nail that is attached to a mono-lateral type external fixator. During the Limb Lengthening Surgery by LON Methodology, an intramedullary nail is surgically embedded into the bone by the surgeon, and an external fixator device is attached to the intramedullary nail, from the outside of the leg.

Once the LON apparatus is surgically attached to the patient’s legs; soon after 3-5 days of post-surgery hospitalization, the lengthening period begins at the hospital, whereby the external fixator is elongated or distracted by 1 mm per day with the intramedullary nail inside their bones. The biggest advantage of having an intramedullary nail in this method is that it helps in correcting any angular bone deformity. Within 60 to 80 days of lengthening, elongation of the bone is stopped, and we let the bone start to heal between the gaps created; and once there is ample weight-bearing bone consolidation, usually 30 to 45 days after the lengthening has been stopped; the doctors could remove the external fixator devices. This allows for quicker recovery time, in comparison to purely external fixator methods; as after this stage the patient’s bones would generally take around 5-6 months to fully heal. Thus, allowing the whole process to complete in 8 to 9 months; which in reality is as fast as any internal method; this is why LON is one of the most preferred methods of Limb Lengthening surgery by our patients worldwide.

What are the advantages of the LON method?

  • The greatest advantage of the LON method is that the duration of the process is reduced, in comparison, to the classical methods, and the results of the patient.
  • This positive outlook, generally, reflects more positively on patient psychology.
  • You don’t need a motorized nail. Patients usually begin to walk.

What are the disadvantages of the LON method?

  • The duration of the surgical operation is longer in comparison to classical surgeries.
  • Generally, prices and costs are higher than classical methods, because of the usage of intramedullary nails.

How many scars would remain on my leg, after the lengthening process is complete?

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. Nevertheless, those patients who would like to get rid of scars can easily have them removed with a minor plastic surgery operation.

Step by step guide to LON method

– Lengthening begins after 4-5 days since the operation. The doctor gives necessary instructions on how to use a special key to turn to screws in order to lengthen bones 1 mm / day. Additionally, bandage change and pin site care instructions are also given. These are important for avoiding infection. After doing the first session of lengthening at the hospital, patients are released.
– Lengthening takes around 2-3 months (usually 1 mm / day. For example, 6 cm takes 2 months, and 7 cm takes 70 days) depending on the lengthened amount
– Another 2-4 weeks pass before slight consolidation is visible on x- rays. Then external fixators are removed.
– 1-1.5 yrs (or less, if bone consolidation is fast) after external fixators are removed, intramedullary nails can also be removed because at this time the bone is fully consolidated
– It is possible to walk during the entire period of fixation, although with some difficulties and limitations. After externals are removed, walking becomes a lot easier and patients are able to walk normally and live their daily life with the exception of doing sports (this will be possible after full consolidation)

Here you can see one of our LON patients walking on the next day after surgery, with the help of a walker device:

What is the maximum recommended amount of lengthening?

Lengthening varies, depending on the choice of bone the patients lengthens, the femurs or the tibias, in their Limb Lengthening Surgery by LON Methodology.

Under the Medical Safety and Surgical guidelines and recommendations, with a single limb lengthening surgery, the patients can lengthen up to 3 inches; or to be exact:
1. Femurs (Thighs): 6 – 8 cms OR
2. Tibias (Calf’s): 5 – 7 cms

However, you may even opt to have two limb-lengthening surgeries, with a gap of 6 months between the two surgeries and gain up to 6 inches or 12 – 15 cms. But it must be remembered that the flexibility of the patient’s legs is fundamental in the lengthening process and achieving the max height achievable within the safe limits. The more flexible your legs are, the more comfortable and pain-free, the patients would be during this lengthening period.

Limb lengthening surgery costs with the LON method?

While this system is much more expensive than the “Holyfix” methodology, it is much cheaper than an automated and internal-only intramedullary nail (PRECICE) methodology.

At the moment, the cost for a single bilateral (Both Legs) surgery, either on the “femoral” or “Tibial” bones for leg lengthening, with ” LON ” Methodology is currently priced at around:  19,000(€) 17,678 Euros. (Please note that the listed discounted prices are valid till the end of the global COVID-19 pandemic unless otherwise mentioned.) .

Please note:  For a double surgery,  first on the femoral bones and later on the tibia bones or vice versa ( with a 6 months consolidation period between both the surgeries ); the price will be calculated as two separate surgeries. Thus, (€) 17,678 Euros multiplied by 2 surgeries: (€) 35,356 Euros.

Limb Lengthening For Limb Length Discrepancy Correction (Non-Cosmetic) Singular bone, either Femur or Tibia; with LON Method is (€) 8,500

Also, for a completely healthy and smooth limb lengthening experience, we provide the following facilities, which are included in the total price:

  • Meeting and greeting our patients at the airports, including transportation to the hotel & hospital
  • Accommodation in a 5-star hotel (1 day)
  • An English-speaking caretaker who will assist our patients 24/7 during the hospital stay
  • Complimentary Istanbul tour, including historical and touristic visits, boat tour, and meals in our famous Turkish restaurants
  • All necessary medical examinations and tests before the surgical operation
  • 5 days of hospitalization
  • Physiotherapist’s assistance and all medications are covered, during the patient’s hospitalization
  • Walker, crutches & wheelchair
  • Transportation to the airport upon departure
  • FREE consultation with doctors and consultants throughout the whole procedure
  • Circulation-enhancing, relaxing massage with a certified traditional Chinese medicine practitioner 1 day per week
  • 24/7 business center use for those who continue their work remotely

The above-mentioned price also includes the following costs, in addition to the surgery itself

  • All hospital charges associated with the operating room and recovery room.
  • Surgeon’s fees.
  • Anesthesiologist’s fees.
  • Surgical assistant’s fees.
  • Hospitalization fees (Internal medicine doctors will be available during the entire hospitalization period).

    You will be informed about the lengthening increase, lengthening process, the prices of the surgical methods, the difference of the methods, the risks of the surgery.

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    Comments
    • Can you please tell me the cost of hotel stay and duration for a limb discrepancy surgery on the tibia? Are there regular x-rays needed throughout? What other costs may be incurred that are not covered in the 8,500 price?

      Thank you for your time

      • Hello thanks for your comment,
        The information you have required has been sent to your mail address.
        For more information and personalized consultation please contact us via WhatsApp/Telegram +90 531 988 30 90 or e-mail [email protected]
        Regards,
        WannaBeTaller Team

    • Is it possible ,both bone femar or tebia surgery simultaneously? I wanna both one at a time with in short period around 3 month and remove after 1 or 1.5 year later.

      • Hello Nadim,
        Thanks for your comment. Having both tibia and femur done at the same time is not possible. It is too risky for your body. You may face with severe complications such as emboli, nerve damage and so on. You can do the second surgery with a gap of 3/6 months after the first sugery. However, the last decision is made by the doctor himself. The removal surgery of external fixators is performed whnenthe lengthening phase is over. Before it is removed, the doctor has your legs scanned and then,sees if there is a strong side of bone consolidation. When everythings seems fine, the surgery is performed.
        For more information and personalized consultation please contact us via WhatsApp/Telegram +90 531 988 30 90 or e-mail [email protected]
        Regards,
        WannaBeTaller Team