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Limb Lengthening by 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).
You can read our Lon vs Precice 2 article.
5 Phases of Limb Lengthening Surgery with LON Method
We explained day by day guide for your surgery process.
1. Pre-Operative: 1-2 Day
Upon your arrival, you will be warmly welcomed by your caretaker at the airport and transferred to your hotel for rest. The next day, you will meet with your surgeon for a face-to-face consultation and undergo pre-operative medical tests, including an X-ray. A physical examination will be conducted to assess flexibility and determine the optimal nail size. To help you relax, you will enjoy a complimentary tour of Istanbul, allowing you to experience the city's rich culture.
2. Intra-Operative: 6 Days
Day 3: The much-anticipated day of your limb lengthening surgery arrives. The skilled surgical team will perform the procedure with utmost precision.
Day 4: Your surgeon will visit you for a follow-up and guide you through a short walk to assess your initial recovery.
Day 5: Dedicated to receiving targeted physical therapy to enhance your healing and mobility.
Day 6: Offers a chance to relax and recover in comfort.
Day 7: You will receive additional physical therapy along with a detailed demonstration of the lengthening process.
Day 8: You will be discharged and transported home in a private ambulance, ensuring a safe and smooth journey as you continue your recovery.
3. Post-Operative (Lengthening Phase): 2-3 Months
Day 9: The distraction phase begins, with 1 mm per day for LON and 0.99 mm for Precice 2.
Day 10-90: The lengthening phase progresses, varying based on your planned height increase. During this period, the number of physiotherapy sessions will be tailored to your general status, crucial for regaining mobility and functionality. You will be able to bear partial weight with the assistance of a walker and use a wheelchair. Throughout the lengthening phase, you will receive necessary medical care and pain relief. Follow-up visits will be conducted at the facility, and regular X-rays will be taken to monitor progress and catch any early signs of potential complications, allowing for preventative measures to be implemented.
4. Pre-Consolidaiton Phase: 20 Days
Day 90-110: Once the X-rays confirm sufficient bone consolidation, a quick and efficient procedure is performed to remove the device. If there is a delay in bone consolidation, the fixators may need to remain in place for a longer period to ensure proper healing.
5. Recovery Phase (Bone-healing/Returning to Daily life): A Year
Day 110-475: Patients are required to send X-rays at regular intervals to allow remote evaluation of bone healing progress. After the removal of the external device, patients should use a walker and crutches for approximately two months before transitioning to walking unaided. Heavy physical exercise and sports are strictly prohibited until the surgeon provides approval. Apart from these restrictions, patients can freely return to their daily routines and work life.
*Please note that the information and the duration shared in the timeline are to give an overall insight regarding the limb lengthening process. The process can be completed early or later than it is anticipated depending on the circumstances and amount of elongation planned to be achieved!
Components of LON 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 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.
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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) – 22,850$ LON method, 48,500$ intramedullary nail (PRECICE 2.2), Precice Stryde, 22,850$ 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 – $155,000
You can visit our limb lengthening surgery price post for more detail.
How many months should I stay for this procedure?
Limb lengthening is not a simple procedure to go through. Considering broken bones and the recovery process, patients should spare a considerable amount of time for it. Notably, the first 3 months are a crucial period for patients in order to get through the process healthily as much as possible. The lengthening period needs to be observed closely by the doctor apart from the recovery, the functionality, and the health condition of the patient. Besides all these, patients must take a proper physiotherapy session from a physiotherapist who is well familiar with the post-operative process of limb lengthening. Patients desiring to have limb lengthening surgery need to stay here for at least 3/4 months by taking into account all these factors.
We provide patient accommodation, post-operative care, and physiotherapy services at Kumburgaz Marin Princess Hotel. For other accommodation facilities and prices, please visit Accommodation services page.
- Accommodation + 3 meals/day
- Personalized Physical Therapy
- X-rays, tests & examinations
- Medications
- Psychologic Counselling Service (Twice a month)
- Dietitian Services (Twice a month)
- Fitness, Free WI-FI internet, daily room cleaning, clean towels, and linen changes
- 24/7 business center use for those who continue their work remotely
- Activities outside the hotel and special tours for the patients to relax, breathe, and increase their motivation once a month
All inclusive: 4,550$ 3,580$/ per month
(3 month-package: 10,540$)
Afonso 2024-08-18 00:21:00
Hi, I'd like to know the overall cost both LON and Precice 2 methods.
ReplySam 2024-06-05 02:09:51
Please send the breakdown costing of surgery, accommodation and physiotherapy charges
ReplyWanna Be Taller - Makbule2024-06-07 12:04
Hello, details will be sent to your mail address. Regards, WBT - Medzonia.
Molly 2024-06-04 10:04:49
Hi there. Can you send me price breakdown for all procedures like physiotherapy charges, surgery charges and accommodation charges. Are these prices in USD?
ReplyWanna Be Taller - Makbule2024-06-07 12:03
Hello, the prices are in USD. Details will be sent to your mail address. Regards, WBT - Medzonia.
Max 2024-05-02 13:32:07
Hi I’ve read your pages and I’m interested in looking to have the precise procedure in the future, I’m 168cm and 32 now, I’m very pro surgery as I’ve had a hair transplant done in Istanbul before so would be interested to know what kind of results someone of myself who doesn’t smoke/drink alcohol regular exercise and has never had leg or joint problems.
ReplyWanna Be Taller - Makbule2024-05-06 15:27
Hello, thank you for the information provided. Detailed information will be sent to you through an email address. Regards, WBT - Medzonia.
ＤＫ 2024-04-22 18:59:35
お金を今貯めています。 太腿 大腿骨のみ8cm伸ばしたいです。 可能ですか？またそうなると4ヶ月は滞在しないといけないです。 500万円くらいかと予想していますが、よく分かりません。 総費用はいくらくらいになるか教えて下さい。
ReplyWanna Be Taller - Makbule2024-04-23 12:02
こんにちは。詳細はメールでお送りします。 ありがとう。 よろしく、WBT - メゾニア。
Joshua David Kaleb Hardwick 2024-04-12 06:09:51
Very interested in consulting and possible scheduling for later 2024
ReplyWanna Be Taller - Makbule2024-04-15 11:29
Hello, detailed information will be sent to your email address. If you are interested, you can have an online consultation with our patient consultation expert to discuss the process in detail. Regards, WBT - Medzonia.
Adel 2024-03-25 04:41:49
Hello, 1-Does the height gained from the surgery have a chance to carry over to future children by the height genes or impossible? 2- i saw a post on your website of a guy that gained 11.5cm from two separate (lon) surgeries at a cost of 27000$. So if i do one tibia surgery this year, the next year i will get to do a femur one freely if i wanted to? 3- i want to know the cost of "lon" surgery with 3 month package and without it and is it necessary for the Month package care or it just came down to personal preference?
ReplyWanna Be Taller - Makbule2024-03-25 11:38
Hello, 1- There is no correlation between gene mutation and limb-lengthening surgery. After you increase your height, it will not pass on to your children. 2- If you are aiming for a 13-15 cm height increase, you need to undergo 2 separate surgeries. For both operations, you have to pay separate fees. 3- Though staying here in the course of the lengthening phase is not mandatory, the doctor highly recommends patients to be accommodated here and receive post-op care from specialists. Staying close to the doctor and the hospital after the height extension surgery provides the opportunity to intervene quickly in any possible complications or problems. Our team considers these possibilities and cares about a healthy extension process by facilitating medical health care and patient accommodation. So far, few patients tried to spend the lengthening phase in their countries and ended up having complications due to the lack of physical therapy and medical care. You will be provided with detailed info through email. Regards, WBT - Medzonia.
Wanna Be Taller - Makbule2024-08-20 12:03
Hello, our team will send you detailed info to your email address. Regards,WBT - Medzonia.