Types of Limb Lengthening Surgery

Nowadays most of the people with short stature, or who were born with limb length discrepancy , or  leg deformities try to solve this problem with a surgery. In this article you can get some important information about this procedure, including different leg lengthening techniques, recovery time, and making sure you’ve chosen the right, experienced surgeon.

Bone lengthening procedure was invented in the 1950s. In the early 1980s, limb lengthening procedures were adventurous with new devices and techniques. But one thing remains a constant with a new advancement: limb lengthening requires a combination of technology and the body’s ability to regrow new bone – under the careful guidance of an orthopedic surgeon and special devices – in order for patients to achieve longer legs.

There are two common types of leg lengthening procedures, both of which require a cutting and a bone stabilizing device, which is either implanted inside the bone (internal limb lengthening) or attached outside the leg (external limb lengthening) to the lengthen the legs and correct deformities.

External Leg Lengthening

There are 3 leg lengthening methods: 

1. LON method,
2. Ilizarov method,
3. LATN method.

Lengthening Over Nail (LON) Method

Lengthening over nails (LON)  is a newer leg lengthening method. A combination of intramedullary nailing along with external fixation significantly reduces external fixation time while maintaining low rate of complications. Great care needs to be taken to prevent pin track infection and deep intramedullary sepsis. This method of limb lengthening surgery requires a small nail, which is then attached to an external fixator. Following surgery, the patient slowly turn the screws to gradually stretch the bones over the nail. It is possible to use ilizarov and any monorail fixator for external limb lengthening procedures in LON method .

Ilizarov Method

In 1982, Gavril Ilizarov who was a Soviet physician, known for inventing the Ilizarov apparatus for lengthening limb bones and the method of surgery named after him, the Ilizarov surgery. The Ilizarov technique was a major breakthrough in leg lengthening, as it was allowed for the orthopedic surgeon to hold the bone in place. The practice of using an external device, such as the Ilizarov apparatus, is referred to as “external method of leg lengthening.”

The innovative surgery begins with an osteotomy, the procedure of surgically cutting a piece of bone, and then requires a procedure to help stabilize the limb with a fixation device, which is often the Ilizarov apparatus.

The surgery is typically performed under general anesthesia. After surgery, the patient will be required to adjust the device. Coupled with physical therapy, this procedure can increase the length of the bone by 5-8 cm in one procedure. In many cases, this equates to approximately 2 to 3 inches of extra bone growth.

Lengthening and Then Nailing (LATN)

In case of LATN (Lengthening and Then Nailing), during 1 st stage surgery, only an external fixator is installed, and after full lengthening, during 2 n d  stage surgery, the external fixator is removed and an intramedullary nail is inserted. During 1 st  stage surgery, future space needed for the internal rod. Also, the correction process before 2 nd  stage surgery requires much knowledge and care from the doctor.

A large advantage of LATN is that bone formation is fast and because of strong internal fixation, compared to LON, patients can return to normal activity 2 or more months faster. Also, since it undergoes a correction process, precice bone alignment can be met.

One drawback is that the amount of time wearing the external fixator may be 2 or 3 weeks longer than LON, because of the correction process.

Internal Leg Lengthening

There are 2 methods for internal leg lengthening;

1. Precice,
2. Precice 2.2.

Intramedullary nailing is a procedure of fixation of fractures that involves use of an intramedullary nail  or rod to fix the fractured bone. Limb lengthening patients , who do not want to carry. There are now cutting-edge technologies that lengthen the bone from the inside, like the Precice and the Fitbone.

Precice

Precice is an internal limb lengthening device that requires the surgical implantation of a titanium rod into the bone cavity. The device is removed after one or two years time through a relatively minor outpatient procedure. It can lengthen the bone by up to 3 inches.

Precice Stryde

Precice Stryde is an improved version of Precice nail. Its main advantage over the earlier Precice 2.2 version is weight bearing capability. With Stryde method, patients can walk during bone lengthening period, while in Precice 2.2 method they would need to use wheelchair and wouldn’t be allowed to walk (it can damage the motorized nail mechanism, requiring the nail to be replaced)

Recovery after Limb Lengthening Surgery

Recovery times can vary depending on which type of surgery you choose. Regardless of whether an internal or external lengthening device is used, there will be a lengthy period of recovery, called the “consolidation phase.”

The total time in the external fixator can be estimated to be approximately 1 month for each centimeter of children and 1.5 to 2 months (or longer) per centimeter for adults. Total fixator time is divided evenly between the distraction and consolidation phases.

Bone healing is evaluated with X-rays. The X-ray shows the amount of calcium present in the bone. After the bone is healed, the internal nails, or external fixators (depending on a surgical method) are removed. Throughout this period, regular physical therapy and follow-up visits will be required.

Cost of Limb Discrepancy Surgery:

Limb (either Femur Or Tibia) Lengthening surgery for limb lengthening, with:

• LON method: 22,850$ (Including removal surgery)
• Precice 2: 48,500$
• Precice Stryde: Not available

For all other types of limb correctional surgeries and treatments please contact our patient’s consultants for more information and pricing.

Services Included in The Surgery Fee

• Meeting and greeting our patients at the airports, including all transportation to the airport upon departure,
• Accommodation at Days Hotel by Wyndham Esenyurt, Istanbul (2 days),
• Istanbul tour accompanied by tour guide ,
• All necessary medical examinations before the surgical operation,
• 5 days of Hospitalization,
• An English-speaking caretaker assisting for 6 days,
• 2 Physiotherapy Sessions & Physiotherapist’s assistance,
• Dressing Service,
• A Walker & Crutches & A Wheelchair,
• Discharging with a private ambulance,
• FREE consultation with doctors and consultant ,
• All hospital charges,
• Surgeon fees, Anesthesiologist fees, and Surgery assistant fees.