#lon method

Most of us know at least a little bit about the history of limb lengthening surgery and applied methods. For those who don’t know, first limb lengthening surgery method effectively applied for cosmetic limb lengthening is Ilizarov method. Limb lengthening techniques have gone a long way from the days of large, cumbersome external fixators, which had to be carried on patient’s legs for 9-12 months or even more.

Our doctors perform leg lengthening operations using a big variety of surgery methods: Holyfix, TSF frame, LON, Precice 2 and Precice Stryde. At first sight, it might be quite confusing to see the names of different surgery methods. You might think: ‘what the hell, I just want to become taller, what are all these methods with different names and prices?’ No need to worry, in this article we will try to help you a little, to make your decision making process easier.

People who plan to undergo limb lengthening surgery can be roughly divided into several groups.

Patients who have absolute minimum budget for the surgery

At the moment, the cheapest method we offer is Holyfix method. This surgery costs 13500 eur as of March 2020. Don’t underestimate this surgery method by judging its price, as it offers huge improvements compared to Ilizarov: more compact external fixators, more comfort for patient, less limitations for movement, a reliable rod-like structure, a scale on the device that allows patients to see their limb lengthening progress. The main drawback for many patients is the long period spent with external fixators: these devices can be removed only after full consolidation of bones (which takes around 9-12 months).

If you can only afford the cheapest of the limb lengthening methods, but have enough time for this procedure, then Holyfix might be the optimum choice for you.

Holyfix external fixators

Patients with little budget but not much time (due to work or studies)

At the moment, our most preferred surgery method by the patients is LON. Around 70-80% of our patients choose this method to become taller. Because this method allows faster removal of external devices and earlier return to daily activities for a moderate price. By saving up some more and adding 3500 eur on top of Holyfix, you get LON surgery for 17000 eur. In LON method, external fixators are removed in 3-4 months after the date of surgery (depending on the amount of bone lengthening). After the devices are removed, with patient’s efforts in physiotherapy and exercises, it can be possible to walk good enough without support in 1-1.5 months. With LON method, you don’t need to have the external devices on your legs for 9-12 months as in Holyfix method, because the internal nails of LON method continue to hold the bone after external devices are removed.

LON method 

Patients with sufficient budget who want high level of comfort and safety, and have enough time

Now we step into the arena of fully internal, motorized nail methods. Precice 2.2 method (35250 eur) comes into mind, because this technique has been successfully applied in cosmetic limb lengthening for many years. There are no external fixators that we can see in Ilizarov, Holyfix and LON methods. Instead, a motorized nail is placed into the bone cavity. The cuts, opened during surgery, are stitched immediately, leaving nearly no room for infection. In contrast, with methods which incorporate external devices, there is a small possibility of getting infection due to open pin sites where pins enter the leg.

In Precice 2.2 method, having no external device also means more comfort and less pain. It is not difficult to imagine that external devices are attached to legs by means of several pins, which enter the soft tissue and bone at several points. All of these cause various degrees of pain. Precice 2.2 intramedullary nail eliminates a significant portion of the pain and discomfort.

The only drawback of Precice 2.2 nail is its limited weight bearing capacity: patients are not allowed to walk or stand during bone distraction period, because Precice nails don’t bear weight and the internal mechanisms can be damaged, causing another surgery for nail replacement. To avoid this, patients have to use wheelchair during the period of bone lengthening (which takes around 2-2.5 months). If you think you can overcome being bound to wheelchair during this period, then this method may be a good option. Patients with sufficient budget who also have very limited time, want to get back to their regular life in shortest time possible, and want maximum comfort and safety At the moment, Precice Stryde method is the most modern, advanced and refined limb lengthening surgery technique available. It has the highest price tag among the surgery methods offered by Wannabetaller. However, it is an improved version of earlier Precice 2.2 method, with all of the same advantages plus increased weight bearing capacity and more reliability. Precice Stryde method allows patients to walk even during bone distraction period: patients begin walking with support from the next day after surgery, and it is possible to walk with some aid throughout the procedure. This earlier ability to walk allows patients to recover faster from this surgery, and get back to their daily routines, work or education earlier than in other limb lengthening techniques.

Leg Lengthening is a complex process that has traditionally been performed on people with limb length discrepancy. It has also been an option for people with dwarfism to gain additional height. More recently, the procedure has been used for people with short stature to add two or three extra inches of height. Limb lengthening for height increase can be done using different surgical techniques, whether with external fixation and/or internal osteosynthesis. Current methods for leg lengthening are: ilizarov, LON/LATN (limb lengthening technique that combines external and internal methods), intramedullary nailing (FITBONE, PRECICE). Please see this link for detailed information: Limb Lengthening Surgery Methods. Limb lengthening post-op period may be divided into three periods, and during these three periods one lays emphasis on different aspects of care.

The Early Post-op period (the Latent Phase)

The early limb lengthening post-op period extends from the time the patient comes out of surgery till the beginning of distraction. After leg lengthening operation, nursing staff teach patients how to clean and care for the skin around the pins that attach the external fixator to the limb (pin site care). Patients are also shown how to recognize and treat early signs of infection (warmth, swelling and redness) and told not to neglect pin site care, which takes about 30-40 minutes every day until the device is removed. It is very important in preventing infection from developing. If there is any redness and pain around a pin-site associated with increased or purulent discharge the patient can start a course of antibiotics.

Distraction Phase

After the end of the latency period (about 7-10 days after surgery) the lengthening phase of the bone is started. By that time you will have learned how to use the device properly. The rate of lengthening is approximately 0.5 – 1 mm per day. It can be accelerated or delayed as per doctor’s advice according to the progress.

It is during the distraction phase that most of the complications of the treatment will occur, and consequently the surgeon has to be constantly on the lookout for the known complications. During the distraction phase, the patient should be seen at least every two weeks. At these visits one should perform a detailed clinical examination covering the points as well as X-ray studies. Out of town patients can just send X-rays and physical therapy reports instead of coming in. After reviewing the x-rays, the doctor email patient, or patient has an online consultation with the doctor, where he/she is given updated weight-bearing instructions depending on the progress of the consolidation (if patient has a surgery with intramedullary nailing system) and other problems or concerns one may have, also is discussed. Specifically, the doctor measures the length of distraction and assesses the degree of maturity of the “regenerate” (the newly formed bone in the area of distraction). The cost of these consultations is included in the total package price.

Consolidation Phase

When the lengthening of the bone to the planned length has been completed, the newly formed callus (it is also called “Regenerate”) needs time to strengthen and to convert to normal bone with satisfactory weight bearing ability. This is called consolidation.

The fixator will remain until the end of the consolidation phase to allow the newly-formed bone to harden. No further adjustments are made to the fixator. The total time in the external fixator can be estimated to be approximately 1 month for each centimeter of lengthening in children and 1.5 to 2 months (or longer) per centimeter for adults. For patients who had surgery with Ilizarov method or other external fixators, the device is removed when new bones are able to carry patient’s weight.At the end of distraction, Ilizarov recommends “training the regenerate”. Simply put, this involves overlengthening the limb by 7 to 10 mm and then compressing this back to the proper length in a gradual fashion. This ensures a larger cross sectional area of regenerate to participate in the consolidation. With Ilizarov frame you will already have been fully weight bearing since after the surgery.

Finally before actually removing the frame the patient may be administered a ‘stress test’ in which all the uprights connecting the proximal and distal segments of bone are disconnected and the patient asked to use the limb in a functional manner (weight bearing for the lower limb and functional activities for the upper limb). If the patient is able to do this the frame can then be removed with confidence. Actual removal of the fixator is usually done under anesthesia. In adults, though it is possible to do without it, it is not recommended as the removal of half pins is quite painful. For futher information you can see: Limb lengthening surgery by Ilizarov Method

During the consolidation phase, if you have a Precice Nail, you will continue to walk with weight bearing restrictions. No more alterations will be made to the PRECICE nail. The PRECICE nail will remain in place throughout the consolidation phase to support the regenerate bone. Depending on the bone that has been lengthened, the length of the regenerate and individual parameters of the patient, full weight bearing is usually allowed between 6 and 8 weeks after the end of the lengthening phase.

The implantable lengthening device should be removed. Although it is made of inert metal (either titanium or stainless steel), there are also other materials including rare earth magnets, etc. The moving parts also can lead to wear and even corrosion. Although it is sealed inside a waterproof chamber, it is possible that after years this seal could leak and the rare-earth magnet be exposed to body fluids. For these reasons it is preferable to remove the device. Timing of nail removal is not critical, it is recommended to be done between 1 and 2 years after insertion. There is no urgency in the timing of removal but it should be done. The removal is an outpatient procedure. Removal of implanted metal devices requires another surgical procedure under general anesthesia. The cost for removal is not included in the initial package price.

During the consolidation phase the risk of complications is reduced markedly, and the patient’s functional abilities increase. Movement and ambulation are encouraged to ensure a speedy consolidation of the regenerate. The age of the patient, bone segment (femur, tibia), corticotomy level and the level of osteotomy (distraction gap) play a big role in the bone-healing. Distraction – consolidation time versus distraction gap is significantly less for femoral than tibial lengthening. Patients 20 years and older healed slower than patients younger than the age of 20 years. Patients 20 to 29 years old healed faster than patients older than 30 years and slower than patients younger than 20 years.

Lengthening over nail (LON, monorail method)

A different strategy for the distraction and consolidation phases aims at reducing the total fixator time by simultaneously placing an intramedullary solid nail at the time of osteotomy and by removing the external device at the end of distraction.

After the distraction phase, the nail is locked to stabilise the gained length and axis before removal of the fixator. The main concern of combining external fixation with solid nailing is deep infection. The risk ranges between 5 and 15 %.

Physiotherapy

Much is spoken about physiotherapy and it’s importance in the both internal and external methods. Unfortunately, this is infrequently translated into practice. One just has to look at many cases with iatrogenic problems to realize that lack of physiotherapy lies at the root of the majority of these. The patient has to participate in a proper program of exercises, mobilization and ambulation. This cannot be stressed enough. Lack of proper physiotherapy can turn even the technically excellent surgery into a poor result, and nowhere is this more true than in the subspecialty of Ilizarov surgery.

Physiotherapy continues during the consolidation phase with the goal of muscle strengthening and re-education and improvement of proprioception of the limb.

This is even more vital in the early post-op period, because the patient with pain is not going to be very cooperative in the physiotherapy and mobilization. Pain also will cause the adoption of protective postures such as flexion of the knee, plantar flexion of the ankle, which later develop into contractures one of the commonest ‘complications’ of the external fixators, especially Ilizarov method.

Physiotherapy session is done every day. The goal of physiotherapy is to preserve the ROM of the joints of the knee, hip and ankle and to stretch the muscles and tendons.

Complications and risks

Cosmetic Leg Lengthening (also called Limb Lengthening) procedures can not be compared with more simple plastic surgery options. They are very complex, painful, expensive and require long recovery times from one half to one full year.

There are some risks and complications related to cosmetic limb lengthening surgery, and for that reason patients should be well informed about all it.

All the risks associated with surgery and the administration of anesthesia exist, including adverse reactions to medications, bleeding and breathing problems.

Specific risks and complications associated with Limb Lengthening Surgery are: poor bone healing (non-union), Premature consolidation, osteomyelitis (bone infection), injury to blood vessels, nerve injury, joint stiffness (contractures), pin loosening in the anchor sites, destruction of cartilage and most common serious risk is infection of the pin sites or wires going through the bone that may result in further bone or skin infections. Pain and difficulty sleeping are other problems that arise during limb lengthening period. Pain is very subjective and the pain threshold vary among people. Each person deals with it in different ways.

Previous designs of internal bone lengthening devices have been fraught with imprecise distraction, resulting in nerve injuries, joint contractures, non-unions, and other complications.

Delayed or failure of consolidation: slow or failed bone healing can occur with any lengthening surgery. This complication can usually be prevented by making drill holes at the level of the planned osteotomy before reaming the bone.

Muscle contractures: muscles normally get tight with lengthening. A muscle contracture occurs when a muscle gets tight enough to prevent a joint from moving through its entire range of motion. To prevent muscle contractures physical therapy is essential. The patient should do daily stretches of the muscles and joints. E.g. knee joint and quadriceps muscles for femur lengthening and ankle joint and Achilles tendon for tibial lengthening. In addition to formal physical therapy the patient should do their own stretches at home several times per day.

Premature consolidation: in this complication the patient bone bridges the gap and prevents further lengthening. Premature consolidation can occur with any method if the patient is a very rapid bone healer. The patient in these cases is able to make bone faster than the speed at which the bone is being lengthened. The only way to prevent this is to speed up the lengthening intentionally for a week or two. The Precice nail with its rate control allows the surgeon to do this. If premature consolidation does occur it requires an outpatient small surgery to re-break the bone through a tiny incision.

Another frequent worry for the patient as well as the surgeon is that of bathing and washing the fixator. This is completely safe, provided that the limb and the fixator is thoroughly dried and the pinsites cleaned again after the bathing.

Recovery

During the recovery period, physical therapy plays a very important role in keeping the patient’s joints flexible and in maintaining muscle strength. Patients are advised to eat a nutritious diet (milk and milk products, sesame, Dark leafy greens, sardines and etc.) and to take calcium supplements. To speed up the bone healing process, gradual weight-bearing is encouraged. And of course sunlight… Without sunlight, the bones cannot become calcified. Open wounds and broken bones heal faster in sunlight. Patients are usually provided with an external system that stimulates bone growth at the site, either an ultrasound device or one that creates a painless electromagnetic field.

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Youtube: Limb Lengthening Surgery

Nowdays most of the  short stature people , 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

Contemporary limb lengthening surgeries , ligaments and nerves. These techniques have only been common for a few decades in the United States, and actually grew out of an earlier procedure developed in Europe roughly 25 years ago.

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 leg lengthening.”

The innovative surgery begins with an osteotomy, the procedure of cutting or removing 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 25-30%. In many cases, this equates to approximately 3 to 3.5 inches of extra bone growth.

When only an external fixator is used, the fixator needs to remain in place for both the distraction and  consolidation phases . If the fixator were removed at the end of the distraction phase, the new bone would collapse and reshorten.

If you would like more information about external fixators please visit:  Limb lengthening Using External Fixation

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 .

Lengthening and then nail (LATN)

In case of LATN (Lengthening and then nail), 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, precise 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

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.

Precise  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.

Fitbone  is another intramedullary lengthening nail, which allows the patient to lengthen the femur and tibia in leg length discrepancies and other serious deformities of the leg bones. This device is implanted into the bone and features a telescopic, electric nail that forces the bone to grow.

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.

Candidates for Limb Lengthening and Deformity Correction Surgery

The most common candidates for limb lengthening are people with birth defects, knock-on knees, foot and / or bowleg deformities, limb length discrepancy, and most other leg deformities. This procedure is also common among people with fractures or broken bones that did not heal properly (malunion or nonunion) and those with dwarfism.

Besides the cosmetic benefits, some patients undergo leg lengthening surgery when they’ve experienced long-term issues associated with their defect, including arthritis. In these instances, as well as cases of deformities, the procedure is likely to be covered by insurance.

In pediatric orthopedist. Both bowing of the legs, in which the knees are abnormally separated, and knock knees, in which the knees are abnormally close together, in a family member during early childhood. In many cases the alignment of the legs corrects naturally. But if it is impossible to correct the legs naturally, it is required to do surgery.

With pediatric leg lengthening, a doctor will first observe the growth plate (the area of ​​the bone that indicates how much the bone will grow). Children with differences in limb lengths and a myriad of other deformities are often good candidates for limb lengthening procedures.

According to the Hospital for Special Surgery, children who have limb lengthening procedures heal in roughly half the time it takes adults to recover. Pediatric patients typically have the same options as adults. They also typically see better results, with the ability to lengthen the bone by up to 8 inches.

Although previously reserved for those with congenital anomalies and developmental disorders, limb lengthening surgery has become popular for cosmetic purposes as well. The procedure is largely the same for those who undergo it.

If you would like to get information about the post-op period you can see: Limb Lengthening Surgery Post-op Period, Problems and Complications

Single Leg Lengthening (Leg Length Discrepancy) Before After wannabetaller.com: https://www.youtube.com/watch?v=_CnwAwyYcZI#action=share

Cost of Limb Discrepancy Surgery:

Singular Limb (either Femur Or Tibia) Lengthening surgery for limb discrepancy correction, with:

Holyfix method: 8,000 Euros

LON method: 9,000 Euros

Precice 2: 18,000 Euros

Precice Stryde: 29,000 Euros

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

Moreover, for a thorough, healthy and smooth treatment experience, we provide the following facilities, which are included in the total price that we charge for the surgeries:

Meeting and greeting our patients at the airports, including all transportation, to and from their hotels & hospitals

Accommodation in a 5-star hotel (1 to 3 days)

An English-speaking caretaker who will assist our patients 24/7

A Complimentary Istanbul tour, including historical and touristic visits, boat tours and meals in our famous Turkish restaurants

All necessary medical examinations before the surgical operation

5 to 7 days of hospitalization

Physiotherapist’s assistance and all medications are covered, during the patient’s hospitalization

Walkers, crutches & wheelchairs

Transportation to the airport upon departure

FREE consultation with doctors and consultants, whenever the patient’s needs, even after the lengthening process has been completed.

Please note that this stated price also includes the following costs, besides, to the surgery itself:

All hospital charges relating to the operating room and recovery room.

Surgeon fees.

Anesthesiologist fees.

Surgery assistant fees.

Hospital fees (Internal medicine doctors will be available during the entire hospitalization period).

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