Lengthening Over Nail Method
Limb lengthening LON Method
The LON method has proven successful in cosmetic limb lengthening surgeries for several years. It is a combined surgical approach where an intramedullary nail is inserted into the bone simultaneously with the attachment of an external fixator. Lengthening is achieved through the use of this external fixator, which is manually turned each day with a special apparatus. After the designated lengthening period, the external fixator is surgically removed from the limb.
Classical limb lengthening with an external fixator often requires an extended period of external fixation until the newly formed bone is fully consolidated. This extended duration of carrying an external fixator can lead to patient dissatisfaction. However, one notable advantage of the LON method is that patients only need to carry the external fixator during the lengthening phase, not the consolidation phase. In comparison to traditional lengthening methods with an external fixator alone, LON significantly reduces the time patients spend with the fixator, often cutting it in half or even less. This reduction contributes to a more favorable experience for patients undergoing limb lengthening.
LON Method Materials
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The intramedullary nail, constructed from solid titanium. It is carefully inserted into the intramedullary canal of the bone, allowing the bone to glide over the nail for the lengthening process. The diameter of the nail is customized based on the patient's intramedullary canal diameter. Once the lengthening phase concludes, the external fixator is removed. The distal part of the intramedullary nail is then securely locked into the bone, transforming the nail into a weight-bearing support. Thanks to its high weight-bearing capacity, patients can walk with full weight. Furthermore, the intramedullary nail is biocompatible with body tissues, ensuring it can remain safely in the body and bone for an extended period.
Monorail External Fixator (for Femur)
The Monorail external fixator, comprised of assembly clamps, a rail, and a distraction-compression unit, is a preferred choice in femoral (upper leg) cosmetic lengthening surgeries using the LON method. The assembly clamps attach to the rail, allowing them to slide along it and connect to each other through distraction-compression units. The fixator, made from a robust metal alloy, boasts an impressive weight-bearing capacity. During the procedure, the rail fixator is affixed to the extremity using half pins. This reliable and durable external fixator system aligns with the surgeon's preference, ensuring stability and effectiveness in achieving the desired cosmetic lengthening outcomes.
Intramedullary
Nail
Ilizarov Frame Eksternal Fixator (for Tibia)
The Circular Fixator, exemplified by the Ilizarov Circular Fixator, has been a reliable external fixator system for nearly a decade, particularly in trauma, deformity, and limb lengthening cases. Known for its high mechanical stability, ease of application, and precise deformity correction, this system utilizes rings attached to the limb through pins and wires. Notably, it is favored by our surgeons for tibia lengthening due to its circular structure, which minimizes the risk of causing deformities. The circular frame's impressive weight-bearing capacity allows patients to walk with full weight bearing, enhancing their mobility and recovery during the healing process.
How the LON Method Looks From the Outside ?
In femur lengthening procedures using the LON method, the monorail fixator is positioned on the outer side of the thigh. It is attached to the extremity with 2 upper and 2 lower pins. For tibia lengthening with the LON method, the circular frame fixator has been adapted for enhanced patient comfort. The modification involves the use of half frames, reducing the weight of the fixator and increasing overall patient comfort. The circular fixator is attached to the calf with one pin, along with 2 wires proximally and 1 pin with 2 wires distally. These adjustments aim to optimize the patient experience while maintaining the effectiveness of the lengthening procedure.
LON Method Surgery
Surgery is meticulously planned by our surgeon and their experienced team based on detailed X-rays taken before the operation and a thorough physical examination. Our surgeon, with over 25 years of expertise in limb lengthening and deformity correction, leads a professional team in performing limb lengthening (LL) surgery. The LON method surgery is conducted under general anesthesia, with an anesthesiologist and a dedicated team ready to ensure the patient's comfort and safety throughout the procedure. Typically lasting 3-4 hours, the surgery involves several key stages:
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General anesthesia: Ensuring the patient is comfortably sedated for the duration of the procedure.
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Drilling of the intramedullary canal: Preparing the bone for the insertion of the intramedullary nail.
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Osteotomy: The intentional cutting of the bone to create two separate segments, a crucial step in the lengthening process.
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Insertion of the solid intramedullary nail: Placing the specialized nail within the bone to guide the lengthening.
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Locking of the proximal part of the intramedullary nail to the bone: Securing the nail in place to maintain stability.
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Attachment of the external fixator: Connecting the external fixator to the bone using pins and wires.
All incisions are made minimally, with each measuring less than 2 cm in size. Throughout the surgery, real-time X-rays are taken at every stage to ensure precision and smooth progress. Specialists in external fixation and intramedullary nails work collaboratively with our surgeon, contributing to a coordinated and expertly executed surgical process.
Hospitalization In LON Method
During the hospitalization period of 8-10 days following limb lengthening surgery, comprehensive care and support are provided to optimize the patient's recovery:
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Medication: The patient receives various medications, including serum, vitamin and mineral supplements, blood thinners, painkillers, and antibiotics to manage pain, prevent infection, and support overall health.
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Caregiver: AFA caregivers are present 24 hours a day to accompany and assist patients during their hospital stay.
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Positioning and Splinting: Nurses and physiotherapists work to position the patient in bed to reduce post-surgery swelling and prevent contractures. A dorsiflexion splint may be utilized, especially after tibia surgeries, to prevent plantar flexion contractures.
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Surgeon Check-Up: The surgeon and their team conduct check-ups twice a day to monitor the patient's progress and address any concerns.
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Walking: Generally, patients start walking training 24 hours after surgery, guided by the surgeon. A walker is used as an assistive device during this initial walking phase.
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Dressing: Pin and incision dressings are performed every 2-3 days to ensure cleanliness and monitor healing.
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Physiotherapy: If the patient's blood levels are normal and they feel well, daily physical therapy sessions are conducted by a physiotherapist. These sessions include stretching, strengthening, mobilization, and walking exercises.
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CPM (Continuous Passive Motion): The use of a CPM device is effective in restoring the patient's range of motion (ROM), preventing contractures, and reducing edema. The device is applied at a level tolerated by the patient, gradually increasing the joint motion.
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Initial Lengthening: The initial lengthening phase typically begins on the 8th day after the surgeon confirms callus formation. The surgeon performs the first extension and educates the patient on the process. The timing of this phase depends on the speed of callus formation, with adjustments made accordingly.
This comprehensive approach ensures that patients receive the necessary care, support, and guidance during the crucial early stages of recovery following limb lengthening surgery.
Consolidation Period In LON Method
The consolidation phase is a critical period characterized by the solidification and strengthening of the newly formed callus or new bone tissue. For individuals undergoing limb lengthening with the LON method, there are notable advantages during this phase. The durability of the intramedullary (IM) nails used in this method allows patients to bear full weight relatively early in the process. However, as a precaution, we recommend the use of a walker or crutches in the immediate post-fixator removal period until patients regain adequate range of motion, muscle strength, and balance.
It is essential to adhere to safe extension limits during this phase to ensure optimal outcomes. LON patients generally exhibit a high recovery rate, and depending on factors such as the rate of callus formation, the extent of lengthening, and the healing capacity of soft tissues, they typically achieve unassisted walking within 1-2 months after fixator removal. Once patients transition to walking without support, the recovery of other physical activities accelerates, allowing them to resume their normal daily routines with increasing ease and confidence.
Intramedullary Nail Removal Surgery
Upon completion of bone healing, signified by the sufficient density and hardening of the callus tissue during the consolidation phase, the bone becomes fully weight-bearing. Subsequently, the intramedullary nail can be removed from the bone. The timeframe for the removal of the intramedullary nail typically spans 1.5 to 2 years, and approval for surgery is granted by our surgeon after a thorough evaluation of the patient's X-rays.
The stages of the intramedullary nail removal surgery include:
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General Anesthesia: Inducing a state of unconsciousness for the duration of the procedure.
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Incision to Reach the Intramedullary Nail Head: Creating an incision to access the head of the intramedullary nail.
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Reaching and Connecting the Intramedullary Nail Head with Special Apparatus: Utilizing specialized tools to reach and connect to the intramedullary nail head.
4. Removal of Proximal and Distal Screws: Extracting screws located at both the proximal and distal ends.
5. Removal of the Intramedullary Nail: Extracting the intramedullary nail itself.
6. Closure of All Incisions with Aesthetic Sutures: Closing all incisions with aesthetic sutures for optimal healing.
Postoperative hospital stay is typically one day. Following the surgery, patients can walk with full weight-bearing. Once the intramedullary nail is successfully removed, the entire limb lengthening process is considered complete.