Lengthening Over Nail Method (LON)
The LON method is a surgical method that has been used successfully in cosmetic limb lengthening surgeries for many years. The LON method is a combined method. It is the method in which an intramedullary nail is inserted into the bone and at the same time an external fixator is attached to the bone and lengthening is done by an external fixator. Lengthening is done with an external fixator. Daily lengthening is completed by manually turning the lengthening segment on the fixator with a special apparatus. After the extension period is over, the external fixator is surgically removed from the extremity. Classical limb lengthening with an external fixator requires a lengthy external fixation time until the regenerate bone is fully consolidated. Patients are generally unhappy if they have to carry an external fixator on their leg for many months. One advantage of LON is that the patient only needs to carry the external fixator during the lengthening phase, not the consolidation phase. When compared to classical lengthening with an external fixator alone, LON cuts the fixator time in half or even less than half.
Materials of LON Method
Intramedullary Nail
The intramedullary nail is made of a solid titanium material and is very durable. It is inserted into the intramedullary canal of the bone and the bone glides over the nail to lengthen. The nail diameter is decided according to the patient’s intramedullary canal diameter. After the lengthening period is over, the external fixator is removed and the distal part of the intramedullary nail is locked into the bone and the nail becomes weight bearing. Since the nail has a high weight bearing capacity, the patient can walk with full weight. Intramedullary nail is compatible with body tissues and can remain harmlessly in the body and bone for a long time.
Monorail External Fixator (for Femur)
Monorail external fixator, which is assembly clamps, rail and distraction-compression unit. Clamps are inserted to rail where they can slide on it. They can be connected to each other with distraction-compression units. Rail fixator is connected to extremity with half pins. The external fixator is metal alloy and has a very high weight bearing capacity. Our surgeon prefer Monorail external fixator in femoral (upper leg) cosmetic lengthening surgeries with LON method.
Circular Frame External Fixator (for Tibia)
Circular Fixator is an external fixator system. Ilizarov Circular Fixator has been used for nearly a decade for trauma, deformity and limb lengthening cases, provides high mechanical stability, ease of application and precise deformity correction. The rings are attached to the limb with pins and wires. It is preferred by our surgeons because it does not cause deformity in tibia lengthening due to its circular structure. The weight bearing capacity of the circular frame is high, so the patient can walk with a full weight bearing.
External View of LON Method
Discover optimal comfort in limb lengthening with our specialized methods. Our femur LON approach features a monorail fixator positioned on the outer thigh, offering stability through 2 upper and 2 lower pins. In the tibia LON method, our circular frame fixator is innovatively modified for enhanced comfort, reducing weight while connecting seamlessly with one pin and 2 wires proximally and 1 pin and 2 wires distally. At the forefront of patient-centric solutions, trust us for a safe and comfortable limb lengthening experience. Explore our advanced techniques for a successful journey.
Surgery in LON Method
Surgery is planned by the surgeon and his team according to the detailed Xray taken before the operation and the physical examination. Our surgeon performs LL surgery professionally with his team, with over 25 years of experience in the field of limb lengthening and deformity correction. LON method surgery is performed under general anesthesia. Anesthesiologist and team are ready during the operation. Surgery usually takes 3-4 hours. Surgery stages;
⦁ General anesthesia
⦁ Drilling of the intramedullary canal
⦁ Osteotomy
⦁ Insertion of the solid intramedullary nail
⦁ Locking of the proximal part of the intramedullary nail to the bone
⦁ Attachment of the external fixator to the bone via pins and wires.
All incisions are made minimally and the incision size is less than 2 cm. With instant x-rays at every stage of the surgery, it is ensured that everything goes smoothly. During the surgery, external fixator and intramedullary nail specialists are present and work in coordination with our surgeon.
Hospitalization in LON Method
Comprehensive Limb Lengthening Care Program: Your Path to Recovery
Hospitalization Time: 8-10 Days
- Benefit from a comfortable and monitored recovery period with an extended stay of 8-10 days.
Medication Regimen:
- Receive personalized care with essential medications including serum, vitamin-mineral supplements, blood thinners, painkillers, and antibiotics.
Dedicated Caregiver Support:
- Experience around-the-clock assistance from AFA caregivers, ensuring continuous support and comfort throughout your recovery journey.
Positioning and Splinting:
- Our skilled nurses and physiotherapists focus on reducing post-surgery edema and preventing contractures through expert positioning. Special dorsiflexion splints are employed to counter plantar flexion contractures, especially following tibia surgeries.
Surgeon Check-ups:
- Benefit from meticulous monitoring as our surgeon and their team conduct check-ups twice a day, ensuring your progress aligns with the expected trajectory.
Early Walking Training:
- Initiate your walking training just 24 hours after surgery, guided by our surgeon. Utilize a walker for assistance during this initial walking phase.
Regular Dressing Changes:
- Experience hygienic care with pin and incision dressings performed every 2-3 days, promoting optimal healing.
Physiotherapy Sessions:
- Engage in daily physiotherapy sessions, tailored to your well-being and blood levels. Our physiotherapist focuses on stretching, strengthening, mobilization, and walking exercises.
Continuous Passive Motion (CPM):
- Embrace joint restoration and reduced edema with the implementation of a Continuous Passive Motion (CPM) device. Applied at a tolerable level post-surgery, gradual angle increases enhance joint motion.
Initial Lengthening Phase:
- Enter the initial lengthening phase on the 8th day, following the surgeon’s assessment of controlled callus formation. Surgeon-guided extensions commence, with patients educated on the process for a collaborative recovery journey.
Embark on your limb lengthening recovery with confidence, supported by our specialized care program tailored to your individual needs.
Lengthening Period Accommodation
Our patients, whose hospitalization period is over, are taken out of the hospital and transferred to the 5-star hotel in the AFA Limb Lengthening Center. During the lengthening period, they stay here for approximately 3 months. AFA Limb Lengthening center, physical therapy center, hydrotherapy pool are located in the same building. AFA medical team and patient consultants are located at the building and meet all the needs of the patients.
Lengthening Process in LON Method
In the LON method, daily lengthening is done with an external fixator. The lengthening rate is usually 1 millimeter per day. Total lengthening of 1 millimeter is usually divided into four and applied every 6 hours. When the lengthening time comes, the patient completes the lengthening by turning the apparatus of the fixator 90 degrees. Lengthening is stopped when the target length is reached.
Physical Therapy in LON Method
The physical therapy process after limb lengthening surgery with the LON method is very important. Physical therapy sessions of our patients are held at the AFA physical therapy center. Physical therapy program is applied 5 days a week. AFA physiotherapists are experienced and professional in physical therapy after limb lengthening surgery. Treatments such as stretching, strengthening, mobilization, pilates, balance, walking, electrotherapy, therapeutic massage are applied by our physiotherapists. Physiotherapists evaluate the patient’s condition together with the surgeon on a weekly basis and update the physiotherapy program.
Dressing in the LON Method
There is a risk of infection in the LON method, as there is an external fixator. Infection may cause pain, limited range of motion, edema and some systemic complications. It negatively affects the patient’s lengthening period and healing process. That’s why pin and wire care protocol is very important. Dressings should be done regularly and in accordance with the protocol. Sterilization, dressing materials and drugs used during dressing affect dressing success. At the AFA Limb Lengthening center, the medical team specializes in dressing and works professionally. Dressings of our patients are carried out regularly in our center twice a week. When there is any sign of infection, it is evaluated together with the surgeon, the dressing frequency is increased and antibiotic treatment is started.
Xrays View of LON Method Monorail
Walking in LON Method
Revolutionary Load Transition in the LON Method: A Seamless Walking Experience
In the LON method, external fixators play a pivotal role by shouldering the entire body weight throughout the lengthening phase. Boasting a remarkable load-carrying capacity, these fixators empower patients to walk with full weight immediately post-operation. As the lengthening period concludes, the external fixator is expertly removed, seamlessly transferring the load-bearing responsibility to the intramedullary nail.
The intramedullary nail, characterized by its robust load-bearing capacity, ensures a smooth transition for patients to continue walking with their full body weight. Experience a revolutionary approach to limb lengthening, where each phase is carefully orchestrated to enhance mobility and foster a successful recovery journey.
Regular Surgeon Visit and Examination
It is very important to follow the patient closely during the extension period. Quality of the lengthening, check of callus(new bone) tissue, examination of pin and wire locations, examination of physical condition, examination of complications are necessary. Our surgeon closely monitors the condition of our patients on a weekly basis. He comes once a week or every other week to check the patients’ x-rays, complications and physical condition.
Fixator Removal Surgery
After reaching the targeted length, fixator removal surgery is performed. Bone length, osteotomy length, whole leg length and callus (new bone tissue) quality are checked by taking an x-ray of the entire leg before the removal surgery. If there is any leg length inequality, extra time is given to the patient for equalization. If the callus tissue is of sufficient quality, the date of surgery is confirmed. The surgery is performed under general anesthesia. The surgery takes about 2 hours. Sergery stages;
⦁ General anesthesia
⦁ Bone length and alignment check at all angles by operating room x-ray
⦁ Locking the distal end of the intramedullary nail to the bone
⦁ Removal and separation of external fixator pins and wires from the extremity
⦁ Muscle lengthening if necessary
⦁ All wounds are sutured and closed with dressing
The hospital stay after fixator removal surgery is usually 1 day. In the hospital, physical examination and gait control are controlled by our surgeon and his team. After the surgery, the final checks are made with xray and the patient is taken out of the hospital.
Consolidation Period in LON Method
The consolidation phase is the period of hardening and consolidation of the newly formed callus (new bone tissue). Patients who have lengthening with the LON method are advantageous in this phase. Since IM nails are quite durable, patients can be mobilized with a full weight bearing, but we recommend that the patient walk with a walker or crutches in the early period after fixator removal surgery until the patient regains sufficient range of motion, muscle strength and balance. As long as the safe extension limits are kept, the recovery rate of our LON patients is quite high. Depending on the rate of callus formation, the amount of lengthening and the healing capacity of the soft tissues, they can generally walk without support 1-2 months after the fixator is removed. After unassisted walking begins, other activities are quickly recovered and patients can return to their normal daily physical activities.
Intramedullary Nail Removal Surgery
After the bone healing is completed, that is, after the callus tissue is sufficiently dense and hardened in the consolidation phase, the bone becomes full weight-bearing and the intramedullary nail can be removed from the bone. The time required for the removal of the intramedullary nail usually takes 1.5 – 2 years. Surgery approval is given by our surgeon by evaluating the patient’s xray. Surgery stages:
⦁ General anesthesia
⦁ Incision to reach the intramedullary nail head
⦁ Reaching and connecting the intramedullary nail head with special apparatus
⦁ Removal of proximal and distal screws
⦁ Removal of the intramedullary nail
⦁ Closure of all incisions with aesthetic sutures
Postoperative hospital stay is usually 1 day. After the operation, the patient can walk with a full weight bearing. After the intramedullary nail is removed, the process is completed.
