Limb Lengthening
Understanding Limb Lengthening Surgery: A Comprehensive Guide
Limb lengthening surgery is designed to increase the length of bones in the arms or legs. This intricate process, known as osteotomy, involves the careful separation of the bone and a gradual process known as distraction, where the bone segments are slowly pulled apart. This creates a space—the osteotomy gap—where new bone tissue begins to form. Over time, as the bone segments continue to separate at a controlled pace, new bone regenerates, culminating in an increase in bone length.
This remarkable procedure leverages the body’s innate ability to generate new bone, along with the regeneration of surrounding soft tissues, ligaments, fascia, blood vessels, and nerves, ensuring a comprehensive enhancement of the limb’s length and function. At the core of limb lengthening is the principle of distraction osteogenesis, a technique that has transformed the possibilities for individuals seeking femur lengthening, tibia lengthening surgery, or an overall height increase through surgery.
Whether you’re considering leg lengthening surgery for cosmetic reasons, such as height increase surgery, or to correct discrepancies in limb length, our facility in Turkey stands at the forefront of this advanced medical practice. Our experienced surgeons utilize state-of-the-art technology and techniques to ensure optimal results for each patient, making limb lengthening surgery in Turkey a sought-after solution for those looking to enhance their stature or improve their quality of life.
How Does Limb Lengthening Work ?
Limb lengthening and deformity correction operate on the principle of distraction osteogenesis. When a bone fractures, the body naturally initiates the regeneration of new bone tissue to heal and restore integrity. In limb lengthening, a deliberate surgical osteotomy (bone cut) is performed, creating two segments that are slowly distracted using orthopedic devices.
The comprehensive process unfolds in three stages:
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Osteotomy: Surgically cutting the bone into two segments.
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Distraction: Controlled separation of bone segments using internal nails or external fixators.
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Consolidation: New bone tissue gradually fills the gap, leading to mineralization and hardening.
Bone segments can be lengthened approximately 10-15% of their original length, with an average rate of one millimeter per day. The lengthening phase is succeeded by consolidation, during which new bone solidifies. Throughout this process, soft tissues—including nerves, muscles, vessels, and skin—stretch and adapt to accommodate the limb lengthening, contributing to a comprehensive and successful outcome.
Limb Lengthening Surgery
During surgery, the surgeon will perform an osteotomy, a procedure where the bone is cut to create two separate segments. Along with the osteotomy, an orthopedic lengthening device will be applied to the bone. These devices can be either internal or external.
Internal devices, such as the PRECICE nail, are inserted into the bone. External fixators, such as the monorail fixator or the Circular (Ilizarov) frame fixator, remain outside the body.
The internal method surgery involves the insertion of an intramedullary nail, performing the osteotomy, and fixing the nail in place. The Lengthening Over Nail (LON) method combines the insertion of the intramedullary nail, performing the osteotomy, and attaching an external fixator. Both surgical methods require minimal incisions.
Limb Lengthening Surgery Methods
Cosmetic limb lengthening uses three main techniques: the internal method (Precice 2), the external method and the combined method (LON).
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Internal (PRECICE) Method: This technique involves inserting specialized intramedullary nails into the bone. These nails are designed to gradually extend, allowing the bone to lengthen over time. The process is controlled by a magnetic external remote controller. Since all components are internal, there are no visible devices on the outside, making it a more discreet and comfortable option.
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External Method: This technique only uses an external fixator, a device attached to the outside of the bone and extremity. Since the external method does not have an intramedullary nail, it can lead to alignment problems, lack of stabilization, and the fixator needs to remain on the leg for a very long time until the bone heals. Due to these issues, the external method is no longer used for cosmetic lengthening. External method is preferred in more severe deformities.
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Combined (LON) Method: This approach uses both an internal nail and an external fixator. The internal nail goes inside the bone, while the external fixator is attached to the outside of the bone. This combination allows for better control of the lengthening process, offering the benefits of internal stabilization with the added control of external adjustment. The external fixator is typically removed once the desired length is achieved, and the internal nail remains to support the bone as it heals.
LON with Monorail
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Type : External + Internal (Combined)
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Bone: Femur
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Weightbearing: Full
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Lengthening Capacity: More than 8 cm
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Fixator: Monorail
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IM Nail: Solid Titanium Nail
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Dailiy Lengthening: Manual
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Advantages: Price, Full Weightbearing
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Disadvantages: Less Comfort, Infection, Scars
PRECICE 2
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Type : Internal
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Bone: Femur and Tibia
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Weightbearing: Partial
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Lengthening Capacity: 8 cm
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Fixator: None
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IM Nail: PRECICE 2 Titanium Nail
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Dailiy Lengthening: External Remote Controller
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Advantages: Less Scars, Patient Comfort, Less Infection Risk
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Disadvantages: Partial Weight Bearing, Price
LON with Ilizarov Frame
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Type : External + Internal (Combined)
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Bone: Tibia
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Weightbearing: Full
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Lengthening Capacity: More than 8 cm
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Fixator: Ilizarov Frame
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IM Nail: Solid Titanium Nail
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Dailiy Lengthening: Manual
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Advantages: Price, Full Weightbearing
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Disadvantages: Less Comfort, Infection, Scars
PRECICE MAX
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Type : Internal
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Bone: Femur and Tibia
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Weightbearing: Full
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Lengthening Capacity: 8 cm
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Fixator: None
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IM Nail: PRECICE MAX Titanium Nail
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Dailiy Lengthening: External Remote Controller
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Advantages: Full Weightbearing, Less Scars, Patient Comfort, Less Infection Risk
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Disadvantages: Price
Limb Lengthening Periods
Latency (Hospitalization) Period
The period spent under observation in the hospital between the operation and the start of the lengthening is called the latency period. During the latency period, callus (new bone tissue) is expected to begin to form between the osteotomy bone ends and no lengthening is performed. After the new bone tissue begins to form at a sufficient level, lengthening is initiated. The latency period usually takes 5-10 days.
Distraction (Lengthening) Period
It is the period from the start of the lengthening process until the targeted length is reached and the lengthening is completed. The patient adjusts the orthopedic device so that it slowly pulls apart the two bone segments. This gradual process of slowly separating the two bone segments is called distraction, which means “pulling apart.” As the two bone segments are slowly pulled apart, new bone forms in the space between them. Usually the lengthening rate is 1 millimeter per day.
Consolidation (Healing) Period
The distraction phase is followed by the consolidation phase, where the regenerate bone slowly hardens. The new bone will not be “healed” until the regenerate bone has hardened and calcified. During consolidation period, the new bone tissue, which gains sufficient hardness and durability, begins to carry a load. After the regenerate bone has fully consolidated, intramedullary nail can be removed.
Which bones I can lengthen to increase my height?
Femur Lengthening
Lengthening surgery can be applied to the thigh(femur) bone. Internal and combined techniques can be applied. The fixator suitable for the femur bone in the LON method is the Monorail fixator. The rate of bone union is faster than the tibia. The lengthening rate for the femur is usually 1 millimeter per day. The safety limit for femur is 8 centimeters.
Tibia Lengthening
Lengthening surgery can be applied to the shin(tibia) bone. Internal and combined techniques can be applied. The fixator suitable for the tibia bone in the LON method is the Circular (ilizarov) frame fixator. Along with the tibia, the fibula is also extended. The lengthening rate for the tibia is usually 0.75 millimeter per day.The safety limit for tibia is 6 centimeters.
Safe Limits In Limb Lengthening
How much taller can I get ?
After limb lengthening surgery, the body undergoes a gradual process, lengthening bones at an average rate of 1 millimeter per day. It’s vital to recognize that, while bones have remarkable healing capacity, the surrounding soft tissues—muscles, nerves, tendons, and fascia—need to adapt at the same rate. The body’s ability to form new bone tissue is high, but there are limits to how much soft tissues can safely stretch without damage.
Extensive studies over many years have established safe limits for limb lengthening, averaging 8 cm for the femur (thigh) and 6 cm for the tibia (shin). However, it’s crucial to understand that these are general guidelines, with individual variations. The key lies in ongoing clinical evaluations during the lengthening process.
Exceeding these safe limits poses risks and can lead to permanent physical damage. At our center, we prioritize patient safety, committing to health over mere centimeters. With a steadfast commitment to ‘Safety First,’ we ensure a responsible and secure approach to every limb lengthening procedure.
Lengthening Process in Limb Lengthening
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. The lengthening rotation is quite and simple and patients can easily do it themselves. Lengthening is stopped when the target length is reached.
PRECICE Method
In the Precice system, the lengthening is performed with the external remote control (ERC) system. ERC device is placed in a certain marked area of ​​the patients leg and lengthening is done with a single button, and it is very easy and comfortable for the patient. The PRECICE has excellent rate control and patients report minimal pain associated with lengthening. Generally, lengthening is done 3 times or 4 times a day, and generally 1 mm lengthening is achieved per day.
Limb Lengthening Physical Therapy
Physical therapy is one of the most important components of limb lengthening. Limb lengthening is a difficult and long process. It includes many complications. Physical therapy ensures that these complications are minimized. The aim of treatment is to maintain and increase range of motion, strengthen muscles, prevent contractures, and increase functionality.
After the lengthening process begins, the soft tissues around the bone, which grows 1mm per day, should grow at the same rate. However, these tissues cannot stretch at this rate. This situation causes the most important complications of lengthening surgery. Stretching occurs in these tissues, especially in the muscle and nerve tissue. Tension increasing in the nerve tissue can cause pain, loss of sensation and loss of movement. The tension in the muscle tissue causes restriction of joint movement and loss of muscle strength. The physical therapy process is very important to avoid such complications.
As AFA, we offer the world’s most intensive and effective limb lengthening physiotherapy to our patients. Each of our physiotherapists specializes in limb lengthening. Our patients complete the extension process without any problem by taking intensive physical therapy 5 days a week without leaving their comfort zone.
Walking After Limb Lengthening Surgery
LON Method
LON Method
Weight Bearing Protocol
Distraction Period: External fixators carry the entire body weight during the lengthening period. The load carrying capacity of external fixators is very high. LON method patients can walk with a full weight bearing, but walking with a walker is recommended during this period due to loss of balance. Consolidation Period: Since the IM nail has a high load-bearing capacity, the patient can walk with a full weight bearing, but it is recommended to use a walker or crutch until the callus tissue reaches sufficient hardness (1-2 months).
PRECICE Method
PRECICE Method
Weight Bearing Protocol
Distraction Period: Precice 2 method patients can walk with partial weight bearing with an assistive device, while PRECICE MAX method patients can walk full weight bearing. However, it is recommended that every patient use a walker or crutches during the lengthening period due to loss of balance.
Consolidation Period: In the consolidation phase, patients with the Precice 2 method should walk with partial weight bearing for a while and use a walker. PRECICE MAX method patients can continue walking with full weight bearing.
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