The LON (Lengthening Over Nails) technique is one of the most prominent modern techniques in bone lengthening surgery, combining internal fixation with an intramedullary nail and external fixation to achieve gradual and safe bone lengthening. This technique has improved the outcomes of limb lengthening procedures by reducing the duration of external device use and accelerating recovery compared to traditional methods.
With advances in orthopedic surgery, the LON technique has become a popular option for patients with limb-length discrepancy or those seeking to increase their height for medical or cosmetic reasons. This procedure relies on the body’s natural ability to form new bone during lengthening, allowing for a gradual and controlled increase of up to several centimeters, while maintaining bone stability and function throughout the treatment period.
What is the LON technique for bone lengthening?
The LON (Lengthening Over Nails) technique is a modern surgical method used in bone lengthening. It involves combining an intramedullary nail with an external fixator to achieve gradual and safe bone lengthening. This method aims to stimulate the gradual, controlled growth of new bone at the osteotomy site, thereby increasing the length of the affected limb while maintaining bone stability during treatment.
This technique is considered an integrated approach that combines the benefits of both internal and external fixation, setting it apart from some other traditional techniques, such as the Ilizarov method, which relies entirely on external fixators, as well as modern internal lengthening techniques such as PRECICE, which uses expandable intramedullary nails without the need for external devices. Choosing the appropriate technique is a medical decision that depends on the patient’s condition, the treatment goal, and the complexity of the required lengthening.
In what situations can LON technology be used?
The LON technique is used for bone lengthening in a range of medical and cosmetic conditions that require limb lengthening or the correction of certain skeletal deformities, It is selected following a careful assessment of the patient’s condition and its suitability compared to other treatment options, such as the Ilizarov method or modern internal fixation techniques, and includes:
- Congenital bone deformities: Used in cases of limb length discrepancy present at birth or structural deformities that affect motor coordination.
- Leg-length discrepancy: This is an effective option when there is a noticeable difference in leg length that affects walking and balance.
- Genetic short stature: This condition is sometimes treated for cosmetic or psychological reasons related to short stature.
- Consequences of injuries or accidents: Used to compensate for a loss of limb length resulting from complex fractures or severe injuries.
- Bone reconstruction procedures: These are used in certain bone repair procedures following surgery, infections, or acquired deformities.
Steps for the LON procedure for bone lengthening
The LON bone lengthening procedure is performed according to a precise surgical plan that involves several sequential stages designed to achieve safe and controlled lengthening while maintaining bone stability throughout the treatment period. These stages include:
- Phase 1 (Surgery): The procedure is performed under general anesthesia, during which the surgeon makes a precise incision in the bone—either in the femur or tibia—and then inserts an intramedullary nail to stabilize the bone from the inside, while also applying an external fixator to control the lengthening process.
- Phase 2 (Start of Lengthening): The lengthening process begins several days after surgery, during which the external fixator is gradually adjusted at approximately 1 mm per day, divided into several increments throughout the day, allowing new bone to form gradually at the site of the cut.
- Phase 3 (Stretching and Follow-up Period): The patient continues daily stretching exercises and attends regular physical therapy sessions to maintain muscle and joint flexibility, under close medical supervision to ensure proper bone growth.
- Stage 4 (Removal of the External Fixator): Once the desired length is achieved, the external fixator is removed in a simple surgical procedure, while the internal screw remains in the bone to support the ossification phase and final recovery until the bone has fully healed.
How much can height be increased using LON technology?
The amount of height gain achieved with LON (Long Bone Lengthening) technology depends on several factors, including bone condition, the patient’s age, and tissue elasticity. However, there are general medical guidelines that must be followed to ensure safety and the quality of results, which are as follows:
- In the femur, A length increase of approximately 8 to 10 cm can be achieved in suitable cases, depending on the body’s response to the lengthening procedure.
- In the tibia, a lengthening of 6 to 7 cm can be achieved safely and naturally over the course of treatment.
- In certain cases, Greater improvement can be achieved through a two-phase treatment plan, but this depends on a thorough medical evaluation and the patient’s ability to tolerate the stretching and rehabilitation phases.
Tips for After LON Surgery for Bone Lengthening
The post-operative phase following LON bone lengthening is one of the most critical stages for treatment success, as outcomes depend heavily on the patient’s adherence to medical instructions and daily care during the lengthening and recovery periods. It includes:
- Keep the external fixation sites clean: Clean the areas where the pins are inserted daily to reduce the risk of infection and inflammation.
- Sticking to physical therapy sessions: Physical therapy helps maintain muscle and joint flexibility and reduces stiffness during recovery.
- Follow the stretching instructions carefully: adhere to the regimen prescribed by your doctor without increasing or decreasing its frequency.
- Avoid putting excessive pressure on the limb: Although you can walk with assistance, you should avoid overexertion or sudden movements that could affect the bone’s stability.
- Proper nutrition: It is recommended to eat a diet rich in protein, calcium, and vitamins to support new bone formation and speed up healing.
- Regular medical follow-up: Regular visits to the doctor are essential to monitor the progress of the lengthening process and ensure that no complications arise.
Advantages of the LON Technique for Bone Lengthening
The LON bone lengthening technique is considered one of the most common methods in limb lengthening due to the balance it offers among safety, effectiveness, and cost compared with other techniques, such as the Ilizarov method or fully internal systems. It includes:
- Shorter duration of external fixator use: The external fixator is removed sooner than with traditional methods, thereby reducing the patient’s daily discomfort.
- Early weight-bearing and walking: This technology allows patients to walk with assistance during the lengthening phase, thereby improving blood circulation and accelerating recovery.
- Safe height increase: Enables a gradual height increase with precise control over the lengthening process to minimize risk.
- Stable and effective results: The intramedullary nail helps to securely stabilize the bone, promoting long-term stability.
- Lower cost compared to some modern technologies: It is a relatively economical option compared to fully internal lengthening systems such as PRECICE.
- Improving psychological well-being: The ability to move around during treatment and reduced duration of complete immobilization positively impact the patient’s psychological state.
Risks and Complications of the LON Technique for Bone Lengthening
Although the LON technique for bone lengthening is considered effective and relatively safe when performed correctly, as with any complex surgical procedure, it may be associated with risks and complications that must be taken into account. These include:
- Inflammation at the pin sites: Inflammation may occur at the sites where the external fixator penetrates the skin; these sites require daily care and close medical monitoring to prevent worsening.
- Pain and Discomfort: During the stretching phase, the patient may experience varying degrees of pain or muscle tightness due to tissue stretching.
- Joint stiffness: Limited mobility may occur in adjacent joints, such as the knee or ankle, if physical therapy is not followed regularly.
- Delayed bone healing: In some cases, new bone formation may be slower than expected, requiring a longer treatment period.
- Problems with bone alignment: Minor deviations in the bone axis may occur if the lengthening process is not closely monitored.
- Skin scarring: External fixators may leave marks or scars on the skin, which vary with skin type and treatment duration.
- Rare complications, such as nerve or blood vessel injury, are rare occurrences and decrease significantly with extensive surgical experience.
The Cost of the LON Technique for Bone Lengthening
Prices for LON surgery vary across European countries and Turkey, with Turkey offering the best value and high-quality care at specialized centers. Prices are approximately as follows:
| The State | Cost in U.S. dollars |
|---|---|
| Turkey | 18,000–30,000 |
| Germany | 70,000–90,000 |
| France | 60,000–85,000 |
| United Kingdom | 75,000 – 10,000 |
| Spain | 55,000 – 7,000 |
Why is Turkey a top choice for LON bone lengthening technology?
Turkey is one of the leading medical destinations for bone lengthening using the LON technique, thanks to the combination of high medical expertise, affordable costs, and modern technologies used in specialized centers, including:
- Offers advanced surgical expertise: Turkey is home to a select group of orthopedic surgeons with extensive experience in limb-lengthening procedures using the latest global techniques.
- Lower costs than European countries: Turkey offers nearly the same level of medical care at significantly lower costs, making it a preferred, cost-effective option.
- Hospitals equipped with state-of-the-art technology: Medical centers rely on advanced equipment and precise monitoring systems to ensure successful procedures and minimize complications.
- Comprehensive medical care: This includes pre- and post-operative follow-up, as well as physical therapy and rehabilitation programs designed to speed up recovery.
- Relatively high success rates: Orthopedic centers in Turkey achieve strong outcomes thanks to their expertise and adherence to modern medical protocols.
- Accessibility and Medical Services for International Patients: Turkey offers comprehensive services for patients coming from abroad, including translation, accommodation, and medical transportation.
The LON technique for bone lengthening is a modern technology that has significantly advanced limb lengthening surgery, combining effectiveness and precision with the ability to achieve a gradual and safe increase in bone length. This method has improved treatment outcomes compared with traditional methods by reducing the duration of external fixator use and providing greater stability during lengthening.
Ultimately, the success of this technique depends primarily on selecting the appropriate case, surgical expertise, and strict adherence to a physical therapy program and medical follow-up. Therefore, the specialist’s medical decision remains the most important factor in ensuring the best possible outcomes safely and effectively, while balancing treatment goals with the patient’s quality of life.
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- Hasler, C. C., & Krieg, A. H. (2012). Current concepts of leg lengthening. Journal of Children’s Orthopaedics, 6(2), 89–104.
