Limb lengthening with external fixator is one of the most advanced medical techniques that has opened new horizons for the treatment of short stature and bone deformities, as this precise technique allows for a gradual and safe increase in bone length, with full control of the growth process and the possibility of adjusting the treatment as needed. With the high demand for limb lengthening surgeries, limb lengthening with external fixators has emerged as a preferred option due to its flexibility and effectiveness in achieving tangible results.
In this article, we will review the steps, advantages, risks, and how to care for the device to ensure a quick recovery and satisfactory results, with an emphasis on the importance of medical follow-up and physical therapy.
What is limb lengthening with external fixators?
Limb lengthening with external fixators is a medical procedure that uses metal devices attached to the bones of the arm, leg, or foot with pins or threaded wires that pass through the skin and muscles and are fixed into the bone. Most of the device remains outside the body, which is why it is called an external fixator. The number of stabilizers varies depending on the patient’s need; some cases require only one external fixator, while others require two or more.
Limb lengthening with external fixator is mainly used to gradually lengthen the bones in a safe and thoughtful manner, in addition to correcting bone deformities or reducing pressure on the joints by distributing the load evenly, making it an advanced medical technique that improves bone length and function, with careful follow-up throughout the treatment period to ensure optimal results.
How does the external stabilizer work?
The external stabilizer device is attached to the bone using pins or wires that pass through the skin and muscles to reach the bone directly. The majority of the device remains outside the body, allowing for manual control of the repositioning of the bone. This device provides precise control over the process of lengthening or stabilizing the bone, allowing for continuous adjustment of the treatment to follow the healing process and achieve optimal results.
Stages of the process from surgery to stabilization
While the concept of lengthening with an external fixator may seem obvious, limb lengthening surgery is a complex procedure that requires a skilled and experienced surgeon. The entire process can take several months and requires great commitment and physical therapy on the part of the patient, but the results can be truly life-changing! The external fixator lengthening procedure involves the following steps:
- General anesthesia: The patient undergoes full general anesthesia, allowing them to sleep through the procedure and remain pain-free and comfortable.
- Surgical stabilization: The external fixator is placed around the affected bone through minor surgery, where pins or wires are inserted through the skin to stabilize the bone.
- Bone fracture: The surgeon cuts the bone to create a small gap that allows the bone to heal and grow back.
- Progressive extension or stabilization: An external fixator can be adjusted daily to gradually widen the gap between the ends of the bone at a set rate (usually 1 mm per day), which stimulates the bone to form new tissue called callus. In cases of fixation only, the retainer keeps the bone in place without extension.
- New bone growth: New bone tissue begins to form in the gap, and the bone gradually stretches until it reaches the desired length.
- Stabilize the bone until it heals: After the extension is completed, the device remains immobilized to support the new bone until it has completely hardened.
This device provides precise control over the bone lengthening or stabilization process, allowing for continuous adjustment of the treatment to monitor healing and achieve optimal results.
Who is this technology for?
Limb lengthening with external fixators is particularly suitable for cases that need to increase bone length in a safe and controlled manner, including:
- Patients with complex bony deformities need gradual correction of length and shape.
- Cases where conventional treatment methods to lengthen bones or correct deformities have been unsuccessful.
- Children and adolescents who are still growing need careful treatment to avoid complications.
- People with short stature due to congenital causes, such as bone growth defects or limb length discrepancies.
- People with shortened leg bones due to previous injuries or diseases, such as osteoporosis or chronic infections.
- People who cannot undergo internal fixation due to certain medical conditions, such as infections or soft tissue issues.
Limb lengthening with external fixators provides precise control of bone growth with continuous medical monitoring, making it the perfect choice for those looking for effective and long-lasting results.
Average height gain after limb lengthening with external fixator
Patients undergoing limb lengthening with external fixator typically achieve an increase in bone length of 5 to 8 centimeters per lengthened bone, so when both the femur and tibia are lengthened, the total length increase can be about 13 centimeters, which equates to more than 5 inches. These results make limb lengthening with external fixators an effective option for those seeking a noticeable and natural increase in height.
How long is the recovery period and physical therapy after limb lengthening with external fixators?
The recovery period after limb lengthening with external fixators varies according to each patient’s case, but in general, the initial recovery period in the hospital takes only about three days. After discharge, the patient begins to gradually regain activity, with full recovery taking up to several months. During this period, physical therapy focuses on increasing muscle strength and improving motor functions, which helps to restore normal movement effectively and safely, so commitment to physical therapy sessions and regular follow-up with the doctor are the key to success in achieving satisfactory results after limb lengthening with external fixators.
Difference between external stabilizer and internal stabilizer
Both external and internal fixators use bone screws attached to plates or rods to prevent compression of the periosteum and improve blood supply to the bone, relying on secondary healing of the bone through bone callus formation, except in cases of simple non-displaced fractures that are fixed with compression plates, but each is characterized by the following:
- External stabilizer: It relies on rods and collars that are fixed outside the body, where pins or wires pass through the skin and bone to attach the bone to the device. The external fixator is characterized by its technical simplicity, high flexibility, and lower cost, making it a popular choice for emergency fixation, pediatric fractures, and cases of final bone fixation in some fractures, such as the distal radius.
- Internal fixator: This involves the subcutaneous placement of internal fixation plates, often locking plates used around joints, that are anatomically designed to precisely stabilize articular fractures. These plates support the joint and areas around the fracture using small-diameter fixed angle screws, and provide greater rigidity than external fixators due to their proximity to the bone surface.
| Internal stabilizer | External stabilizer | characteristic |
| An internal device or screw that is surgically implanted into the bone | An external fixation device that attaches to the bone from the outside via wires and screws | Installation method |
| Invisible, radiographs are needed to check the situation | Visible externally and easily customizable | Vision and inspection |
| Relatively shorter thanks to more stable internal stabilization | Often longer due to the need for external stabilization | Duration of treatment |
| Higher surgical risks, but fewer infections | Wiring site infections, discomfort from the external device | Common complications |
| Minimal impact, allowing for relatively normal movement | Limited by the large external device | Impact on daily mobility |
| Better in terms of looks and comfort | May cause psychological discomfort due to appearance | Psychological comfort |
| Highest cost due to technology and complex surgery | Less expensive compared to an internal stabilizer | Cost |
| Cases that require faster recovery and better appearance | Cases that need constant adjustment or patients on a tight budget | suitable for |
Daily care of the exoskeleton after bone lengthening surgery
Daily care of your external fixation device is crucial for successful limb lengthening and avoiding complications. Several key steps must be adhered to, including:
- Rotate the device’s supports according to a schedule set by the doctor or care team to stimulate the gradual extension of the bone, taking care to follow the instructions precisely to avoid any damage.
- Watch for pain and discomfort, as it is important to distinguish between normal stretching pain and any signs that indicate an issue that needs to be seen by a doctor.
- Clean the insertion sites of metal pins and wires daily using special disinfectants to prevent infections that can cause serious complications.
- Regularly check the skin around the stabilization sites for any signs of redness, swelling, or abnormal fluid production.
- Keep the device dry and clean, especially during bathing or daily activities, to minimize the risk of infection.
- Inform the medical team immediately if you notice any issues such as excessive swelling, severe pain, or discolored skin.
Careful adherence to daily care of the external fixation device goes a long way in speeding up healing, minimizing risks, and ensuring optimal lengthening success.
The main complications of limb lengthening with external fixators
Although limb lengthening with external fixator is one of the most effective procedures for correcting short stature and achieving accurate results, there are a range of potential complications that may arise during treatment, so understanding these risks in advance is essential to make an informed decision and ensure safe and effective results. Common complications of limb lengthening with external fixator include the following:
- Osteomyelitis is a serious complication that requires immediate medical treatment
- Injury to the nerves or blood vessels surrounding the pin site can lead to chronic pain or sensory impairment
- Compartment Syndrome is an emergency condition that requires immediate surgical intervention
- Malunion or non-union of the bone is a major cause of delayed recovery or failure of the operation
- Failure or loosening of the frame or wires, which may affect the accuracy of the fixation and the stability of the bone
- A new fracture around the stabilization site due to bone weakness or excessive weight bearing
- Pin site inflammation as a result of not regularly cleaning the surrounding skin
- Soft tissue perforation due to compression or inaccurate stabilization
Comparison of cosmetic and functional outcomes after limb lengthening with external fixator surgery
Limb lengthening with external fixator surgery is a complex technique that aims to increase bone length while preserving the motor function of the affected limb, but the cosmetic and functional results may vary in importance and impact:
Cosmetic results
- Increase bone length and improve skeletal symmetry: Significant increases in limb length can be achieved, resulting in improved longitudinal symmetry between limbs.
- Scars and staple marks: Fixing an external device requires the insertion of pins and wires through the skin and bone, leaving visible scars that can be cosmetically unpleasant.
- Soft tissue changes: Hardening or fibrosis of the surrounding skin and muscles may occur due to the prolonged presence of the device, which may affect the appearance of the limb and lead to mild asymmetry.
Functional results
- Strengthening muscles and motor function: The lengthening and immobilization period causes a relative loss of muscle strength due to lack of movement, requiring intensive rehabilitation to restore strength and motor function.
- Restoring joint mobility: The success of regaining mobility depends on the type and length of immobilization, as well as intensive physical therapy to prevent joint stiffness.
- Nerve and vessel complications: Possible injury to surrounding nerves or blood vessels during staple placement, which may affect sensitivity and muscle strength.
- Ability to perform daily activities: The ultimate goal is to regain the ability to walk, bear weight, and return to normal activities without pain or functional impairment.
While cosmetic outcomes focus on achieving a symmetrical limb appearance and appropriate length, functional outcomes are governed by the limb’s natural mobility, muscular strength, and ability to perform daily activities without restrictions, so balancing the two in limb lengthening with external fixator surgery requires careful planning, meticulous surgery, and intensive follow-up treatment.
Impact of the device on the patient’s daily life
The use of an external fixation device in cases of lengthening with an external fixator has several effects on the patient’s daily life, which can be summarized as follows:
- Hygiene and care requirements: The sites where the wires penetrate the skin must be carefully cared for to avoid infections, which can lead to serious complications such as osteomyelitis, so medical sources recommend following strict cleaning protocols.
- Appearance: The device is clearly visible, which may cause psychological embarrassment or social discomfort in some patients. Medical studies indicate that this issue may affect the patient’s psychological quality of life.
- Restriction of movement: The presence of pins and wires outside the body limits the natural freedom of movement and affects the patient’s daily activities, such as dressing, sleeping, and walking, which require lifestyle modifications.
- Psychosocial limitations: In addition to the physical impact, patients may experience anxiety and depression as a result of appearance changes and prolonged dependence on the device.
- Pain and discomfort: External fixation is often accompanied by pain and discomfort, especially at the beginning of treatment, and may affect rest and sleep.
Top tips to speed healing and minimize pain after lengthening with an external fixator
To ensure proper healing and achieve the best possible results from external fixator lengthening, it is important to follow the following steps carefully:
- Regularly practicing physical therapy exercises at home, and not neglecting to attend physical therapy sessions, as they are an essential part of restoring strength and muscle function
- Eat a healthy, balanced diet rich in vegetables, fruits, proteins, and whole grains; these elements support bone growth and facilitate recovery
- Avoid practicing any sports activity in excess of your doctor’s recommendations, as excessive stress can cause injuries or significantly delay bone healing
- Commit to regular visits to the doctor for imaging tests and to monitor the progress of bone healing during the lengthening stages
Adhering to these guidelines not only minimizes the chances of complications but also greatly enhances the long-term success of limb lengthening with external fixator.
Cost of limb lengthening with external fixator surgery
The cost of external stabilizer lengthening in Turkey usually ranges between 25,000 and 65,000 Euros, which is much lower compared to European countries or the United States, where the cost of the procedure may exceed 100,000 euros. The cost of external stabilizer lengthening is influenced by several key factors:
- Hospital and equipment: The price of the procedure varies according to the quality of the hospital and the techniques used. Modern hospitals with state-of-the-art equipment and advanced rehabilitation centers increase the cost of lengthening.
- Experience of the surgeon: The experience and reputation of the orthopedic surgeon who specializes in external fixator lengthening have a direct impact on the price and quality of the results.
- The type of technique used: Lengthening techniques and prices vary depending on the method of lengthening, such as LON or PRECICE.
- Post-operative care: Recovery includes physical therapy sessions and regular medical follow-ups, which are an important part of the cost of external fixator lengthening to ensure the success of the procedure and achieve the best results.
In conclusion, limb lengthening with external fixator is an advanced and effective medical option for those looking to increase bone length in a precise and safe manner. Despite its challenges and potential risks, limb lengthening with external fixator provides precise control and gradual bone growth with continuous medical follow-up to ensure the best results, and adherence to daily care, physical therapy, and regular follow-up are keys to success, speeding up recovery and minimizing complications. If you are considering lengthening your height, choosing limb lengthening with external fixator under a specialized and experienced medical team is the first step toward achieving your goal confidently and safely.
Sources:
- Limb Lengthening and Reconstruction Society. (n.d.). External fixators. Retrieved May 24, 2025, from
- Paley Institute. (n.d.). Limb lengthening. Retrieved May 24, 2025, from
