Lengthening Over Nail (LON) Technique for Limb Lengthening

The Lengthening Over Nail (LON) technique is a widely recognized surgical method for limb lengthening in Turkey , particularly for individuals seeking height increase or correction of limb discrepancies. This method combines both external and internal fixation techniques, offering the benefits of each. The LON technique involves the gradual lengthening of bones, typically in the legs, using an external fixator followed by the insertion of an internal nail to provide long-term support. 

How Does the Lengthening Over Nail (LON) Technique Work?

The Lengthening Over Nail (LON) technique is a structured, multi-phase process that involves precise surgical and postoperative management. The procedure combines the use of an external fixator and an internal nail, ensuring controlled and safe bone lengthening while maintaining stability. Below is a detailed explanation of how the LON method limb lengthening process works:

Step 1: Before LON Technique Planning

The first phase of the LON limb lengthening process involves meticulous planning to determine the best approach for the individual patient:

Advanced imaging techniques, such as X-rays, CT scans, and MRI, are used to assess the patient’s bone structure and determine the optimal nail length for the procedure. These images help in identifying any deformities or challenges that may arise during surgery.

The surgeon discusses the entire process with the patient, explaining the risks, benefits, and expectations associated with the lengthening over nail technique. This consultation ensures that the patient is well-prepared and understands the steps involved in the procedure.

Choosing the correct nail length is crucial. The surgeon carefully selects the appropriate nail size based on the patient’s bone length and the amount of lengthening required. The nail must be strong enough to support the bone as it lengthens and heals.

Step 2: Application of the External Fixator

The next stage of the LON technique involves the surgical application of an external fixator, which stabilizes the bone and allows for controlled lengthening.

Placement of the Fixator: Under anesthesia, the surgeon places the external fixator around the limb. The fixator is attached using pins or wires that are inserted through the bone to provide stability. This device allows for the gradual adjustment of bone length over time.

Osteotomy (Bone Cutting): An osteotomy is performed at the pre-determined site on the bone. This controlled surgical cut enables the separation of the bone segments, allowing them to be gradually pulled apart during the distraction phase. The precision of the osteotomy is critical to minimizing risks and ensuring successful bone regeneration.

Step 3: Distraction Phase

The distraction phase is the most crucial part of the lengthening over nail technique, as it involves the gradual lengthening of the bone segments:

The surgeon or patient adjusts the external fixator daily, typically lengthening the bone at a rate of 1 mm per day. This controlled distraction stimulates the formation of new bone tissue in the gap created by the osteotomy.

The surgeon monitors the progress of the LON limb lengthening process using X-rays and clinical evaluations. Regular follow-ups are essential to ensure the bone grows at a consistent rate and remains properly aligned. Adjustments to the fixator or nail lengths may be necessary to achieve the best outcome.

Step 4: Insertion of the Internal Nail

Once the desired bone length is achieved, the external fixator is removed, and an internal nail is inserted to provide stability during the healing process:

Internal Nail Insertion: The surgeon carefully inserts the internal nail into the bone, ensuring it is the correct length and size to support the newly lengthened bone segments. The nail length must be appropriate to provide long-term stability, as the bone continues to consolidate and heal.

Removal of the External Fixator: The external fixator is then removed, significantly reducing discomfort for the patient. The internal nail remains in place, providing the necessary structural support as the bone hardens and strengthens over time. This transition is a key advantage of the LON method limb lengthening, as it allows for improved patient mobility and comfort.

Step 5: Consolidation Phase

The final phase of the lengthening over nail technique is the consolidation phase, where the newly formed bone tissue hardens and strengthens:

Bone Maturation: During this phase, the new bone tissue begins to calcify and solidify. The internal nail supports the bone, ensuring that it remains aligned and stable as it hardens.

Physical Therapy and Rehabilitation: Physical therapy is crucial to help the patient regain mobility, flexibility, and muscle strength. Since the external fixator is removed, patients can engage in more extensive exercises to promote faster recovery and prevent joint stiffness.

Applications of the Lengthening Over Nail (LON) Technique

The Lengthening Over Nail (LON) technique is a versatile approach in orthopedic surgery, making it an effective solution for various bone lengthening and correction needs. It is particularly beneficial for addressing limb discrepancies, enhancing height, correcting deformities, and restoring limb length post-trauma. The adaptability of the LON technique, combined with the precise use of different nail lengths, allows for tailored treatment plans that meet the unique requirements of each patient. Below are the most common applications of the LON technique:

Limb Length Discrepancy Correction

The correction of limb length discrepancies is one of the primary uses of the LON technique. Limb length discrepancies can arise from several causes, including congenital conditions (such as growth plate disturbances), diseases (like bone infections), or trauma (fractures or injuries). These discrepancies may significantly impact mobility, posture, and the overall quality of life for affected individuals.

The LON method limb lengthening gradually addresses these discrepancies by equalizing the length of the limbs. The surgeon starts with the external fixator, which is used to carefully distract the bone segments while monitoring progress. Once the desired length is achieved, an internal nail of appropriate nail length is inserted to stabilize the bone during the consolidation phase. This method ensures that the patient achieves balanced limb lengths, improving mobility, reducing pain or discomfort from imbalances, and enhancing daily functionality.

Cosmetic Height Increase

The lengthening over nail technique is also widely utilized for cosmetic height increase, a procedure sought by individuals desiring an increase in stature. Height increase through the LON method is performed by lengthening the bones of the legs—typically the femur or tibia—using an external fixator followed by an internal nail.

The LON technique offers a reliable and safe approach for patients looking to achieve height enhancement. By gradually lengthening the bones, patients can reach their desired height while minimizing risks and complications. The ability to use different nail lengths is crucial in this application, as the internal nail must be carefully selected to match the newly lengthened bone segments. This careful planning ensures that the internal nail provides adequate support and stability, allowing for a safe and controlled recovery. Patients opting for this procedure typically undergo comprehensive planning and consultation to determine the achievable height increase and the ideal nail length for their specific case.

Bone Deformity Correction

Another significant application of the LON technique is the correction of bone deformities, such as angular misalignments like bow legs (genu varum) or knock knees (genu valgum). These deformities may result from developmental abnormalities, genetic factors, or trauma, and they can affect both appearance and function.

The LON technique allows surgeons to gradually adjust and correct these deformities. By using the external fixator to control the angle and alignment of the bone segments during the distraction phase, surgeons can ensure that the bones grow into the correct alignment. After the initial correction, an internal nail of suitable nail length is inserted to maintain the new alignment during the consolidation phase. 

The nail lengths used are tailored to the patient’s specific needs, ensuring that the internal support structure remains stable and effective as the bone heals. The flexibility of the LON method limb lengthening enables precise adjustments, making it an effective solution for correcting various deformities and enhancing both the appearance and functionality of the limb.

Post-Traumatic Limb Lengthening

In instances where a patient has experienced bone loss or shortening due to trauma—such as fractures, accidents, or surgical interventions—the LON limb lengthening technique is a valuable tool for restoring the limb to its original length. Traumatic injuries often lead to bone shortening, resulting in functional limitations, gait abnormalities, and pain. The LON technique is particularly beneficial for these cases, as it allows for gradual bone regeneration while providing stability and alignment.

During the procedure, the surgeon uses the external fixator to gradually lengthen the bone, encouraging new bone growth at the osteotomy site. Once the desired length is achieved, an internal nail is inserted to stabilize the newly formed bone. The selection of the appropriate nail length is crucial in this phase, as it must align with the patient’s anatomy and the amount of bone that has been regenerated. 

The internal nail supports the bone as it consolidates, ensuring that the limb regains its full functionality and strength. The LON method offers a reliable solution for patients recovering from trauma, helping them regain their mobility and return to daily activities with improved limb strength and length.

Advantages of the Lengthening Over Nail (LON) Technique

The Lengthening Over Nail (LON) technique offers several advantages that make it a preferred method for limb lengthening and correction. These benefits include:

Reduced Duration of External Fixator Use

One of the primary advantages of the LON technique is the reduced time patients spend with an external fixator. By transitioning to an internal nail after the initial lengthening phase, the duration of discomfort associated with external devices is minimized. This approach significantly reduces the risk of pin-site infections and improves patient comfort.

Enhanced Stability and Safety

The use of an internal nail in the LON limb lengthening procedure enhances the stability and safety of the bone during the healing process. The internal nail provides structural support, maintaining bone alignment and reducing the risk of fractures, especially during the consolidation phase. This added stability is a crucial benefit of the lengthening over nail technique.

Improved Mobility During Recovery

With the external fixator removed earlier in the treatment process, patients experience greater mobility during the recovery phase. The internal nail provides support while allowing the patient to engage in physical therapy and rehabilitation exercises more comfortably. This improved mobility helps speed up recovery and enhances overall outcomes.

Customizable and Versatile Approach

The LON method limb lengthening is highly customizable, allowing surgeons to adjust both the external fixator and the internal nail to suit the patient’s specific needs. This versatility makes the LON technique suitable for various applications, including height increase, limb discrepancy correction, and bone deformity treatment. The ability to select appropriate nail lengths ensures that each procedure is tailored for optimal results.

Is the LON Technique the Right Choice for You?

The Lengthening Over Nail (LON) technique is a reliable and effective method for limb lengthening and correction, but it may not be suitable for everyone. Deciding if it’s the right choice depends on several factors:

The patient’s age and overall health are important considerations when deciding on the LON technique. Younger patients with good bone regeneration capacity generally have better outcomes, but the procedure can also be adapted for older individuals if they are in good health and have strong bone density.

Whether the patient seeks height increase, correction of limb discrepancies, or deformity treatment, the lengthening over nail technique can be an effective option. However, it is essential to consult with an experienced orthopedic surgeon who specializes in LON limb lengthening. The surgeon will evaluate the patient’s condition, conduct imaging tests, and provide a personalized treatment plan.

LON Technique in Turkey

The Lengthening Over Nail (LON) technique is an advanced and effective approach to limb lengthening, combining the benefits of external and internal fixation methods. It offers increased stability, shorter external fixator duration, and improved mobility, making it a preferred option for individuals seeking height increase or limb correction. While the LON technique carries some risks, proper planning, with Healthy Türkiye, skilled surgical execution, and dedicated postoperative care help maximize the chances of a successful and safe outcome.