Personalised Treatment Method Should Be Chosen During Lengthening

Different methods can be used for lengthening surgery, depending on the patient’s condition. Each method has its own advantages and disadvantages. Here, it is important to develop a patient-specific approach. Technique to be used in lengthening surgery; It is determined according to the factors that cause short stature, patient history, economic and psychological factors. The most advantageous method is the method recommended by the doctor according to the patient’s bone structure and health status. Today, mostly combined (LON) and Precice 2 methods are used for lengthening.

What is the Combined Method (LON)?

 In the combined lengthening technique (LON: Lengthening Over Nails), the device is placed both inside the bone and outside the leg, and lengthening is performed for an average of 2-3 months. After three months, the part outside the leg is removed. The intramedullary nail in the bone can be removed with an additional operation, if desired, after the bone has fully fused. While an average lengthening of 6-7 centimeters is achieved in a single session, an extension of approximately 10-13 centimeters can be achieved by applying the method to both the lower and upper legs.

In the combined (LON) method, a closed nail and a fixator system that provides extension from the outside are applied together in bone and lengthening surgery. Thanks to the nails placed in the space inside the bone, it is aimed to save it earlier from the fixators placed from the outside. Since the extension specialist is ensured to remain stable, it is provided to lengthen more anatomically. While the most important advantage of the method is that it is more cost-effective, it is preferred because it is widely used and allows the patient to carry the full load. The surgeries in which this method is applied take about 3-4 hours, general or local anesthesia is preferred. With the help of small incisions, the external fixator is attached from the skin to the bone and a nail that provides lengthening is inserted into the space inside the bone. Thus, the extension process can be done with the help of a fixator.

What are the advantages of the combined method?

The advantages of this method can be listed as follows:

After the operation, a healthy lengthening process is achieved in a shorter time. It takes less time to return to daily life. After the surgery, it is possible to walk with the help of a walker by giving the entire weight of the body. During the treatment process, patients can walk without support after a while with their own determination and strength, bend their knees, and external fixators can be removed after the lengthening process is completed. When a problem arises, it can be solved with external devices. The most important advantage is that it can be made at more affordable prices. The method has some advantages as well as some disadvantages. Some of these are the superficial infection of the nail bottoms, the need for daily dressing and the limitation of movement.

In the combined method, the patient’s devices are easily removed with a small operation after the patient’s treatment process is over. Nails (Intrameduels) attached to the space inside the bone come into play. Thanks to the presence of these nails, patients can walk normally without a device, with full load on their legs, until bone tissue is formed. The nails in the bone are removed with a small operation in approximately 8-12 months, when the bones are 100% fused.

 What is the Precice 2 method?

In addition to the combined method, there is a method called Precice 2 in lengthening surgeries. Since this method is a closed system, it is based on the extension of nails placed in the bone with the help of a remote control. In addition to increasing patient comfort, there are no externally applied devices. However, the method does not provide full weight bearing like the external fixator method, and it is a more expensive method than the combined method. The operations performed with the Precice II method take approximately 3-4 hours, and these operations are performed under general or regional anesthesia. A motorized nail is inserted into the marrow cavity of the bone by entering through small incisions, and these nails are produced individually. After the newly formed bone is completely fused, the nail inside can be removed with an additional operation. When applied to the lower and upper legs at the same time, an elongation of 12-13 centimeters is achieved. It achieves an average of 6-8 centimeters of lengthening in a single session.

What are the pros and cons of Precice 2?

If we list the advantages of the Precice 2 method, we can say the following:

The nails used in this method are produced individually. Since the method is applied closed, the risk of skin infection is almost non-existent. No external device is worn, patients can easily wear the clothes they want, take a shower and swim. Since it is a closed method, it does not need to be dressed every day, it does not cause discomfort both in daily life and at night. Therefore, the comfort of the patient is higher.

Each method has advantages as well as disadvantages. This method is more costly than the combined (LON) method. If any problem arises, it is not possible to make any external intervention to the Intramedullary nails that are inserted into the bone for lengthening. There is a limitation of movement as there is a gap between the two bones due to lengthening and it is necessary to wait for this gap to be filled. Since the lengthening process is done every day, the patient has to keep the extension control with him at all times. As in the LON method, there is no system that will carry the entire burden of the patient. During the treatment process, patients have to use a wheelchair. Since the patient cannot walk easily and cannot use the extended limb, weakness may occur in the muscles. Because of this weakness, physical therapy should be applied regularly. After the patient’s treatment process is over and the bones are fully fused and the lengthening is completed, the nails are easily removed with a small operation. Thus, patients can walk normally and are discharged from the hospital the next day.