Limb Lengthening Surgery

The only scientific and practical way to increase the height after the growth plates are closed.

What is limb lengthening surgery?

Limb lengthening surgery, also known as height increase surgery, is a method of lifting the bones of the arms or legs. This is done gradually so that the length of the bones and soft tissues (skin, muscles, nerves, etc.) increases slowly. Typically, this process takes several months. Height enhancement surgery can be performed with gradual correction. At the International Limb lengthening center of IRAN, we typically lift the femur (thighbone), and the calf (calf bone).

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You definitely have some questions about limb lengthening surgery in your mind, we recommend you to watch this video to get acquainted with limb lengthening  surgery:

How does limb lengthening surgery work?

During limb lengthening surgery, the doctor cuts the bone to create two separate bone sections. The surgical procedure for cutting a bone is called an osteotomy. During limb lengthening surgery, soft tissues such as muscles and nerves also increase in length.

Your doctor will always use an orthopedic device to increase bone length.

Orthopedic devices to increase bone length can be placed inside the bone, called internal devices, such as MTNs or orthopedic limb lengthening devices that remain outside the body, which are called external fixation, such as Taylor Spatial Frame or Ilizarov device.

After limb lengthening surgery, the bones rest for five to seven days to begin the increase in the process. This period is called the delay period. After the delay period, the doctor trains an orthopedic device to the volunteer to slowly separate two bone sections. As two parts of the bone are slowly separated, a new bone is formed in the space between them. This new bone increases the overall length of bone. New bone is called rebuilt bone.

During the distraction phase, the volunteer (or family member) adjusts the device each day to separate the bony parts at a slow rate of approximately 1 mm (0.04 inches) per day. This amount may be slightly different for different bones. For example, the treatment plan may be 0.75 mm per day in the tibia, but 1.0 mm per day in the femur or arm. This gradual increase forces the body to constantly build and grow new bones and soft tissues, such as skin, muscles, nerves, and blood vessels. The augmentation phase continues until the bone reaches the desired length.

Limb Lengthening Surgery

Approximately 1 inch (2.5 cm) long can be added per month. The patient should visit the doctor twice a month during the distraction phase to make sure that bone length is not very quick or so slow. Based on the appearance of bone reconstructed in X-ray photographs, the doctor may accelerate or reduce the speed of bone length. During the increase process, the patient should physiotherapy two and five times a week.

The increasing stage is followed by the stage of consolidation, where the reconstructed bone slowly hardens. In a common case, the length of 5 cm (2 inches) takes about 2 months to reach the desired length, but it takes 5 to 6 months to solidify.

To help improve the construction and growth of bone, patients should avoid nicotine in any form, have a healthy diet with plenty of protein and consume vitamin supplements and minerals. At the stabilization stage, the doctor advises the patient to start applying weight (with the help of a cane or walker), which also makes the bone tightening and improvement.

If the device is used outside the body, to protect more of the new bone, the doctor may use gypsum or ask the patient to close the brace for a while after removing the external fixation. In contrast, when an internal device is removed after lifting the length of the bone, no plaster or split is used.

Limb Lengthening Methods

There are three methods for limb lengthening and each method is chosen according to the physical and financial condition of the person.

Limb Lengthening by MTN or Manual Telescopic Nail Method

In the MTN method, a telescopic nail is installed inside the bone and a small screw is placed outside the leg. There is only a small screw on the skin. Therefore, it is much easier to walk and live with it. In addition, less pain is felt than other methods of limb lengthening surgery. This method is performed only in Iran and in Iran International Center for limb lengthening.

Limb Lengthening by LON or Lengthening Over Nail Method

In this method, the osteotomy of the bone is performed and then a nail is placed into the canal of the lower leg and external fixation is placed on the bone outside of the leg and increases gradually. After completing the increase phase, the bottom of the slices is installed and then external fixation will be removed.

Limb Lengthening by LATN or Lengthening And Then Nailing

In the LATN limb lengthening method, an osteotomy is performed first. We install the external fixation device from the outside, on the leg, or on the thigh. When the augmentation is complete, we insert the inner bar into the tibia or femur. This inner rod is mounted on the leg with five or six screws. Then we fix the place of increase so that it does not shorten again. Then we separate the external fixation from the leg.

What types of orthopedic devices can be used for limb lengthening?

At the International Center for Limb Lengthening in Iran, we use a variety of orthopedic devices to lengthen bones. We choose which device will work greatest based on each person’s unique situation.

What happens if the bone is lengthened too slowly?

Even though the usual lengthening rate is 1 mm per day, each person responds differently to bone lengthening. The bones of some people are very quickly healed and maybe hardened before the completion of treatment. This is the case of premature consolidation. When the reconstructed bone hardens, two other bone groups cannot be separated. The bone may recover before reaching the desired length. The doctor often sees the patient during the distraction phase to prevent premature consolidation.

When during the follow-up visit, premature consolidation in X-rays is seen, one of the options is selectable and performable, for example, the increase rate may increase from 1 mm per day to 1.5 mm or even 2 mm per day. If the reconstructed bone is fully strengthened, it may be necessary to cut the bone again with surgery to continue the lengthening can continue. This requires a return to the operating room, usually as an outpatient procedure, which means that the patient does not need to stay in the hospital.

What happens if the bone is lengthened too quickly?

Even though the usual rate of lengthening is 1 mm per day, some people’s bones need more time to heal and may require more bone formation time. For example, healing may be slower in smokers and diabetics.

The regenerated bone should be formed so that it can act as a bridge between two bone sections separated. The doctor will want to see the patient every 7 to 14 days during the distraction phase to make sure the bones, muscles, and nerves are well responsive to lengthening.

In cases where the bone is weak, the orthopedic device can be adjusted for temporary bone shortening until the reconstructed bone is improved. After starting the reconstruction between bone sections, the doctor allows the patient to lengthen the bone.

Another issue that can occur during limb lengthening is that soft tissues (muscles, nerves, ligaments, tendons) may resist stretching during the lengthening process, which can cause them to stiffen. . A non-surgical option for treating stiff muscles is to increase the amount of stretching during physiotherapy sessions. During the distraction process, the patient should receive physiotherapy two to five times a week.

How much can each bone be lengthened?

According to Dr. Nader Motallebi Zadeh’s experiences, in the …..magazine has been published in 2014. (references)
The rate of lengthening is 6 centimeters, of course, In case of immediate person’s need and lack of disruption in the proportion of the individual, provided that the bone and tendon conditions are suitable for 7 centimeters may also be allowed.

In therapy cases, such as the difference in length of the organs, it is different, and up to 35 centimeters lengthening have been done by Dr. Motallebi Zadeh (reference)

What could avoid me from achieving my lengthening aim?

If patients do not attend physiotherapy or household exercises, their muscle strength and their motion range may be affected, and the doctor may stop their lengthening. Muscle contractures can lead to the tightening of the joints or even dislocation of the joints. The doctor may temporarily stop the lengthening process to improve performance or permanently.

Keep in mind that large goals in limb lengthening may require more than one lengthening surgery. For example, instead of 4 inches lengthening, it may be easier to perform a 2-inch lengthening and then add another 2 inches a few years later. Some patients may need additional surgery before or after lengthening to correct other previous orthopedic problems.

Do lengthened arms and legs function well after treatment?

Adults and children can usually have a normal and active life after lengthening and limb lengthening surgery. (reference)
Most of our patients have achieved increased performance (better walking/gait), improved muscle strength, and maintained range of motion (flexibility). Much of the success depends on experienced surgeons, support staff, and physiotherapists working with motivated patients through every stage of the process.

Patients may need to attend physiotherapy sessions several times a week to maintain range of motion (flexibility) and increased muscle strength. Our physiotherapists have years of experience and have developed exercises, and other unique therapies to help maximize your chances of success.

5 important tips about height increase surgery by Dr. Nader Motallebi Zadeh (with English subtitle)

Limb Lengthening Surgery Workflow

Usually, volunteers for limb lengthening surgery during consultation through comprehensive information and available in cyberspace, or using the experiences and abilities of Dr. Motallebizadeh already obtained almost complete information, and at the time of advice, the most common question for them is the possibility of complications, and usually, after becoming more familiar with the results of the previous years of the team and talking to people who have done this operation years ago, most of their concern is resolved.

After a definitive decision to have limb lengthening surgery, the neurology and psycho consultation team perform special studies. They determine the necessity of this surgery and actually identify the real and necessary needs. Obviously, if this need is not approved by the consultant, surgery does not take place.

Then the final measurements based on height, weight, and radiological photos are made. Then the necessary devices are provided not to have any defects during the operation.

Usually, in the LATN method of limb lengthening surgery, the duration of the first operation, which includes the osteotomy of both legs and the placement of the external device (external fixation), takes around an hour. After the lengthening phase, it takes about two hours and thirty minutes to remove the external fixation and place the internal bars, and then, unlike the surgery, limb lengthening by the LON method no longer needs to use fiberglass.

A pain pump (intrathecal pump), which is a special device for the same purpose (pain control), is usually used to control postoperative pain. This device injects strong painkillers continuously and slowly, helping to control postoperative pain.

The next day of limb lengthening surgery one of the doctors of the limb lengthening center of Iran visit the volunteer and check all the required items and allowed the launch. Almost most people are able to walk (indeed with Walker), and they are discharged from two days.

Why choose Iran International Center for Limb Lengthening?

The International center for limb lengthening of Iran is known because of its expertise in limb lengthening. Your doctor at the International Center for limb lengthening of Iran will spend time to make sure you understand all your choices and then start your treatment to meet your specific needs. Our patients use our team-centered approach to renowned children’s orthopedic surgeons and adults in the world and specialist physician assistants, nurses, and physiotherapists. We help patients who need limb lengthening to achieve the best possible results.

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