Comparison of Limb Lengthening Methods: LON vs. Precice 2 vs. Fitbone

Lengthening Over Nail (LON) Method

Overview:

• The LON method combines both external and internal fixation. It involves the insertion of a metal rod inside the bone and the use of an external fixator.

Procedure:

• Initial surgery to insert the internal rod and external fixator.
• Gradual lengthening process through the external fixator.
• Removal of the external fixator once the desired length is achieved, leaving the internal rod to stabilize the bone.

Advantages:

• Stability: The internal rod offers additional support, reducing the risk of deformities.
• Cost-effective: Generally less expensive than the Precice 2 and Fitbone methods.
• Widely used: Proven track record with many successful cases.

Disadvantages:

• Discomfort: The external fixator can be uncomfortable and may cause scarring.
• Infection risk: Risk of infection due to the external device.
• Longer recovery: The presence of an external device can extend the recovery period.

Ideal Candidates:

• Patients looking for a cost-effective solution.
• Those who can manage the discomfort and maintenance of an external fixator.

Popularity:

• Most people prefer the LON method due to its cost-effectiveness and proven success rate.

Precice 2 Method

Overview:

• The Precice 2 method is an all-internal limb lengthening technique that utilizes a motorized, telescopic nail inserted into the bone. Lengthening is controlled magnetically via an external remote control.

Procedure:

• Initial surgery to insert the telescopic nail.
• Gradual lengthening process controlled by an external remote.
• No external fixator is used, resulting in a more comfortable experience.

Advantages:

• Comfort: No external devices, leading to a more comfortable and aesthetically pleasing experience.
• Precision: Magnetically controlled lengthening allows for precise adjustments.
• Lower infection risk: Reduced risk of infection due to the absence of an external device.
• Faster recovery: All-internal approach often leads to quicker recovery times.

Disadvantages:

• Cost: More expensive due to advanced technology and equipment.
• Eligibility: Not suitable for all patients, depending on bone quality and medical history.

Ideal Candidates:

• Patients seeking a more comfortable and less invasive experience.
• Those willing to invest in a more advanced and precise method.

Fitbone Method

Overview:

• The Fitbone method is an advanced all-internal limb lengthening technique developed in Germany. It uses a fully internal motorized nail that is controlled externally through power transmission, eliminating pin-site infections and minimizing scarring.

Procedure:

• Initial surgery to implant the motorized intramedullary nail and a receiver under the skin.
• After a rest period (typically 7 days), gradual lengthening process controlled by placing an external transmitter over the implanted receiver.
• Patient activates lengthening by pressing a button on the control device.
• No external fixator is used, resulting in a comfortable experience with minimal scarring.

Advantages:

• Fully internal system: No external fixators, eliminating risk of pin-site infections.
• Minimal scarring: Only four small incisions with discreet cosmetic result.
• Precision: Complete control of distraction amount, speed, and rate, which can be modified according to bone healing and rehabilitation needs.
• Early mobility: Patients can walk with walker or crutches from day one after surgery.
• Everyday comfort: Clothing, hygiene, and movement are less restricted.
• Deformity correction: Allows axial and torsional corrections as part of limb lengthening using reverse planning method.
• Bidirectional control: The nail can lengthen and, under surgeon guidance, shorten if medically necessary.

Disadvantages:

• Cost: More expensive due to advanced motorized technology.
• Receiver requirement: The small receiver under the skin must be used correctly for the system to work properly.
• Weight-bearing limitations: Full, unassisted walking is possible only after the bone has gained enough strength.
• Commitment required: Following postoperative guidelines, daily physiotherapy and exercises are necessary.

Ideal Candidates:

• Patients seeking a fully internal solution without external frames.
• Those who prefer minimal scarring and early mobility.
• Patients ready to commit to physiotherapy, regular follow-ups, and daily exercises.
• Those seeking both medical safety and a more natural daily life during treatment.

Technology:

• Developed by Prof. Dr. Dr. Rainer Baumgart in Germany, launched in 1997.
• Uses a motorized system with no battery; powered by electricity transmitted through external induction coil.
• Available in three different lengths allowing distraction distances of 40 mm, 60 mm, or 80 mm.
• Can achieve up to 8 cm lengthening in the femur and up to 7 cm in the tibia.