Combined Method

This method combines the fixator system and the nail. So, what advantages does this combination offer us? In traditional methods (monolateral fixator, Ilizarov), during the consolidation process (bone maturation – around 6 months), we are dependent on the fixator systems. However, in the combined method, after a consolidation period of 1-2 weeks, we remove the fixator systems and perform distal locking of the intramedullary nail. This reduces our dependence on fixator systems. Reducing this time provides significant advantages such as a quicker return to daily activities, early return to work, the ability to choose more freely clothing, and avoiding unnecessary bandages and infection risks. Additionally, the combination method provides an advantage in mobilization compared to the precise method due to the significant advantage it offers in load transfer.

Evaluation

After the patient is examined by the doctor and no physical or psychological obstacles are observed, the next step is taken. A high-quality and properly calibrated leg length X-ray is taken. Then, the doctor evaluates whether the bone structure is suitable for surgery by making all measurements on the X-ray. Based on the measurements taken, a decision is made on which bone to choose for lengthening, and the patient is prepared for preoperative tests and consultations.

After the tests and consultations are completed without any issues, the patient is asked to fast for 8 hours before the scheduled surgery time.

Surgery

Installation of the stepping system Ensuring stepping system locking (approximately 3 months after 8 cm) Removal of the intramedullary nail (optional, at least 1 year later)

Before entering the surgery, a final evaluation is performed, X-ray assessments are reviewed, informed consent forms, necessary documents, and the completeness of materials are checked, and the type of anesthesia the patient will receive is determined in consultation between the anesthesia doctor and the patient.

After ensuring a suitable operating environment and draping, the surgical steps are carried out:

• Necessary measurements and markings are made.
• Preparation of the osteotomy line.
• Determination of the entry point for the nail.
• Reaming of the bone.
• Completion of the osteotomy.
• Placement of the intramedullary nail and proximal screw locking.
• Installation of the fixator system.
• Placement of the ankle screw.
• Fibula osteotomy.
• Intraoperative monitoring of lengthening under fluoroscopy.

The same procedures are applied in the same order for the other side and completed.

Early Follow-up

After the surgery is completed, a 30-45 minute recovery process is initiated, and the patient is transferred to their room.

To minimize early postoperative pain, the patient is given combined method anesthesia (epidural block + general anesthesia) or postoperative PCA follow-up. Elevation and cold application are started immediately.

The patient’s general evaluation is repeated daily, and rest and in-bed exercises are recommended. The first mobilization and exercises are taught with the assistance of a physiotherapist. Postoperative X-ray

Day 4: Exercises and general check-up

Day 5: Discharge and transfer to the hotel by ambulance

Long-Term Follow-up

Teaching the patient how to perform lengthening and monitoring its applicability (video)

Physical therapy (with a physiotherapist and independent exercises) Bandage follow-up (video) X-ray follow-ups (every 15 days) Doctor visits (via video motorcycle)

Advantages

Price-performance suitability compared to the precise method The chance of external intervention in case of complications Early removal of the fixator system and the advantages it brings, compared to classical methods

Disadvantages

Less comfort and pin site care compared to the precise method Increased nail cost compared to the classical method Inability to turn the leg onto the upper leg in some patients if it is done from the femur, leading to sleep problems Desire to remove the intramedullary nail after complete recovery

Why Should I Choose the LON Method?

Early removal of fixator systems compared to classical methods The most cost-effective method in terms of price-performance Early mobilization and full weight-bearing capability

Why Shouldn’t I Choose LON?

Pin site care Some skin problems Manual lengthening Extra operation for nail removal