Arm Lengthening Surgery

Humerus Distraction Osteogenesis

Arm lengthening (Humerus distraction osteogenesis) is a specialized orthopedic procedure to increase the length of the upper arm bone through distraction osteogenesis. This biological process involves creating a controlled separation in the bone, stimulating the body to generate new bone tissue in the gap.

We perform this surgery for two primary patient groups: those with medical discrepancies (post-traumatic or congenital) and those seeking cosmetic arm lengthening to correct disproportionate arm-to-body ratios.

Prof. Dr. Yuksel Yurttas is a pioneer in this specific field, having performed the world’s first cosmetic arm lengthening using the Fitbone system.

This guide details how humerus lengthening works, method options, lengthening limits, recovery timeline, key risks and eligibility criteria.

Arm Lengthening Methods

Arm (Humerus) lengthening is performed using three distinct categories of surgical devices. The choice of method depends strictly on the patient's anatomy and the goal of the surgery. Prof. Dr. Yurttas has extensive surgical experience with all three methods described below, utilizing them based on the specific medical or cosmetic needs of the case.

1. External Fixation

This method uses a rigid frame connected to the bone with pins and wires that pass through the skin. The lengthening adjustments are made on the external frame itself. External fixation is typically reserved for complex reconstructive cases, such as correcting severe deformities, bone infections, or non-unions where an internal nail cannot be safely inserted. It involves open pin sites that require daily cleaning to prevent infection. The external frame can be cumbersome on the arm and significantly restricts sleeping positions and daily comfort.

2. Internal Magnetic Nails (Precice)

The Precice system is a titanium telescopic nail implanted inside the bone. It lengthens via a magnetic interaction between the internal nail and an external remote controller held against the skin. This is a widely used option for both femoral and tibial lengthening. It offers a comfortable recovery compared to external frames. However, titanium nails have specific weight-bearing restrictions. In the context of the arm, this can sometimes limit how aggressively a patient can use their upper body during the lengthening phase.

3. Internal Motorized Nails (Fitbone)

The Fitbone is a fully internal, motorized lengthening nail made of stainless steel. It is lengthened by transmitting energy from an external control set to a receiver placed under the skin. This advanced system is the current standard of care in our practice for cosmetic arm lengthening due to its durability and functional advantages.

Three types of arm lengthening methods side-by-side: External Fixator, Precice 2, and Fitbone.

Cosmetic Arm Lengthening: The Fitbone System

Prof. Dr. Yuksel Yurttas has performed humerus lengthening using external fixators, the Precice magnetic system, and the Fitbone system. For cosmetic arm lengthening, he now exclusively utilizes the Fitbone system.

As the first surgeon in the world to perform cosmetic arm lengthening using the Fitbone nail, he bases this decision on specific mechanical advantages that directly impact the patient's recovery experience.

Stainless Steel Durability: The Fitbone nail is constructed from high-strength stainless steel. This material offers robust stability and higher load-bearing capabilities compared to titanium alternatives.
Immediate Function: The superior stability of the implant allows patients to use their hands and move their arms starting the day after surgery.
Mobility: Patients remain mobile throughout the lengthening process. There is no need to keep the arm immobilized, which is critical for preventing joint stiffness.

X-ray and illustration showing arm lengthening process - dr yuksel yurttas

Technical Specifications

We exclusively utilize the Fitbone fully internal motorized nail for cosmetic humerus lengthening. This technology represents the most advanced method for arm lengthening because it prioritizes patient comfort, hygiene, and early mobilization.

Mechanism: The Fitbone nail is implanted inside the hollow canal of the humerus. It contains a miniaturized motor and gear system.
Activation: There is no external frame or magnetic device required for lengthening. The system is activated by a specific external control unit that transmits energy to a receiver placed under the skin.
Incision Profile: The surgery is minimally invasive, typically requiring only four small incisions per arm to insert the nail and perform the osteotomy (bone cut).

Fitbone humerus nails are available in 9 mm and 11 mm diameters. Since the humerus has a narrow medullary canal compared to the femur or tibia, preoperative measurement is critical to confirm that your anatomy can safely accommodate the minimum 9 mm implant.

Lengthening Rate and Limits

Arm lengthening is a gradual biological process where the distraction rate is strictly controlled to protect the neurovascular structures.

Distraction Rate: 0.66 mm per Day

We limit distraction to approximately 0.66 mm daily. The standard 1 mm rate used for legs is too aggressive for the humerus. Upper extremity nerves are far less tolerant to tension. This slower pace is mandatory to prevent nerve injury and allow the muscles to lengthen without contracture.

Maximum Achievable Length: 5 cm per Arm

The safe limit for humeral lengthening is generally 5 cm. This cap is dictated by biological safety, not hardware capacity. We stop the lengthening process if nerve symptoms arise or if soft tissue tightness begins to restrict full elbow extension.

cosmetic arm lengthening with fitbone - world's first

Fitbone Arm Lengthening Timeline

Day 1: Arrival, hotel check-in, and patient orientation
Day 2: Preoperative examinations, X-rays, and blood tests
Day 3: Surgery with the Fitbone internal lengthening system
Day 4: Mobilization begins; immediate use of the hands and arms for light tasks
Day 6-8: Discharge from the hospital (typically 3–5 days post-surgery)
Day 8: The distraction (lengthening) process starts (5 days post-surgery)
Day 8-85: Daily distraction phase, 0.66 mm per day (up to 5 cm target)
Month 3-5: Consolidation phase; return to normal daily activities and routine tasks
Month 9-12: Full bone consolidation; bone is completely solid for high-impact stress
Month 12-18: Removal of the nail in a short procedure after full recovery

Everyday Life During Arm Lengthening with Fitbone

Clothing: Since the system is fully internal, patients can wear normal shirts and short sleeves immediately provided the surgical incisions are properly protected during early recovery.
Daily Lengthening Routine: The lengthening process is brief and performed by the patient using a compact and portable external unit. It takes only a few minutes each day and does not disrupt the daily schedule.
Mobility: Walking is completely unaffected. Unlike leg lengthening, patients do not require crutches or wheelchairs and retain full lower-body mobility immediately after surgery.
Arm Function: The high stability of the Fitbone system allows patients to use their arms for light daily living activities and personal care immediately after surgery. Functional use is actively encouraged to maintain mobility and prevent stiffness.
Travel: Air travel is permitted. A medical implant identification card is provided to navigate airport security screenings.
Compliance: Regular physiotherapy and strict adherence to the surgeon's instructions are mandatory throughout the lengthening process and until full recovery.
Restrictions: Heavy lifting and high-impact activities involving the arms are strictly prohibited until X-rays confirm full bone consolidation.

Rehabilitation and Recovery

Functional recovery is as important as the lengthening itself. Our protocol is designed to maintain full range of motion in the shoulder and elbow while protecting the regenerating bone throughout the distraction and consolidation phases.

Hospital Stay & Discharge

Patients typically remain in the hospital for 3 to 5 days following surgery. Discharge is authorized once pain is well-managed and the patient demonstrates safe, functional arm movement.

Physical Therapy

Rehabilitation focuses on maintaining two specific ranges of motion to prevent contracture:

Elbow Extension: The biceps muscle is prone to tightening during lengthening. Daily stretching is required to maintain the ability to fully straighten the arm.
Shoulder Mobility: Keeping the shoulder joint mobile prevents adhesive capsulitis ("frozen shoulder") and protects the rotator cuff from implant irritation.
Muscle Strengthening: In addition to stretching, targeted strengthening exercises (particularly for the triceps) are performed to counteract biceps tightness and support active elbow extension.

Consolidation & Progressive Recovery

Recovery is a continuous, active process. Patients do not need to wait for full bone consolidation to resume daily life.

The Consolidation Phase: Once the target length is reached, the distraction stops. The new bone tissue begins to mineralize and harden.
Return to Routine: Patients gradually return to work, social life, and standard daily routines during this phase. Functional independence is achieved well before the bone is fully healed.
Final Clearance: While daily life resumes early, heavy lifting and high-impact sports are permitted only after X-rays confirm full corticalization (complete bone solidity).

Risks and Complications

Patient safety is the priority. In addition to general surgical risks (such as infection), candidates must be aware of the specific complications associated with humeral lengthening.

Radial Nerve Neurapraxia: Temporary weakness or numbness in the wrist or hand (drop wrist) caused by the tension of the nerve. This usually resolves by pausing the lengthening process but requires immediate medical reporting.
Joint Stiffness: Loss of full elbow extension is the most common complication if physical therapy protocols are not strictly followed.
Delayed Union: The bone may heal slower than expected, which would extend the consolidation period before heavy lifting is permitted.
Premature Consolidation: In rare cases (often in younger patients with rapid healing), the bone may heal too quickly, blocking further lengthening. This may require a minor procedure to re-break the bone and continue distraction.
Shoulder Irritation: Mild discomfort may occur at the nail insertion site (rotator cuff). This is typically temporary and managed with physical therapy or resolves after the nail is removed.
Device Malfunction: As with any mechanical device, rare technical malfunctions (such as mechanism jamming) can occur, potentially requiring surgical revision.

prof. dr. yuksel yurttas performing arm lengthening surgery with fitbone internal system

The Critical Factor: The Radial Nerve

The most critical anatomical structure in arm lengthening is the Radial Nerve. This nerve winds directly around the back of the humerus (in the spiral groove) and controls the ability to extend the wrist and fingers.

The surgical technique must account for the nerve's exact location. Dr. Yuksel Yurttas performs the osteotomy (bone cut) at a precise level to avoid heat damage or mechanical contact. Intraoperative nerve monitoring is standard protocol to confirm the nerve remains functional throughout the implantation.

The Necessity of Expertise

Humeral lengthening is biomechanically and anatomically distinct from femoral and tibial lengthening. The neurovascular complexity of the upper arm requires a surgeon with specialized experience in upper extremity reconstruction. As the first to implement the Fitbone system in this anatomy for bilateral cosmetic lengthening, Dr. Yurttas offers the highest level of clinical expertise necessary for managing the demands of humeral distraction and protecting nerve function.

All-Inclusive Cosmetic Humerus Lengthening Program by Prof. Dr. Yuksel Yurttas

Prof. Dr. Yurttas has engineered the world’s only comprehensive 105-day specialized program for cosmetic humeral lengthening based on extensive clinical and real-world experience. This exclusive protocol centralizes every surgical and rehabilitative requirement of this complex procedure.

Next Step: Patient Evaluation and Consultation

Humeral lengthening is performed only on carefully selected candidates who meet specific criteria. Prof. Dr. Yuksel Yurttas reserves the right to decline any patient for the procedure for any reason, as the primary goal is to maintain the highest standards of medical safety and successful outcomes.

1. Preliminary Assessment: To begin the process, please complete our Patient Evaluation Form. This allows our medical team to review your history and suitability for the procedure.

2. Initial Measurement: The first step is to confirm your humeral canal diameter is sufficient to accommodate the Fitbone nail. This typically requires a diameter between 9 mm and 11 mm.

3. Personalized Consultation: For a free, personalized consultation and to discuss your specific case, you can reach us directly via WhatsApp: +90 533 973 52 89