Hello, I am the right femur. You usually meet me only on X-rays, but today it is my turn to speak. I have been living together with the friend upstairs – the brain – for many years. One day, while looking in the mirror, that friend thought: “Wouldn’t it be nice if we were a little taller?” That single thought was the beginning of a completely new journey for me.
As we were heading to the operating room, the friend upstairs was slightly nervous but calm. Deep inside I was saying: “I am ready, let’s begin.” When the surgeon made a controlled cut and divided me into two segments, it might sound dramatic from the outside – but I knew this was actually a carefully planned opportunity to grow again.
My muscle neighbours were surprised at first. Quadriceps complained, “What kind of stretch is this?” while the hamstrings muttered, “I wasn’t flexible to begin with, why are you making this harder?” I tried to calm them down and reminded them that everything was happening under control.
Every day, the gap between my two segments was slowly increased by about 0.75–1 mm. From the outside it may look like “just a millimetre”, but inside, for me, this meant the start of a huge biological construction site.
The moment I was cut, the body’s alarm system went off: “Femur injured, send new vessels!” Within a few days, thin capillary blood vessels started to grow into the distraction gap. Without them, healing would not be possible. They were the first team to bring oxygen, nutrients and healing energy to the area.
Then the main workers arrived: osteoblasts. Their job was to produce new bone matrix (osteoid), build collagen scaffolds and initiate mineralization. Step by step, they were reconstructing me from the inside. Osteoclasts were also there in the background, clearing away weak or damaged tissue and keeping the construction site clean.
Inside the gap, a soft, gel-like matrix formed first, followed by a cartilage-like layer and finally young, spongy bone tissue. This young tissue is called callus. It served as a temporary but vital bridge between my two ends throughout the distraction phase.
Fortunately, the friend upstairs does not smoke. If there were cigarettes in this story, things inside would be very different: blood vessels would narrow, oxygen delivery would decrease, the osteoblasts would lose their energy and the quality of the callus would suffer. Consolidation would take longer, and the risk of infection would be higher.
In other words, for a bone going through limb lengthening, smoking would be like trying to pour concrete on a construction site while someone keeps shutting off the water. Staying away from cigarettes in this period is critical for both bone quality and healing speed.
While I was lengthening, my neighbours were not just sitting idle. Quadriceps was saying, “I’m stretching, I’m adapting,” while the hamstrings complained at first but eventually got used to the new length. The peroneal nerve sent warning signals whenever the tension became too high: “Slow down a bit!” And the tendons needed time to align with the new length and tension patterns.
Limb lengthening surgery is not only about the bone; it is a true team effort between bone, muscles, nerves, blood vessels and tendons.
When the distraction phase was completed, my length had increased – but I still felt like a young sapling: tall yet fragile. The consolidation phase was the time when I would truly gain strength and mature.
The spongy callus that formed during distraction gradually became denser. Osteoblasts worked in a more organised way, collagen fibres thickened and the structure began to strengthen, almost as if concrete were being poured from within in a controlled manner.
Calcium and phosphate crystals started to settle into the callus, increasing bone mineral density. At the same time, the new vascular network matured: vessel diameters widened, walls strengthened and their capacity to nourish the area improved. Nutrition, vitamin D and overall health during this period directly affected the quality of the bone I was becoming.
The key to this phase was the right load at the right time. Never loading me at all could slow down bone formation, while too much load too early could increase the risk of fracture. The correct physiotherapy programme and controlled weight-bearing helped me become stronger, step by step.
Over time, the callus transformed from a soft, spongy structure into a denser trabecular network and eventually into solid, cortical, weight-bearing bone. It felt as if a protective varnish was being applied in thin layers day after day. In the end, I once again became a confident, load-bearing femur.
After months of this journey, I became both longer and stronger. The friend upstairs regained confidence; the way we walked, stood and moved changed. In a very real sense, we grew together.
As a femur, here is my final message: It takes courage to lengthen, but it takes patience to become strong. If you stay patient, avoid smoking, work with an experienced team and trust the process, this journey can truly become a fresh start to a new life.
Sedat Duman, MD
With years of experience, Time To Be Taller serves its patients in its clinic located in Mall of Istanbul.
