Salamehfix

Picture an Ilizarov frame with the rings cut away, leaving three curved segments on the front of the leg. That is Salamehfix 1. The arcs come in sizes that follow the shape of the thigh or shin, and the designer's site makes a point of the back of the leg being free of hardware, which matters for sleeping and sitting. Wires and pins enter the bone at several angles and levels, which is where the stability comes from. The distraction rods between the arcs are hinged. Turn them and the bone segments move apart; adjust the hinge and they also angulate, so a bowed leg can be straightened while it lengthens.

Your day is frame care and turns. The 2025 paper's abstract does not state the daily distraction rate, and neither does the designer's website, so ask. Pin-site cleaning is a daily job, and in the frame-only protocol the fixator stays on through both distraction and consolidation, a mean of 260 days to bone healing in the published series.

Two places: Tartous, on the Syrian coast, and Frankfurt am Main. The 2025 paper lists Prof. Salameh's affiliation as the Salamehfix Limb Lengthening Center in Tartous and his co-author Dr. Michael Schmidt's as the OUZ Center in Frankfurt; the designer's site lists both locations and describes operating in Frankfurt with Schmidt. His training, per his own biography, was Russian: a medical degree in Saint Petersburg in 1983, then a PhD fellowship in external fixation at CITO in Moscow from 1987 to 1991. He has presented the hinge system at ASAMI and SICOT meetings since 2001.

The frame's natural patient is one whose legs need straightening as well as lengthening, a bowed tibia for example, because it does both in one treatment. Of the 1,103 patients in the series, 640 had simultaneous lengthening and deformity correction and 193 were stature cases. For a straight-legged cosmetic patient the case for an external frame over an internal nail is weaker, and rests on full weight-bearing, cost, and not having an implant left in the bone. Anyone choosing it accepts a single-surgeon system.

What the paper states: mean lengthening 5.6 cm across all 1,103 patients, range 2 to 18 cm; a mean of 6.5 cm in the 193 stature cases; mean bone healing time 260 days. The abstract does not state the distraction rate, frame time per centimetre, or follow-up after frame removal.

The designer's website adds unpublished specifics. An Arabic-language post puts cosmetic lengthening at up to 8 cm; the cosmetic page shows individual patients at 7.5 cm and 8.5 cm and describes lengthening 'up to 13 cm while correcting varus deformity'. One patient is described as gaining 16.5 cm in two stages two years apart. The same page states that lengthening toward 13 cm 'can lead to ballerina foot, necessitating fractional tendon lengthening': the designer telling you that equinus contracture is a real cost of large gains on this frame.

Weight-bearing is immediate; the site shows patients walking on the third day after surgery. Removal is the frame coming off once the bone has consolidated. Since late 2024 the designer has also combined the frame with an internal nail in a modified lengthening-over-nail protocol for the tibia, described on his site as a first case in Frankfurt.

It is an external fixator, so the standard frame risks apply: pin-site infection, pins tethering muscle, joint stiffness, and visible hardware for the better part of a year. The published series reports these at strikingly low rates: 25 superficial pin-site infections, 9 contractures and 1 deep infection across 1,103 patients, which is under 3% for superficial pin infection. Novikov's 131-patient Ilizarov cosmetic series in Clinical Orthopaedics and Related Research reported a 37% overall complication rate. The abstract does not say how events were graded or who recorded them, so a patient cannot tell whether the gap is the frame or the counting.

Two device-specific points deserve a direct question. First, hinges: a frame that can angulate on purpose can also angulate by accident if a hinge is set or locked wrongly, and the abstract reports no alignment data at follow-up. Second, the equinus problem the designer himself describes, ballerina foot at large tibial gains, sometimes needing a tendon-lengthening procedure. Neither appears in the complication counts above.

One paper. Salameh G, Schmidt M, International Orthopaedics 2025;49(11):2599–2605, PubMed 40956411, published online 16 September 2025. A PubMed search for 'Salamehfix' returns that paper and nothing else (September 2026). It is a retrospective, single-system series spanning 24 years, written by the surgeon who designed the device and the colleague he operates with; the authors declare no competing interests. No independent centre has published results with the frame, and it does not appear in the 2020 Bone & Joint Research systematic review of cosmetic stature lengthening, which pooled 795 patients across Ilizarov, LON, LATN, ISKD and PRECICE series.

Before 2025 the record was conference presentations: the designer's biography lists 'a new hinge system' talks at ASAMI meetings in Rome (2001) and Kyoto (2006) and at the Ilizarov Centre in Kurgan (2007). Twenty-four years of use and one paper is a thin record for 1,103 patients. That does not make the frame bad. It makes it unverified, which is a different thing, and one you should price in.

There is effectively one clinic, so read the surgeon.

Ask for the full paper, not the abstract, and check three things in it: how complications were defined, how many of the 193 stature patients were followed to the end, and what the frame time per centimetre was. If the definitions are narrow, the low infection count means less.

Ask what the Frankfurt arrangement is. Which hospital, who is the admitting surgeon under German law, who manages pin sites once you fly home, and who takes the frame off. A device carried by one surgeon between two countries needs a written continuity plan.

Ask who manufactures the frame and whether it carries a CE mark; the website and the paper's abstract are silent on both.

Ask for the price in writing with removal, physiotherapy and any tendon-lengthening procedure itemised; the site does not publish one. And be wary if the pitch leans on 16.5 cm or 13 cm. The series mean for stature patients is 6.5 cm.