11. Why Maximum Lengthening Should Not Be the Goal
Patients frequently ask:
“How many centimeters can I gain?”
But the most important question is not the maximum mechanically achievable length.
Greater lengthening also increases the amount of adaptation required from:
✔ Muscles
✔ Tendons
✔ Nerves
✔ Blood vessels
✔ Joints
✔ Skin and fascia
Therefore, the planned target should be adjusted according to actual tissue response during treatment.
12. How Much Height Can Be Gained?
There is no single safe or appropriate amount for every patient.
In published cosmetic stature-lengthening studies, average achieved lengthening has commonly been in the several-centimeter range; one systematic review of 795 patients reported a mean final lengthening of about 6.7 cm, but the included techniques and patient populations varied widely. This should not be interpreted as a recommended target for every patient.
Appropriate lengthening depends on:
✔ Original bone length
✔ Soft-tissue flexibility
✔ Joint motion
✔ Nerve tolerance
✔ Bone regeneration
✔ Body proportions
✔ Surgical method
✔ Rehabilitation progress
13. External Fixation
Traditional limb lengthening has often used external fixation.
Methods include:
✔ Circular Ilizarov frames
✔ Monolateral external fixators
✔ Hybrid methods
External fixation allows controlled adjustment and can be useful in complex deformity correction.
Potential disadvantages include:
✔ Pin-site infection
✔ Scarring
✔ Patient discomfort
✔ Difficulty with clothing and daily activities
✔ Joint stiffness
✔ Longer time wearing an external frame
External fixation remains valuable in appropriately selected complex cases.
14. Ilizarov Method
The Ilizarov technique uses a circular external-fixation system.
Its major strengths include the ability to manage:
✔ Lengthening
✔ Angular deformity
✔ Rotational deformity
✔ Bone loss
✔ Nonunion
✔ Complex reconstruction
Although newer internal devices have reduced reliance on external frames for some indications, the biological principle developed through Ilizarov techniques remains fundamental to modern limb lengthening.
15. Monolateral External Fixation
A monolateral or straight-bar external fixator may be used in selected cases.
Compared with circular frames, it can be less bulky but remains an external device with pin or wire fixation through the skin.
Its role depends on:
✔ Bone anatomy
✔ Desired correction
✔ Patient age
✔ Deformity
✔ Bone quality
✔ Surgeon preference
16. Lengthening Over Nail
Lengthening over nail (LON) combines an intramedullary nail with an external fixator during the distraction phase.
The technique was developed partly to reduce the prolonged duration of external fixation.
After the desired length is achieved, the internal nail helps maintain alignment and stability while the external frame can be removed according to the surgical protocol.
However, it still carries risks associated with both internal and external fixation.
17. Internal Lengthening Nails
Modern intramedullary lengthening systems allow gradual bone lengthening without a prolonged external frame.
Potential advantages include:
✔ No external pins during the main lengthening period
✔ Less pin-site scarring
✔ Easier clothing and daily hygiene
✔ Improved patient comfort in selected patients
However, internal nails have their own limitations and complications.
Systematic review data involving motorized intramedullary nails such as PRECICE and FITBONE found device-, bone- and treatment-related complications in a substantial proportion of lengthened segments, emphasizing that internal nails should not be regarded as complication-free.