Orthopedics focuses on the musculoskeletal system. Learn about the diagnosis, treatment, and rehabilitation of bone, joint, ligament, and muscle conditions.
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Once the plan is set, the journey begins. The uniqueness of limb lengthening lies in the fact that the surgery is merely the initial step. The actual treatment happens at home, day by day, as you or your family member perform the distractions. This active participation makes patients true partners in their care.
The treatment phase spans several months, encompassing the surgery, the lengthening period, and the consolidation period. It is a time of focus and discipline. Understanding the daily routine, pain management strategies, and the signs of complications is essential for a smooth journey. This section breaks down the timeline, demystifying the “click” of the nail and the daily reality of growing taller.
The surgery is typically performed under general anesthesia. For an internal nail, small incisions are made at the hip or knee. The surgeon prepares the canal of the bone and inserts the nail. Then, using a special saw or drill, they perform the osteotomy—the controlled cutting of the bone.
This cut is crucial. It must be clean and preserve the periosteum (the outer skin of the bone) because that is where the new bone cells live. The nail is then locked in place with screws. If an external fixator is used, pins are drilled through the skin into the bone, and the frame is assembled around the leg. The surgery usually takes 2 hours.
After surgery, you wake up in the recovery room. You do not start lengthening immediately. You wait for about 5 to 7 days. This is the “latency phase.”
During this time, the body rushes to the injury site with blood and cells to start the healing process. You risk preventing healthy bone formation if you pull too soon. If you wait too long, the bone might heal shut (consolidate) before you start. This week is for rest, pain control, and learning how to move with crutches or a walker.
This is the active phase. If you have an internal magnetic nail (like Precice), you will use an External Remote Controller (ERC). You place this device on your leg over the magnet spot. It makes a whirring noise as it spins the magnet inside your leg.
You typically do this 3 or 4 times a day. Each session lengthens the nail a tiny amount, usually totaling 1 millimeter per day. This slow rate is the “sweet spot”—fast enough to keep the bone from healing shut, but slow enough to allow new bone and soft tissue to grow. You generally won’t feel the bone moving, but you will feel the muscles getting tighter over time.
You will have X-rays every 1 to 2 weeks. The doctor checks to see if the gap is opening (“distracting”) and if new bone (“regenerate”) is forming.
The regenerated image looks like wispy clouds in the gap on the X-ray. If the bone is forming too poorly, the doctor might slow down the rate (e.g., 0.75 mm/day). If it’s healing too fast, they might speed it up.
As the bone gets longer, the muscles have to stretch. They don’t like this. They will fight back by getting tight. Stretching exercises are mandatory.
You must spend time every day stretching your hamstrings, quads, and calf muscles. If they get too tight, they can cause joint contractures (stiffness) or even bend the new bone.
Once you reach your goal length, you stop the distraction. The hard work of lengthening is done, but the bone is weak. The gap is filled with soft, immature bone.
Now you must wait for it to mineralize and harden. This takes time—typically 1 to 2 months for every centimeter lengthened. During this time, you usually cannot bear full weight on the leg. You continue to use crutches or a walker. X-rays will show the cloudy bone turning solid white. Once the cortex (outer shell) is thick enough on 3 out of 4 sides, the doctor will clear you for full weight-bearing.
Pain is highest immediately after surgery and then usually becomes a dull ache during lengthening. Nerve pain (zinging or burning) can occur if nerves are stretched too fast.
Doctors use a multimodal approach: narcotics for the short term, anti-inflammatories (used cautiously as they can slow bone healing), and nerve medications like gabapentin. Muscle relaxers help with spasms. Most importantly, physical therapy and stretching help relieve the mechanical tension that causes the pain.
The internal nail or external frame is not permanent. A second, smaller surgery is performed to remove the hardware once the bone has fully healed, which usually takes about a year after the initial surgery.
This is recommended especially for younger patients to prevent issues later in life. For such external operations, they are removed right in the clinic or operating room once the bone is solid.
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If you put too much weight on the leg before the bone is solid, the nail can bend or break. This requires surgery to replace the nail. Following weight-bearing restrictions is non-negotiable.
With an internal nail, you can shower once the incisions heal (2 weeks). You can take a shower with an external frame, but you’ll need to carefully clean the pin sites afterwards to avoid infection.
Eventually, it looks exactly like your old bone. It remodels over time to have a hollow center (marrow) and a rigid outer shell. You won’t be able to tell where the new bone starts and ends.
Nicotine constricts blood vessels and is toxic to the cells that build new bone. Smoking increases the risk of poor bone formation and nonunion (failure to heal) dramatically. It is strictly forbidden during the process.
No. Trying to go faster than 1 mm/day is dangerous. The bone won’t be able to keep up, leaving a hollow gap (fibrous union) that won’t support weight. It can also damage nerves permanently. Patience is safety.
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