The LON (Lengthening Over Nail) Method – a hybrid nail extension technique

Date posted: March 27, 2026

The Lengthening Over Nail method was developed as an attempt to combine the stability of an internal implant with the mechanics of an external fixator. It is a hybrid solution used in selected clinical cases, including bone lengthening.

Like other techniques, the LON method is based on distraction osteogenesis. The process begins with a cut in the bone. An intramedullary nail is inserted into the bone to provide stability. An external fixator is then applied to facilitate the lengthening process.

Once the desired length has been achieved, the external fixator is removed, and the nail remains in the bone until complete union is achieved. At a later stage, the implant must be removed.

The advantage of this method is that it reduces the duration of brace wear compared to traditional external-only lengthening and provides additional internal stabilization. However, combining the two systems also carries certain risks.

During the extension:

The pins still penetrate the skin and soft tissues,
it is possible for bacteria to spread into the bone,
The number of operations is increasing.

In practice, this means at least:

surgery to implant a nail and a brace,
the procedure to remove the braces,
surgery to remove the nail.

In the context of cosmetic leg lengthening, this means a greater physical strain on the body, a longer recovery process, and a higher risk of complications compared to fully internal methods.

The LON method has its place in reconstructive orthopedics; however, when used for surgical height increase in healthy patients, it requires very careful patient selection.

Summary – the LON method

connects the external apparatus and the intramedullary nail,
is based on distraction osteogenesis,
reduces the time spent wearing an external device,
requires several procedures during treatment,
carries the risk of infection associated with pins,
in cosmetic bone lengthening, it is increasingly being replaced by fully internal methods.

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