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Lengthening is the term given to the surgical elongation of the bone. The causes of a short bone are many but naming a few - anatomical deficiencies, congenital, traumatic, or as a result of disease e.g. post traumatic shortening, congenital deformities and shortening, developmental deformities, growth plate abnormalities, stature lengthening (cosmetic lengthening).

Bone lengthening is a surgical procedure. It can be an acute or gradual process.

Acute lengthening involves the surgeon making a cut in the bone and moving the bone into its new position. The bone is held in place with metal ware (plates and screws), also known as internal fixation.

Gradual lengthening is the process where the bone is cut and the cut ends of the bone are pulled apart (called distraction), using an external device called external fixator or an internal device like nail (ISKD- Intra-medullary Skeletal Kinetic Distractor).

When there is a discrepancy in the limb length, it is advisable to correct the discrepancy at the earliest instance. A neglected limb length discrepancy leads to:

  1. An awkward gait
  2. Compensatory deformities can develop
  3. Early knee joint arthritis
  4. Back pain, spondylosis & deformities of spine.

Fixator is not the only method used for lengthening of bone, to reduce the fixator time other methods like - LON(lengthening over nail) & LATN(lengthening and then nailing) are also available.

In Lengthening over Nail i.e. bone lengthening done over an intramedullary nail, an intramedullary nail is inserted in the bone; an external fixator is also applied; the bone is cut and distraction is done using the fixator while the nail is still inside the medullary canal – that is why the name lengthening over nail. Once the distraction is over the nail is locked and the fixator can then be removed.

Lengthening and then Nailing is the procedure where an external fixator is applied; the bone is cut and distraction is done. Once distraction is completed another surgery is done in which an intramedullary nail is inserted and the fixator is removed.