Limb lengthening: LON vs internal nail (PRECICE) vs Ilizarov compared

Cosmetic and functional limb lengthening is done today with three main approaches: the external Ilizarov frame, the LON method (an external fixator plus an internal nail) and fully internal motorised nails such as PRECICE. All three rely on the same biology, but they differ a lot in comfort, infection risk and how long you live with hardware outside your leg. You don’t pick the method from a menu: an orthopaedic surgeon who specialises in limb reconstruction recommends it after examining your bones.

This guide explains how each technique works, its honest pros and cons, and what to ask before considering surgery in Yerevan, Armenia.

How does limb lengthening work?

Every technique uses distraction osteogenesis, the principle developed by Soviet surgeon Gavriil Ilizarov in the mid-20th century. The surgeon makes a controlled cut in the bone (osteotomy), waits a few days for early healing, then pulls the two ends apart very slowly, usually around 1 mm a day split into several small steps. The body fills the gap with new bone, while muscles, nerves and blood vessels gradually adapt.

There are two phases: distraction, when length is gained, and consolidation, when the new bone hardens. Consolidation typically takes considerably longer than distraction, which is why a few hours in theatre turn into many months of treatment.

As a general guide, many surgeons limit lengthening to roughly 5–8 cm per bone segment (femur or tibia) and avoid going beyond about 15% of the bone’s length, because complication rates rise sharply after that. Your own limit is set by the specialist.

The Ilizarov method: the classic external frame

The Ilizarov apparatus is a circular frame of metal rings fixed to the bone with wires and pins that pass through the skin. It is adjusted from the outside and can correct deformities (bowed legs, rotation, leg length differences) as well as lengthen.

• Pros: well-established, excellent control over the direction of lengthening, strong for deformity correction, lower hardware cost.
• Cons: you wear the frame through distraction and the whole consolidation phase, often many months; pin-site infections are common; small pin scars; sleeping, dressing and getting around are harder.

The LON method: lengthening over nail

LON stands for Lengthening Over Nail. The surgeon places a nail inside the bone canal and also attaches an external fixator. The fixator does the lengthening; once the target length is reached, the nail is locked and the frame removed. The nail then supports the bone while it consolidates.

• Pros: time in an external frame drops to roughly the distraction phase; fewer months of pins in the skin; mid-range cost.
• Cons: pins and infection risk remain for weeks; two procedures are needed for the frame; a pin-track infection close to the nail can become a deeper problem.

A related approach, lengthening and then nailing (LATN), inserts the nail at the end of distraction. The goal is the same: less time in an external device.

Internal lengthening nails (PRECICE and similar)

Motorised internal nails sit entirely inside the bone. With the PRECICE nail, a magnet inside the implant is turned by an external remote controller held over the thigh or shin several times a day, following the surgeon’s schedule. Nothing passes through the skin.

• Pros: far lower risk of superficial infection, more comfort, neater scars and an easier daily routine during treatment.
• Cons: expensive implant; not suitable for every bone (canal width and shape matter); strict weight-bearing limits; rare device failure; usually removed in a second operation once the bone has healed.

LON vs PRECICE vs Ilizarov: which is better?

No method is best for everyone. The table summarises typical differences; timelines vary with the number of centimetres, the bone and how your body responds.

Your surgeon will weigh your age (growth plates must be closed), bone anatomy, any alignment problems, smoking, body weight and expectations. For cosmetic height increase, many teams also ask for a psychological assessment, because it is an emotionally loaded decision with a long recovery.

Limb lengthening risks you should know

This is major orthopaedic surgery, not a quick cosmetic procedure. The main risks, whatever the technique, are:

• Knee or ankle stiffness and contractures if muscles don’t keep pace with the bone.
• Nerve irritation or injury from stretching.
• Slow consolidation, weak new bone or, the opposite, premature consolidation.
• Infection (mainly with external fixators), deep vein thrombosis and, rarely, embolism.
• Implant failure or the need for extra operations.

A good team manages this with regular X-rays, by adjusting the distraction rate and with daily physiotherapy. Our month-by-month recovery guide covers the details.

Limb lengthening in Yerevan: how it is organised

In Yerevan, limb lengthening is performed by orthopaedic and trauma surgeons, not plastic surgeons. Which techniques a team offers depends on its experience and equipment, so Medarmenia checks for you which method the surgeon uses, their experience with cosmetic lengthening and how follow-up is organised. We won’t promise a specific method before that assessment.

• Length of stay: plan for several weeks at least. The distraction phase needs frequent checks, so many patients stay near the surgeon for that entire period.
• Travel: many nationalities, including EU citizens, can enter Armenia visa-free; check current entry rules for your passport before booking.
• Going home: your surgeon clears you to travel based on bone healing, clot risk and mobility. At home you’ll need a local orthopaedic surgeon and physiotherapist, plus remote check-ins with the Yerevan team.

You can see the other procedures we coordinate on our surgeries page.

Frequently asked questions

How many centimetres can limb lengthening add?

Typically about 5–8 cm per bone segment, with surgeons usually more cautious in the tibia than the femur. The final figure depends on your bones, muscles, nerves and how well you tolerate the process.

What is the LON method?

It combines an external fixator that does the lengthening with an internal nail that supports the bone afterwards. This lets the frame come off much earlier than with a classic Ilizarov.

Does a PRECICE nail stay in for life?

Usually not. Once the bone is fully consolidated, often a year or more later, surgeons commonly recommend removing it in a simpler second procedure.

Is limb lengthening painful?

Yes, there is pain and muscle tightness, especially during distraction and at night. It is managed with scheduled pain relief and physiotherapy and usually eases once lengthening stops.

Who decides which technique is right for me?

The orthopaedic surgeon, after full-length X-rays, an examination and an honest conversation about your goals. You can bring preferences, but the choice is a medical one.

If you’re considering this surgery, send us your height, age and questions. We’ll arrange an online consultation with a specialist and, if you’re a candidate, a personal estimate based on the technique the surgeon proposes.

This article is for general information and does not replace a consultation with a qualified doctor.