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Technique · Combined internal and external

Lengthening over nail (LON)

A combined technique in which an intramedullary nail and an external fixator are applied in the same operation; the frame produces the lengthening while the nail is already in the bone.

listed providers
5
countries
4
provider types
3
care models
3

Methods here are lengthening techniques, kept separate from the devices used with them and from providers' own procedure names. Listings are provider-reported and publicly sourced, and informational only — LimbAtlas does not recommend a technique or device, and suitability depends on an individual clinical assessment. Confirm current details directly with a provider. Diagrams are simplified illustrations, not to scale and not of any specific device.

Classification

Category
Combined internal and external
Also called
LON, Lengthening over a nail, Lengthening over an intramedullary nail

How it works

Paley and colleagues (1997) describe the nail and the external fixator being applied together at the time of the bone cut. After gradual distraction, the nail is locked and the fixator is removed.

The International Center for Limb Lengthening describes the frame's pins and wires being placed around the nail so that they do not touch it.

Typical components

  • An intramedullary nail (it does not itself lengthen)
  • An external fixator that produces the lengthening and is removed afterwards

Devices providers name with it

Device types: Monolateral external fixator, Circular external fixator.

A device is not a technique: the same frame or nail can be part of different techniques. Listed devices are ones providers name on LimbAtlas, not a complete market list.

Points to discuss with a treating team

  • The International Center for Limb Lengthening notes that pin infections can spread to the nail in the bone canal. Ask how this risk is monitored.
  • Ask which external fixator is used with the nail, and when each is planned to be removed.

Rehabilitation

AAOS describes regular follow-up visits and extensive rehabilitation, including physical therapy and home exercise, for both internal and external lengthening.

Where providers list this method

What listing providers offer

Provider types

  • Hospital3 of 5
  • Surgical clinic1 of 5
  • All-in-one patient care center1 of 5

Care models

  • Surgery + rehabilitation5 of 5
  • Surgery + accommodation1 of 5
  • Fully coordinated care1 of 5

Services stated in profiles

Rehabilitation

  • Available5

Accommodation

  • Available1
  • Not publicly stated4

Patients operated elsewhere

  • Not publicly stated5

Across 5 listed providers.

Related methods

Related by how the taxonomy groups methods, not by clinical similarity or suitability.

Providers currently listing this method

5 listed providers · shown alphabetically

  • Reception desk of the Paley Middle East Clinic at Burjeel Medical City

    Burjeel Medical City — Paley Middle East Clinic

    Abu Dhabi, United Arab Emirates

    Hospital · Surgery + rehabilitation

    • Fully internal lengthening
    • External fixation
    • Lengthening over nail (LON)
    Partially verified

  • Live Life Taller

    Istanbul, Turkey

    All-in-one patient care center · Surgery + rehabilitation +2

    • Fully internal lengthening
    • Lengthening over nail (LON)
    Partially verified

  • Paley European Institute

    Warsaw, Poland

    Surgical clinic · Surgery + rehabilitation

    • Fully internal lengthening
    • External fixation
    • Lengthening over nail (LON)
    Partially verified
Refine these providers in the directory

Related guides

  • Getting started

    What is limb lengthening?

    A plain-language introduction: the principle of gradual bone lengthening, the main ways it is carried out, why people consider it, and what the process involves over time.

    4 min readReviewed

  • Methods & devices

    Internal and external limb lengthening

    How the four techniques LimbAtlas records differ in where the lengthening hardware sits — inside the bone, outside the limb, or both — and what that structural difference does and does not tell you.

    4 min readReviewed

  • Methods & devices

    LON and LATN: two combined techniques

    How lengthening over nail (LON) and lengthening and then nailing (LATN) differ in the order in which a frame and a nail are used — explained from the studies that describe them, without comparing outcomes.

    4 min readReviewed

Sources

  1. Femoral lengthening over an intramedullary nail. A matched-case comparison with Ilizarov femoral lengthening (opens in a new tab)

    The Journal of Bone and Joint Surgery (American volume), 1997;79(10):1464-1480 · Scientific source · checked 3 Oct 2026

    Paley D, Herzenberg JE, Paremain G, Bhave A. Abstract used for the definition of lengthening over a nail only.

  2. Lengthening Over Nail (opens in a new tab)

    International Center for Limb Lengthening, Sinai Hospital of Baltimore · Hospital website · checked 3 Oct 2026

    Used for the components of lengthening over a nail and its pin-site consideration.

  3. Lower Limb Length Discrepancy (opens in a new tab)

    OrthoInfo, American Academy of Orthopaedic Surgeons · Professional medical source · checked 3 Oct 2026

    Patient information focused on children. Used only for general descriptions of external and internal lengthening, follow-up and rehabilitation.