Lengthening Over the Nail

This approach is relatively new. An intramedullary nail is inserted with two external rings. Distraction starts as usual on the 5th day after the surgery. When the necessary length of the segments is achieved and X-ray control reveals adequate bone formation, a second surgery is performed to put in locking screws and to remove the frame. The advantages of this method are a shortening of necessary time that patients carry an external frame, and relative comfort. The disadvantages are some technical difficulties, including a higher threat of infection and the necessity of 3 surgeries under general anesthesia.