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Sequential Limb Lengthening: A Novel Staged Approach Combining External Fixation and a Motorized Intramedullary
T Cerasoli1, G Balboni1, C Musiani2
1Department of Biomedical and Neuromotor Sciences DIBINEM, Alma Mater Studiorum University of Bologna, Bologna, Italy, unibo.it.
Case Reports in Orthopedics
|May 18, 2026
Summary
This study introduces a novel sequential limb lengthening technique for large tibial defects, combining external fixation with motorized intramedullary nails. This staged approach successfully addressed a 16-cm bone defect, offering potential advantages over existing methods.
Area of Science:
- Orthopedic surgery
- Limb reconstruction
- Bone regeneration
Background:
- Large posttraumatic tibial defects pose significant reconstruction challenges.
- External fixation and intramedullary nails have limitations for extensive bone lengthening.
- Existing literature lacks descriptions of fully sequential limb lengthening using both methods.
Purpose of the Study:
- To present a novel staged limb lengthening technique.
- To review existing literature on limb lengthening strategies.
- To compare the sequential approach with current methods.
Main Methods:
- A case report of a 16-cm tibial defect treated sequentially.
- External fixation for initial bone transport (10 cm).
- Motorized intramedullary nail for subsequent lengthening (6 cm).
- Comprehensive literature search of limb lengthening techniques.
Main Results:
- No prior studies found describing a fully sequential external fixation to intramedullary nail approach.
- The described sequential technique successfully lengthened a 16-cm tibial defect.
- The approach facilitated controlled distraction and bone transport.
Conclusions:
- A novel staged limb lengthening technique combining external fixation and intramedullary nailing is presented.
- This sequential conversion may reduce external fixation index and improve stability.
- Further research is warranted to assess long-term outcomes of this approach.
