Motorized, telescopic, intramedullary lengthening nails for limb length and deformity correction

A new generation of remote controlled internal limb lengthening nails is now available. This article will review the history, techniques, and early outcomes of motorized limb lengthening nails. Recommendations are made for patient selection, preoperative planning, intraoperative techniques, postoperative care, and avoidance of complications. These devices allow an accurate and well controlled rate and rhythm of distraction for limb lengthening. Early clinical reports indicate improved outcomes and less patient pain compared with external fixator lengthenings. Proper preoperative planning is an essential part of the methodology. Acute intraoperative correction is often required with fixator-assisted nailing techniques, as later adjustment during or after lengthening is not possible without additional surgery. Antegrade and retrograde femoral and antegrade tibial techniques are discussed, including patient indications, preoperative planning, surgical steps, pearls, pitfalls, and complications.