Research Summaries: Key Published Studies in Limb Lengthening

How to Use This Research Digest

These studies answer different questions in different populations. A complication percentage from external fixation, achondroplasia, or mixed reconstructive indications is not a direct estimate for an adult elective internal-nail procedure. Each summary below separates the finding from the limit.

2020 Cosmetic Stature Lengthening Systematic Review

Marwan and colleagues included 11 studies with 795 patients. Mean achieved lengthening was 6.7 cm, and the authors reported generally favorable satisfaction and functional outcomes. Most patients in the included literature used older external-fixator or LON methods; only 63 received implantable nails. The review called for clearer indications, contraindications, and guidelines. It should not be read as a modern device-specific risk estimate. ^[1]

2023 Multicenter FITBONE and PRECICE Cohort

Frost and colleagues reviewed 314 lengthened segments in 257 patients with mixed indications. Fifty-three percent of patients had at least one recorded complication under the study's classification. Tibial lengthening had a higher adjusted risk than femoral lengthening. The crude length-gained model suggested about 1% higher risk per millimeter, but the adjusted confidence interval included no effect, and the authors said the adjusted analysis provided no evidence that amount lengthened increased risk. ^[2]

2023 PRECICE Versus STRYDE Matched-Pair Analysis

Vogt and colleagues reported osteolysis in 31 of 48 STRYDE segments compared with 1 of 91 PRECICE segments. The observational study describes radiographic and clinical findings; it does not establish that the study caused the recall or that every recipient had the same outcome. FDA recall information should be cited separately. ^[3][8]

2013 Randomized LON Versus Ilizarov Study

In 31 limbs, LON reduced external-fixator duration and had fewer overall reported complications than conventional Ilizarov lengthening. Three of the 15 LON limbs developed deep intramedullary infection. The small trial supports a trade-off discussion, not a claim that LON is simply safer. ^[4]

2008 LATN Case-Matched Comparison

Rozbruch and colleagues found shorter external-fixator time and a lower bone-healing index with lengthening then nailing than with classic external fixation in a case-matched cohort. LATN still requires a later operation for nail insertion and carries conversion, infection, and implant risks. ^[5]

2016 Regenerate Comparison in Tibial LON and LATN

Ryu and colleagues compared radiographic regenerate measurements in 31 LON patients and 89 LATN patients. Reaming before distraction in LON was associated with temporarily lower pixel-value ratios during distraction. The study did not prove that one technique is superior for all complications or long-term outcomes. ^[6]

2025 Meta-Analysis of Cosmetic Lengthening

A meta-analysis pooled seven heterogeneous observational studies totaling 489 patients. No procedure-related deaths were reported in the included cohorts. That observation does not establish zero mortality or reliably quantify a rare event, and differences between external fixation and internal nails are vulnerable to selection, era, technique, and reporting differences. ^[7]

2023 Staged Bilateral Lengthening in Achondroplasia

Verdoni and colleagues reported 46 procedures across 92 segments in 33 patients with achondroplasia, with 19 complications. The population, goals, anatomy, age distribution, staging, and external-fixation techniques limit direct application to adult cosmetic stature lengthening. ^[9]

Current Device Status Must Come From Regulators

Peer-reviewed device outcome papers can lag regulatory events. The FDA states that stainless-steel Precice devices, including STRYDE, remain recalled and should not be implanted. A separate Class II recall identifies affected PRECICE MAX catalog and lot combinations and remained open when the FDA record was updated on July 14, 2026. Current status must be checked at the exact device and lot level. ^[8][10]