Skip to main content
Limb Lengthening Library

Research summary

External Fixators vs Internal Nails: A 2025 Cosmetic Lengthening Review

Seven studies and 489 patients compared external fixation with internal nails. Read the complication findings and limits of this observational evidence.

Topic: outcomesType: reviewYear 2025

In brief

Does the cosmetic lengthening meta-analysis establish one safer method?

A meta-analysis of seven observational studies and 489 cosmetic-lengthening patients reported more Paley problems in external-fixator cohorts. Heterogeneity and selection prevent a universal safety ranking; no observed deaths does not establish zero mortality.

Limits: This summary explains evidence context and limitations; it is not medical advice.

Evidence
Peer-reviewed evidence
Source set
Peer-reviewed sources
Updated
References
1 listed

Editorial responsibility: Limb Lengthening Library editorial team. Independent medical review is not claimed unless a named reviewer is listed. How sources are reviewed.

Topic: outcomesType: reviewYear: 2025

Study Question

The authors pooled seven studies with 489 patients to compare reported complications and functional outcomes after cosmetic limb lengthening with or nails. The article was published in the July 2025 volume of the Journal of Orthopaedics, with a 2024 online DOI. [1]

Main Reported Findings

The pooled data showed more Paley problems in external-fixator cohorts and reported high satisfaction in several studies. No procedure-related deaths were reported among the included cohorts. The paper also presented obstacle and complication categories, but definitions and reporting were not uniform across all source studies.

Important Limitations

  • Only seven studies were included, totaling 489 patients.
  • The evidence was observational and heterogeneous rather than randomized.
  • External-fixator and internal-nail groups can differ by era, indication, selection, technique, and follow-up.
  • Paley categories and denominators may not have been applied identically across studies.
  • A sample of this size cannot reliably quantify rare outcomes such as mortality.

Responsible Interpretation

The analysis supports discussing different complication profiles for external and . It does not prove that an internal nail is safer for every patient, that causes the observed differences, or that either method has zero mortality. Provider-specific outcomes for the proposed device, segment, indication, and follow-up remain necessary.

Sources

Verification policy

Informational only. Not medical advice.