Limb Lengthening Complications and How We Prevent Them
Short answer
Limb lengthening is major surgery and has real risks. The most common problems are muscle and joint tightness, nerve irritation, slow bone healing, infection (mainly at pin sites with LON), blood clots and hardware problems. Most of them are caught early and treated by slowing the lengthening, daily physiotherapy and regular X-rays. Serious permanent problems are uncommon when the surgeon controls the speed and the patient follows the program.
1. Joint stiffness and contracture
• What it is: Muscles and tendons do not keep up with the bone, so the knee or ankle loses movement. In the tibia, the Achilles tendon is the usual problem (equinus).
• Warning signs: You cannot fully straighten the knee, or the heel will not reach the floor.
• Prevention and treatment: Daily stretching with our physiotherapist, night splints when needed, and slowing or pausing the lengthening. Rarely, a small tendon-release procedure is needed.
2. Nerve irritation
• What it is: Nerves are stretched along with the bone.
• Warning signs: Numbness, tingling, burning pain or weakness in the foot.
• Prevention and treatment: Report it the same day. Slowing or pausing the lengthening usually resolves it.
3. Slow bone healing, non-union and premature consolidation
• What it is: The new bone (regenerate) forms too slowly, does not harden, or hardens too early and stops the lengthening.
• How often: Non-union occurs in less than 1% of our patients.
• Prevention and treatment: Regular X-rays let the surgeon adjust the daily rate. If we see signs of delayed healing, we may stop the lengthening early to protect the bone. Not smoking, good nutrition and vitamin D help. Slow healing may need extra time, bone stimulation or, rarely, a bone graft.
4. Infection
• What it is: With LON, the pins of the external frame pass through the skin, so pin-site infections can occur. Deep bone infection (osteomyelitis) is rare; to date we have not had a case in our patients. Read our article on osteomyelitis.
• Warning signs: Redness, discharge, rising pain or fever.
• Prevention and treatment: Daily pin-site care, sterile surgery and antibiotics when needed. Internal nails (PRECICE, FITBONE) have no pin sites.
5. Blood clots (DVT)
• Prevention: Blood thinners after surgery, early movement, and a blood-thinner injection 2 hours before any long flight (flying is possible from 15 days after surgery).
• Our surgical technique: Before reaming the bone canal, we open several small holes in the bone. During reaming, the fat inside the bone flows through these holes to a single point instead of entering the bloodstream. We collect this bone fat, process it into stem cells and apply them to the osteotomy area just before finishing the surgery. This lowers the risk of fat embolism and clots dramatically and improves healing in the osteotomy area at the same time.
• Our record: To date, we have not had a case of embolism in our patients.
• Warning signs: Calf swelling or pain, sudden shortness of breath. Shortness of breath is an emergency.
6. Hardware problems
Rarely, a nail or screw can fail or an internal nail can stop lengthening. These are managed surgically if needed.
How often do complications happen?
• Non-union (bone not healing): less than 1% of our patients.
• To date, we have not had a case of embolism or osteomyelitis (deep bone infection) in our patients.
• Other complications: about 1% each, as a standard rate at our clinic.
Every patient has the basic mandatory complication insurance, and we cover surgery-related complications during the first 3 months. See Complication cover.
FAQ
Can complications be permanent?
Rarely. Most are temporary and treated during the program. This is why we keep patients in Istanbul for the lengthening phase.
Is the internal nail safer than LON?
It removes pin-site infections. Other risks, such as stiffness and nerve irritation, are similar.
What happens if I have a complication after I go home?
Send photos, videos or X-rays on WhatsApp the same day. Our team reviews them and tells you what to do.
Questions about the risks for your own case? Message us on WhatsApp (+90 533 016 45 62) for a free online consultation with Op. Dr. Fatih Arslanoğlu.
Medically reviewed by Op. Dr. Fatih Arslanoğlu, Asst. Prof. of Orthopedics and Traumatology · Last reviewed: 31 October 2026