Tibial Lengthening Over an Intramedullary Nail

Summary: Lengthening over a nail (LON) or transport over a nail (TON) are relatively new techniques and were first described in the femur by Paley and Herzenberg in 1997. The technique combines traditional Ilizarov distraction osteosynthesis with the convenience of a tibial intramedullary (IM) nail and requires only 1/3 of the external fixator time compared with standard Ilizarov technique. The most serious potential complication of osteomyelitis can arise as superficial infection tracks along a wire or pin which is in contact with the IM nail. Osteomyelitis was not encountered in the Vietnam LON/TON series and can be avoided by careful placement of wires and pins. Expensive implants are not required and hence it is suitable for the management of post-traumatic shortening (LON) and segmental bone loss (TON) in developing countries. The Surgical Implant Generation Network IM nail system can be used reliably with these techniques.