What Is the LON Method? Facts and Misconceptions About the Most Common External Fixator System
Among the various limb lengthening methods, LON (Lengthening Over Nail) has become one of the most frequently discussed — especially in Turkey, where it’s widely used. As a hybrid system that combines both external fixation and an internal rod, LON often stands at the center of comparisons between external and internal techniques.
In this article, we’ll explain what LON actually is, where it stands among the other external systems, and — most importantly — clarify some common misconceptions and partial truths surrounding this method.
What Is the LON Technique, Really?
The LON method involves two phases:
• First, an external fixator is used to gradually distract the bone, allowing it to lengthen (typically 1 mm per day).
• Meanwhile, an intramedullary nail (internal rod) is inserted inside the bone to provide internal stability.
• Once the target length is achieved, the external fixator is removed, and the internal nail supports the bone through the healing (consolidation) process.
This hybrid system allows for both controlled lengthening and improved support during recovery.
Common Misconceptions About the LON Method
“You can’t lengthen more than 7–8 cm with LON.”
This is not entirely accurate.
While 7–8 cm is a commonly targeted length for femur and 5–6 cm for tibia in LON, it is possible — with proper planning, good bone structure, and patient compliance — to achieve up to 10 cm of lengthening.
However, the focus should not be only on the number of centimeters, but on ensuring safe progress with balanced muscle and nerve adaptation.
“LON is a very painful and difficult process.”
This is an exaggeration.
With proper surgical technique, pain management, and physical therapy, the LON process can be managed quite comfortably.
Yes, the presence of an external fixator may cause temporary discomfort or skin sensitivity, but this is manageable and time-limited.
Additionally, the internal nail offers stability during healing, which is a major advantage in terms of patient safety.
“Once the fixator is removed, everything is back to normal.”
This is a common misunderstanding.
While fixator removal is a milestone and offers significant psychological and physical relief, the healing process does not end there.
The internal nail continues to provide support, and the bone still requires weeks to months of consolidation.
Patients need to continue with rehab and avoid full physical loading until advised.
“The results from LON are not permanent.”
This is false.
When performed on the right patient, with experienced surgical planning and a structured rehab program, the results from LON are long-lasting.
However, proper post-operative follow-up and eventual nail removal (in many cases) are essential for long-term success.
“LON is a low-tier alternative to other systems.”
This is a biased view.
LON may be more cost-effective, but that does not mean it is inferior.
With the right team and patient profile, LON can deliver excellent outcomes.
Some surgeons even prefer it for complex deformities or when full magnetic systems are not accessible.
Advantages of the LON Method
- Earlier fixator removal compared to classical external systems
- Additional safety through the internal nail
- Cost-effective and accessible
- Broad suitability across patient profiles
- Combines mechanical support with controlled distraction
Limitations of LON
- Higher infection risk around pin sites during fixator phase (requires strict hygiene)
- Less comfortable compared to fully internal systems
- Requires two surgeries (for fixator installation and removal)
- Dependent on surgeon experience and patient compliance
Conclusion: LON Is a Balanced Choice — Not a Miracle, Not a Nightmare
The LON method is a viable, effective and accessible approach when performed by skilled hands with a clear recovery plan.
It’s neither a second-class option nor a shortcut.
Patients with limited access to high-end magnetic systems may find LON to be a practical and successful path.
✅ If your priority is affordability and surgical reliability, LON may be a strong candidate.
✅ If comfort, aesthetics, and minimal external hardware are your goals, an internal-only system like PRECICE may better suit you.
