Updated: September 30, 2025 • Orthopedics & Traumatology

When Should Nails Be Removed in Limb Lengthening Surgery? Optimal Timing and Expert Insights

Intramedullary nails used in limb lengthening play a crucial role in the distraction and consolidation phases. One of the most common patient questions is: “When should the nail be removed?” Below you’ll find the main factors, the ideal timeframe, and what to expect after removal.

Is Nail Removal Necessary?

In some cases, nails can remain in place for years. However, for young and active individuals, removal is usually recommended to reduce long-term irritation, pain, or infection risks. Keeping the nail avoids another surgery, but removal provides a healthier long-term outcome.

Note: The decision is always individualized and should be made together with your surgeon.

Factors Affecting Nail Removal Timing

Bone healing: Radiographic confirmation of full consolidation.
Patient factors: Age, bone density, and comorbidities.
Surgical method: LON, Precice, Fitbone or other techniques.
Complications: Pain, loosening, or infection may require earlier removal.
Activity level: Plans to return to sports or heavy physical activity.

Optimal Removal Time

Generally, nails are removed 12–18 months after full consolidation. This timeframe allows the bone to regain strength and safely bear weight without internal support.

Risks of early removal: Higher risk of fracture or collapse.
Risks of late removal: Persistent irritation, discomfort, or implant-related issues.

Reminder: The calendar does not decide; bone biology does. Timing must be based on X-ray evidence and clinical findings.

How Is Nail Removal Performed?

Performed under general or spinal anesthesia, often with a minimally invasive approach.
Duration depends on the nail type and fixation method.
Hospital stay is usually 1 day, with early mobilization encouraged.
Wound care is simple; stitches are removed after 10–14 days if not absorbable.

Care After Nail Removal

Physiotherapy: To restore muscle strength and joint mobility.
Return to activity: Daily activities quickly; sports after surgeon’s approval.
Follow-up: Regular checks during the first 6 months.
Nutrition: Adequate vitamin D, calcium, and protein intake supports healing.

In summary, nail removal is usually planned between 12–18 months after complete healing, tailored to the patient’s condition and clinical progress. Consult your orthopedic team to determine the best timing for you.

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