The nail is inserted throught the top of the femur, close to the hip joint. A small incision (1 to 2 cm) allows inserting the nail inside the bone canal after its transverse section, then fixed at its two extremities with screws into the bone. There are only 3 small scars (1 to 3 cm), closed with intradermal suture and surgical 'superglue'.
Alternative inwards and outwards rotatory maneuvers of the lower limb allows Ratcheting the nail, and thus enlarging the gap between the two bone fragments. Please see the pages on 'Ratcheting ' to understand better.
Ratcheting is generally non or slightly painful when the patient did an optimal preoperative preparation: when he is well conditionned for the postoperative period, he decreases his stress and thus relaxes more easily, allowing easier clicks. Gains of 10 to 15 cm can be obtained with a secondary exchange of nails.
Picture (above): X-rays after a bilateral lengthening of 8.5 cm.
Picture (left): Good healing of the gain zone; (below): Patient before and fater a 5 cm lengthening of the right femur (discrepancy of length).