Minimally Invasive Management of Peri-implant Fractures in Intramedullary Limb Lengthening: A Technical Note

Objective: This study aimed to describe a novel minimally invasive surgical technique for the management of intraoperative and postoperative fractures occurring at the tip of intramedullary lengthening nails without altering the original treatment plan.

Methods: This technical note describes a surgical technique applied in two representative cases of peri-implant fractures encountered during intramedullary limb lengthening procedures between 2011 and 2017. The technique involves bypassing the fracture line by utilizing the residual elongation capacity of the nail, followed by stabilization with a percutaneously applied locking compression plate (LC-DCP) and cable system. Key technical steps, intraoperative considerations, and postoperative management are outlined.

Results: The described technique enabled successful stabilization of both intraoperative femoral and postoperative tibial fractures without implant exchange or alteration of the treatment plan. The planned lengthening goals were achieved, fracture healing was confirmed radiographically, and both patients regained pain-free ambulation with satisfactory functional outcomes. No major complications or alignment problems requiring additional intervention were observed.

Conclusion: This technique provides a practical, reproducible, and minimally invasive solution for managing peri-implant fractures associated with intramedullary lengthening nails. By preserving the existing implant and avoiding additional surgical procedures, it may reduce treatment complexity, cost, and morbidity while maintaining satisfactory clinical outcomes.

Cite this article as: Armağan R, Sülek Y, Kanar M, Eren OT. Minimally invasive management of peri-implant fractures in intramedullary limb lengthening: A technical note. Acta Orthop Traumatol Turc. 2026; 60(4), 0503, doi: 10.5152/j.aott.2026.25503.