PRECICE Nail: The Internal Limb Lengthening Guide & Costs

Internal limb lengthening surgery is a modern technique used for height increase and leg lengthening. It relies on an internal PRECICE Nail, a telescopic, magnetically controlled rod implanted inside the femur (thigh bone) or tibia (shin bone) to stabilize bone and control elongation. 

Unlike external fixators like Holyfix or hybrid methods such as LON, this approach is fully internal, offering stronger fixation, better cosmetic results, and faster recovery. Discover with International Clinics how modern PRECICE nail limb lengthening can safely and effectively increase height and correct leg-length differences. 

What is Internal Limb Lengthening Surgery?

Internal limb lengthening surgery is a modern technique used for height increase and correcting leg-length differences. It relies on a telescopic, magnetically controlled rod that is implanted inside the femur or tibia after the surgeon performs a controlled bone cut (osteotomy). Unlike older external fixators or hybrid methods, this technique is fully internal. The intramedullary nail provides stable fixation, a cleaner cosmetic appearance, and more comfortable mobility during recovery.

What is PRECICE NAIL Limb Lengthening Surgery?

The Precice Lengthening System from Globus Medical/NuVasive is an internal limb lengthening method that does not require any external frame. During surgery, the bone is carefully cut, and a telescopic metal rod called a lengthening nail is placed inside the bone canal. 

This nail contains a small magnetic motor that can be controlled from outside the body using a remote-like device. As the motor expands the nail, it gradually increases the distance between the two bone segments, allowing new bone to form in the gap.

After the procedure, the patient uses an External Remote Controller (ERC). This handheld device contains a rotating magnet. When it’s placed against the treated limb and activated, the magnet triggers the motor inside the Precice nail to slowly extend. As the nail lengthens, the bone naturally lengthens with it, leading to controlled and gradual limb growth.

Advantages of PRECICE Nail Limb Lengthening

• No External Hardware: Eliminates bulky external frames, reducing infection risk and improving comfort and appearance.
• Precision & Control: The External Remote Controller (ERC) allows accurate, customizable lengthening, typically about 1 mm per day.
• Faster Recovery & Less Pain: Internal rod method is generally less painful and simpler than external devices, with fewer complications.
• Better Mobility & Cosmetic Results: Patients can move more easily during recovery, and the internal nail is hidden, offering a cleaner aesthetic.

Types of PRECICE Nail Limb Lengthening

PRECICE 2 is established and reliable, ideal for smaller bones, but requires more cautious post-operative care. PRECICE MAX focuses on convenience and greater lengthening, enabling faster rehabilitation with higher weight-bearing.

1. PRECICE 2 Nail

PRECICE 2 is a widely used titanium internal nail commonly used for smaller bones and pediatric patients, allowing controlled lengthening of 8–10 cm. It includes a “keeper” mechanism that prevents accidental unwinding, ensuring precise bone extension. Available in diameters of 8.5 mm, 10.7 mm, and 12.5 mm, it supports gradual recovery with limited initial weight-bearing (~50 lbs), making it suitable for patients who require careful stabilization during the healing process.

2. PRECICE 2.2 Nail

PRECICE 2.2 is an improved version of PRECICE 2, offering higher strength and enhanced control over bone lengthening. It is suitable for adults or cases requiring greater length gains, while still being compatible with smaller bones. Careful post-operative monitoring is essential to achieve safe and predictable results.

3. PRECICE Stryde Nail

Stryde is the latest generation nail, a stronger stainless-steel internal nail designed for higher weight-bearing, enabling full weight-bearing during the lengthening process. This allows patients to walk and perform normal daily activities while gradually increasing bone length. Stryde is ideal for those who want faster functional recovery and a more natural mobility experience, though it is less widely available compared to other PRECICE systems. It uses the same magnetic ERC controller, but it became less widely available due to safety concerns regarding bone reactions around the implant.

4. PRECICE MAX (PMAX) nail

PRECICE MAX is the newest version designed for larger length gains and faster rehabilitation, supporting higher weight-bearing (up to 150–200+ lbs). 

Available in more diameters and allows earlier, fuller weight-bearing, offering faster recovery and greater comfort, but is less universally accessible.

Patients can perform daily activities sooner and manage lengthening at home using an External Remote Controller (ERC), making it a convenient option for adults seeking quicker results. Its availability is more limited, and the cost is higher than earlier models.

Types by Bone Treated

• Femoral PRECICE: Used for lengthening the thigh bone (femur). It’s the most common option and allows the largest height gain with stable recovery.
• Tibial PRECICE: Designed for the shin bone (tibia). It offers controlled lengthening but usually allows slightly less gain compared to the femur and requires careful alignment.
• Humeral PRECICE: Used for lengthening the upper arm bone (humerus). It’s mainly done for arm-length differences rather than cosmetic height.

What are PRECICE Nail Sizes?

The PRECICE 2 nail is available in diameters of 8.5, 10.7, and 12.5 mm, with a maximum lengthening of up to 80 mm (about 3 inches), suitable for femur and tibia, including pediatric cases. The newer PRECICE MAX offers larger diameters (10, 11.5, 13, 14 mm) for higher strength and weight-bearing, allowing lengthening up to 250 mm depending on the size, making it ideal for faster rehabilitation and greater limb-length gains.

How does PRECICE Nail Limb Lengthening Work?

1. Surgical Implantation: A surgeon inserts the PRECICE nail into the hollow center (marrow canal) of the shortened bone and makes small cuts (osteotomies) to create a gap for new bone to form.
2. External Control: A handheld External Remote Controller (ERC) is placed over the implant. Magnets in the ERC activate a gear system inside the nail.
3. Gradual Lengthening: The patient (or caregiver) uses the ERC to activate small lengthening sessions multiple times a day, gradually extending the nail and the bone.
4. Bone Regeneration: New bone (callus) fills the space created by the lengthening, eventually solidifying and replacing the implant.
5. Implant Removal: After the desired length is achieved and the new bone has hardened (usually 9-12 months later), a final minor surgery removes the nail.  

Who is a Candidate for PRECICE Nail Limb Lengthening?

Candidates for internal PRECICE nail limb lengthening are typically adults or adolescents whose bones have mostly matured and who are in good overall health. 

Ideal patients may seek the procedure to increase height, correct limb-length discrepancies, or address deformities caused by injury, congenital conditions, or disease.

Patients should have healthy bone structure, no active infections, and realistic expectations about the gradual process and required rehabilitation. 

A thorough evaluation by an orthopedic surgeon specializing in limb lengthening is essential to determine suitability and ensure safe, effective results.

Who Benefits Most?

• Children & Adolescents: Ideal for growing kids with significant limb length issues, avoiding external frames.
• Adults with Discrepancies: Those with post-traumatic shortening, congenital conditions (like hip dysplasia), or bone loss.
• Cosmetic Height increase: People dissatisfied with their height can use it for gradual, subtle increases.
• Post-Injury/Disease: Patients needing to correct deformities or length issues from fractures or skeletal conditions.

PRECICE Nail Limb Lengthening Cost 2025

The cost of limb lengthening with a PRECICE nail varies depending on the surgeon, location, and whether one or both legs are treated. In the U.S., prices for a single leg range from $54,000 to $85,000, while bilateral procedures can reach $100,000–$150,000 or more, with combined tibia and femur lengthening sometimes exceeding $250,000. 

Turkey offers more affordable options, typically $28,000–$35,000 per leg, often including surgery, hospital stay, the PRECICE nail, imaging, and basic physiotherapy. 

Many clinics also provide all-inclusive packages covering accommodation, transfers, and translation services, designed for international patients to ensure a smooth and hassle-free experience.

PRECICE Nail limb lengthening cost by country 

Recovery after PRECICE Nail Limb Lengthening Surgery

Recovery after PRECICE nail limb lengthening is generally faster and more comfortable compared to traditional external fixator methods. The internal rod system provides superior bone alignment and stabilization, promoting smoother and quicker bone healing.

Patients often experience a better emotional and aesthetic outcome, as there is no bulky external frame, smaller scars due to the absence of pins, and a lower risk of infection.

Recovery Timeline After PRECICE Nail Surgery

Mobility During Recovery of PRECICE Nail 

With the PRECICE nail, patients can often start gentle walking earlier compared to external fixators like LON or Holyfix. The internal rod provides stable bone support, allowing safer, more comfortable mobility and reducing the risk of joint stiffness during recovery.

Pain and Comfort with PRECICE Nail 

Internal limb lengthening generally causes less pain than external devices. There are no pins protruding through the skin, which minimizes soft tissue irritation, lowers infection risk, and makes daily activities easier during the distraction and consolidation phases.

Physical Therapy After PRECICE Nail Surgery

After surgery, physical therapy is crucial to maintain joint mobility, muscle strength, and proper gait. Patients are encouraged to begin gentle exercises early under the supervision of a specialized physiotherapist. The lengthening phase usually lasts several weeks to months, followed by the consolidation phase, during which the new bone hardens and becomes strong enough to support full weight.

PRECICE Nail Limb Lengthening Before & After Results

Patients undergoing PRECICE nail limb lengthening can expect gradual and controlled increases in height or correction of limb discrepancies. 

Clinical photos often show visible improvements in limb symmetry and overall stature, with bones fully consolidated after several months. Recovery is smoother than external frames, with fewer complications and better mobility during treatment.

You can expect height gain of around 2-3 inches (5-8 cm) per limb using Precice nails, with the femur generally allowing for more (up to 8 cm) and the tibia slightly less (5-7 cm), but safety limits often mean doctors recommend capping gains at 3-5 cm per bone to avoid complications like joint stiffness or tendon issues, though total height can reach 4-6 inches (10-15 cm) with bilateral (both legs) surgery.

Risks and side effects of PRECICE Nail

Recovery from PRECICE nail limb lengthening may involve temporary discomfort and minor complications, but serious issues, though rare, require careful monitoring and intervention. The PRECICE nail system for leg lengthening is a minimally invasive procedure designed to minimize scarring compared to older methods that use bulky external frames. The scars are typically small, strategically placed, and tend to fade significantly over time. 

Common Temporary Side Effects

• Pain & Discomfort: Localized at the surgical site or due to tissue stretching.
• Joint Stiffness: Particularly in the knee or ankle, typically managed through physiotherapy.
• Adjustment Needs: Occasionally, distraction rates may need modification (slower or faster).
• Temporary Numbness: Tingling or reduced sensation (hypoesthesia) in the limb.

Serious Complications 

Although PRECICE nail limb lengthening is generally safe, some complications can occur. Infections (osteomyelitis) may develop in the bone, sometimes requiring antibiotics or even nail removal. 

Bone healing problems, such as delayed healing, non-union, or mal-union, can affect results. Nerve or vessel injury may happen, causing irritation or damage to nerves or blood vessels. Muscles or tendons can tighten, leading to tissue contractures that limit movement. 

Although stiffness is common and minor, other serious Joint issues, partial dislocations (subluxation), or full dislocations, especially in the knee, can occur. 

Rarely, compartment syndrome, a dangerous swelling or bleeding that increases pressure inside the muscles, may develop and need immediate medical attention.

Device-Related Risks

In rare cases, issues can occur with the nail itself. For example, nail breakage is more likely when the same nail is used for a second lengthening procedure. Implant failure happens when the internal mechanism stops working, preventing the nail from lengthening the bone as planned. These problems are uncommon, but it’s important to monitor closely and contact your surgeon immediately if anything unusual occurs.

PRECICE Nail Limb Lengthening in Turkey

If you are considering height increase or limb-length correction, an accurate diagnosis and personalized evaluation by a specialized team are the most important first steps. Contact International Clinics today to schedule a comprehensive consultation with limb-lengthening experts and ensure a safe, effective treatment plan tailored to your needs.

FAQs About PRECICE NAIL