A Stryde nail that broke: what a 2026 case report says about old fillers and cosmetic limb lengthening

The patient was a 43-year-old woman, 155 cm tall, who had both femurs lengthened with PRECICE Stryde nails at another hospital in 2019. The operation was cosmetic: no medical condition lay behind her height. In 2010 she had had her buttocks augmented with Aquafilling, an injectable gel. Because it was injected, it left no scar, and because nobody asked about earlier cosmetic procedures, it never came up before surgery.

During the lengthening operation the team saw a gel-like material leaking into the surgical field. Only when she was questioned afterwards did she mention the filler, placed almost ten years earlier. The table follows the case from there, using the timings the authors report.

Aquafilling is a hydrogel filler used to add volume to the breasts, hips and legs. According to the case report it is made mostly of saltwater with polyamide components, it behaves much like human tissue, and its effect lasts a long time after injection. It has not been approved by the US FDA, but it has been approved and used in several countries; the authors name Türkiye, Serbia, Malaysia, Japan and Korea.

The complication reported most often with it, in the plastic-surgery literature the authors review, is migration. The gel moves away from where it was injected and can form complex cystic collections.

That is the trap here. A breast implant or a surgical buttock augmentation leaves a scar that a surgeon will notice and ask about. An injection does not. The authors make the point directly: some earlier aesthetic procedures cannot be detected on physical examination. If nobody asks, they stay invisible until they cause a problem.

The authors conclude that gel migrating from the old buttock injection reached the osteotomy site, the cut in the femur that the nail slowly pulls apart, and set off an inflammatory reaction there. The new bone that should have filled the gap formed poorly. Delayed union, they write, was the main problem. On the left side it ended as a nonunion, with the nail failed and angled at the osteotomy.

Infection was looked for repeatedly and never found. There was no fever, blood tests were normal or did not point to infection, and every culture came back negative, at the first hospital and at the authors' hospital. Tissue taken during the revision showed "active chronic inflamed connective tissues with degenerative changes": inflammation, not infection.

The report contains no metallurgical analysis of the broken nail and does not claim the device was defective. What it describes is a bone that did not heal around a nail, in a patient whose wounds kept discharging a foreign gel.

No, and the distinction matters for anyone who still has a Stryde. The PRECICE Stryde was withdrawn under an FDA Class II recall initiated on 12 February 2021, after corrosion at the nail's telescoping junction was linked to bone changes around the implant. The case report does not mention corrosion or the recall. It attributes the healing failure to migrated filler, not to the nail's metal.

The timeline is still worth knowing. This patient's nails went in during 2019, before the recall. The report describes the Stryde as the third-generation PRECICE nail, whose main difference from earlier versions was its load-bearing capacity: patients could move freely during lengthening and consolidation, which made rehabilitation easier. Stryde is no longer implanted.

If you have a Stryde in place, keep to the monitoring your surgeon set up after the recall. Our recall explainer covers the imaging schedule and the questions to ask, and the Stryde method page sets out how the nail compares with PRECICE 2.

A single case report cannot give a rate, and the authors do not try to. What they do is set the case against earlier series, and those numbers show why a broken nail is unusual while poor healing is not.

In a 2014 series of 24 patients with 26 PRECICE nails, Schiedel and colleagues reported two nail breakages, one at a weld seam and one after a fall during consolidation. A Hannover series of 37 femoral lengthenings with the ISKD, an older mechanical nail, found insufficient regenerate bone in 8. The risk factors in that series were distraction faster than 1.5 mm a day, age 30 or over, smoking, and gains beyond 4 cm. Wound problems and infection, the authors add, are uncommon with fully implanted nails, which is part of why this case stood out.

The broadest picture comes from a 2021 systematic review of 983 segments lengthened with FITBONE or PRECICE nails. It found one complication for every three segments, and in one segment of every four a complication with major impact: a substantial change of plan, a missed lengthening goal, or a new problem or permanent sequela. Device and bone complications were the most frequent. Against that background, the filler in this case was a new cause of a known problem, and one that a single pre-operative question could have flagged.

The recommendation is short. Anyone being assessed for aesthetic leg lengthening should be asked specifically about earlier cosmetic filler procedures, and imaging such as MRI can help locate filler that has moved from where it was injected. The authors expect more patients with aesthetic concerns to ask for these operations, which makes the question more relevant every year.

In practice part of the job falls to the patient. Before a consultation, write down every cosmetic procedure you have had, including injections that left no mark: what was injected, where, when and by whom. Bring whatever records exist. If gel or filler has ever been placed in your buttocks, hips or legs, say so at the start, and ask the surgeon whether it changes the plan or calls for imaging before surgery.

The report's lesson is that the question has to be asked. If your surgeon does not ask it, raise it yourself.

It is one patient. The report cannot say how often a hidden filler causes trouble after lengthening, whether the risk differs between femur and tibia, or how much length this patient gained, because those details of the first operation, done elsewhere, are not reported.

It is also about one product. Aquafilling is a hydrogel. The report says nothing about hyaluronic-acid fillers, and nothing about fat transfer, the technique behind the Brazilian butt lift. Do not read it as evidence for or against lengthening after either; ask your surgeon.

Nor does it make the Stryde, or any nail, more or less safe in general. The nail failed where the bone had not healed. The authors' contribution is narrower and more useful than a verdict on a device: a warning that a cosmetic history can reach into an orthopedic operation, and a screening step that costs one question. Case reports are how new complications first enter the literature, and the authors suggest animal studies to work out the mechanism.

The case was published in 2026 in the Medical Bulletin of Sisli Etfal Hospital (volume 60, issue 1, pages 120 to 123) by Muharrem Kanar, Enver İpek and Süleyman Çakırtürk. Kanar, the first author, conceived, designed and wrote the report. The patient gave written consent for publication, and the paper was externally peer-reviewed. Kanar and İpek work in the orthopedics and traumatology department of Şişli Hamidiye Etfal Research and Training Hospital in Istanbul; Çakırtürk is at Afyonkarahisar State Hospital.

Assoc. Prof. Dr. Muharrem Kanar performs limb lengthening, including cosmetic lengthening, and has published on motorized lengthening nails and hexapod frames. This article retells his report with his permission, in our words; the findings, numbers and conclusions are the paper's. He is also listed as a clinical reviewer on this site, with a published conflict-of-interest statement.

The short version for patients: this Stryde nail failure began with a filler nobody asked about. Tell your surgeon about every cosmetic procedure you have had.