Theoretically speaking, how exactly does the procedure of multiple surgeries/lengthenings beyond 2 standard femur+tibia lengthenings (by multiple surgeries here I mean 4 total lengthenings [femur+tibia, femur+tibia], usually a year apart) for LON work?

For the Precice method, Dr. Paley explains it through Option 5 in his booklet, which involves first lengthening the tibia and femur at the same time staggered three weeks apart, 4cm each bone. We then stop and allow the bones to heal. One year later, the femurs and the tibias and fibulas can be cut and the same nail used to restart the lengthening again.

Is there an alternative to such procedure for LON method, and how would it differ? For instance, would the same nail be used, or would four separate nails be necessary?