Fig. 2

A 2.1y boy (Patient 4) with CPT of the left had two procedures of the tibia in another hospital previously. Radiographs showed the fragmental bone grafting but nonunion of the pseudarthrosis (a, b). Two years after combined surgery with Ilizarov fixator, intramedullary rodding of the tibia and wrapping autogenic iliac bone graft, the radiography showed a primary union of pseudarthrosis with LLD of 2 cm and angulation of tibia (c, d). A proximal tibial osteotomy and lengthening was carried out to correct the angulation deformity and equalize the limb length (e, f). Lateral callus was observed in this patient (g). Lengthening procedure was suspended for 2 weeks until new regenerate bone formation was observed around the callus. The length gained was 3.8 cm with HI of 63 d/cm (h, i). X rays of the last follow-up showed solid union of the lengthening segment and good alignment of tibia (j, k). The next step is to push the whole rod into tibia cavity when there is enough length in proximal tibia