Fig. 3

Another representative case (Patient 6). A 14.5y boy with CPT associated with neurofibromatosis type 1 (NF1) had radiological findings of proximal tibial dysplasia (a, b). Then a combined Ilizarov fixator with intramedullary rodding of the tibia and wrapping autogenic iliac bone graft technique was carried out to manage the pseudarthrosis. And simultaneously a proximal tibial osteotomy was implemented to have access to the normal alignment with the same intramedullary rodding. Two years after the procedure, the radiography showed a primary union of pseudarthrosis but nonunion of osteotomy site with LLD of 8 cm(c, d). A proximal tibial lengthening and compression of the primary osteotomy site was carried out to equalize the limb length (e– g). The length gained was 8 cm with HI of 68 d/cm. Then the ex-fixator was removed and the intramedullary rod was pushed into the tibia cavity. The radiography showed both the lengthening segment and the primary osteotomy site were union (h, i). One year after removal of ex-fixator, X rays showed well corticalization of the lengthening segment with good alignment of tibia, however the ankle joint was stiff with degenerative changes (j)