Fig. 1

Schematic photographs and intra-operative appearance depicting the “Eiffel Tower” double titanium elastic nailing in combined management of CPT. Resection of the tibial pseudarthrosis (a). The proximal tibial stump was split into two flaps. The bone ends were docked (b) and two TENs were inserted into the tibia (c). Two additional k-wires were set in a crossed fashion for interlocking fixation at the pseudarthrosis site. The grafted cortex was cut into match-sticks’ size pieces, mixed with cancellous bone graft, and wrapped longitudinally around the docking area, secured with the absorbable sutures. The remaining cancellous bone graft compacted circumferentially between the grafted cortex pieces and the pseudarthrosis site (d). External fixator was applied (e). The drawn images were prepared by the authors