This woman came to us with a complicated problem after having a severe double level fracture of the tibia. The upper level was united but crooked. The lower level was ununited and also crooked.	Ilizarov device used to simultaneously correct the upper malunion and the lower nonunion.	Final radiograph obtained after correction.

Patient before surgery	Patient after surgery

Nonunion of tibial fracture. The ankle joint is severely damaged and cannot be salvaged. Our treatment method is to fuse the ankle in a normal position and to lengthen the tibia over an intramedullary nail. Note the Ilizarov device distracting the bone at the lengthening site. This is the lengthening-over-nail technique, pioneered by ICLL surgeons. The final results are normal alignment and leg length.

The International Center for Limb Lengthening
Sinai Hospital of Baltimore
2401 West Belvedere Avenue
Baltimore, Maryland 21215, USA
phone: 410-601-8700
toll-free: 800-221-8425
fax: 410-601-9576