Repair of Tibial Nonunion with Acute Shortening and Proximal Osteotomy for Lengthening with an Intramedullary Lengthening Nail

Case report of a 62-year-old female with a persistent atrophic nonunion of the distal tibia and a symptomatic 2 cm limb length discrepancy. Treatment consisted of a single surgery to repair the nonunion with exchange rodding, bone morphogenetic protein (BMP)-2Bone morphogenetic protein (BMP)-2, and autograft bone from the anterior iliac crest. A new lengthening nail was inserted and a proximal corticotomy was performed at the same setting. A plate was inserted at the nonunion to ensure the distraction of the bone was focused at the proximal corticotomy.