3C.49 (a) Large distal defect in the tibia; LRS ADVanced (53000 series) in place. Proximal metaphyseal osteotomy. (b) Middle segment moved distally until docking occurs. (c) Optional additional lengthening proximally if indicated. Caution: Where lengthening is involved, resect at least 1 cm of fibula; distal syndesmosis screw.

3C.50 (a) Large central bony defect; LRS ADVanced (53000 series) in place. (b) Proximal and distal osteotomies. (c) Simultaneous proximal and distal transport until gap closed. Caution: Where lengthening is involved, resect at least 1 cm of fibula; distal syndesmosis screw.

3C.51 (a) Large peripheral bony defect; LRS ADVanced (53000 series) in place. (b) Two osteotomies performed in the longer bone fragment. (c) Simultaneous proximal transport with both internal clamps moved proximally until gap closed. Caution: Where lengthening is involved, resect at least 1 cm of fibula; distal syndesmosis screw.

3C.52 (a) Small distal defect in the tibia. LRS ADVanced (53000 series) in place. (b) Immediate compression distally between middle and distal clamps; proximal osteotomy. (c) Lengthening at proximal osteotomy site until length restored. Caution: Remove segment of fibula at least 1 cm longer than defect. Distal syndesmosis screw.

3C.53 Bone loss treated with TrueLok Fixator. (a) Distal defect in the tibia; TrueLok Fixator in place. Proximal metaphyseal osteotomy. (b) Middle segment moved distally until docking occurs. Optional additional lengthening proximally if indicated. Caution: Where lengthening is involved, resect at least 1 cm of fibula.