Fig. 2A–F.

A 40-year-old patient had 6-cm bilateral cosmetic femoral lengthening using the ISKD nail. One side uneventfully consolidated and insufficient bone regenerate developed on the other side mainly owing to a high distraction rate (1.9 mm/day), age older than 30 years, and length gain greater than 4 cm. (A) Anteroposterior and (B) lateral radiographs show partial regenerate failure (Type I). (C) Anteroposterior and (D) lateral radiographs obtained 7 months after exchange nailing and iliac bone grafting + osteogenic protein-1 show good union of the tricortical autologous iliac bone graft. (E) An intraoperative photograph of the partial defect in the bone regenerate and (F) the harvested tricortical iliac autograft ready to be fitted in the defect site are shown.