Fig. 3A–F.

A 25-year-old patient had posttraumatic femoral shortening and 6-cm femoral lengthening using the ISKD nail. There was complete failure of regenerate formation (Type IIb) mainly caused by a high distraction rate (1.7 mm/day), smoking, lengthening greater than 4 cm, osteotomy at the site of previous trauma, and acute correction of associated deformity. Followup (A) AP and (B) lateral radiographs show complete absence of regenerate that caused a segmental femoral defect. (C) Anteroposterior and (D) lateral radiographs show the segmental bone transport using an external fixator with the nail in place, the “monorail technique.” The new osteotomy site was made in a healthy area, with a distraction rate of 1 mm/day, and the patient stopped smoking. (E) Anteroposterior and (F) lateral radiographs show consolidation of the newly formed regenerate and healing of the docking site after 7 months.