Fig. 3.

a,b,c,d. Large varus deformity with an obvious upper tibial extra-articular deformity and also a “pagoda tibia” showing an intra-articular deformity. Ilizarov fixator was used to fix the double osteotomy. The Upper osteotomy is an L-shaped osteotomy with elevation of medial tibial condyle. This is fixed with two Cancellous screws. This improves the congruity of the articular contact. The gap is filled with an excised piece of the fibula. The upper osteotomy zone is also fixed with two half-pins. 4 cm intervening zone had a fixation with two half pins. All these four pins are fixed to the upper ring. A Distal dome osteotomy is performed with the lateral translation of distal fragment which allows adequate correction of mechanical axis ( seen on intra-operative x-rays).