Fig. 4

Case 10: Radiographic presentation of a 5-year-old girl with right congenital pseudoarthrosis of the tibia treated via debridement, autogenous bone grafting, and external fixation prior to ipsilateral fibula transfer. a, b Preoperative anteroposterior and lateral radiographs: The tibial lesion was approximately 14.7 cm, and the remaining normal tibia was shorter than the contralateral side by approximately 18.5 cm. c, d Postoperative radiograph with ipsilateral fibular transfer. e, f 5 months after the ipsilateral fibular transfer. g, h 3.7 years postoperative follow-up, a deformity of the posterior arch of the proximal tibia can also be seen. i, j Due to the proximal posterior arch of the tibia, she underwent an oblique osteotomy and a gradual lengthening of the fibula via external fixation. k, l Radiographs were again taken 1.3 year after the proximal epiphysis osteotomy and fixation. m, n 7 months after the fracture of the right distal femur, the distal femur showed an anterior arch deformity. o–q 6 years postoperative follow-up, significant hypertrophy of the transplanted fibula can be seen