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Osteochondroma is the most common benign bone tumour. They most commonly affect the long tubular bones and almost half of osteochondromata are found around the knee. Osteochondroma arising from the distal metaphysis of the tibia typically result in a valgus deformity of the ankle joint secondary to relative shortening of the fibula. This case describes the use of Ilizarov technique for fibular lengthening following excision of a distal tibial osteochondroma. A 12-year-old girl presented with a 3-year history of a large swelling affecting the lateral aspect of the right distal tibia. Plain radiographs confirmed a large sessile osteochondroma arising from the postero-lateral aspect of the distal tibia with deformity of the fibula and 15 mm of fibular shortening. The patient underwent excision through a postero-lateral approach and subsequent fibular lengthening by Ilizarov technique. The patient made excellent recovery with removal of frame after 21 weeks and had made a full recovery with normal ankle function by 6 months. The Ilizarov method is a commonly accepted method of performing distraction osteogenesis for limb inequalities; however, this is mainly for the tibia, femur and humerus. We are unaware of any previous cases using the Ilizarov method for fibular lengthening. This case demonstrates the success of the Ilizarov method in restoring both fibular length and normal ankle anatomy.

Z-plasty is used to lengthen scars and wounds. We describe the use of a modified technique to shorten wounds in ten consecutive patients undergoing acute shortening of a limb as part of an Ilizarov procedure. The modified technique gave good exposure, easy closure of the wound and fewer problems with healing than standard incisions. One of the more useful techniques of the Ilizarov method for treating segmental defects and nonunion is the ability to shorten a limb acutely and then subsequently lengthen it at a different site where the tissues are healthy. This method has been reported to have a lower rate of problems with alignment of the docking site. There is less need for bone grafting 1 compared with classic bone transport in which a segment of bone is moved within its soft-tissue envelope while the limb is maintained at its normal length. Although there are fewer bony complications with procedures involving acute shortening, skin closure is often difficult. Sinuses, old scars and the relative inelasticity of the skin because of chronic inflammation add to the difficulty of closing the incision. Transverse incisions at the site of shortening are easier to close, but have the disadvantage of limited exposure of the bone during debridement, which is often of critical importance. Z-plasty is a plastic surgical technique usually used to lengthen a scar. We have introduced its use for shortening scar tissues. The zig-zag incisions used in our design of Zplasty are a method of exposure which allows great versatility in the closure of soft tissues.We have evaluated the use of techniques of Z-plasty to provide good exposure of the ends of the bones for debridement as well as allowing easy skin closure. Patients and MethodsThe normal principle of Z-plasty is the transportation of two triangular-shaped flaps. The long and central limb of the 'Z' is usually placed along the line of the scar to be lengthened or reorientated. The two lateral limbs extend from this line at varying angles which determine the percentage lengthening of the central limb. Once these flaps have been raised they are transposed, resulting in reorientation of the scar and its effective lengthening, which is possible because of the recruitment of skin from the lateral to the long limb of the Z-plasty (Fig. 1a).In limb shortening we use this principle in reverse. Diagrams showing a) the normal Z-plasty used to lengthen the distance between A and B at the expense of length between C and D and b) the Z-plasty technique used to shorten the distance between A and B.