A bstract Aim We describe a novel technique of bone splitting and bone grafting in managing hypoplastic or hourglass-shaped regenerated bone in distraction osteogenesis. Background Hourglass-shaped regenerated bone is a potential complication during distraction osteogenesis which is vulnerable to fracture when loaded. Our novel technique overcomes this by increasing the diameter of new bone formation via bone splitting and bone grafting. Case description We report three cases with hypoplastic regenerated bone following distraction osteogenesis. It was treated with bone splitting and bone grafting. Although one case was complicated with an iatrogenic transverse fracture during the surgery, all three cases achieved the goal of increasing bone diameter during the subsequent consolidation phase. Conclusion This relatively simple and novel surgical intervention can overcome the hourglass-shaped appearance, thus preventing potential fracture. Clinical significance We emphasise the importance of identifying hypoplastic regenerate bone before the consolidation phase of distraction osteogenesis. The novel technique described is a simple surgical intervention which can prevent potential fracture through the newly formed bone. How to cite this article Lee HS, Tasarib R, Hamzah FC, et al. A Novel Technique—Bone Splitting and Bone Grafting in an Hourglass-shaped Bone Following Distraction Osteogenesis. Strategies Trauma Limb Reconstr 2020;15(3):175–178.