Van Nes rotationplasty. Preoperatively, ankle joint of shortened extremity is approximately at level of opposite knee joint. A, Long incision on lateral aspect of leg extends from hip to midshaft of tibia. B, Quadriceps and sartorius tendons are taken down distally to expose adductor hiatus and femoral artery; peroneal nerve is dissected free. C, After resection of knee joint and freeing of femoropopliteal artery, tibia is externally rotated 140 degrees. D, Further rotation of 40 degrees more is possible after tibial osteotomy, allowing stretch on soft tissues to spread over greater distance. External rotation is preferred to internal rotation to prevent stretching of peroneal nerve. E, Fixation with medullary Rush rod. SEE TECHNIQUE 29.32.