Typical Ilizarov frame for moderate tibial lengthening. A, In skeletally immature child with intact physes, proximal segment would not have enough room for two rings. Single ring distal to proximal tibial epiphysis is used with drop wire for additional segmental stabilization of proximal segment. For significant amount of lengthening, third ring can be placed more distally to allow greater mass of soft tissue for recruitment into lengthening process. B, If necessary, Ilizarov rings can be used to complete the posterior aspect of the corticotomy by externally rotating the distal segment. SEE TECHNIQUE 29.46.