Clamshell osteotomy as described by Russell et al. A, Anteroposterior standing radiograph of lower extremity, showing shortened tibia with medially translated distal tibial segment and varus malunion at inferior end of intercalary segment. B, Lateral radiograph demonstrating marked deformity of tibia highlighted by marked posterior translation and apex posterior angulation at superior end of intercalary segment. C, Tibial clamshell osteotomy with soft tissues included. Anterolateral muscular sleeve is being retracted posteriorly, exposing lateral aspect of tibia. Osteotomy is initiated 3 to 5 cm posterior to anterolateral tibial prominence and angled posteromedially and parallel to subcutaneous surface of tibia. D, Surgical exposure for tibial osteotomy. Anterolateral muscular envelope retracted posteriorly. Transverse osteotomies are denoted by blue lines, and circles represent drill holes. E, Lateral view showing osteotomy parallel to anteromedial surface of tibia. (A to D from Russell GV, Graves ML, Archdeacon MT, et al: The clamshell osteotomy: a new technique to correct complex diaphyseal malunions: surgical technique, J Bone Joint Surg Am 92A[Suppl 1 pt 2]:158, 2010; E redrawn from Pires RE, Gausden EB, Sanchez GT, et al: Clamshell osteotomy for acute fractures in the malunion setting: a technical note, J Orthop Trauma 32(10):e415, 2018.) SEE TECHNIQUE 58.12.