• Metaphyseal malunions and nonunions of the lower extremity pose a challenge in the setting of complex, multiplanar deformity and poor bone quality

• Optimal treatment corrects all parameters of deformity and provides stable fixation for early weight bearing and rehabilitation

• Current options for correction include single and double cut osteotomies stabilized with plate fixation, or gradual correction with fine wire circular fixation

• Both classic osteotomies and fine wire circular frames have significant limitations

• The clamshell osteotomy was developed to simplify the correction of tibial and femoral diaphyseal malunions and nonunions, but had not been studied for use in metaphyseal and meta-diaphyseal deformities.