The Ilizarov technique for bone lengthening is an effective way to achieve an increase in bone length without the use of bone graft or internal hardware fixation, as demonstrated in this case of hereditary multiple exostoses (HME).  In this technique, progressive distraction across an osteotomy site with preserved periosteum leads to osteogenesis across the intervening gap, thus lengthening the bone. With the distracted gap actively increased by 1mm/day, the physician can accurately achieve the desired bone length.