SummaryTreatment of complex tibia fractures with associated longitudinal bone loss remains a difficult treatment challenge. Treatment modalities that are used to assist limb salvage efforts include external fixation, internal fixation, limb lengthening, bone transport, and a variety of techniques to help remedy the soft tissue deficits. External fixation has the advantage of easy technical application, but is poorly tolerated over time, and conversion to internal fixation is often advantageous to the patient. In this article, we present several difficult cases in which these combined procedures were successfully performed.