The multifocal procedure, in which two osteotomies are performed, is indicated in the presence of large bone defects, extreme shortening, shortening combined with metaphyseal deformity where lengthening takes place in more than one site, and fractures with soft tissue defects and exposed bone. The application technique of the external device is quite similar to that for bone transport, with the only difference being that in this procedure two compression-distraction units are used simultaneously.

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The monofocal procedure is performed for lengthening at a single osteotomy site, for deformity correction with or without lengthening, and when increased stability is required. This procedure may be also used in bone and soft tissue defects when the bone loss is less than 2cm.

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