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Tibial turn-up plasty is a reconstructive procedure used to increase above-knee amputation (AKA) residual limb length in limb salvage cases with viable distal tissues. We report using a novel variation of the turn-up plasty procedure in a patient with a previously irradiated femur and chronic treatment-resistant distal femoral osteomyelitis. For patients who may be considering an AKA and have healthy tissue distally, femorotibial turn-up plasty with intercalary fibular autograft can provide increased stump length for improved mechanical advantage. Even in a previously irradiated femur, a very competent and stable femorotibial construct can be formed through the combination of intercalary fibular autograft strut, femoral potting, and locking compression plate with quadcortical screw fixation that spans the length of the fibular strut.