Fig. 1.

Preoperative and postoperative imaging of all cases.

A. Case #1. Femoral shaft fracture treated with a non-locking lateral plate, resulting in varus malunion. Nine years later, the patient presented with a distal femur articular fracture, which we stabilized with a locked lateral plate contoured to the shaft deformity after removing the previous implant. Treatment failed, however, resulting in non-union, which we salvaged using a nail-plate combination.

B. Case #2. Subtrochanteric fracture proximal to 25-year-old plate fixation and recurvatum malunion. It was treated by removing the implants and stabilizing the bone with cerclages and a locked lateral periprosthetic plate.

C. Case #3. Femoral neck fracture following internal fixation of a distal diaphyseal fracture with a retrograde intramedullary nail, performed seven months earlier. A nail exchange was performed, this time using a cephalomedullary device and an additional anti-rotational screw in the femoral neck.

D. Case #4. Non-displaced subtrochanteric fracture proximal to lateral locking plate fixation of the distal femur performed 18 months earlier. Treatment consisted of partial removal of distal implants and cephalo-medullary nailing.