Fig. 1A–F.

A 13-year-old boy sustained a comminuted midshaft femur fracture (A), which was treated with a monolateral external fixator. After 18 weeks, three cortices were healed radiographically (B) and the external fixator was removed. The patient had a low-energy fall 3 days after removal of the fixator and application of a long leg cast, sustaining a refracture through the original fracture site (C). The refracture was treated with open reduction and submuscular plating (D). The latest radiographs 2 years after submuscular plating demonstrate complete fracture healing (E). At latest followup, the patient had full knee ROM and no leg length discrepancy or angulation (F).