PMC3504200_01
Mechanical failure of the initial internal fixation two weeks postoperatively.
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fig1
Revision of initial internal fixation with static intramedullary nailing and bone allografts.
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fig2
Bone allografts were also placed on the fracture site (Figure 2). 
Radiographic image showing refracture of the femoral shaft and a bending deformation of the intramedullary nail.
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fig3
Plain radiography revealed a refracture of the femoral shaft and a bending deformation of the intramedullary nail (Figure 3). 
Surgical technique. (a) A proper osteotomy was performed as to facilitate the creation of a longitudinal bone window along the anterolateral side of the distal part of the femoral shaft. The osteotomy extended from the fracture site distally to the greater trochanter. (b) Anterolateral window of the femoral shaft approximately 2 cm in width. (c) Removal of the intramedullar nail through the window. (d) Reattachment of the bone window, after the placement of a new reconstruction nail, which was secured by a buttress plate (Accord) and cerclage wires.
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fig4
The osteomized bone strip window was secured with a special buttress plate (Accord, Smith & Nephew, Inc., Memphis, Tenn, USA) stabilized by cerclage wires (Figures 4(a)-4(d)). 