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Open access

Joshua Odendaal, Elizabeth Peacock, Jack Cruz, Saqib Noor and James G. Gollogly



A bent femoral intramedullary nail is a rare complication following secondary trauma to an unhealed femoral fracture site. Existing strategies for removal require the use of specialized instrumentation such as a diamond tipped drill or a high speed burr. Specialized orthopedic instrumentation is often expensive and frequently unobtainable in the developing world.


To provide a solution in resource poor settings and describe a unique approach to managing such complex cases.


Novel, low cost, and successful use of industrial instruments for removing a femoral nail bent in situ in a 43 year old man who would have likely required a much more extensive operation without it.


Instrumentation was obtained from a local market and at a fraction of the cost of specific orthopedic instruments. This case presents a technical tip for managing this complication in the developing world.


In a resource poor setting, we can recommend the judicious use of inexpensive industrial materials and instruments to manage complex cases.

Open access

Maxim J. Hatton, Tho Ly, Saqib Noor and James G. Gollogly


Background: A new case of congenital pseudarthrosis of the tibia (CPT) presents yearly to CSC, but treatment is prolonged, and not always successful.

Objective: To study the outcomes of treatment, and to determine whether a relationship with neurofibromatosis (NF) was of significance.

Methods: A review of the medical records at our centre revealed 11 cases of CPT, 5 of which were associated with neurofibromatosis.

Results: Most patients had multiple operations for their case of CPT, which did finally lead to union in 6 out of 6 cases with no NF, but in only 1 case out of 5 when NF was present.

Conclusion: Late presentation and severe deformity can be overcome, and union can be achieved, but NF has a deleterious effect on obtaining union.