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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.

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.