Abstract
Re-operation for osteosynthesis with long gamma nail is a valid therapy for femoral shaft fracture after osteosynthesis with PFN. We experienced a case in which the implant broke 10 months after the second operation.
Compression on the fracture location may have been slight because of strong intramedullary fixation, and may have caused pseudoarthrosis of the femoral shaft, eventually leading to the breaking of the implant.
An alternative method to treat pseudoarthrosis is to modify the design of implants or dynamization. However, dynamization requires caution in ensuring against breaking of the cortex of the femoral bone by the nail itself. Therefore the nail must be modified to suit the bone.
