Total femur fixation using the “nail-plate docking technique” for ipsilateral femur shaft fracture

In an aging society, the number of femoral fractures is increasing, as well as the incidence of periprosthetic fractures. These secondary fractures are often difficult to fixate stably because of the osteoporotic bone and the existence of the former implant. Herein, we present two cases of secondary femoral shaft fractures after osteosyntheses for distal femur fractures with polyaxial locking plates (Non-Contact-Bridging Distal Femur, NCB-DF®, ZimmerBIOMET, Winterthur, Switzerland). Antegrade intramedullary nails (Natural Nail®-GT Femoral, ZimmerBIOMET, Winterthur, Switzerland) were utilized without removal of the NCB-DFs. In these osteosyntheses, proximal locking screws of NCB-DFs were inserted and locked into the distal inter-locking holes of Natural Nails. This “nail-plate docking technique” could allow for more stable fixation of the whole femur with minimally invasive surgical intervention while preserving the existing implant. Although there are a few surgical technical knacks and pitfalls in inserting the screw, further fractures of the femur could also be prevented with this technique.