Fig. 1 Anteroposterior (AP) and lateral (Lat.) radiographs show the fracture of the left femoral shaft when patient visited ER: Winquist and Hansen classification type 1 (AO/ASIF - A1).

Fig. 2 AP radiographs show the postoperative state (B) of OR & IF with plating and bone grafts 7 months ago due to nonunion of the left femur subtrochanteric fracture (A) 14 years ago.

Fig. 3 AP and Lat. radiographs after 1st operation.

Fig. 4 AP and Lat. radiographs show that refracture between two plates which occurred 1 month after first operation: Winquist and Hansen classification type 3.

Fig. 5 The use of a broad dynamic compression plate (DCP, 12-hole) as a medial buttress, combined with a broad DCP (14-hole). The plate is fed into the intramedullary canal in a retrograde fashion and then, using the curved impactor. Two or three screws might thread the lateral cortex only and impact against the plate, pushing it medially (this picture does not illustrate). The other screws are inserted through the holes in both plates. To accomplish this, a 3.2 mm drill is used to drill the lateral cortex with the appropriate drill guide. A 1.6 mm Kirschner wire is then passed through the hole and is used to feel the hole of the medullary plate. When the direction is known, the drill is directed in the same path toward the medial cortex, which is penetrated. Insertion of these screws is frequently skewed so that the screws actually thread the hole in the plate as they pass into the medial cortex. In the drawing, the third screw from the top would have this effect [Illustration referred from Springer-Verlag, publisher3)].

Fig. 6 Postoperative AP and Lat. radiographs: Intramedullary plate in combination with the lateral plate.

Fig. 7 AP and Lat. radiographs show complete union after 13 months.