Introduction and Aims: Congenital femoral deficiency (CFD) can be managed by femoral lengthening using callotasis with external fixation. A common complication is fracture with angular deformation soon after fixator removal. We developed a novel technique to overcome this complication using intermedullary stabilisation. Special hand reamers are needed to re-establish medullary canal blocked by cortical plates around previous external fixator pin sites and not yet recanalised regenerate bone.

Method: Since 2000, we treated nine of these fractures in children with an average age of 5.4 years. The children had spent an average of 22 weeks in a fixator, gaining a mean of 7cm of length. Most fractures occurred as ‘spontaneous’ events at a mean of three weeks after fixator removal, resulting in a transverse fracture through the regenerate bone, host-regenerate interface, or proximal pin sites. All were stabilised with intermedullary nailing.

Results: Union was achieved satisfactorily in approximately six weeks. No serious complications, such as infection, avascular necrosis, or non-union, occurred. All bones were successfully realigned, and the mean loss of length was only 0.7cm.

Conclusion: Careful surgical technique, using specific operative steps described (including use of flexible hand reamers to create canal, small percutaneous osteotomies to allow proper reduction, and Rush pins for stabilisation) has achieved good results. We recommend this approach to surgeons involved in the management of fractures occurring after fixator removal.