Removal of bent intramedullary nail in diaphyseal segmental femoral fracture with intra-articular distal femoral fracture after below-knee amputation.

Refracture accompanied by nail bending in healed or unhealed femoral fractures is a rare complication, and its removal is challenging intraoperatively. A man in his mid-20s presented to the emergency department with a deformed thigh with a puncture wound in a below-knee amputee limb following a road traffic accident, and radiographs revealed a diaphyseal segmental femur fracture with an intra-articular distal femur fracture with a bent femur nail in situ. Attempts to remove a bent femoral nail frequently fail non-invasively and may cause iatrogenic damage. Cutting the bent femur nail using a conventional jumbo cutter and a nail-plate construct (exchange nailing and 14-hole distal femur locking plate with bone grafting) to fix the fracture can tackle this type of condition. He was followed up in the outpatient department and was able to mobilise with crutches with a good range of knee movement and a below-knee prosthesis in situ.