title: The role of composite technique in managing peri implant re-fractures in a case with supracondylar fracture of the femur: a case report.
abstract: BACKGROUND
  Osteoporosis of the long bones challenges the orthopaedician in several ways. Amongst the difficulties encountered are the reduced bone mass, increased bone brittleness and medullary expansion, which must be factored in when deciding the type of surgical method to be used. One of the commoner complications of fixation of fractures in such bone is the occurrence of peri implant fractures with subsequent management requiring significant surgical acumen and judgment.
  
  
  METHODS
  We report a case who sustained a supracondylar fracture of the femur, which was managed initially by a dynamic condylar screw assembly. The patient sustained a peri implant fracture during her rehabilitation, which was managed by the application of a longer side plate. 4 months postoperatively the patient sustained another peri implant fracture. Using a minimally invasive method we removed the screws from the plate and passed an intramedullary implant. The whole assembly was rotationally stabilized using an Ilizarov fixator. The union proceeded uneventfully.
  
  
  CONCLUSIONS
  Use of such minimally invasive methods can be beneficial in such complicated situations.
authors.affiliation: Government Hospital for Bone and Joint Surgery, Bagat Barzullah Srinagar, Kashmir India. draltafk@yahoo.com
authors.forename: Altaf Ahmad
authors.initials: AA
authors.lastname: Kawoosa
authors.forename: Shabir Ahmad
authors.initials: SA
authors.lastname: Dhar
authors.forename: Mohammed Farooq
authors.initials: MF
authors.lastname: Butt
authors.forename: Ghulam Nabi
authors.initials: GN
authors.lastname: Dar
authors.forename: Mohammed Ramzan
authors.initials: MR
authors.lastname: Mir