Fig. 1

Structural failure after angled blade plate endoprosthesis. The first patient that needed revision surgery (ID 7) was a male with shepherd’s crook deformity of the femur and was previously treated elsewhere for a pathological femoral fracture by means of a valgus osteotomy combined with a short angled blade plate (Fig. 1). The coxa vara persisted however (FNSA 67°), associated with severe pain complaints for which he was referred to the LUMC, 8 years after his first surgery. A subtrochanteric osteotomy was performed and fixation was undertaken using a larger blade plate and a temporary external fixator, which resulted in improvement of the coxa vara (FNSA 97°) and good functional outcome. Pain was adequately controlled with additional bisphosphonate therapy. Four years later the patient unfortunately sustained a fracture of the femoral diaphysis, distal to the angled blade plate. This part of the femur was also affected with fibrous dysplasia and together with the stress riser of the distal angled blade plate formed a weak location in the femur, prone to fracturing. The angled blade plate was removed and a longer angled blade plate was inserted to cover the whole area of the affected femur. This procedure was followed by a good functional outcome and disappearance of pain symptoms lasting to the end of follow up