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manipulation, hardware removal, arthrolysis, and quadricepsplasty were needed. One patient was lost to follow-up. The final results of the knees were good, with more than 100 degrees range of movement. It is important to adhere to established internal fixation protocols in the treatment of these complex nail tip fractures. ABSTRACT Patients with in situ intramedullary nails sustaining a second distal femoral fracture following highvelocity trauma are infrequently reported in the literature. Wedoi:10.1177/230949900501300313 pmid:16365494 fatcat:iitdczltrfht7cpz22dvj5ajai