【Abstract】Breakage of locking bolts is an impor-
tant cause of interlocking nail failure in femoral fractures. It
usually occurs in the form of single breakage in one of the
distal bolts of the nail or nail breakage around the distal
locking hole. Here we report an unusual case of intramedul-
lary femoral nail failure with segmental breakage of both the
distal locking bolts. Such a scenario usually complicates
further management. We successfully managed this case
with exchange nailing without bone grafting. Here we briefly
reviewed the literature regarding such an unusual presenta-
tion and discussed in detail the possible etiology of such a
presentation and the management options when facing such
a complex situation.
Key words: Femoral fractures; Bone screws; Frac-
ture fixation, intramedullary; Fracture healing