McCune-Albright Syndrome (MAS) is characterized by endocrinopathies, café-au-lait spots, and fibrous dysplasia. Bisphosphonates are the most prescribed treatment for reducing the pain but their long-term use has been associated with atypical fractures of cortical bones like femur in patients. We present a 23-year-old girl diagnosed with MAS. She had an atypical mid-shaft left femoral fracture that happened during simple walking. She also had a history of long-term use of alendronate. Because of the narrow medullary canal, we used 14 holes hybrid locking plate for the lateral aspect of the thigh to fix the fracture and 5 holes dynamic compression plate (instead of the intramedullary nail) in the anterior surface to double fix it, reducing the probability of device failure. With double plate fixation and discontinuation of alendronate, the complete union was achieved five months after surgery

Genu valgum is an angular deformity caused by several reasons, such as congenital syndromes, post-traumatic bone dysplasia, or an idiopathic form. It generates cosmetic problems, difficulties in function, and pain. Manipulating the growth plate by hemiepiphysiodesis with implants helps to achieve the correct alignment. We presented twin girls diagnosed with genu valgum deformity who were suffering from cosmetic problems and pain. We used growth modulation to temporarily arrest the growth plate. This procedure was followed by photographs and after 8 months, the implants were removed without having overcorrection. A brief literature review was also performed concerning the reported cases in the international databases, such as PubMed and Google Scholar on growth modulation for genu valgum deformity in twins. Twin girls with genu valgum deformities underwent hemiepiphysiodesis surgeries. We used reconstruction plates and 3.5 mm non-cannulated screws to fix both the distal femur and proximal tibia to temporarily arrest the growth plate. When we achieved the correct alignment the devices were removed.