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VOLUME 17 , ISSUE 1 ( January-April, 2022 ) > List of Articles

TECHNICAL ARTICLE

A Novel Surgical Technique for Extraction of a Firmly Integrated Broken Intramedullary Nail

Charlotte MB Somerville, Helena Hanschell, Mehdi Tofighi, Om Lahoti

Citation Information : Somerville CM, Hanschell H, Tofighi M, Lahoti O. A Novel Surgical Technique for Extraction of a Firmly Integrated Broken Intramedullary Nail. 2022; 17 (1):55-58.

DOI: 10.5005/jp-journals-10080-1550

License: CC BY-NC-SA 4.0

Published Online: 24-05-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Aim: To present a novel technique developed in our institution to remove incarcerated and broken intramedullary (IM) tibial and femoral nails. Background: IM nails are commonly used to treat diaphyseal fractures in both the tibia and femur. These nails can become problematic for the orthopaedic surgeon when they need to be removed, especially in the rare event that the nail has failed and broken. This can leave part of the nail deep in the bone and incarcerated. Multiple techniques have been described to remove a broken nail but we present a novel technique developed based on our experience. Technique: After all other methods to remove the broken nail have failed, a window technique can be employed. This requires a small window of bone to be removed from the cortex overlying the remaining IM nail. A carbide drill is then used to drill a hole into the nail to gain purchase. The edge of an osteotome is placed in the hole in the nail through the window and gently hammered upwards to push the nail towards the over-reamed nail entry point. The nail is repeatedly drilled and pushed until the nail can be removed. The bone window is then replaced. Conclusion: This is a novel technique that works when all other options including hooks, wire stacks and specialist nail removal techniques have failed. It is simple, efficient and effective for both the tibial and femoral nails.


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  1. Cereijo C, Attum B, Rodriguez-Buitrago A, et al. Intramedullary nail fixation of tibial shaft fractures: suprapatellar approach. JBJS Essent Surg Tech 2018;8(3):12. DOI: 10.2106/JBJS.ST.17.00063.
  2. Cruz-Sánchez M, Torres-Claramunt R, Alier-Fabrago A, et al. Salvage for nail breakage in femoral intramedullary nailing. Injury 2015;46(4):729–733. DOI: 10.1016/j.injury.2014.12.003.
  3. Ruiz AL, Kealey WD, McCoy GF. Implant failure in tibial nailing. Injury 2000;31(5):359–362. DOI: 10.1016/s0020-1383(00)00002-4.
  4. Rosa N, Marta M, Vaz M, et al. Intramedullary nailing biomechanics: evolution and challenges. Proc Inst Mech Eng H 2019;233(3):295–308. DOI: 10.1177/0954411919827044.
  5. Lambers A, Rieger B, Kop A, et al. Implant fracture analysis of the TFNA proximal femoral nail. J Bone Joint Surg Am 2019;101(9):804–811. DOI: 10.2106/JBJS.18.00997.
  6. Stenroos A, Brinck T, Handolin L. Recommendation of use of checklists in tibial intramedullary nail removal: retrospective study of mechanical complications related to nail removal. Injury 2018;49(7):1341–1347. DOI: 10.1016/j.injury.2018.05.005.
  7. Acharya M, Alani A, Almedghio S. The fish hook technique of extracting broken intramedullary nails. Acta Orthop Belg 2008;74(5):686–688. PMID: 19058706.
  8. Middleton RG, McNab IS, Hashemi-Nejad A, et al. Multiple guidewire technique for removal of the short distal fragment of a fractured intramedullary nail. Injury 1995;26(8):531–532. DOI: 10.1016/0020-1383(95)00103-g.
  9. Weinrauch PC, Blakemore M. Extraction of intramedullary nails by proximal stacked wire technique. J Orthop Trauma 2007;21(9): 663–664. DOI: 10.1097/BOT.0b013e3181583b34.
  10. Zimmerman KW, Klasen HJ. Mechanical failure of intramedullary nails after fracture union. J Bone Joint Surg 1983;65(3):274–275. DOI: 10.1302/0301-620X.65B3.6841394.
  11. Lovell J, Krishna D, Gehr E. Stuffing the nail: a simple technique for the extraction of a broken femoral nail. Trauma Case Rep 2017;30(9): 34–41. DOI: 10.1016/j.tcr.2017.05.011.
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