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Vatsya P, Mittal S, Karpe A, Trikha V. 'Extended tibia osteotomy': a technical tip for removal of incarcerated reamer with broken guide wire bead during tibia nailing and literature review. BMJ Case Rep 2022; 15:e247812. [PMID: 35260402 PMCID: PMC8905891 DOI: 10.1136/bcr-2021-247812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/03/2022] Open
Abstract
Intramedullary nailing has become a standard of care for tibia fractures. Reaming is an essential part of this technique due to its multiple advantages like a better fit and earlier union. In young bone, with a narrow cortical canal, incarceration and breakage of reamer is a possibility. This can be removed with a ball-tip guidewire. In our case, the broken incarcerated reamer was complicated by a broken ball-tip of the guidewire, leading us to invent a novel medial tibial osteotomy window for the reamer removal. This can be a handy tool for a stuck surgeon intraoperatively.
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Affiliation(s)
- Pulak Vatsya
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Samarth Mittal
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Aashraya Karpe
- Department of Opthalmology, Dr Shroff's Charity Eye Hospital Delhi, New Delhi, India
| | - Vivek Trikha
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
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Maharjan R, Shrestha BP, Chaudhary P, Rijal R, Shah Kalawar RP. Functional outcome of patients of tibial fracture treated with solid nail (SIGN nail) versus conventional hollow nail - A randomized trial. J Clin Orthop Trauma 2021; 12:148-160. [PMID: 33716440 PMCID: PMC7920208 DOI: 10.1016/j.jcot.2020.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/05/2020] [Accepted: 07/09/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Trauma related disabilities disproportionately affects low and middle income countries due to lack of resources, skills and optimal implants. Despite adequate animal studies, biomechanical studies, cohort studies and comparison studies we are not aware of any randomized trial to compare the functional outcome of SIGN (Surgical Implant Generation Network, US) solid nailing with a hollow nailing for tibial shaft fracture. METHODS Sixty patients (≥16 years) of closed and Gustilo grade I traumatic fractures of the leg were randomized into SIGN solid nailing or hollow nailing group. Cases with compromised soft tissue and grossly deformed medullary canal were excluded. Functional outcome and need for resurgery were the primary outcomes while the secondary outcomes were duration of surgery, intraoperative blood loss, overall pain (VAS), radiological union (RUST), surgery related complications (infection, malalignment, shortening, nonunion) and pain/range of motion (ROM) of knee/ankle. All SIGN surgery related data were entered and retrieved online from www.signsurgery.org. RESULT The demographical parameters were symmetrically distributed between the groups (p > 0.05). 2 cases in SIGN nailing and 4 cases in hollow nailing needed open reduction. The functional outcome, as assessed by blinded physiotherapist using Johner and Wruh criteria, was excellent in 18 (62.06%), good in 6 (20.68%), fair in 3 (10.34%) and poor in 2 (6.89%) for SIGN nail whereas it was 16 (57.14%), 8 (28.57%), 3 (10.71%) and 1 (3.57%) respectively for hollow nail. There was 1 case of implant failure and 1 case of infection. Intraoperative blood loss (397 ± 94.47 ml versus 350 ± 75.43 ml, p = 0.037) and duration of surgery (94.8 ± 14.57 min versus 82.0 ± 12.36 min, p = 0.001) were significantly more in hollow nailing group. At final follow up, overall pain on weight bearing (VAS score) and radiological union (RUST score) were 2.1 and 11.7 for SIGN nailing while they were 2.7 and 11.3 respectively for hollow nailing.(p = 0.41 and 0.45 respectively) The malrotation (p = 1.000), shortening (p = 1.000), varus-valgus angulation (p = 0.511), AP angulation (p = 0.706), ROM ankle (p = 0.239) and ROM knee (p = 0.086) were similar. CONCLUSION Solid SIGN nailing gives comparable functional outcome as conventional hollow nailing for tibia shaft fracture. For developing world with limited resources, SIGN nail is useful which is supplied freely and is designed to be used without image intensifier and fracture table.
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Unstable AO/OTA type 31-A1.2 intertrochanteric femur fracture: An unusual case report. Trauma Case Rep 2020; 28:100326. [PMID: 32642536 PMCID: PMC7334604 DOI: 10.1016/j.tcr.2020.100326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2020] [Indexed: 11/20/2022] Open
Abstract
AO/OTA type 31-A1.2 intertrochanteric femoral fractures generally are considered stable intertrochanteric fractures. We report a case of an unstable AO/OTA type 31-A1.2 intertrochanteric femoral fracture. Primary internal fixation was performed with a long cephalomedullary nail taking instability into account. Postoperative X-rays showed an acceptable reduction with a slight fracture gap in extension on the lateral trochanteric side. However, additional salvage surgery was required because the long cephalomedullary nail broke as a result of the instability caused by non-union and varus deformity of the proximal femur. More attention should be directed to strategies of primary internal fixation including choice of fixation instrumentation in terms of mechanical stability because this type of fracture can be remarkably unstable despite radiographic diagnosis of a usually stable AO/OTA classification type 31-A1.2 fracture.
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Hagedorn JC, Brinker MR, Achor TS. A novel technique for the removal of a solid intact tibial nail without interlocking screws. CURRENT ORTHOPAEDIC PRACTICE 2018. [DOI: 10.1097/bco.0000000000000689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zheng XL, Park YC, Kang DH, Seok SO, Yoon YK, Yang KH. A blocking-wire technique for removal of a broken hollow intramedullary nail. Injury 2016; 47:1601-3. [PMID: 27170540 DOI: 10.1016/j.injury.2016.04.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 02/02/2023]
Abstract
We present a simple method to remove the distal portion of the broken nail just using the bulb-tipped guide pin and a blocking Kirschner wire. At first, we removed the proximal part of the broken nail and all interlocking screws. Next, we introduced the bulb-tipped guide wire into the distal part of the nail with fluoroscopic guidance until it passed the interlocking hole that would be used. After snugly fitting the blocking Kirschner wire into the interlocking hole of the nail, the bulb-tipped guide wire is then pulled to engage the blocking wire complex in the interlocking hole. The bulb-tipped guide wire and broken nail are removed by sequential stroke using a ram.
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Affiliation(s)
- Xuan-Lin Zheng
- Department of Orthopedics Surgery, Yonsei University, College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea.
| | - Young-Chang Park
- Department of Orthopedics Surgery, Yonsei University, College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea.
| | - Dong-Hyun Kang
- Department of Orthopedics Surgery, Yonsei University, College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea.
| | - Sang-Ok Seok
- Department of Orthopedics Surgery, Yonsei University, College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea.
| | - Yeo-Kwon Yoon
- Department of Orthopedics Surgery, Yonsei University, College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea.
| | - Kyu-Hyun Yang
- Department of Orthopedics Surgery, Yonsei University, College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea.
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Kim YM, Joo YB, Lee KY. Use of a Nancy nail to remove a broken intramedullary nail: A technical note. Injury 2015; 46:2498-501. [PMID: 26304001 DOI: 10.1016/j.injury.2015.07.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 07/14/2015] [Indexed: 02/02/2023]
Abstract
Intramedullary (IM) nailing is a standard surgical technique for treating long bone diaphyseal fractures. However, one complication is breakage of the IM nail. Many methods have been reported for removing broken nails. We devised another technique, using a Nancy nail, for removing a broken IM nail and report on the surgical technique and a case involving the use of our method.
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Affiliation(s)
- Young-Mo Kim
- Department of Orthopedic Surgery, Chungnam National University, School of Medicine, Daejeon, Republic of Korea
| | - Yong-Bum Joo
- Department of Orthopedic Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea.
| | - Ki-Young Lee
- Department of Orthopedic Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea
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Removal of a broken cannulated intramedullary nail: review of the literature and a case report of a new technique. Case Rep Orthop 2013; 2013:461703. [PMID: 24455369 PMCID: PMC3886368 DOI: 10.1155/2013/461703] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 12/04/2013] [Indexed: 11/18/2022] Open
Abstract
Nonunion of long bones fixed with nails may result in implant failure. Removal of a broken intramedullary nail may be a real challenge. Many methods have been described to allow for removal of the broken piece of the nail. In this paper, we are reviewing the different techniques to extract a broken nail, classifying them into different subsets, and describing a new technique that we used to remove a broken tibial nail with narrow canal. Eight different categories of implant removal methods were described, with different methods within each category. This classification is very comprehensive and was never described before. We described a new technique (hook captured in the medulla by flexible nail introduced from the locking hole) which is a valuable technique in cases of nail of a small diameter where other methods cannot be used because of the narrow canal of the nail. Our eight categories for broken nail removal methods simplify the concepts of nail removal and allow the surgeon to better plan for the removal procedure.
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Liodakis E, Krettek C, Kenawey M, Hankemeier S. A new technique for removal of an incarcerated expandable femoral nail. Clin Orthop Relat Res 2010; 468:1405-9. [PMID: 19655211 PMCID: PMC2853664 DOI: 10.1007/s11999-009-1022-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Accepted: 07/22/2009] [Indexed: 01/31/2023]
Abstract
UNLABELLED Removal of intramedullary nails often is relegated to younger surgeons but may be difficult and challenging. We describe difficulties with removal of an incarcerated expandable femoral nail and a new technique for retrograde mobilization of an intramedullary nail through a small infrapatellar incision. No special device was necessary for successful implant removal. LEVEL OF EVIDENCE Level V, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Emmanouil Liodakis
- Department of Trauma Surgery, Medical School Hannover, Carl-Neuberg-Str 1, 30625 Hannover, Germany
| | - Christian Krettek
- Department of Trauma Surgery, Medical School Hannover, Carl-Neuberg-Str 1, 30625 Hannover, Germany
| | - Mohamed Kenawey
- Department of Trauma Surgery, Medical School Hannover, Carl-Neuberg-Str 1, 30625 Hannover, Germany ,Orthopaedic Surgery Department, Sohag Faculty of Medicine, Sohag, Egypt
| | - Stefan Hankemeier
- Department of Trauma Surgery, Medical School Hannover, Carl-Neuberg-Str 1, 30625 Hannover, Germany
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de Amorim Cabrita HAB, Malavolta EA, Teixeira OVR, Montenegro NB, Duarte FA, Mattar R. Anterograde removal of broken femoral nails without opening the nonunion site: a new technique. Clinics (Sao Paulo) 2010; 65:279-83. [PMID: 20360918 PMCID: PMC2845768 DOI: 10.1590/s1807-59322010000300007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 12/17/2009] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE We describe a new technique for removing the distal fragments of broken intramedullary femoral nails without disturbing the nonunion site. METHODS This technique involves the application of an AO distractor prior to the removal of the nail fragments, with subsequent removal of the proximal nail fragment in an anterograde fashion and removal of the distal fragment through a medial parapatellar approach. Impaction of the fracture site is then performed with a nail that is broader than the remaining fragmented material. RESULTS Nails were removed from five patients using the technique described above without any complications. After a mean follow-up period of 61.8 months, none of these patients showed worsened knee osteoarthritis. CONCLUSION The original technique described in this article allows surgeons to remove the distal fragment of fractured femoral intramedullary nails without opening the nonunion focus or using special surgical instruments.
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Theivendran K, Cooper JP. Removal of broken solid femoral nail: a modified bent tip guide wire technique. Arch Orthop Trauma Surg 2009; 129:1667-71. [PMID: 19169696 DOI: 10.1007/s00402-009-0814-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2008] [Indexed: 11/30/2022]
Abstract
A broken solid femoral nail can be challenging to remove. We describe a modified bent tip guide wire technique for extraction of a broken solid retrograde femoral nail from the proximal femur. The broken nail was removed successfully through the original retrograde entry point to allow for an exchange femoral nailing in a patient with a hypertrophic non-union. This novel technique avoids any additional exposure other than that required to remove and insert the nail.
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Affiliation(s)
- Kanthan Theivendran
- University Hospital Birmingham, Selly Oak, Raddlebarn Road, Birmingham, B29 6JD, UK.
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11
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Pretell Mazzini J, Rodriguez Martin J, Resines Erasun C. Removal of a broken intramedullary femoral nail with an unusual pattern of breakage: a case report. Strategies Trauma Limb Reconstr 2009; 4:151-5. [PMID: 19777163 PMCID: PMC2787202 DOI: 10.1007/s11751-009-0066-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 08/13/2009] [Indexed: 11/26/2022] Open
Abstract
To the best of our knowledge, only 3 cases, including the present case, have been reported with a three part broken pattern. However, this is the first case associated with a distal locking screw broken. We report the case of a 31-year-old patient who sustained an open femoral shaft fracture . The fracture was stabilized with a Kuntcher femoral nail. After 7 months of the initial surgery he presented with a three part broken intramedullary nail and the distal locking screw broken. We used a combined technique for the removal of the nail through the nonunion fracture site; we used a pull out technique for the middle fragment and a curved thin hook for the distal fragment. Then we applied bone allograft and stabilized with a cannulated intramedullary femoral nail (Synthes, Oberdorf, Switzerland). After 2 years of follow up the nonunion was consolidated and the patient presented a good clinical outcome. This is of particular interest because it is a unique case and the association with a broken distal locking screw is reported for the first time in this study. A combination of methods through the nonunion site approach and an alternative instrumental is a good method for the removal of a hollow femoral intramedullary nail with this unusual pattern of breakage.
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12
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Whalley H, Thomas G, Hull P, Porter K. Surgeon versus metalwork--tips to remove a retained intramedullary nail fragment. Injury 2009; 40:783-9. [PMID: 19442972 DOI: 10.1016/j.injury.2008.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 12/12/2008] [Indexed: 02/02/2023]
Affiliation(s)
- Helen Whalley
- Academic Department of Clinical Traumatology, West Building, Institute of Research and Development, Edgbaston Birmingham, United Kingdom.
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13
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Three-Part Broken Intramedullary Nail Reconsideration: A Case Report and Review of the Literature. ACTA ACUST UNITED AC 2009; 66:E4-8. [DOI: 10.1097/01.ta.0000221707.40720.7d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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A novel technique for the removal of a broken solid tibial nail. CURRENT ORTHOPAEDIC PRACTICE 2008. [DOI: 10.1097/bco.0b013e328313a8b1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Despite advances in metallurgy, fatigue failure of hardware is common when a fracture fails to heal. Revision procedures can be difficult, usually requiring removal of intact or broken hardware. Several different methods may need to be attempted to successfully remove intact or broken hardware. Broken intramedullary nail cross-locking screws may be advanced out by impacting with a Steinmann pin. Broken open-section (Küntscher type) intramedullary nails may be removed using a hook. Closed-section cannulated intramedullary nails require additional techniques, such as the use of guidewires or commercially available extraction tools. Removal of broken solid nails requires use of a commercial ratchet grip extractor or a bone window to directly impact the broken segment. Screw extractors, trephines, and extraction bolts are useful for removing stripped or broken screws. Cold-welded screws and plates can complicate removal of locked implants and require the use of carbide drills or high-speed metal cutting tools. Hardware removal can be a time-consuming process, and no single technique is uniformly successful.
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Ilizarov treatment for femoral mal-union or non-union associated with fatigue fracture of an intramedullary nail. Injury 2008; 39:256-9. [PMID: 18164004 DOI: 10.1016/j.injury.2007.07.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Accepted: 07/25/2007] [Indexed: 02/02/2023]
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17
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Chen CE, Weng LH, Ko JY, Wang CJ. Management of nonunion associated with broken intramedullary nail of the femur. Orthopedics 2008; 31:78. [PMID: 19292160 DOI: 10.3928/01477447-20080101-07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study analyzed 14 patients with 17 broken intramedullary nails for the treatment of femoral fractures. Average distance from the fracture site was 7.9 cm in cases in which nail breakage occurred at the junction between the cylindrical and cloverleaf portions and 6.4 cm in cases in which nail breakage occurred at the screw hole. Eleven patients with 14 broken nails were treated with exchange nailing and bone grafting, 2 were treated with plating and bone grafting, and 1 was treated with extracorporeal shock wave therapy. Nonunion or delayed union is the main cause of nail breakage. Exchange nailing with bone grafting is a safe and effective method of treatment for a broken intramedullary nail with nonunion.
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Affiliation(s)
- Chin-En Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan, Republic of China
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De Pedro JA, Blanco JF, Ellis S. A simple technique for the capture of broken intramedullary locking screws using laparoscopic forceps. THE JOURNAL OF TRAUMA 2006; 61:1283-4. [PMID: 17099547 DOI: 10.1097/01.ta.0000199387.07398.bf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- José A De Pedro
- Department of Orthopaedic Surgery, University Hospital of Salamanca, Salamanca, Spain.
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19
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Abstract
This report describes a technique for removal of a broken interlocking intramedullary nail with a small diameter and narrow hollow using a modified smooth guide wire.
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Affiliation(s)
- Si Young Park
- Department of Orthopaedic Surgery, Yongdong Severance Hospital, Yonsei University College of Medicine, Kangnamgu, Seoul, Korea
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Gosling T, Allami M, Koenemann B, Hankemeier S, Krettek C. Minimally invasive exchange tibial nailing for a broken solid nail: case report and description of a new technique. J Orthop Trauma 2005; 19:744-7. [PMID: 16314724 DOI: 10.1097/01.bot.0000161540.24280.34] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We present a minimally invasive technique for the removal of a broken solid tibial nail. A special device was invented that minimizes the extraction difficulties. After minimal over-reaming, the device is slid in an antegrade fashion over the nail and locked. Retraction is safe and easy. This article is an illustrative case-presentation describing the device and the surgical technique.
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Affiliation(s)
- Thomas Gosling
- Trauma Department, Hannover Medical School, Hannover, Germany.
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22
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Balcarek P, Burchhardt H, Stürmer KM. Minimal-invasive Entfernung eines gebrochenen Oberschenkelmarknagels. Unfallchirurg 2005; 108:419-22. [PMID: 15909208 DOI: 10.1007/s00113-004-0871-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The removal of a broken femoral nail due to refracture or nonunion is always a surgeon's challenge. Especially the distal fragment is often difficult to remove. We describe here another minimally invasive and safe method using the antegrade and retrograde approach to the femur.
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Affiliation(s)
- P Balcarek
- Abteilung für Unfallchirurgie, Plastische- und Wiederherstellungschirurgie, Universitätsklinikum, Göttingen.
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Abstract
We present a case illustrating the extraction of a distal segment of a broken cannulated tibial nail. Using minimal soft tissue dissection, a ball-tipped guidewire is inserted through the medial malleolus. It is then threaded through the distal aspect of the broken nail. The guide wire is advanced further proximally out the standard knee incision. When the ball tip engages the end of the broken nail, it can be removed easily.
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Affiliation(s)
- Jason W Levine
- Department of Orthopaedic Surgery, Medical College of Ohio, 3065 Arlington Avenue, Toledo, OH, USA
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Steinberg EL, Luger E, Menahem A, Helfet DL. Removal of a broken distal closed section intramedullary nail: report of a case using a simple method. J Orthop Trauma 2004; 18:233-5. [PMID: 15087967 DOI: 10.1097/00005131-200404000-00007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A simple method to remove a broken distal closed section intramedullary nail is presented. The surgical technique and a case report are described. This technique eliminates the need for an additional exposure, other than that required to insert the nail, or any specialized equipment.
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Affiliation(s)
- Ely L Steinberg
- Departmernt of Orthopedic Surgery B, Tel-Aviv Sourasky Medical Center, 6 Weitzmann Street, Tel-Aviv 64239, Israel.
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Milia MJ, Vincent AB, Bosse MJ. Retrograde removal of an incarcerated solid titanium femoral nail after subtrochanteric fracture. J Orthop Trauma 2003; 17:521-4. [PMID: 12902791 DOI: 10.1097/00005131-200308000-00008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Intramedullary nailing with a solid titanium nail can result in significant bone ingrowth. Failure of an implant requires removal for replacement with another device. Previous methods have included use of extractors for cannulated nails. When extractors are not available or are inadequate, a simple retrograde push-out method can be used as described here.
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Affiliation(s)
- Marc J Milia
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina 28232, USA.
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