Removal of a broken distal closed section intramedullary nail: report of a case using a simple method

A novel minimally invasive broken nail extractor for cannulated intramedullary nails: Trial and application in a few cases

Successful and minimally invasive extraction of a broken distal end of an intramedullary nail is challenging. This study introduces a simple and reproducible technique for the extraction of broken cannulated intramedullary nails using a novel minimally invasive broken nail extractor. Five amputated adult lower-leg specimens were used to create models of the broken distal end of the cannulated intramedullary nails remaining in the medullary cavity of the distal tibia. Two orthopedic resident physicians with experience in tibial intramedullary nail implantation were selected to blindly extract the broken intramedullary nail using the novel minimally invasive broken nail extractor. The extraction outcome was assessed. The broken nail extractor was applied to 3 patients with broken intramedullary nails remaining in the medullary cavity of the distal tibia. In the lower-leg specimens, the extraction success rate was 100%, the median number of extraction times was 1.9 (range 1-3.5), and the median duration of extraction was 38 s (range 20-52 s). All the broken intramedullary nails in the 3 patients were successfully extracted without complications related to the surgery. The study shows that our technique is simple, reproducible, and has a high extraction success rate, but more case applications are needed to verify its effect.

'Extended tibia osteotomy': a technical tip for removal of incarcerated reamer with broken guide wire bead during tibia nailing and literature review

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.

Dissociation of a Femoral Intramedullary Magnetic Lengthening Nail During Routine Hardware Removal: A Case Report

CASE

A 15-year-old boy with a right femur length discrepancy secondary to infection underwent hardware removal 1-year status-post right femur osteotomy with placement of an antegrade intramedullary magnetic lengthening nail after successful lengthening of 4.2 cm. During hardware removal, dissociation between the proximal (outer) and distal (inner) components of the device was observed. The distal component was removed using an endoscopic pituitary rongeur after considering multiple possible techniques.

CONCLUSIONS

In the event of nail disconnection during removal of an intramedullary implant, we recommend use of a long pituitary rongeur to retrieve the distal nail component.

Novel Method for Removal of Broken Intramedullary Interlocking Nail with a Subtrochanteric Fracture: A Case Report

CASE

A 45-year-old man with ankylosing spondylitis with bilateral ankylosed hips presented with subtrochanteric femur fracture with a broken intramedullary nail in situ. The nail was removed by making a hole in the nail using a carbide bit and putting a Steinmann pin in this hole to extract the nail.

CONCLUSIONS

This novel broken intramedullary nail extraction technique is especially useful for nonunions or implant failures that occur in the proximal shaft/subtrochanteric area, and the instruments used are also readily available. There is minimal radiation exposure, and it is an effective method to remove the distal part of the broken nail.

Catastrophic Failure of a Carbon-Fiber-Reinforced Polyetheretherketone Tibial Intramedullary Nail: A Case Report

CASE

We present a case of a rare low-energy catastrophic failure of a carbon-fiber-reinforced polyetheretherketone tibial intramedullary nail at 10 weeks after placement in a 36-year-old man. We describe our experience with extraction of the device.

CONCLUSION

Carbon-fiber composite implants are approved for clinical use in orthopaedic trauma applications. The rare failure of carbon-fiber implants presents unique challenges because typical extraction techniques cannot be used. With the patient described herein, a terminally threaded guidewire was used to cannulate and extract the distal segment of the nail.

A blocking-wire technique for removal of a broken hollow intramedullary nail

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.

Removal of the broken femoral nail with T-reamer technique: A three-case report

Nonunion of femoral shaft fracture is an uncommon complication after closed intramedullary nailing which often leading to nail breakage. Removal of the broken femoral nail with closed manner is a challenging procedure for orthopedic surgeons. The removal technique with the T-reamer is a closed method, which does not require either a nonunion site opening or knee exposing. We reported 3 cases of nonunion femoral shaft with broken slotted and non-slotted hollow nail which were successfully removed without any complication. All fractures healed uneventfully without open the fracture site or bone grafting.

Use of a Nancy nail to remove a broken intramedullary nail: A technical note

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.

Removal of a broken cannulated intramedullary nail: review of the literature and a case report of a new technique

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.

A new technique for removal of an incarcerated expandable femoral nail

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.

Management of a trochanteric fracture complicated by a bent solid intramedullary femoral nail in situ: description of technique

A femoral refracture in the presence of an intramedullary nail in situ remains a challenging technical problem. This is particularly true when dealing with vintage implants phased out from the market, which lack a specific extraction device. In the present case report, we share our experience on the fixation technique of a trochanteric femur fracture in the presence of a "classic" solid Schneider nail, which had been implanted more than 20 years earlier. Detailed preoperative planning and adequate surgical technique represent prerequisites for successful management of such a demanding condition with the aim of reducing the imminent risk of intraoperative technical complications and adverse patient outcome.

Removal of broken solid femoral nail: a modified bent tip guide wire technique

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.

Removal of broken distal intramedullary nail with a simple method: a case report

Breakage of the intramedullary nail has long been recognized as an uncommon complication of intamedullary nailing of long bones. Retrieval of the distal fragment of a broken nail is a challenging problem. The surgeon needs to be familiar with as many methods of distal fragment extraction as possible. Herein we report a case of broken intramedullay nail, which was removed with a small reamer, wedged into the distal segment of the nail.

Removal of broken long gamma nail: a modified guide wires technique

We report a simple alternative procedure, modified ball-tipped guide wires technique, to remove a broken long gamma nail at the level of lag screw hole which is detected during a removal procedure. The fragment retained in the medullary canal was successfully removed without complication.

Removal of broken hardware

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.

Removal of a broken intramedullary nail with a narrow hollow

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.

Minimally invasive exchange tibial nailing for a broken solid nail: case report and description of a new technique

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.