Removal of a broken cannulated tibial nail: a simple intramedullary technique

A novel surgical technique for removal of intramedullary nails when there is a failure of the proximal extraction device: Report of two cases and review of literature

Diaphyseal fractures of the tibia is a common injury with an incidence of 16.9/100,000 population. Surgical treatment with intramedullary interlocking nail is the treatment of choice in closed diaphyseal tibial injuries. Removal of the nail is required in non-union, infected implant, implant failure or during exchange nailing procedure. Implant removal surgery presents some unique challenges to the Orthopaedic surgeons like broken nails, broken screws and failure of the extraction devices to engage with the threads of the nail due to stripping of the threads in the proximal part of the nail. Various techniques have been described by different authors to extract a broken distal piece of the nail. There are only a few articles described for the removal of an intramedullary nail when there is failure of the proximal extraction device. The failure of the proximal extraction device occurs due to the use of ill-fitting extraction bolts, cross threading and the presence of a very tight nail leading to stripping of the proximal threads. We describe a simple and novel technique with the use of the Stainless-Steel wire along with the extraction bolt when there is a failure of proximal extraction device for the extraction of cannulated or solid intramedullary nails.

Extraction of Broken Tibial Interlock Nail with a Retrograde Hooked Guide Wire: A Novel Surgical Technique

Introduction

Removal of a distal piece of a broken nail often possesses a technical challenge. Several methods have been described in the past to extract a distal piece by using specialized instruments like such as hooks, olive wires, and talwalkar radial square nail etc. It is difficult to extract a distal piece from a proximal incision site and often fracture or the nonunion site has to be opened. In this article, we describe a novel technique to extract a distal piece of broken intramedullary tibia nail by retrograde manner using a guide wire with a “‘U”’ shaped bend at its distal end to hook the tip of a distal piece of broken nail and help in extraction.

Case Report

A 43- year-s old male presented with complain of pain in left leg since 3 months. Patient had sustained left- sided compound Grade 2 tibia shaft fracture in a road traffic accident 4 years back. He was operated with tibia interlock nail followed by skin grafting for wound coverage in a different facility. On clinical examination: There was tenderness around distal tibia, no swelling, no coronal or sagittal plane fracture mobility, and no crepitus or loss of transmitted movements which suggested fracture union clinically. Radiographs confirmed complete union of tibia shaft fracture with hypertrophic nonunion of distal fibula with broken intramedullary nail IMN at the level of proximal most screw hole of distal locking holes with both distal locking screws broken. As fracture was united, we planned for removal of broken nail without opening fracture site. For extraction for distal tibial broken nail part, we used this new Retrograde Hooked Guide Wire technique.

Conclusion

It is a simple, cost effective, minimally invasive procedure with minimal blood loss and decrease time of surgery that can be used before attempting more invasive extraction methods and hence should be included in standard procedures for extraction.

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.

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.

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.