Removal of bent intramedullary nail: Two case reports

Removal of a Bent Humeral Intramedullary Nail: A Case Report and Review of Removal Techniques

CASE

We present a case of a (65°) bent intramedullary nail (IMN) in a humerus after a pseudoarthrosis in a 65-year-old man. Bent IMNs have been described in femurs and tibias, but are considered rare. Possibly even rarer is the bending of a humeral IMN. This report provides an overview of removal techniques and our approach to this uncommon complication: open sectioning of the bent IMN and 2-piece extraction through the fracture site.

CONCLUSION

Removal of a bent or broken IMN is a rare and challenging surgical problem. A bent humeral IMN requires a different and more careful approach for extraction than bent nails in the lower extremity, given the greater potential for neurovascular disruption.

Technique for Extraction and Revision of a Bent Intramedullary Nail for a Subtrochanteric Femur Fracture: A Case Report

CASE

A 17-year-old adolescent boy presented 2 months after initial intramedullary nail (IMN) fixation of a comminuted subtrochanteric fracture with refracture at the previous site and approximately 20° varus angulation of the nail. The bent femoral nail was successfully extracted using an open technique using Lohman bone-holding clamps and a broad plate. At the 1-year follow-up, fracture union was achieved.

CONCLUSIONS

Removal of a deformed IMN is rare. No standardized protocol exists in guiding orthopaedic surgeons. A thorough review of techniques is discussed on this unusual complication.

Removing a bent femoral nail - man versus metal: A case report

Introduction

Intramedullary nailing is the treatment of choice for femoral shaft fractures in adults with excellent clinical results and low complication rates reported in the literature. However, in situ bending of a femoral nail is a rare complication that merits special attention. While there are several extraction techniques and algorithms the scientific evidence to support these decision-making tools is unconvincing.

Presentation of case

A 26-year old man presented to the Accident and Emergency Department with a deformed thigh following a low-energy injury. Radiographs showed a bent femoral nail in situ and the patient disclosed that he had surgery four weeks earlier for a fractured femur sustained in a motor vehicle accident. A treatment algorithm was followed in planning the surgical strategy, but ultimately a simple hacksaw blade was used to cut and remove the nail. The fracture which was stabilised by exchange nailing went on to uncomplicated union and the patient recovered fully.

Discussion

Non-invasive methods of removing a bent femoral nail are often unsuccessful and may result in iatrogenic injuries. Surgeons should assess the available local resources and first consider using simple open methods when attempting to remove a bent femoral nail.

Conclusion

Open extraction methods often disregard the low-resource environment in which many surgeons work. We describe a simple and economical technique that uses a regular hacksaw blade to cut and remove a bent femoral nail.

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Using modern implants, insitu bending of a femoral nail is a rare occurrence.

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Closed extraction methods are often unsuccessful and may lead to iatrogenic injuries.

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An open technique using a simple hacksaw can be used in low-resource settings without access to sophisticated extraction tools.

The impact of the level of anxiety and temperament in asymptomatic or mildly symptomatic patients requesting implant removal surgery after tibia intramedullary nailing

BACKROUND

Implant removal (IR) surgery is one of the most frequent procedures in orthopedic practice. Many of the IR surgeries result from patient request rather than a medical necessity. The purpose of the study was to investigate the association between the level of anxiety, type of temperament and psychopathological status, and the willingness to receive IR surgery in asymptomatic or mildly symptomatic patients. We also aimed to compare pre- and postoperative pain scores and document the complication rates after IR surgery.

METHODS

The patients who received tibia intramedullary nailing after tibia diaphyseal fracture with a minimum of 18 months follow-up were included in the study. A total of 246 asymptomatic or mildly symptomatic patients were evaluated, and all patients received detailed oral and written information about the risks of IR surgery. The patients who wished to receive IR surgery were called Group 1 (N = 104), and the patients who did not wish to have surgery were called Group 2 (N = 146). All patients were referred to a psychologist to complete the Beck anxiety inventory (BAI), Symptom checklist-90-R (SCL-R-90), and the Temperament Evaluation of Memphis, Pisa, and San Diego Autoquestionnaire (TEMPS-A).

RESULTS

The mean age of the patients was 32.31 ± 9.56. One hundred thirteen (45.9%) of the patients were male, and 133 were female (54%). Mean BAI and SCL-90-R were higher in Group 1 than Group 2 (P = 0.001). Anxious and irritable temperament was higher in Group 1 (P = 0.045 and P = 0.035 respectively), and non-dominant and hyperthymic temperament was higher in Group 2 (P = 0.02 and P = 0.04 respectively).

CONCLUSIONS

The level of anxiety and type of temperament is associated with the willingness to receive implant removal surgery in asymptomatic or mildly symptomatic patients. Measures to reduce anxiety levels may reduce the rate of unnecessary implant removal surgeries, associated patient care costs, and potential complications.

In Situ Straightening of a Bent Tibiofemoral Intramedullary Nail: Case Report and Review of the Literature

Background: Intramedullary nailing is considered the gold standard for the surgical management of diaphyseal long bone fractures of the lower extremity. A rare complication following intramedullary nailing of a femur or tibia fracture is periprosthetic fracture following secondary trauma with deformation of the nail itself. We present a case of a 51-year-old male with a long history of prior left knee arthrodesis with a tibiofemoral nail who sustained a work injury resulting in a proximal tibia fracture and bent tibiofemoral nail. Clinically, he presented with significant varus and procurvatum limb deformity and a six-centimeter limb length discrepancy. The patient was successfully managed with in situ straightening of the tibiofemoral nail under a general anesthetic with return to work three months following manipulation. Level of Evidence: IV.