Removal of a bent intramedullary nail with a posttraumatic sagittal plane deformity

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.

Bent Tibial Nail with Refracture: A Cost-Effective Removal Method: A Case Report

CASE

A 45-year old man presented with a right open tibial fracture with a prominent, fixed deformity because of a retained right tibial intramedullary nail from a previous tibial fracture. After multiple futile intraoperative attempts to extract the bent nail, it was finally sectioned using an industrial drill bit that permitted its removal and revision tibial nailing.

CONCLUSIONS

A tibial fracture resulting in a retained, bent nail presents unique challenges for nail extraction and subsequent exchange nailing. Failed implant removal can be limited by the equipment available in the operating theater. In this setting, the judicious use of inexpensive industrial materials and instruments may be effective in select cases.

Surgical management of angulated femoral intramedullary nails associated with closed fractures: A systematic review of the literature

Background

Femoral nail bending is a rare complication of intramedullary (IM) fixation of femoral diaphyseal fractures. Published literature regarding this injury pattern has thus far been limited to case reports or case series, thus no universally accepted surgical treatment strategy has been developed.

Methods

A systematic review was conducted using the Pubmed/MEDLINE and Scopus/EMBASE databases. A standardized template was used to extract data including author, year of publication, patient demographics, degree of angulation, mechanism of injury, time since initial procedure to reinjury, surgical treatment, and clinical outcomes. A case report from our institution was described as well.

Results

27 cases in 25 reports were included in the qualitative analysis. All of the patients were males, and the ages ranged from 17 to 66 (mean age = 27.8). The degree of deformity ranged from 18 to 85° (mean 35.6), most commonly in a varus or apex anterior orientation. The nail deformities were corrected via one of six general surgical techniques: full transection of the nail, partial sectioning and manual straightening, limited corticotomy or longitudinal bone window, straightening with the assistance of a plate and reduction clamps, closed manipulation, or extraction without the need for manipulation. The fractures were then most commonly treated with revision IM nail.

Conclusions

The bent IM nail is a rare and challenging injury to treat. No one technique has been identified as "the gold standard" and each case must be approached with its unique characteristics in mind.

Removal of bent intramedullary nail: Two case reports

INTRODUCTION

The removal of bent intramedullary (IM) nail can become a challenge. Therefore, various methods have been reported for the extraction of nails after femoral refracture. We want to share our successful treatment.

PATIENT CONCERNS

Case 1. A 44-year-old man was admitted to our clinic after falling while playing soccer. He complained severe right thigh pain with a visible deformity of the femur. His medical history revealed a right femoral shaft fracture caused in a traffic accident which had been treated with intramedullary nailing. Case 2. A 27-year-old man, who had suffered a right femur fracture after a motorcycle accident and been treated with an IM nail, presented after falling down the stairs. He had severe right thigh pain without any open wound or neurologic deficit.

DIAGNOSIS

Case 1. Plain radiographs revealed a refracture of the right femoral shaft and a bent IM nail. The initial varus deformity of the nail was 60.1° in the coronal plane. Case 2. The valgus deformity of the nail was 16.1° with an apex-posterior angulation of 34.8° in the sagittal image of plain radiographs.

INTERVENTIONS

Case 1. Initial manual reduction was tried in emergency room. Then, under general anesthesia closed reduction of the fracture and bent IM nail was done. After closed reduction, the nail was straightened and extracted smoothly. Case 2. Closed manipulation was attempted initially. But no difference in the deformity was achieved. Therefore, via skin incision, the bent nail was progressively sectioned with high-speed cutting burr until the nail could be straightened.

OUTCOMES

Case 1. The patient was mobilized with partial-weight bearing assisted with a crutch on postoperative day two. One year after surgery, the fracture union was complete and the patient was pain-free. Case 2. Six months after surgery, the fracture union was complete with sufficient callus formation around the fracture site.

CONCLUSION

There is no gold standard method to remove a bent IM nail. However, since manual reduction to straighten the bent nail causes minimal soft tissue damage, it should be considered first. If it fails, other methods should be attempted, progressing from the minimally invasive technique to more invasive methods.

Bent femoral intramedullary nail: a case report and review of the literature

Intramedullary nailing is considered the gold standard technique for the treatment of femoral shaft fractures. A rare complication of this technique is nail bending after a new trauma. In these cases nail removal might be really challenging. The present paper provides a brief review of surgical techniques purposed in the literature for bent nail removal and describes a clinical case. (www.actabiomedica.it)

Removal of a bent intramedullary nail in lower extremity: report of two cases and review of removal techniques

Removal of a bent intramedullary nail (IMN) is a rare but challenging orthopedic problem. Several removal techniques have been described up to date; however, there is no extensive review and no algorithm to manage these cases in current literature. The purpose of this paper is to present two cases that presented with bent IMN and provide an algorithm for management of this rare complication.

Jumbo Cutter for Removal of A Bent Femoral Interlocking Nail: A Cost Effective Method

Closed diaphyseal femoral shaft fractures can be treated with multiple surgical options. It is more challenging to remove a bent nail than a broken one because it is difficult to retrieve the bent nail through the intramedullary canal. Various authors have published their techniques for removal of bent femoral interlocking nail. This article describes a simple technique using Jumbo cutter for sectioning and removal of bent interlocking nail. This technique will help orthopaedic surgeons to remove bent nail without using any specialised metal cutting instruments.

Use of the F-Tool for the removal of a bent intramedullary femoral nail with a sagittal plane deformity

Locked intramedullary nailing is the current standard of treatment for femoral shaft fractures and has low complication rates. Bent femoral intramedullary nails resulting from secondary trauma are rare and technically challenging. This article describes a case of a 36-year-old man who presented with a bent femoral intramedullary nail following a motorcross accident. The patient had a previous femoral shaft fracture treated with an intramedullary nail. Previous reports outlined methods to remove bent femoral nails through the fracture site and proximally; however, this article describes a novel technique combining the use of a Midas Rex MR7 high-speed burr (Medtronic, Minneapolis, Minnesota) and the F-Tool (Synthes, West Chester, Pennsylvania) to facilitate nail extraction.The patient was placed in the lateral decubitus position. After limited exposure at the fracture site, the intramedullary nail was weakened at the apex of the deformity with a Midas Rex MR7 high-speed burr. We then used the F-Tool to straighten the nail to facilitate removal through the original proximal insertion site. The F-Tool allows forces to be concentrated at the apex of the deformity and minimizes soft tissue damage. Additional advantages of our technique include limited exposure and the ability to remove the nail in 1 piece.