Anterograde removal of broken femoral nails without opening the nonunion site: a new technique

Removal of a Broken Intramedullary Nail: A Case Report and Technical Description

The removal of a broken intramedullary nail is a challenging procedure. Several surgical techniques have been described to remove the distal end of the nail. Here, we report the surgical technique for removing broken Fitbone® lengthening nail using a cerclage wire. This is an effective and reproducible technique that does not require specialized equipment, the development of a cortical window, or an arthrotomy and is applicable for all types of intramedullary nails.

'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.

Removal of broken reamer stuck into femoral shaft in implanting PFNA: a case report

Femoral intertrochanteric fracture is very common in elderly population. The usual treatment for these patients is intra-extramedullary fixation. In normal situations, expand medullary cavity is needed, in order to implant various intramedullary implants. On rare occasion, which will in turn lead to the reamer is stuck into the medullary cavity of femoral shaft. Open or closed technique for moving of the broken nails had been reported before. We firstly report a novel technique by using handy tool which included in orthopaedic instrument set to remove the broken reamer stuck into femoral cavity when implanting a PFNA.

A technique for extraction of the distal segment of a broken femoral nail using a flexible reamer

INTRODUCTION

Extraction of broken femoral nails in peri-implant fractures is becoming an increasingly common problem faced by orthopaedic surgeons. Different closed and open techniques for removal of broken nails have been previously described but due to variations in equipment and fracture configurations these methods are not always easily reproducible. We describe an open surgical technique using simple equipment that can be utilised when other methods of extraction have failed.

CASE PRESENTATION AND SURGICAL TECHNIQUE

We present a case of a peri-implant fracture secondary to non-union involving a short cephalomedullary nail where the broken distal segment of nail was significantly more distal to the femoral fracture site. After multiple failed attempts at extraction with previously described closed techniques a rectangular cortical window was created 2cm distal to the tip of the broken nail using a saw. An antegrade guide wire was passed through the nail and pulled out of the bony window. A flexible intramedullary reamer was subsequently passed in retrograde fashion over the guide wire and a simple pushout technique was used to push both segments of the broken nail through the original insertion site. An exchange nailing was performed and the cortical window was reattached using a cable.

DISCUSSION

This is a simple technique that does not require any specialist equipment and does not require the fracture site to be disturbed. The use of a flexible reamer as a pushout device is ideal as there are multiple size options allowing the surgeon to match the size of the medullary canal with the reamer. Furthermore, the flexibility of the reamer allows easy access through a lateral bone window.

CONCLUSION

Broken femoral nail extraction can be technically challenging and when other closed methods have failed we believe our technique offers a simple alternative that can be added to the armamentarium of solutions.

Stuffing the nail: A simple technique for the extraction of a broken femoral nail

The extraction of broken femoral nails can be a challenging procedure and surgeons should be familiar with many different techniques. This paper demonstrates a case study and new, simple and cost effective technique for the removal of broken cannulated femoral nails. Our technique uses two guide wires of variable diameter and had several key points of differentiation from previous methods. Firstly, stuffing the nail with guide wires of greater total diameter than the cannula; secondly, reversing the second guide wire and finally, bending the tips of the wires. These innovations allow the technique to be used for narrow cannulated nails, superior purchase along the length of the nail, easy wire insertion and limited soft tissue damage. Our technique for the removal of broken femoral nails is quick, effective, cheap and easy to replicate and can be used by any generalist orthopaedic surgeon with basic equipment.

A Technical Note for Extracting an Incarcerated Femoral Kuntscher Nail

Introduction:

The use of the Kuntscher nail has been the most important advancement in trauma surgery. One of the problems is the difficulty to remove it. A new extraction technique is described in the present case report.

Case Report:

A 46-year-old man was referred for hip osteoarthritis. He had an acetabulum fracture and a femoral shaft fracture treated 30 years ago with a reamed Kuntscher femoral nail. Lateral hip approach was performed and after attempting to remove the nail with the specific tools being unsuccessful we decided to be more aggressive. Firstly, we performed a simple unicortical osteotomy on the lateral side from the proximal part to below the callus in order to decompress the femoral canal without success. Secondly, a trench in the greater trochanter around the proximal hole was performed to hit the nail from below which was still insufficient and furthermore, the hole broke when hitting the nail so we needed to drill a new hole distally. Finally, the Kuntscher nail was removed. Several cerclages closed the osteotomy and a bone graft was used to close the trench. The patient had a good evolution at one year of follow-up.

Conclusion:

With this case report, we present a new salvage technique to remove an incarcerated Kuntscher nail when all the described methods have failed.

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.

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 cannulated femoral nail: a novel retrograde impaction technique

This report presents a surgical technique to remove a broken cannulated nail from the femur. A Harrington rod was modified for retrograde impaction of the retained fragment. The broken implant was finally removed without complication. This particular procedure was safe, simple, and promising.

A survey of recently published papers on orthopedics in the Brazilian scientific press

This paper is a review of articles published in Brazilian scientific periodicals in recent years. Its main purpose is to bring to the attention of the readership of Acta Ortopedica Brasileira original contributions to the field published in non-specialized journals. We hope that this will serve as a general scientific update for readers. The review includes works published in six ISI indexed non-orthopedic journals, following a literature search conducted in fourteen such journals.

A simple method for removal of the distal segment of a broken femoral intramedullary nail: a case report

ABSTRACT

We report a method for removing the distal segment of a broken locked intramedullary nail secondary to nonunion of the femur following radiotherapy for fibromatosis. A Kirschner wire with one tip fashioned into a hook was used to remove the distal segment without opening with the nonunion site. Details of the procedure are described.

KEY WORDS

Broken intramedullary nail, removal of distal segment.

Estudo de publicações brasileiras em periódicos gerais de artigos sobre aparelho locomotor

Sào estudados os perfis de publicação de artigos relacionados ao aparelho locomotor em duas revistas médicas brasileiras gerais indexadas. Os autores estudam o perfil de publicação de artigos com registro no PUBMED, em um período de dois anos. Selecionados 39 artigos com distribuição heterogênea entre as revistas estudadas. Observaram-se nítida progressão no número de artigos entre os anos estudados em ambas as publicações, principalmente em Clinics. Entre as áreas de interesse os artigos referentes a cirurgia, abordagens clínicas e estudos biomecânicos tiveram expressiva presença em Clinics. Na RAMB os estudos estiveram centrados exclusivamente na área de interesse clínico. Quanto ao desenho predominaram em Clinics ensaios clínicos, revisões e séries de casos. Na RAMB Houve predomínio de séries de casos, revisões e estudos diagnósticos

Closed retrograde retrieval of the distal broken segment of femoral cannulated intramedullary nail using a ball-tipped guide wire

BACKGROUND

Extracting broken segments of intramedullay nails from long bones can be an operative challenge, particularly from the distal end. We report a case series where a simple and reproducible technique of extracting broken femoral cannulated nails using a ball-tipped guide wire is described. This closed technique involves no additional equipment or instruments.

MATERIALS AND METHODS

Eight patients who underwent the described method were included in the study. The technique involves using a standard plain guide wire passed through the cannulated distal broken nail segment after extraction of the proximal nail fragment. The plain guide wire is then advanced distally into the knee joint carefully under fluoroscopy imaging. Over this wire, a 5-millimeter (mm) cannulated large drill bit is used to create a track up to the distal broken nail segment. Through the small knee wound, a ball-tipped guide wire is passed, smooth end first, till the ball engages the end of the nail. The guide wire is then extracted along with the broken nail through the proximal wound.

RESULTS

The method was successfully used in all eight patients for removal of broken cannulated intramedullary nail from the femoral canal without any complications. All patients underwent exchange nailing with successful bone union in six months. None of the patients had any problems at the knee joint at the final follow-up.

CONCLUSION

We report a technique for successful extraction of the distal fragment of broken femoral intramedullary nails without additional surgical approaches.