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

We present a case illustrating the extraction of a distal segment of a broken cannulated tibial nail. Using minimal soft tissue dissection, a ball-tipped guidewire is inserted through the medial malleolus. It is then threaded through the distal aspect of the broken nail. The guide wire is advanced further proximally out the standard knee incision. When the ball tip engages the end of the broken nail, it can be removed easily.     

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 a broken massive reamed tibia nail

Summary A problem has arisen when replacing the reamed tibia nail by the massive unreamed tibia nail. In case of nail fracture it is difficult to remove the distal fragment from the medullary cavity. It may also occur that the connecting screw between the insertion handle and the nail breaks off at the edge of the implant, which much complicates removal of the nail. The authors have developed a technique to remove the implant without having to saw a fissure in the marrow. A concave instrument is slid over the part of the nail left behind after which the two are connected by means of a K wire. This method has been successfully applied in 2 patients.      

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 a broken trigen intertan intertrochanteric antegrade nail

Implant breakage is a serious complication after cephalomedullary nailing for unstable intertrochanteric fracture. Failure usually occurs at the lag screw hole in the nail body. On the other hand, lag screw failure is extremely rare and occurs around the nail-lag screw junction. We experienced rare mechanical failure of the Intertan nail, which showed breakage at the lag screw hole and failure of the integrated compression screw underneath the main lag screw.     

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.     

Removal of the broken tip of a hexagonal screwdriver from a nail end cap using a magnetic bar

The tip of the hexagonal screwdriver can be broken and retained in the recess of the end cap of an intramedullary nail. It can happen when the position of the patient's limb suddenly changes during the tightening procedure. Removal of the broken tip is necessary due to metal incompatibility and for the potential of a future procedure. A simple solution for this problem is presented, the use of a magnetic bar normally used for removal of orbital metallic foreign bodies.     

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

A simple method to remove a broken distal closed section intramedullary nail is presented. The surgical technique and a case report are described. This technique eliminates the need for an additional exposure, other than that required to insert the nail, or any specialized equipment.     

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.     

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

IntroductionExtraction 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 techniqueWe 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 2 cm 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.DiscussionThis 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.ConclusionBroken 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.     

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.     

Exchange femoral nailing: a new technique for removal of a broken nail

Exchange femoral nailing is the preferred method for treating femoral nonunions. When the index femoral nail is broken, the difficulty of exchange nailing increases dramatically. In this article, we describe a new technique for removing a broken retrograde nail--advancing it out of the proximal end of the femur.