[A simple and rapid method for removal of broken unreamed tibial nails]

Removal of a Broken Stainless-Steel Intramedullary Lengthening Stryde Nail: A Case Report and Review of the Literature

CASE

We report a 15-year-old female patient who underwent femur lengthening with a stainless steel intramedullary lengthening Stryde nail that broke at the end of the lengthening course and required removal. Given the solid noncannulated nature of the nail, this required special strategy to remove broken parts.

CONCLUSION

Stryde nails are stainless steel lengthening nails that were developed to allow more freedom with weight bearing. Regardless of this change, hardware failure remains possible. In addition to maintaining regenerate integrity, a surgeon must be creative when attempting to remove solid nail types because many techniques for removing failed hardware were developed for cannulated devices.

Mechanical failure of the Intramedullary Skeletal Kinetic Distractor in limb lengthening

Between October 2001 and September 2009 we lengthened 242 lower-limb segments in 180 patients using the Intramedullary Skeletal Kinetic Distractor (ISKD). Mechanical failure was defined either as breakage of the ISKD or failure of the internal mechanism to activate. Retrieved nails which failed mechanically were examined by the manufacturer for defects. In all, 15 ISKDs in 12 patients (13 limbs) failed mechanically representing an overall failure rate of 6.2%, with fracture of the device occurring in ten of the 15 failures. Two nails in one patient failed to lengthen and had to be replaced. The manufacturer detected an error in the assembly of the nail, which prompted a wide recall. One nail jammed after being forcefully inserted, and two nails failed to lengthen fully. Lengthening was achieved in all 12 patients, although three required a second operation to exchange a defective nail for a new, functioning device.

The ISKD is a complex mechanical device which lengthens by the oscillation of two telescopic sections connected by a threaded rod. The junction between these sections is surrounded by a keyring collar. This keyring collar is the weakest part of the device.

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.

Tibia fracture following removal of the ETN (Expert Tibia Nail): a case report

We report on a patient who sustained a fracture of the tibial shaft during the removal of the newest type of an intramedullary nail (Expert Tibia Nail, Synthes. In this case report, we discuss the causes of this complication and possible ways to prevent this.

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.

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 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.