1
|
Walters S, Trompeter A. Broken tibial nail extraction: a useful technique. Ann R Coll Surg Engl 2024. [PMID: 38445599 DOI: 10.1308/rcsann.2023.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
|
2
|
M L V SK, Nag HL, Gupta A. Removal of distal part of a broken intramedullary nail from the femoral shaft using stainless steel (SS) wire - An innovative surgical technique. JOURNAL OF ORTHOPAEDIC REPORTS 2022; 1:100036. [DOI: 10.1016/j.jorep.2022.100036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
|
3
|
Abalkhail TB, McClure PK. Removal of a Broken Stainless-Steel Intramedullary Lengthening Stryde Nail: A Case Report and Review of the Literature. JBJS Case Connect 2021; 11:01709767-202112000-00082. [PMID: 34937043 DOI: 10.2106/jbjs.cc.21.00464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
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.
Collapse
Affiliation(s)
- Talal B Abalkhail
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD.,Department of Orthopedics, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Philip K McClure
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| |
Collapse
|
4
|
Garg BK, Dave H. Extraction of Broken Tibial Interlock Nail with a Retrograde Hooked Guide Wire: A Novel Surgical Technique. J Orthop Case Rep 2021; 11:38-40. [PMID: 34557436 PMCID: PMC8422007 DOI: 10.13107/jocr.2021.v11.i05.2196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Removal of a distal piece of a broken nail often possesses a technical challenge. Several methods have been described in the past to extract a distal piece by using specialized instruments like such as hooks, olive wires, and talwalkar radial square nail etc. It is difficult to extract a distal piece from a proximal incision site and often fracture or the nonunion site has to be opened. In this article, we describe a novel technique to extract a distal piece of broken intramedullary tibia nail by retrograde manner using a guide wire with a “‘U”’ shaped bend at its distal end to hook the tip of a distal piece of broken nail and help in extraction. Case Report A 43- year-s old male presented with complain of pain in left leg since 3 months. Patient had sustained left- sided compound Grade 2 tibia shaft fracture in a road traffic accident 4 years back. He was operated with tibia interlock nail followed by skin grafting for wound coverage in a different facility. On clinical examination: There was tenderness around distal tibia, no swelling, no coronal or sagittal plane fracture mobility, and no crepitus or loss of transmitted movements which suggested fracture union clinically. Radiographs confirmed complete union of tibia shaft fracture with hypertrophic nonunion of distal fibula with broken intramedullary nail IMN at the level of proximal most screw hole of distal locking holes with both distal locking screws broken. As fracture was united, we planned for removal of broken nail without opening fracture site. For extraction for distal tibial broken nail part, we used this new Retrograde Hooked Guide Wire technique. Conclusion It is a simple, cost effective, minimally invasive procedure with minimal blood loss and decrease time of surgery that can be used before attempting more invasive extraction methods and hence should be included in standard procedures for extraction.
Collapse
Affiliation(s)
- Bipul K Garg
- Department of Orthopaedic Surgery, Sir J.J. Group of Hospitals and Grant Medical College, Mumbai, Maharashtra, India
| | - Harshit Dave
- Department of Orthopaedic Surgery, Sir J.J. Group of Hospitals and Grant Medical College, Mumbai, Maharashtra, India
| |
Collapse
|
5
|
Johnson MA, Karkenny AJ, Arkader A, Davidson RS. Dissociation of a Femoral Intramedullary Magnetic Lengthening Nail During Routine Hardware Removal: A Case Report. JBJS Case Connect 2021; 11:01709767-202103000-00046. [PMID: 33684083 DOI: 10.2106/jbjs.cc.20.00950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
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.
Collapse
Affiliation(s)
- Mitchell A Johnson
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | | |
Collapse
|
6
|
Iqbal F, Zamir M, Ahmed N, Kamal SW, Memon N. Ball tipped guide wire for broken nail removal: a case report. SICOT J 2021; 7:10. [PMID: 33683195 PMCID: PMC7938723 DOI: 10.1051/sicotj/2021010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/10/2021] [Indexed: 11/20/2022] Open
Abstract
A broken intramedullary nail is a well-known complication of non-union of femur shaft fractures. Numerous surgical techniques have been presented before in patients with non-union of long bone fractures. We report the surgical technique used to perform removal of the broken distal segment of a nail in a patient who achieved uneventful union after intramedullary nailing of closed femur shaft fracture. A ball-tipped guidewire was inserted through the broken segment of the femur nail. A pre-bend plain wire was then inserted. With the help of a vise-grip, both wires were twisted in order to make a secure handle between guidewires and a broken implant. With the help of a mallet upward-directed blows were applied to extract a broken segment of the nail. We found ball-tipped guidewire technique a useful and effective technique in removing the broken distal portion of the nail.
Collapse
Affiliation(s)
- Faizan Iqbal
- Department of Orthopaedic Surgery, Patel Hospital, 75300 Karachi, Pakistan
| | - Mehroze Zamir
- Department of Orthopaedic Surgery, Patel Hospital, 75300 Karachi, Pakistan
| | - Nasir Ahmed
- Department of Orthopaedic Surgery, Patel Hospital, 75300 Karachi, Pakistan
| | - Syed Wajahat Kamal
- Department of Orthopaedic Surgery, Patel Hospital, 75300 Karachi, Pakistan
| | - Nouman Memon
- Department of Orthopaedic Surgery, Patel Hospital, 75300 Karachi, Pakistan
| |
Collapse
|
7
|
Soni A, Sharma A, Kansay RK, Vashist D. Novel Method for Removal of Broken Intramedullary Interlocking Nail with a Subtrochanteric Fracture: A Case Report. JBJS Case Connect 2020; 9:e0182. [PMID: 31815808 DOI: 10.2106/jbjs.cc.19.00182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 45-year-old man with ankylosing spondylitis with bilateral ankylosed hips presented with subtrochanteric femur fracture with a broken intramedullary nail in situ. The nail was removed by making a hole in the nail using a carbide bit and putting a Steinmann pin in this hole to extract the nail. CONCLUSIONS This novel broken intramedullary nail extraction technique is especially useful for nonunions or implant failures that occur in the proximal shaft/subtrochanteric area, and the instruments used are also readily available. There is minimal radiation exposure, and it is an effective method to remove the distal part of the broken nail.
Collapse
Affiliation(s)
- Ashwani Soni
- Department of Orthopaedics, Govt. Medical College and Hospital, Chandigarh, India
| | - Anmol Sharma
- Department of Orthopaedics, Govt. Medical College and Hospital, Chandigarh, India
| | - Rajeev Kumar Kansay
- Department of Orthopaedics, Govt. Medical College and Hospital, Chandigarh, India
| | - Deepam Vashist
- Department of Orthopaedics, Govt. Medical College and Hospital, Chandigarh, India
| |
Collapse
|
8
|
Unstable AO/OTA type 31-A1.2 intertrochanteric femur fracture: An unusual case report. Trauma Case Rep 2020; 28:100326. [PMID: 32642536 PMCID: PMC7334604 DOI: 10.1016/j.tcr.2020.100326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2020] [Indexed: 11/20/2022] Open
Abstract
AO/OTA type 31-A1.2 intertrochanteric femoral fractures generally are considered stable intertrochanteric fractures. We report a case of an unstable AO/OTA type 31-A1.2 intertrochanteric femoral fracture. Primary internal fixation was performed with a long cephalomedullary nail taking instability into account. Postoperative X-rays showed an acceptable reduction with a slight fracture gap in extension on the lateral trochanteric side. However, additional salvage surgery was required because the long cephalomedullary nail broke as a result of the instability caused by non-union and varus deformity of the proximal femur. More attention should be directed to strategies of primary internal fixation including choice of fixation instrumentation in terms of mechanical stability because this type of fracture can be remarkably unstable despite radiographic diagnosis of a usually stable AO/OTA classification type 31-A1.2 fracture.
Collapse
|
9
|
Lovell J, Krishna D, Gehr E. Stuffing the nail: A simple technique for the extraction of a broken femoral nail. Trauma Case Rep 2017; 9:38-41. [PMID: 29644323 PMCID: PMC5883248 DOI: 10.1016/j.tcr.2017.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2017] [Indexed: 11/26/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Jane Lovell
- Hervey Bay Hospital, University of Queensland, Australia
| | | | - Eugene Gehr
- Hervey Bay Hospital, University of Queensland, Australia
| |
Collapse
|
10
|
Zheng XL, Park YC, Kang DH, Seok SO, Yoon YK, Yang KH. A blocking-wire technique for removal of a broken hollow intramedullary nail. Injury 2016; 47:1601-3. [PMID: 27170540 DOI: 10.1016/j.injury.2016.04.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 02/02/2023]
Abstract
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.
Collapse
Affiliation(s)
- Xuan-Lin Zheng
- Department of Orthopedics Surgery, Yonsei University, College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea.
| | - Young-Chang Park
- Department of Orthopedics Surgery, Yonsei University, College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea.
| | - Dong-Hyun Kang
- Department of Orthopedics Surgery, Yonsei University, College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea.
| | - Sang-Ok Seok
- Department of Orthopedics Surgery, Yonsei University, College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea.
| | - Yeo-Kwon Yoon
- Department of Orthopedics Surgery, Yonsei University, College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea.
| | - Kyu-Hyun Yang
- Department of Orthopedics Surgery, Yonsei University, College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea.
| |
Collapse
|
11
|
Removal of a broken cannulated intramedullary nail: review of the literature and a case report of a new technique. Case Rep Orthop 2013; 2013:461703. [PMID: 24455369 PMCID: PMC3886368 DOI: 10.1155/2013/461703] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 12/04/2013] [Indexed: 11/18/2022] Open
Abstract
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.
Collapse
|
12
|
Metikala S, Mohammed R. Closed retrograde retrieval of the distal broken segment of femoral cannulated intramedullary nail using a ball-tipped guide wire. Indian J Orthop 2011; 45:347-50. [PMID: 21772629 PMCID: PMC3134021 DOI: 10.4103/0019-5413.82342] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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.
Collapse
Affiliation(s)
- Sreenivasulu Metikala
- Trauma and Orthopaedics Surgeon, Sri Venkateswara Trauma and Orthopaedic Clinic, Kadapa, Andhra Pradesh, India
| | - Riazuddin Mohammed
- Registrar-Trauma and Orthopaedics, Hywel Dda NHS Trust, Carmarthen, United Kingdom,Address for correspondence: Mr. Riazuddin Mohammed, Registrar- Trauma and Orthopaedics, Hywel Dda NHS Trust, Carmarthen, SA31 2AF, United Kingdom. E-mail:
| |
Collapse
|
13
|
Pretell Mazzini J, Rodriguez Martin J, Resines Erasun C. Removal of a broken intramedullary femoral nail with an unusual pattern of breakage: a case report. Strategies Trauma Limb Reconstr 2009; 4:151-5. [PMID: 19777163 PMCID: PMC2787202 DOI: 10.1007/s11751-009-0066-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 08/13/2009] [Indexed: 11/26/2022] Open
Abstract
To the best of our knowledge, only 3 cases, including the present case, have been reported with a three part broken pattern. However, this is the first case associated with a distal locking screw broken. We report the case of a 31-year-old patient who sustained an open femoral shaft fracture . The fracture was stabilized with a Kuntcher femoral nail. After 7 months of the initial surgery he presented with a three part broken intramedullary nail and the distal locking screw broken. We used a combined technique for the removal of the nail through the nonunion fracture site; we used a pull out technique for the middle fragment and a curved thin hook for the distal fragment. Then we applied bone allograft and stabilized with a cannulated intramedullary femoral nail (Synthes, Oberdorf, Switzerland). After 2 years of follow up the nonunion was consolidated and the patient presented a good clinical outcome. This is of particular interest because it is a unique case and the association with a broken distal locking screw is reported for the first time in this study. A combination of methods through the nonunion site approach and an alternative instrumental is a good method for the removal of a hollow femoral intramedullary nail with this unusual pattern of breakage.
Collapse
|
14
|
Whalley H, Thomas G, Hull P, Porter K. Surgeon versus metalwork--tips to remove a retained intramedullary nail fragment. Injury 2009; 40:783-9. [PMID: 19442972 DOI: 10.1016/j.injury.2008.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 12/12/2008] [Indexed: 02/02/2023]
Affiliation(s)
- Helen Whalley
- Academic Department of Clinical Traumatology, West Building, Institute of Research and Development, Edgbaston Birmingham, United Kingdom.
| | | | | | | |
Collapse
|
15
|
Three-Part Broken Intramedullary Nail Reconsideration: A Case Report and Review of the Literature. ACTA ACUST UNITED AC 2009; 66:E4-8. [DOI: 10.1097/01.ta.0000221707.40720.7d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Abstract
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.
Collapse
|
17
|
Maini L, Jain N, Singh J, Singh H, Bahl A, Gautam VK. Removal of a multisegmental broken nail by close technique using a TEN nail. ACTA ACUST UNITED AC 2008; 66:E78-80. [PMID: 18277264 DOI: 10.1097/01.ta.0000236051.08735.eb] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Lalit Maini
- Department of Orthopaedics, Maulana Azad Medical College, Delhi, India.
| | | | | | | | | | | |
Collapse
|
18
|
Ilizarov treatment for femoral mal-union or non-union associated with fatigue fracture of an intramedullary nail. Injury 2008; 39:256-9. [PMID: 18164004 DOI: 10.1016/j.injury.2007.07.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Accepted: 07/25/2007] [Indexed: 02/02/2023]
|
19
|
Chen CE, Weng LH, Ko JY, Wang CJ. Management of nonunion associated with broken intramedullary nail of the femur. Orthopedics 2008; 31:78. [PMID: 19292160 DOI: 10.3928/01477447-20080101-07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study analyzed 14 patients with 17 broken intramedullary nails for the treatment of femoral fractures. Average distance from the fracture site was 7.9 cm in cases in which nail breakage occurred at the junction between the cylindrical and cloverleaf portions and 6.4 cm in cases in which nail breakage occurred at the screw hole. Eleven patients with 14 broken nails were treated with exchange nailing and bone grafting, 2 were treated with plating and bone grafting, and 1 was treated with extracorporeal shock wave therapy. Nonunion or delayed union is the main cause of nail breakage. Exchange nailing with bone grafting is a safe and effective method of treatment for a broken intramedullary nail with nonunion.
Collapse
Affiliation(s)
- Chin-En Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan, Republic of China
| | | | | | | |
Collapse
|
20
|
|
21
|
De Pedro JA, Blanco JF, Ellis S. A simple technique for the capture of broken intramedullary locking screws using laparoscopic forceps. THE JOURNAL OF TRAUMA 2006; 61:1283-4. [PMID: 17099547 DOI: 10.1097/01.ta.0000199387.07398.bf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- José A De Pedro
- Department of Orthopaedic Surgery, University Hospital of Salamanca, Salamanca, Spain.
| | | | | |
Collapse
|
22
|
Maini L, Singh J, Agarwal P, Gautum VK, Dhal AK. Removal of Broken Kuntscher???s Nail: An Innovative Close Technique. ACTA ACUST UNITED AC 2005; 59:1518-20. [PMID: 16394935 DOI: 10.1097/01.ta.0000198352.05833.88] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Lalit Maini
- Department of Orthopeadics, Maulana Azad Medical College/LN Hospital, New Delhi, India.
| | | | | | | | | |
Collapse
|
23
|
|
24
|
Balcarek P, Burchhardt H, Stürmer KM. Minimal-invasive Entfernung eines gebrochenen Oberschenkelmarknagels. Unfallchirurg 2005; 108:419-22. [PMID: 15909208 DOI: 10.1007/s00113-004-0871-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The removal of a broken femoral nail due to refracture or nonunion is always a surgeon's challenge. Especially the distal fragment is often difficult to remove. We describe here another minimally invasive and safe method using the antegrade and retrograde approach to the femur.
Collapse
Affiliation(s)
- P Balcarek
- Abteilung für Unfallchirurgie, Plastische- und Wiederherstellungschirurgie, Universitätsklinikum, Göttingen.
| | | | | |
Collapse
|
25
|
van Eerten PV, Reemst PHM, Repelaer van Driel OJ. Minimally invasive femoral nail extraction. Arch Orthop Trauma Surg 2005; 125:197-200. [PMID: 15723191 DOI: 10.1007/s00402-005-0799-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2004] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Case report about a minimally invasive technique for removal of a femoral antegrade nail (FAN). Femoral nails are introduced by minimally invasive techniques, but are often removed with more invasive surgery. MATERIALS AND METHODS Four cases of young patients are described in whom the femoral nail was removed after consolidation by a minimally invasive extraction technique at the trochanteric site. By using a threaded wire for locating the proximal entrance of the femoral nail followed by reaming over the wire, the entrance of the nail in the trochanteric region is freed. Then the extraction bolt can be placed over the wire and the nail can be extracted through the same incision as it was inserted in, without enlarging the incision. DISCUSSION This case report discusses a technique for minimally invasive femoral nail extraction, not the necessity of removing nails. Leaving out the endcap at the initial operation is the only preoperative condition, since the endcap blocks the entrance of the nail. This operation is done with fluoroscopic guidance. The difficult part is the reaming. The reamer must not be damaged when approaching the nail entrance. This minimally invasive femoral nail extraction technique is applicable for various types of femoral nails. CONCLUSION Minimally invasive extraction of femoral nails is possible and needs more attention. The level of evidence is a level IV case series.
Collapse
Affiliation(s)
- P V van Eerten
- Trauma Department, Maxima Medical Center, P.O. Box 90052, 5600 PD Eindhoven, The Netherlands.
| | | | | |
Collapse
|
26
|
Steinberg EL, Luger E, Menahem A, Helfet DL. Removal of a broken distal closed section intramedullary nail: report of a case using a simple method. J Orthop Trauma 2004; 18:233-5. [PMID: 15087967 DOI: 10.1097/00005131-200404000-00007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
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.
Collapse
Affiliation(s)
- Ely L Steinberg
- Departmernt of Orthopedic Surgery B, Tel-Aviv Sourasky Medical Center, 6 Weitzmann Street, Tel-Aviv 64239, Israel.
| | | | | | | |
Collapse
|
27
|
Milia MJ, Vincent AB, Bosse MJ. Retrograde removal of an incarcerated solid titanium femoral nail after subtrochanteric fracture. J Orthop Trauma 2003; 17:521-4. [PMID: 12902791 DOI: 10.1097/00005131-200308000-00008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Intramedullary nailing with a solid titanium nail can result in significant bone ingrowth. Failure of an implant requires removal for replacement with another device. Previous methods have included use of extractors for cannulated nails. When extractors are not available or are inadequate, a simple retrograde push-out method can be used as described here.
Collapse
Affiliation(s)
- Marc J Milia
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina 28232, USA.
| | | | | |
Collapse
|
28
|
Affiliation(s)
- Lalit Maini
- Department of Orthopaedics, Sushruta Trauma Centre, Lok Nayak Hospital Annexe and Maulana Azad Medical College, New Delhi, India.
| | | | | | | |
Collapse
|
29
|
Krikler SJ. Intramedullary nailing. Injury 2001; 32:677-8. [PMID: 11600111 DOI: 10.1016/s0020-1383(01)00169-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|