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Poutoglidou F, Krkovic M. Removal of a Broken Intramedullary Nail: A Case Report and Technical Description. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:982-985. [PMID: 36561224 PMCID: PMC9749120 DOI: 10.22038/abjs.2022.65407.3133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/14/2022] [Indexed: 12/24/2022]
Abstract
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.
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Affiliation(s)
- Freideriki Poutoglidou
- Addenbrookes Major Trauma Unit, Department of Trauma and Orthopaedics, Cambridge University Hospitals NHS Trust, Cambridge, Cambridgeshire, UK
| | - Matija Krkovic
- Addenbrookes Major Trauma Unit, Department of Trauma and Orthopaedics, Cambridge University Hospitals NHS Trust, Cambridge, Cambridgeshire, UK
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Vatsya P, Mittal S, Karpe A, Trikha V. 'Extended tibia osteotomy': a technical tip for removal of incarcerated reamer with broken guide wire bead during tibia nailing and literature review. BMJ Case Rep 2022; 15:e247812. [PMID: 35260402 PMCID: PMC8905891 DOI: 10.1136/bcr-2021-247812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/03/2022] Open
Abstract
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.
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Affiliation(s)
- Pulak Vatsya
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Samarth Mittal
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Aashraya Karpe
- Department of Opthalmology, Dr Shroff's Charity Eye Hospital Delhi, New Delhi, India
| | - Vivek Trikha
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
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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.
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Affiliation(s)
- Mitchell A Johnson
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Jiang GQ, Zhang YD, Zhuang YQ. Removal of broken reamer stuck into femoral shaft in implanting PFNA: a case report. SICOT J 2018; 4:31. [PMID: 30004864 PMCID: PMC6044857 DOI: 10.1051/sicotj/2018024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 05/06/2018] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Gang-Qiang Jiang
- Department of Orthopedics, Ningbo NO. 6 Hospital, NO. 1059 ZhongShan Road, 315040 Ningbo, PR China
| | - Ya-Di Zhang
- Department of Orthopedics, Ningbo NO. 6 Hospital, NO. 1059 ZhongShan Road, 315040 Ningbo, PR China
| | - Yun-Qiang Zhuang
- Department of Orthopedics, Ningbo NO. 6 Hospital, NO. 1059 ZhongShan Road, 315040 Ningbo, PR China
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Abstract
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.
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Affiliation(s)
- C Zhao
- Maidstone and Tunbridge Wells Hospitals Trust, Tunbridge Wells, United Kingdom.
| | - G J R Slater
- Maidstone and Tunbridge Wells Hospitals Trust, Tunbridge Wells, United Kingdom.
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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.
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Affiliation(s)
- Jane Lovell
- Hervey Bay Hospital, University of Queensland, Australia
| | | | - Eugene Gehr
- Hervey Bay Hospital, University of Queensland, Australia
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R M, D VV, A LG, P G, F ML. A Technical Note for Extracting an Incarcerated Femoral Kuntscher Nail. J Orthop Case Rep 2017; 6:10-12. [PMID: 28116256 PMCID: PMC5245924 DOI: 10.13107/jocr.2250-0685.476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Marí R
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de l'Esperança, Sant Josep de la Muntanya 12. 08024 Barcelona, Spain
| | - Valverde Vilamala D
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de l'Esperança, Sant Josep de la Muntanya 12. 08024 Barcelona, Spain
| | - León García A
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de l'Esperança, Sant Josep de la Muntanya 12. 08024 Barcelona, Spain
| | - Guirro P
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de l'Esperança, Sant Josep de la Muntanya 12. 08024 Barcelona, Spain
| | - Marqués López F
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de l'Esperança, Sant Josep de la Muntanya 12. 08024 Barcelona, Spain
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Pongsamakthai W, Apivatthakakul T, Sangkomkamhang T. Removal of the broken femoral nail with T-reamer technique: A three-case report. J Clin Orthop Trauma 2016; 7:22-26. [PMID: 28018065 PMCID: PMC5167516 DOI: 10.1016/j.jcot.2016.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 07/16/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022] Open
Abstract
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.
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Affiliation(s)
- Wanjak Pongsamakthai
- Department of Orthopaedics, Khon Kaen Hospital, Khon Kaen 40000, Thailand,Corresponding author.
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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.
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Removal of a broken cannulated femoral nail: a novel retrograde impaction technique. Case Rep Orthop 2013; 2013:601982. [PMID: 24349812 PMCID: PMC3852813 DOI: 10.1155/2013/601982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 10/07/2013] [Indexed: 11/17/2022] Open
Abstract
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.
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Rocha-e-Silva M, Maris Gomes A. A survey of recently published papers on orthopedics in the Brazilian scientific press. ACTA ORTOPEDICA BRASILEIRA 2012; 20:367-71. [PMID: 24453633 PMCID: PMC3861957 DOI: 10.1590/s1413-78522012000600010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 06/25/2012] [Indexed: 11/22/2022]
Abstract
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.
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Pan K, Reuben P. A simple method for removal of the distal segment of a broken femoral intramedullary nail: a case report. Malays Orthop J 2012; 6:66-8. [PMID: 25279064 DOI: 10.5704/moj.1207.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Kl Pan
- Department of Orthopaedics, Universiti Malaysia Sarawak, Kuching, Malaysia
| | - Pr Reuben
- Department of Orthopaedics, Sarawak General Hospital, Kuching, Malaysia
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Kirankumar Patel K, Caramelli B, Rocha E Silva M. The locomotor system as seen in Brazilian medical journals: a restricted collection of papers. Rev Assoc Med Bras (1992) 2011; 57:475-86. [DOI: 10.1590/s0104-42302011000400025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 05/27/2011] [Indexed: 11/21/2022] Open
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The locomotor system as seen in Brazilian medical journals: a restricted collection of papers. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1016/s0104-4230(11)70096-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Camargo OPD, Leme LEG. Estudo de publicações brasileiras em periódicos gerais de artigos sobre aparelho locomotor. ACTA ORTOPEDICA BRASILEIRA 2011. [DOI: 10.1590/s1413-78522011000600011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
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
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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.
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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:
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