Method for Removing Broken Proximal Femoral Nails Using Existing Screw Hole

Abstract

The use of intramedullary nailing to treat proximal femoral fractures has increased in recent years. Nail breakage is a rare complication of intramedullary nailing of the femur, and generally occurs at the non-united fracture site. Removal of the distal fragment of a broken nail is a challenging problem. In this article, the authors describe the methods used to remove strongly fixed broken intramedullary nails. Level of Evidence IV; Case series.

Characteristics of intramedullary nail breakage in pertrochanteric femur fractures: a summary of 70 cases

“…The following factors need to be considered by orthopaedic surgeons, as Tomas-Hernandez et al [ 7 ] recommend in their article: the type of previous fracture, the quality of the remaining bone stock in the trochanteric area and femoral head, the patient’s age and functional demands, the ease of removing broken implants and the surgeon’s criteria. While we agree with this strategy for revision surgery, we consider that (1) although many ingenious methods of implant removal have been reported [ 8 , 18 , 28 ], partial removal of the IM nail is sufficient for patients whose fractures have healed unless the patient strongly refuses this method; (2) in osteosynthesis revision, which kind of internal fixation is performed should be determined on the basis of the orthopaedic surgeon’s familiarity with the procedure of specific fixation (Fig. 4 ).…”

Removal of a Broken Stainless-Steel Intramedullary Lengthening Stryde Nail

“…Laparoscopic forceps were also used to retrieve the distal part of a solid broken nail 24 . Other authors attempted to extract the broken distal portion by creating a metaphyseal bone window and either tapping 25 or levering the distal piece out 26 .…”