Multiple Fracture of Medullary Tube During Intramedullary Nailing of Long Bone Fractures

Abstract

Intramedullary nailing is an accepted treatment for the fixation of femoral and tibial shaft fractures. There is a low but significant incidence of intraoperative complications during intramedullary nailing. During this procedure, a medullary tube may be used to exchange the bent olive-tipped reaming guidewire for the straight guidewire. A review of the literature found only one report of a fracture of the medullary tube. Two cases in which the medullary tube fractured into multiple pieces are presented.

Breakage of the Radiopaque Wire from the Medullary Tube during Closed Antegrade Intramedullary Nailing for Femoral Shaft Fracture

“…The medullary tube maintains fracture reduction while the bent ball-tipped reaming guide wire is being exchanged for the straight nail guide wire in the reamed medullary canal. Breakage of the medullary tube has been reported during closed intramedullary nailing, [2][3][4] and could potentially increase surgical morbidity. In 2 patients, the closed nailing was converted to open nailing so as to retrieve the broken medullary tube.…”

“…In 2 patients, the closed nailing was converted to open nailing so as to retrieve the broken medullary tube. 2,4 One patient had persistent postoperative pain and underwent another surgery for removal. 4 The appearance and mechanical properties of the medullary tube change over time.…”

“…2,4 One patient had persistent postoperative pain and underwent another surgery for removal. 4 The appearance and mechanical properties of the medullary tube change over time. 5 When the medullary tube is new, it is white and flexible, which allows bending into a semicircle.…”