Removal of a bent intramedullary nail in lower extremity: report of two cases and review of removal techniques

Abstract

Removal of a bent intramedullary nail (IMN) is a rare but challenging orthopedic problem. Several removal techniques have been described up to date; however, there is no extensive review and no algorithm to manage these cases in current literature. The purpose of this paper is to present two cases that presented with bent IMN and provide an algorithm for management of this rare complication.

Removing a Bent Femoral Intramedullary Nail Cost Effectively: A Case Report

“…The cost and availability of required tools or equipment, operating room conditions and the surgeon's expertise are also important. The next treatment options should be planned after removing the bent nail, which is either using an intra or extramedullary device 5 . If there is distal screw present, the distal screw should be removed first before cutting the nail.…”

“…However, there is no gold standard protocol reported in the literature, and there is no single best method to remove a bent intramedullary nail. A few authors claimed that they have described novel techniques, but most shared similar steps with slight modifications 5 . There are in principle, five techniques of bent IM nail removal: (1) standard extraction with no additional intervention, (2) in situ straightening via external force on the femur followed by standard extraction, (3) partial weakening of the nail using high-speed burr and F tool followed by manual straightening, (4) fully sectioning of the nail using high-speed burr or metal cutter and extracting the nail in two pieces, and (5) using plate and reduction clamps to straighten the nail 5 .…”

How to Remove a Bent Intramedullary Nail from Long Bones

“…The next technique is to extract the nail by cutting the nail by a saw dental drill high-speed burr [16,17]. This technique with saw and drill has some disadvantages include: heat burn, debris formation In this technique, continuous irrigation is mandatory to prevent heat damage and debris formation [18].…”

“…The last technique discussed in the literature is to use a femoral plate to straighten the nail and extract it by the standard method. This technique is reported only in femoral nails an can be used in a minimally invasive manner [17,19].…”

Extracción compleja de clavos de fémur tipo Küntscher. Trefinas y otras técnicas

“…Con el paso del tiempo han surgido nuevos modelos y evoluciones en los clavos IM, convirtiéndose en el tratamiento de elec- ción para estas fracturas. 1,2 A medida que aumenta su uso también se incrementa la necesidad de su retirada: fracturas periimplante, infecciones, seudoartrosis, molestias relacionadas con el material o interferencia en cirugía protésica de las articulaciones artrósicas vecinas. La técnica de implantación de clavos IM está bien reglada, sin embargo, su descarte en ocasiones supone un desafío frente al cirujano.…”