A simple method for removal of a broken intramedullary nail

K.S. Sivananthana, K. Raveendrana, T. Kumara, S. Sivananthanb,*aDepartment of Orthopaedic Surgery, Hospital Fatimah, Ipoh, MalaysiabRoyal Victoria Hospital, 88 Greystown Avenue, Belfast, BT9 6UL UK

Accepted 7 February 2000

Abstract

The removal of broken implanted intramedullary nails secondary to re-fracture or non-union is challenging. In 12 cases a

simple and safe method has been used to remove broken implants. 7 2000 Elsevier Science Ltd. All rights reserved.

Keywords: Broken intramedullary nail; Re-fracture; Non-union

1. Introduction

When a nail breaks the distal end is di�cult to

remove. Several methods have been described [1±4]

and our experience of a simple technique is described

in the following cases.

2. Materials

Between 1994 and 1999 12 broken intramedullary

nails were removed. Five cases were associated with re-

fracture and seven with non-union. There were nine

broken femoral nails and three broken tibial nails; of

the femoral nails, ®ve were Targon (Aesculap) nails,

one GK nail (Howmedica) and three Synthes nails

(AO); of the tibial nails two were Synthes (AO) nails

and one Targon (Aesculap).

3. Technique

3.1. Femoral nail

The operation is performed with the patient in thelateral position with image-intensi®er guidance. Theintramedullary canal is opened at the greater trochan-ter and the proximal locking screws removed. Theproximal part of the nail is then removed. A guidewire is passed down the intramedullary canal into thedistal fragment of the broken nail. If removing theproximal part of the nail is di�cult, the proximal seg-ment is reamed two sizes larger than the removed nail.A nail which is 3 mm smaller in diameter than the bro-ken nail is passed over the guide wire down the intra-medullary canal and impacted into the opening of theremaining distal fragment of the broken nail (Fig. 3).The distal locking screws are removed via small in-cisions. Both nails (broken distal nail and the smallernail) are then pulled out. In one case the Targon nailwas broken in two places in the lower third of thefemur. Here, the same technique was employed toremove both the distal nail fragments (Figs. 1±3).

3.2. Tibial nail

The operation is performed with the patient supineand the leg hanging over the edge of the operating

Injury, Int. J. Care Injured 31 (2000) 433±434

0020-1383/00/$ - see front matter 7 2000 Elsevier Science Ltd. All rights reserved.

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* Corresponding author. Tel.: +44-05-5495012; fax: +44-05-

5495021.

E-mail address: srkortho@tm.net.my (S. Sivananthan).

table with the knee at a right angle. The proximal partof the nail is exposed and the proximal locking screwsare removed. The proximal end of the broken nail isremoved. The distal fragment of nail is then removedusing the same technique as with the femoral nail.

4. Results

In all 12 cases removal of the distal nail fragmentwas simple and uncomplicated. The average time takenwas 30 min.

5. Discussion

This method of nail removal is simple and safe, andcan be performed in a short time without the need forspecial equipment. However, the distal locking screwsshould only be removed after the smaller diameter nailhas been impacted into the opening of the remainingdistal fragment of the broken nail as the remaining dis-tal locking screws serve to stabilise the distal fragmentof the broken nail. The site of the non-union or re-fracture is undisturbed. There is also minimal localdamage thus minimising morbidity and complications.

References

[1] Davies NM, Farnell RD, Unwin AJ, Jones JR. A technique for

removal of fractured locking screws from an intramedullary nail.

Injury 1997;28:159.

[2] Georgiadis GM, Heck BE, Ebraheim NA. A technique for

removal of intramedullary nails when there is failure of the prox-

imal extraction device: a report of three cases. J Orthopaedic

Trauma 1997;11(2):130±2.

[3] Khan M, Schranz PJ, Ward MW. Removal of a broken intrame-

dullary tibial nail using a hand reamer. Injury 1997;28:693±4.

[4] Levy O, Amit Y, Velkes S, Horoszowski H. A simple method for

removal of a fractured intramedullary nail. J Bone Joint Surgery

(Br) 1994;76-B:502.

Fig. 1. Femoral nail broken in two places.

Fig. 2. Distal segments of broken femoral nail being removed.

Fig. 3. Line diagram. Impacting a smaller sized nail (over guide

wire) into proximal end of second broken nail fragment,in order to

remove distal segments of broken nail.

K.S. Sivananthan et al. / Injury, Int. J. Care Injured 31 (2000) 433±434434