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Joint Diseases and
Related Surgery
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Case Report · Open access

A novel feasible technique for rapid removal of broken proximal femoral nails: A case series

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Jinxi Hu

Department of Orthopedic, Yueyang Affiliated Hospital of Hunan Normal University, Yueyang, China

ORCID: 0000-0001-5913-0326

Fei Wen

Department of Orthopedic, People`s Hospital of Rongchang District, Chongqing, China

ORCID: 0000-0001-5089-862X

Wenbin Chen

Department of Anatomy, Tarim University School of Medicine, Alaer, China

ORCID: 0000-0002-0795-5534

Ping Wang

Department of Anatomy, Tarim University School of Medicine, Alaer, China

ORCID: 0000-0002-4865-3209

Abstract

Proximal femoral nail (PFN) fixation is a technique widely used to treat various femoral fractures, but femoral re-injury may occur, leading to PFN breakage. Broken nail removal, particularly removal of the distal broken nails, is usually challenging. Herein, we describe a feasible approach to successfully remove broken femoral intramedullary nails in three sites (proximal, middle, and distal section) of the PFN. Three patients required surgery for PFN breakage. We performed a novel technique using minimal exposure and a cerclage wire to remove the PFN fragment, which a distal knot on the wire was applied to hold the PFN fragment, and the removal trajectory was completed through the minimal exposure, a distal femoral bone window, and the marrow cavity. We successfully operated these three patients and removed the PFN fragments rapidly and effectively. In conclusion, this novel technique is rapid, feasible, and cost-effective, and can also be promising in removing intramedullary nail breakages in other long bones.

Declarations

Author Contributions

Manuscript drafting: J.H., F.W., W.C., P.W.; Data collection: J.H., F.W., W.C.; Data analysis: W.P., F.W.; Study design: J.H., F.W., P.W.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

This study was partially supported by the President program of Tarim University with the grant number TDZKSS202237 (P.W.) and the Health Commission of Chongqing (2022WSJK063, F.W.).

Patient Consent for Publication

A written informed consent was obtained from each patient.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Kassem E, Younan R, Abaskhron M, Abo-Elsoud M. Functional and radiological outcomes of dynamic hip screw with trochanteric stabilizing plate versus short proximal femoral nail in management of unstable trochanteric fractures: A randomized-controlled trial. Jt Dis Relat Surg 2022;33:531-7. DOI: 10.52312/jdrs.2022.800.
  2. Whalley H, Thomas G, Hull P, Porter K. Surgeon versus metalwork--tips to remove a retained intramedullary nail fragment. Injury 2009;40:783-9. DOI: 10.1016/j.injury.2008.12.009.
  3. Blake SM. A technique for the removal of the distal part of a broken intramedullary nail. Ann R Coll Surg Engl 2009;91:169-70. DOI: 10.1308/rcsann.2009.91.2.169.
  4. 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. DOI: 10.4103/0019-5413.82342.
  5. 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. DOI: 10.5704/MOJ.1207.011.
  6. Tantigate D, Riansuwan K, Mahaisavariya B, Sukjaitham K. Breakage of a lag screw of cephalomedullary nail: A technique of removal. Clin Orthop Surg 2015;7:261-3. DOI: 10.4055/cios.2015.7.2.261.
  7. Surucu S, Aydin M, Gurcan MB, Daglar S, Umur FL. The effect of surgical technique on cognitive function in elderly patients with hip fractures: Proximal femoral nailing versus hemiarthroplasty. Jt Dis Relat Surg 2022;33:574-9. DOI: 10.52312/jdrs.2022.623.
  8. Bilekli AB, Bahtiyar EE, Zeybek H, Neyişci Ç, Erdem Y, Çankaya D. Radiation exposure during proximal femoral nailing: Traction table versus conventional table. Jt Dis Relat Surg 2022;33:338-44. DOI: 10.52312/jdrs.2022.638.
  9. Stahel PF, Flierl MA, Morgan SJ, Smith WR. Management of a trochanteric fracture complicated by a bent solid intramedullary femoral nail in situ: Description of technique. J Orthop Trauma 2010;24:e25-30. DOI: 10.1097/BOT.0b013e3181b2f70d.
  10. Garlock AN, Donovan J, LeCronier DJ, Houghtaling J, Burton S, Atkinson PJ. A modified intramedullary nail interlocking design yields improved stability for fatigue cycling in a canine femur fracture model. Proc Inst Mech Eng H 2012;226:469-76. DOI: 10.1177/0954411912443627.
  11. Marwan M, Ibrahim M. Simple method for retrieval of distal segment of the broken interlocking intramedullary nail. Injury 1999;30:333-5. DOI: 10.1016/s0020-1383(99)00092-3.
  12. Gosling T, Allami M, Koenemann B, Hankemeier S, Krettek C. Minimally invasive exchange tibial nailing for a broken solid nail: Case report and description of a new technique. J Orthop Trauma 2005;19:744-7. DOI: 10.1097/01.bot.0000161540.24280.34.