J Korean Fract Soc.  2014 Oct;27(4):315-320. 10.12671/jkfs.2014.27.4.315.

Removal Methods for Broken Proximal Femoral Nails Using Ball Tip Guide Wire: Technical Note and Two Cases Report

• Park BJ
• Cho HM

• KMID: 2015488
• DOI: http://doi.org/10.12671/jkfs.2014.27.4.315

Abstract

Recently, the use of intramedullary nailing for proximal femoral fractures has increased. Breakage of the nail usually occurs at the un-united fracture site, and it is a rare complication of intramedullary nailing of the femur. However, removal of the distal fragment of a broken nail is a challenging problem. Herein, the authors describe the methods used for removal of relatively fixed or strongly fixed broken intramedullary nails in two different cases.

Keyword

Femur; Trochanteric fractures; Broken nail

MeSH Terms

Femoral Fractures
Femur
Fracture Fixation, Intramedullary
Hip Fractures

Figure

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  Fig. 1 Intertrochanteric fracture in a 69-year-old male. (A) The postoperative antero-posterior view of the hip shows a wellreduced trochanteric fracture treated with a proximal femoral nail antirotation. (B) Nonunion and broken nail developed at three months after the first operation. (C) Antero-posterior view of both femurs after exchange nailing.

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  Fig. 2 (A) Author-made ball tip guide wire (distal tip). (B) Author-made ball tip guide wire (bowing). (C) Removal of the distal segment under fluoroscopic guidance. (D) Eccentric position of the ball tip.

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  Fig. 3 Subtrochanteric fracture in a 69-year-old woman (A) fixed by a proximal femoral nail antirotation (PFNA). (B) Nonunion and broken nail developed at three months after the first operation. (C) The second operation was performed using a locked plate. A broken distal nail tip remained after removal of the proximal part of the PFNA. (D) Nonunion and hardware failure developed at six weeks after the second operation. (E) Antero-posterior view of the left femur after nailing.

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  Fig. 4 (A) A small burr was used in the opening. (B) Guide wire retrogradely delivered through the distal end. (C) A large burr was used in the opening. (D) Schanz screw delivered through a widened hole.

Reference

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