Clin Orthop Surg.  2016 Jun;8(2):210-213. 10.4055/cios.2016.8.2.210.

New Technique for Removal of the Ulnar Intramedullary Nail Failed to Remove: Broken Assembly Piece in the Nail

• Yi JW
• Oh BH
• Kim SB
• Heo YM
• Kim TG
• Kim DH
• Jung YS

• KMID: 2412348
• DOI: http://doi.org/10.4055/cios.2016.8.2.210

Abstract

Methods about removal of intramedullary nail in complicated cases were reported in some literatures but there are no reports about nail removal in the ulna. The authors would like to report such a case and the technique. We removed bone of the inlet site and created another bony window using an osteotome to expose the interlocking screw holes. Only a bony window the size of 2 inter-interlocking holes at the most proximal part of the nail can be used to remove the nail with minimal damage of the triceps brachii tendon and soft tissue.

Keyword

Intramedullary nailing; Device removal

MeSH Terms

Adult
Bone Nails/*adverse effects
*Device Removal
Fracture Fixation, Intramedullary/*instrumentation/*methods
Humans
Male
*Prosthesis Failure
Ulna/diagnostic imaging/*surgery

Figure

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  Fig. 1 Radiograph showing a broken particle of the assembly device in the proximal part of the intramedullary nail.

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  Fig. 2 A nail moved 1 inter-interlocking hole distance, but not enough to grip.

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  Fig. 3 A nail tip exposed enough to grip after being moved 2 interinterlocking hole distance.

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  Fig. 4 A mimetic diagram. Red line indicates 2 skin incisions. (This is not real image, but schematic representation of the nail.)

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  Fig. 5 Red rectangle means 1 inter-interlocking hole sized bony window. (This is not real image, but schematic representation of the nail.)

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  Fig. 6 Removal process. (A) A yellow bar means impactor on the central interlocking hole. (B) A nail moved proximally for half inter-interlocking hole length. (C) Impactor meets the proximal wall of the bony window, after which another interlocking hole appears at the distal part of the window. (D) Place impactor on the most-distal interlocking hole. (E) Final step: a nail exposed enough to be handled. (These are not real images, but schematic representations of the nail.)

Reference

1. Incavo SJ, Kristiansen TK. Retrieval of a broken intramedullary nail. Clin Orthop Relat Res. 1986; (210):201–202.

2. Levy O, Amit Y, Velkes S, Horoszowski H. A simple method for removal of a fractured intramedullary nail. J Bone Joint Surg Br. 1994; 76(3):502.

3. Georgiadis GM, Heck BE, Ebraheim NA. Technique for removal of intramedullary nails when there is failure of the proximal extraction device: a report of three cases. J Orthop Trauma. 1997; 11(2):130–132.