Anterograde Removal of Broken Femoral Nails without Opening the Nonunion Site: A New Technique

• Published in: Clinics (São Paulo, Brazil) Vol. 65; no. 3; pp. 279 - 283
• Main Authors: de Amorim Cabrita, Henrique Antônio Berwanger, Malavolta, Eduardo Angeli, Teixeira, Otávio Vilhena Reis, Montenegro, Nei Botter, Duarte, Fernando Aires, Mattar, Rames
• Format: Journal Article
• Language: English
• Published: Brazil Elsevier España, S.L.U 01-03-2010; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; Faculdade de Medicina / USP; Elsevier España
• Subjects: Adult; Bone Nails; Clinical Science; Complications; Device Removal - methods; Female; Femoral fractures; Femoral Fractures - diagnostic imaging; Femoral Fractures - surgery; Follow-Up Studies; Fracture fixation; Fracture Fixation, Intramedullary - instrumentation; Fracture Fixation, Intramedullary - methods; Fracture healing; Humans; Intramedullary; Knee Joint; Male; MEDICINE, GENERAL & INTERNAL; Orthopedics; Osteogenesis, Distraction - instrumentation; Osteogenesis, Distraction - methods; Pseudarthrosis - diagnostic imaging; Pseudarthrosis - therapy; Radiography; Treatment Outcome; Young Adult; Fracture fixation; Femoral fractures; Fracture healing; Intramedullary; Complications; Orthopedics
• ISSN: 1807-5932; 1980-5322; 1980-5322
• DOI: 10.1590/S1807-59322010000300007

We describe a new technique for removing the distal fragments of broken intramedullary femoral nails without disturbing the nonunion site.
This technique involves the application of an AO distractor prior to the removal of the nail fragments, with subsequent removal of the proximal nail fragment in an anterograde fashion and removal of the distal fragment through a medial parapatellar approach. Impaction of the fracture site is then performed with a nail that is broader than the remaining fragmented material.
Nails were removed from five patients using the technique described above without any complications. After a mean follow-up period of 61.8 months, none of these patients showed worsened knee osteoarthritis.
The original technique described in this article allows surgeons to remove the distal fragment of fractured femoral intramedullary nails without opening the nonunion focus or using special surgical instruments.