A Novel Technique for the Removal of Elastic Intramedullary Nail in Pediatric Long Bones: A Technical Note.

Vinay K Gautam,Gauri A Oka,Mahesh Mone,Ashish S Ranade

doi:10.7759/cureus.9717

Abstract

Elastic stable intramedullary nails have been commonly used to treat unstable long bone fractures in children. The nail tip at the insertion site can cause problems. The nail tip should be of optimal length as a prominent nail tip or a short nail tip, or both, may cause different sets of problems. If the nail tip is short, nail removal after fracture union can be difficult and may pose challenges. A short nail tip may lead to difficulty in nail removal, longer duration of surgery, and need for special equipment for extracting the nail. Few techniques have been suggested in the past for removing elastic nail with the short tip, but all these techniques need special instruments. We describe a surgical technique using a metallic suction cannula to aid elastic nail removal. This method utilizes an easily available instrument in the operating room and does not need any special equipment.

Highlights

Elastic stable intramedullary nailing (ESIN) is a commonly used modality for surgical stabilization of longbone fractures in children
The nail tip should be of optimal length as a prominent nail tip or a short nail tip, or both, may cause different sets of problems
A short nail tip may lead to difficulty in nail removal, longer duration of surgery, and need for special equipment for extracting the nail

Summary

Introduction

Elastic stable intramedullary nailing (ESIN) is a commonly used modality for surgical stabilization of longbone fractures in children. It is widely used for treating unstable fractures of the radius, ulna, femur, and, occasionally, the tibia and the humerus. Elastic stable intramedullary nail is removed after fracture union. We describe a technique using a metallic suction cannula to remove the elastic nail when the tip of the nail is short and cannot be held with a plier or similar instrument. The tip was bent to approximately 30 degrees (Figure 4) At this point, the cannula was removed, and the plier was used to grab the nail tip and the nail was extracted using a combination of longitudinal traction and rotatory movements (Figures 5, 6).

Discussion

Conclusions

Disclosures

Lascombes P