A Useful Technique for Removing a Broken Guide-wire in the Femoral Neck Through the Proximal Femoral Nail Hole During Operation

Wenrui Wu,Zhengang Zha,Tengfeng Zhuang,Ning Liu,Simin Luo

doi:10.11648/j.js.20190705.13

Abstract

Context: Cannulated instruments are usually used while operating around the hip joint for fractures. For example, femoral neck fracture, intertrochanteric fracture, etc. Perioperative instrument breakage such as kirschner wires and guide pins is not infrequent. The fragment of instruments must be removed in order to avoid injury some important organizations. If the fragment further migrate to the acetabulum can result in serious or fatal complications. Removing a broken guide-wire is difficult and challenging even for experienced surgeons. Case Report: We present a simple and useful method to remove the broken guide-wire in the hip joint just using cannulated reamer to ream over the guide wire under the C-arm image intensifier. At first, confirm the cannulated reamer to sight the broken end of the wire, and passed through the broken guide-wire. Then, further reaming with low speed rotation till the beginning of the reamer encased the broken guide-wire. The reamer was withdrawn a few millimeters, after confirmation of the broken guide-wire dislodgment and firmly engaged within the drill lumen by the C-arm image intensifier. Reverse the guide-wire slightly with the reamer through the Proximal Femoral Nail hole. Conclusions: With this method, the authors were able to remove the broken guide wire easily in a few minutes.

Highlights

Failure or breakage of orthopedic instruments such as Kirschner, drill bits and guide-wire during the operation is not an infrequent occurrence, and has been reported in various clinical settings [1,2,3,4]
We reports 2 cases of broken guide-wires during PFNA placement for intertrochanteric fracture of the femur and discusses a new technique for removing the broken guide-wire quickly in the hip joint
Two patients with intertrochanteric fractures of the femur were admitted for PFNA fixation

Summary

Introduction

Failure or breakage of orthopedic instruments such as Kirschner, drill bits and guide-wire during the operation is not an infrequent occurrence, and has been reported in various clinical settings [1,2,3,4]. The most commonly reported breaks of instruments during orthopedic procedures are drill bits, followed by Kirschner wires and cannulated guide-wire [3]. The breakage of instruments must be removed in order to avoid injury of the arteries and nerves, articular cartilage damage and consequent early degenerative arthritis if they are located near nerves, vessels, or joint surfaces [5,6]. If these further migrate to the acetabulum can lead to devastating and catastrophic complications. We reports 2 cases of broken guide-wires during PFNA (proximal femoral nail antirotation, PFNA) placement for intertrochanteric fracture of the femur and discusses a new technique for removing the broken guide-wire quickly in the hip joint

Case Report

Surgical Technique

Discussion