Callus cap over a Küntscher nail: A case report and literature review for heterotrophic ossification

Abstract

Introduction: Intramedullary Nailing (IMN) has been the gold standard treatment for femoral shaft fractures. Earlier it was managed by Küntscher nail (K nail) fixation. However, in developing countries K nail may still be used as a low-cost fixation device. Heterotrophic Ossification (HO) is a rare complication following nailing in the treatment of femoral shaft fractures. HO along the K nail presenting with late symptomatology have been discussed rarely. Case report: A 43-year old male presented with a symptomatic callus cap along the proximal end of a left sided femoral K nail. He developed severe pain after a prolonged duration approximating around twenty years of the primary femoral fixation. The hip joint pain intensified with significant limitation affecting daily routine activities. Excision of the smooth contoured callus cap along with the removal of nail was done. The hip function recovered with painless full range of hip motion. There was no evidence of recurrence noted at a twoyear follow-up. Discussion: The smooth contour of the cap correlated to a persisting HO around the protruding end of K nail with no initial symptoms. The compressive and pressure symptoms along with the callus cap encroachment now contributes to the painful symptoms. The late symptomatology may reasonably be attributed to either impingement or abutment of the callus cap along the pelvic wall. Conclusion: K nail is an uncommon fixation device for femoral fracture fixation. HO following K nail being another uncommon infrequent complication. The symptomatic acquired HO should be considered for excision to preserve the hip joint function and maintain the ability to do activities of daily living. Keywords: callus cap; heterotrophic ossification; un-reamed nailing; femur fracture; küntscher nail. Abbreviations: IMN: Intramedullary Nail; HO: Heterotrophic Ossification; K-nail: Küntscher Nail.