Cortical fragment penetration into distal joints after intramedullary nailing – A rare complication

Abstract

Intramedullary nailing (IMN) is a standard treatment for humeral, tibial and femoral shaft fractures. It is a minimally invasive procedure allowing fracture fixation without exposing the fracture site. Therefore, this procedure offers advantages compared to open reduction and internal fixation (ORIF). Biomechanically, IMN is the optimal implant for shaft fractures allowing immediate postoperative weight bearing in most cases. Nevertheless, as with every treatment modality for fracture fixation, complications are inevitable. Perioperative complications include incorrect nail insertion with consecutive axial and rotational malalignment. Furthermore, comminution of the shaft after inserting a nail into a medullar cavity that is too narrow and problems associated with reaming and locking are common. Postoperative complications include infection, delayed union, malunion and implant breakage. Only few reports have been published describing the problem of fragment protrusion into the knee joint after femoral IMN. The present case report describes two cases of fragment protrusion and penetration into distal joints after femoral and tibial IMN. To the best of our knowledge, the complication of fragment penetration after tibial nailing has not been described in the literature to date.