Embracing the Timeless Value of Vintage Instrumentation in Orthopedics for Broken Femoral Nail Extraction with Novel Technique.

Abstract

Intramedullary nail placement is a preferred method for femoral shaft fractures due to biomechanical advantages. Despite its simplicity and efficacy, complications, such as pseudoarthrosis and nail fracture, pose challenges. Removing the distal fragment presents a vexing issue, often requiring specialized instruments. Current retrograde techniques may not be universally accessible, potentially leading to non-union site opening and tissue damage. While intramedullary nailing benefits fracture treatment, addressing its removal complications is crucial for further advancements. In this case, universal zig and K-nail reamers are used to extract the broken nail. A 42-year-old male suffered an injury to his left thigh in a bike collision. Radiological examination revealed an oblique fracture in the proximal 1/3rd and distal 2/3rd junction of the left femur shaft. Closed reduction and internal fixation were initially performed, but delayed union occurred. Nine months post-surgery, a broken femoral nail and non-united fracture were observed. The patient underwent successful removal and replacement of the broken nail with a wider intramedullary nail. The procedure involved using a universal zig for removal of the proximal fragment and K-nail reamers to remove the distal fragment of the broken nail, and inserting a wider proximal femoral nail. The patient was discharged in satisfactory condition with tolerable weight-bearing. Broken femoral nail presents a unique challenge to the operating surgeon. It requires diligent planning with appropriate instruments and techniques. There have been many techniques devised to tackle this problem and the use of K-nail reamers as described in this case is another innovative method in this regard.