Removal of a Broken Solid Femoral Nail

Abstract

An intramedullary nail subjected to cyclical loading will fatigue if stresses on the nail exceed its endurance limit. The factors that influence failure of the nail are the stability of the fracture, a non-union or delayed union, and the rehabilitation program2,3,14,16. The methods to remove the distal fragment of a broken hollow nail rely on the passing of hooks or screws down the center of the nail1,8,10,15. For a solid nail, this technique is not possible. We describe a technique for the removal of the distal segment of a broken solid femoral nail. A twenty-four-year-old man sustained a closed fracture of the left femur, just distal to the isthmus, in a high-velocity motor-vehicle accident. The fracture was classified as B3 according to the AO system11 and as C2 according to the system of Tscherne and Oestern (Fig. 1-A). Other injuries included cerebral contusions, fractures of the right femoral condyle and the right tibial plateau, and dislocations of the right elbow and the right carpometacarpal joint. After initial resuscitation, the left femoral fracture was stabilized with a femoral nail, 420 by nine millimeters, made of titanium alloy (Ti-6Al-7Nb; Synthes, Paoli, Pennsylvania). The nail was inserted without reaming and was locked proximally and distally with two locking screws, each with a core diameter of 4.3 millimeters and an outer diameter of 4.9 millimeters7 (Fig. 1-B). Fig. 1-A: Preoperative radiograph showing the infra-isthmal fracture of the femoral shaft. The screw in the medial femoral condyle had been placed during a previous repair of the posterior cruciate ligament. Fig. 1-B: Radiograph made after insertion of a solid titanium-alloy nail with static locking with screws. The fracture was nailed in slight distraction. At the initial operation, …