Abstract
Non-union after closed femoral interlock nailing is an uncommon complication and occurs when a patient starts early weight-bearing, due to faulty surgical technique or after re-trauma. Removal of broken with broken locking bolt is a difficult and challenging procedure. The present case report deals with a case of the broken intramedullary nail with a broken distal locking bolt. A 30 years male patient was inserted interlocking nail for fracture shaft femur five years back. He presented with pain with instability and inability in weight-bearing after re-trauma. An X-ray revealed a broken nail with a broken distal locking bolt. The far fragment of the broken bolt was engaging bone and nail both and was the main obstacle. His nail with the broken bolt removed and re-nailing did in a single sitting. Steinmannpin (St.pin) was inserted through the distal piece of the nail to push the trapped small screw piece.
Highlights
Non-union after closed femoral interlock nailing is an uncommon complication and occurs when a patient starts early weight-bearing, due to faulty surgical technique or after retrauma
Open method was adopted to remove a broken nail with broken distal locking bolt, followed by re-nailing
An X-ray revealed a broken nail with a broken distal locking bolt
Summary
The whole procedure was lengthy and technically demanding but was safe at the same time. Removal of the broken nail with indwelling broke locking bolt either proximal or distal is a not easy procedure & a potential challenge in orthopedic surgery. The technique of creating a hole just distal to the proximal locking bolt of distal fragment for the removal of the distal nail fragment has been used successfully by Kretteck et al [4]. They placed a Hohmann-type lever into this opening to push the piece in the direction of the fracture focus. In the case of subtrochanteric fracture, distal fragment removed by retrograde impulsion and fractured proximal femoral nail by medial arthrotomy, as mentioned by Milia et al, the patients were follow upto a year of this kind of surgery but they had no knee pain and any other problems [5]
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