A Modified Levering Technique for Removing a Broken Solid Intramedullary Tibial Nail: A Technical Tip
Intramedullary tibial fixation is a commonly used and highly successfully treatment in acute fractures, nonunion settings, and correctional procedures. In the setting of a nonunion, removal of a failed implant can add to operative time and surgeon frustration while further compromising bone in an area already at risk for failure. Here we present a technique, using readily accessible equipment, for removing a distal solid tibial nail fragment in a manner that preserves bone.
In developing our technique, which includes modifications of other methods, we used cortical windows, levering, and anterograde reaming to permit removal of a broken solid fragment through a nonunion site and with minimal additional destruction of bone. Although an existing cortical window was used, the newly created cortical window was significantly smaller than windows used in other techniques, and it avoids the articular surface. This technique can be performed with common, readily accessible equipment, which may be helpful in situations in which broken nails are encountered unexpectedly. In summary, this simple, safe, and effective technique uses standard equipment to preserve bone, decrease operative time, and alleviate surgeon frustration in complicated hardware removal surgeries.
Am J Orthop. 2016;45(6):E352-E354. Copyright Frontline Medical Communications Inc. 2016. All rights reserved.
