Date: Fri, 17 Jan 2003 22:04:39 EST
Subject: Broken femoral nail
Hello all:
I would appreciate advice on how to remove this fractured Synthesis titamium cannulated femoral IM nail.
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Any special jigs or devices to pull from proximally so as not to have to get into the femoral nonunion site or push back from the knee.
Thank you.
Sincerely and respectively,
M. Bryan Neal, MD
Arlington Orthopedics and Hand Surgery Specialists, Ltd.
Arlington Heights, Illinois 60005
Date: Sat, 18 Jan 2003 08:30:44 -0500
From: Bill Burman
See previous discussion on broken femoral nail (distal).
For further information see broken nail extraction discussion from Orthopaedica Belgica.
Date: Sat, 18 Jan 2003 21:04:45 -0500
From: Fred Barrick
Synthes makes a broken nail extraction set. Perhaps Zimmer does also. You have to make incisions to remove the screws, of course. I would replace the nail with a larger one of a different make so that the locking screws are at a different site.
E. Frederick Barrick, MD
Director Orthopaedic Trauma Inova
Fairfax Hospital
Date: Mon, 20 Jan 2003 08:03:26 -0500
From: James Carr
Hey Bryan
These are not as hard now that good nail removal sets are out. I use the Zimmer one. The easiest way is to remove the proximal piece by standard technique. The broken screw will remain in the medial cortex, but can usually be removed with a long pituitary or similar instrument. I have even used the bronchoscopy set for ones at the distal canal. Sometimes it is dragged out with the nail. You then ream the proximal portion to accept the new nail- go approx 2 mm bigger. I know Zimmer and Synthes make some big diameter ones. I find the best way to get the distal piece of the nail out is with the use of two bulb tip guide wires. The Zimmer set has various sizes. You pass both out the end of the nail. When both are drawn back at the same time, they incarcerate in the end, and pull the distal piece out nicely. I will commonly place an unlocked nail in these situations, and try to avoid static locking unless needed for stability. You can even place the reamings at the fracture site for bone graft, although most would say this is unnecessary. Let us know how it goes.
James B. Carr, MD
Palmetto Health Orthopedics
Date: Mon, 10 Feb 2003 14:12:05 -0700
From: Thomas A. DeCoster
It's been almost a month since this case (femoral shaft nonunion with broken Synthes nail) was posted. What did you end up doing? Were you able to remove the broken nail? What technique worked? Did you try any techniques that did NOT work? Were you able to remove the entire broken locking screws? What technique? How did you treat the nonunion? How is it looking?
Thanks.
Great case.
Tom DeCoster