Date: Sat, 31 Jan 2004 18:03:16 +0000
From: Jeff Richmond
Subject: Removal of Kuntscher Nail
Anyone have any tips on removing an infected Kuntcher Femoral nail? Are the hooks on the Winquist set sufficient, or do I need anything else?
North Shore University Hospital
Manhasset, New York
Date: Sat, 31 Jan 2004 22:24:18 EST
If it is truly an old Kuntscher nail the Winquist hooks should work fine. Other early nails (like Synthes) were much thinner walled and the hook will cut through the eye. The eye of a Kuntscher nail is 180 degrees opposite the slot. It is hard (but important) to tell whether the eye is anterior or posterior on an AP radiograph or C-arm. It helps to drive the nail in a bit further to break up the nail-bone interface before attempting to extract it. A conical bolt from Winquist set can be used to impact it.
Is it a femoral nail?
Date: Sat, 31 Jan 2004 22:44:49 -0600
From: "Obremskey, William T"
Do you have xrays? Are you sure it is a Kuntscher? I have been fooled before by two interlocking clover nail that were put in in Mexico that looked like a Kuntscherand are essentially a solid nail. Pics would help.
Date: Sun, 1 Feb 2004 07:49:36 -0500
From: James Carr
The hooks will likely work. You can always use the 2 small bulb tip guide wire trick, or the large "easy out" if need be.
James B. Carr, MD
Palmetto Health Orthopedics
Date: Sun, 1 Feb 2004 15:06:36 +0000
From: Jeff Richmond
Thanks- I'll post the films this week. I have memories from residency seeing someone try to extract one through the knee and only got it half out.
Date: Sun, 1 Feb 2004 20:33:00 +0500
From: Alexander Chelnokov
Hello James and colleagues,
JC> The hooks will likely work. You can always use the 2 small JC> bulb tip guide wire trick, or the large "easy out" if need be.
We sometimes use a wire loop tied to a sliding hammer for extraction of nails.
Alexander N. Chelnokov
Ural Scientific Research Institute of Traumatology and Orthopaedics
7, Bankovsky str. Ekaterinburg 620014 Russia