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Panacea Journal of Medical Sciences


Extraction of broken intramedullary nail in ununited fractures of femur by doubling up the tip of guide wire: An innovative technique


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Author Details: Arun Vashisht, OP Gupta, Avinash Rastogi

Volume : 6

Issue : 2

Online ISSN : 2348-7682

Print ISSN : 2249-8176

Article First Page : 69

Article End Page : 73


Abstract

Femoral shaft fractures are treated by close intramedullary interlocking nailing, that allows early ambulation and preservation of fracture haeamatoma. But a good number of patients present with disturbed union and broken nail. Extraction of the broken nail, especially of its distal segment, is quite challenging without opening and disturbing the fracture site. We describe an innovative technique of broken nail extraction with the help of a doubled up tip guide wire and a cannulated extractor. 12 patients with broken nails were subjected to our technique by first passing a guide wire through the broken nail up to the subchondral bone and then advancing through intercondylar notch into the flexed knee and then exiting the wire out of knee by a small incision. Tip of the exited wire is then doubled up over itself like a loop, so that it may behave like a ball tipped wire. A cannulated extractor is threaded over the proximal part of the wire and screwed into the proximal end of the broken nail, which is then extracted. All broken nails were extracted easily. No patient developed heamarthrosis or compromise in knee function. No sign of early or delayed knee infection was seen. The mean follow up period was 15.4(range18-24) months. We found this innovative technique simple, safe, inexpensive, requiring no sophisticated instrumentation and steep learning curve.

Keywords:
Extraction, Broken nail, Innovative