Extraction of Broken Intramedullary Nails Using Olive-Tipped Guidewire and Minifragment Screws.

Abstract

In nonunion surgery, removing a broken intramedullary nail can be technically challenging and time-consuming, often requiring either creating a bone window or an open approach to retrieve the broken nail. A simple, effective, and minimally traumatic technique is presented for removing the difficult-to-access part of broken canulated intramedullary nails. First, the olive-tipped guidewire is inserted and advanced down the nail until the olive end protrudes out of the broken nail. A minifragment screw is inserted through a locking screw hole in the broken part under fluoroscopy. The guidewire is then gradually retracted until it becomes jammed with the minifragment screw in the locking hole of the nail. The construct is sturdy enough to retrieve the broken nail using the necessary force. Ten cases were retrospectively reviewed, including 4 short cephalomedullary femur nails, 1 long cephalomedullary femur nail, 2 antegrade femur nails, and 3 tibia nails, where this technique was used. All broken nails were successfully extracted in no more than 2 attempts. The average extraction time was 21 minutes (17 minutes for femur nails and 26 minutes for tibia nails). This technique relies solely on existing incisions and bone approaches required for standard nail removal, thus avoiding extra trauma to soft tissues and bone.