Removal Methods for Broken Proximal Femoral Nails Using Ball Tip Guide Wire: Technical Note and Two Cases Report

Bong-Ju Park; Hong-Man Cho

doi:10.12671/jkfs.2014.27.4.315

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Park and Cho: Removal Methods for Broken Proximal Femoral Nails Using Ball Tip Guide Wire: Technical Note and Two Cases Report

Technical Trick

Journal of the Korean Fracture Society 2014; 27(4): 315-320.

Published online: 20 October 2014

DOI: https://doi.org/10.12671/jkfs.2014.27.4.315

Removal Methods for Broken Proximal Femoral Nails Using Ball Tip Guide Wire: Technical Note and Two Cases Report

Bong-Ju Park, M.D., Hong-Man Cho, M.D.

Department of Orthopedic Surgery, Gwangju Veterans Hospital, Gwangju, Korea.

Address reprint requests to: Hong-Man Cho, M.D. Department of Orthopedic Surgery, Gwangju Veterans Hospital, 99 Cheomdanwolbong-ro, Gwangsan-gu, Gwangju 506-705, Korea. Tel: 82-62-602-6162, Fax: 82-62-602-6164, chm1228@naver.com

Received 13 June 2014 Revised 15 August 2014 Accepted 27 August 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Recently, the use of intramedullary nailing for proximal femoral fractures has increased. Breakage of the nail usually occurs at the un-united fracture site, and it is a rare complication of intramedullary nailing of the femur. However, removal of the distal fragment of a broken nail is a challenging problem. Herein, the authors describe the methods used for removal of relatively fixed or strongly fixed broken intramedullary nails in two different cases.

Keywords: Femur, Trochanteric fractures, Broken nail

Figures and Tables

Fig. 1

Intertrochanteric fracture in a 69-year-old male. (A) The postoperative antero-posterior view of the hip shows a wellreduced trochanteric fracture treated with a proximal femoral nail antirotation. (B) Nonunion and broken nail developed at three months after the first operation. (C) Antero-posterior view of both femurs after exchange nailing.

Fig. 2

(A) Author-made ball tip guide wire (distal tip). (B) Author-made ball tip guide wire (bowing). (C) Removal of the distal segment under fluoroscopic guidance. (D) Eccentric position of the ball tip.

Fig. 3

Subtrochanteric fracture in a 69-year-old woman (A) fixed by a proximal femoral nail antirotation (PFNA). (B) Nonunion and broken nail developed at three months after the first operation. (C) The second operation was performed using a locked plate. A broken distal nail tip remained after removal of the proximal part of the PFNA. (D) Nonunion and hardware failure developed at six weeks after the second operation. (E) Antero-posterior view of the left femur after nailing.

Fig. 4

(A) A small burr was used in the opening. (B) Guide wire retrogradely delivered through the distal end. (C) A large burr was used in the opening. (D) Schanz screw delivered through a widened hole.

Notes

Financial support: None.

Conflict of interest: None.

References

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