ABSTRACT
Extraction of broken implant is a challenging task for orthopaedic surgeons. Many times it requires innovative ideas or some unusual methods, all of which has not been listed in literature. We hereby report such a case of 40-year-old male who presented with severe limping and history of previously treated right femur fracture. The radiographs showed an intramedullary nail which was segmentally broken. Femur nail was broken at the non-united fracture and below the fracture at the level of distal interlocking screw. We successfully removed a broken implant by using such one innovative -close retrograde method. The segments of broken nail were removed through knee arthrotomy without opening the fracture site. Non-union was treated by exchange nailing without bone grafting and patient recovered well on follow up. To our best of knowledge very few cases of extraction of segmentally fractured nail have been reported in literature until now.
ABSTRACT
PURPOSE: To evaluate of efficacy of the treatment options for a femoral shaft nonunion occurring after intramedullary nailing. MATERIAL AND METHODS: Thirty-one patients with nonunion of a femoral shaft fracture, who had been treated with interlocking intramedullary nailing from January 1996 to December 2000, were examined. Twenty-six had oligotrophic nonunion and five were hypervascular. Forty-five procedures were performed for 31 nonunions; bone grafting for 14, exchange nailing for 13, plate augmentation and bone grafting for 14 and dynamization for 4 cases. RESULTS: The success rate after a single procedure was only 58%. The four dynamization cases failed to unite. Seven of the 13 (54%) nonunion cases treated with nail exchange healed satisfactorily. All cases treated with plate augmentation and bone grafting achieved successful union. The mean period from fracture to union was 20 months. CONCLUSION: Exchange nailing is not always a reliable procedure for treating nonunion of a femoral shaft fracture. Plate augmentation and bone grafting were found to be a successful mode of therapy for the femoral shaft nonunion without complications.