Yamaji Akihiro, Yanagisawa Yohei, Mishima Hajime, Yamazaki Masashi
Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, Japan.
Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, Japan.
Int J Surg Case Rep. 2024 Oct;123:110287. doi: 10.1016/j.ijscr.2024.110287. Epub 2024 Sep 11.
In treating nonunion, the removal of a broken nail is often difficult. We report a technique for removing a broken Kuntscher intramedullary nail. In this technique, a chisel is inserted into the lumen of the intramedullary nail, and the nail is rotated.
A 57-year-old man presented to our hospital with femoral diaphyseal nonunion lasting 17 years after injury. The patient suffered a right femoral diaphyseal fracture at 40 years old and was treated with a Kuntscher intramedullary nail. The patient underwent two additional surgeries at another hospital for the nonunion; however, the nonunion did not heal, and the intramedullary nail broke. The patient was diagnosed with noninfectious hypertrophic nonunion and underwent surgery. We resected part of the lateral cortex of the femoral diaphyseal nonunion and reached the proximal end of the broken Kuntscher intramedullary nail. We inserted a chisel into the lumen of the intramedullary nail, held the chisel using pliers, and rotated the nail to separate it from the surrounding tissue. The proximal side of the broken intramedullary nail was easily removable. One year after surgery, the right femoral pseudarthrosis was healed with a bony callus.
This procedure was possible because of the structural characteristics of the intramedullary nail, which is straight without curvature but has grooves.
We removed a broken Kuntscher intramedullary nail without causing an iatrogenic fracture by fenestration of the cortex and rotation of the nail.
在治疗骨不连时，取出折断的髓内钉往往很困难。我们报告一种取出折断的克氏髓内钉的技术。在该技术中，将凿子插入髓内钉的管腔，并旋转髓内钉。
一名57岁男性因股骨骨干骨折后骨不连17年就诊于我院。患者40岁时发生右股骨干骨折，接受了克氏髓内钉治疗。患者在另一家医院因骨不连又接受了两次手术；然而，骨不连未愈合，髓内钉折断。患者被诊断为非感染性肥大性骨不连并接受手术。我们切除了股骨骨干骨不连处外侧皮质的一部分，到达折断的克氏髓内钉的近端。我们将凿子插入髓内钉的管腔，用钳子夹住凿子，并旋转髓内钉使其与周围组织分离。折断的髓内钉近端很容易取出。术后一年，右股骨假关节通过骨痂愈合。
由于髓内钉的结构特点，即笔直无弯曲但有凹槽，该操作得以实现。
我们通过皮质开窗和旋转髓内钉取出了折断的克氏髓内钉，且未造成医源性骨折。
