Brenner Joseph, Joiner Jonathan, Schweller Eric, Ren Emily, Nasr Kerellos, Vaidya Rahul
University of Toledo College of Medicine and Life Sciences, Toledo, OH.
Department of Orthopedic Surgery, McLaren Oakland Graduate Medical Education, Pontiac, MI.
OTA Int. 2024 Dec 20;8(1):e355. doi: 10.1097/OI9.0000000000000355. eCollection 2025 Mar.
Intramedullary femoral nails (IMFNs) need to be removed for subsequent joint replacement, refracture, nonunion, or infection. The tools used to extract newer IMFNs may not be suited for removal of older implants, especially if broken. The purpose of this study was to describe a novel technique in femoral nail extraction when primary measures fail and a report on 6 cases where it was used.
The technique is used after standard techniques including the Winquist set fail. A guide rod is passed through the center of the incarcerated nail (IN) to the distal end or to the proximal end if it is a retrograde nail. The femur is approached through a separate incision either through the knee for an antegrade nail or through the proximal femur for a retrograde nail. The guide rod is delivered through the opposite end by either hitting it through the end of the bone or breaching the end with a starting wire and starting reamer. The guide rod is then delivered into the field. Using flexible reamers over the delivered guide rod, the femur is reamed up to the IN. A second IMN slightly smaller in diameter is chosen and passed to touch the distal end of the IN, guided by the guide rod to keep the nails aligned. The second nail is impacted, which pushes the IN out its insertion point.
Hardware extraction is difficult for any surgeon, and extraction of older or broken nails with lower grade material poses even greater challenges. This technique is meant as an extra tool for avoidance of corticotomy when primary means for nail extraction have failed. We present 6 cases with 5 successful results.
对于后续的关节置换、再骨折、骨不连或感染，需要取出股骨髓内钉（IMFN）。用于取出新型IMFN的工具可能不适用于取出旧的植入物，尤其是在植入物断裂的情况下。本研究的目的是描述一种在主要方法失败时取出股骨髓内钉的新技术，并报告6例应用该技术的病例。
在包括温奎斯特器械在内的标准技术失败后使用该技术。将一根导杆穿过嵌顿钉（IN）的中心至远端，如果是逆行钉则至近端。通过单独的切口接近股骨，对于顺行钉可通过膝关节切口，对于逆行钉可通过股骨近端切口。通过用骨端敲击导杆或将起始钢丝和起始扩孔钻穿过骨端将导杆从另一端穿出。然后将导杆送入手术区域。在送入的导杆上使用柔性扩孔钻，将股骨扩孔至嵌顿钉处。选择一根直径略小的第二根髓内钉，在导杆引导下使其接触嵌顿钉的远端以保持两根钉子对齐。敲击第二根钉子，将嵌顿钉从其插入点推出。
对于任何外科医生来说，取出内固定物都很困难，而取出材质等级较低的旧钉子或断裂钉子则带来更大挑战。当主要的取钉方法失败时，该技术旨在作为一种避免进行皮质切开术的额外工具。我们报告6例病例，5例取得成功。
