Durrani Salman, Saini Jitender, Kaushik Nischay, Kumar Juvesh, Kumar Pramod, Agrawal Shubham
Orthopedic Surgery, Dr Baba Saheb Ambedkar Medical College and Hospital, New Delhi, IND.
Orthopedics and Trauma, Dr Baba Saheb Ambedkar Medical College and Hospital, New Delhi, IND.
Cureus. 2025 Aug 26;17(8):e91011. doi: 10.7759/cureus.91011. eCollection 2025 Aug.
Non-union following intramedullary nailing of diaphyseal long bone fractures represents a serious complication necessitating timely and effective intervention. The situation becomes considerably more complex in the presence of a broken femoral nail, which poses additional technical challenges for the operating surgeon. Conventional management strategies typically entail removal of the existing nail, followed by re-fixation with a larger intramedullary nail, plate fixation, or external fixation constructs. Our case describes a 34-year-old male patient who presented with aseptic femur non-union complicated by refracture and hardware failure. The intramedullary nail had broken at two distinct sites as revealed by radiographs. A novel technique was employed to remove the broken hardware without surgically exposing the fracture site, followed by exchange nailing with a larger-diameter implant. A distal entry point in the femur was created in addition to the proximal entry site. After removal of the broken locking screws, a jig was attached proximally, and a solid reamer was introduced distally to engage the tip of the retained nail fragment. Simultaneous hammering was performed from both proximal and distal directions, enabling the extraction of all three nail fragments through the proximal entry point. The procedure was completed with the insertion of a wider intramedullary nail. The patient underwent successful fixation with exchange nailing, demonstrated progressive radiological healing, and ultimately achieved fracture union. At final follow-up, he had returned to full function without pain or restriction of daily activities. The described approach not only overcomes the challenges of implant removal but also raises awareness and shows a method to overcome its difficulty. This particular technique also reduces the risk of intraoperative and postoperative complications.
骨干长骨骨折髓内钉固定后骨不连是一种严重的并发症，需要及时有效的干预。当股骨钉断裂时，情况会变得更加复杂，这给手术医生带来了额外的技术挑战。传统的治疗策略通常包括取出现有的钉子，然后用更大的髓内钉重新固定、钢板固定或外固定架固定。我们的病例描述了一名34岁男性患者，他出现无菌性股骨骨不连，并伴有再骨折和内固定失败。X线片显示髓内钉在两个不同部位断裂。采用了一种新技术，在不手术暴露骨折部位的情况下取出断裂的内固定物，然后用更大直径的植入物进行交锁髓内钉置换。除了近端入点外，还在股骨上创建了一个远端入点。在取出断裂的锁定螺钉后，在近端连接一个导向器，向远端插入一个实心扩髓钻以接合保留的钉碎片尖端。同时从近端和远端方向进行锤击，使所有三个钉碎片通过近端入点取出。该手术以插入更宽的髓内钉完成。患者通过交锁髓内钉置换成功固定，显示出逐渐的影像学愈合，并最终实现了骨折愈合。在最后一次随访时，他已恢复全部功能，无疼痛或日常活动受限。所描述的方法不仅克服了取出植入物的挑战，还提高了认识并展示了一种克服其困难的方法。这种特殊技术还降低了术中及术后并发症的风险。
