BACKGROUND
Intramedullary nails are commonly used for internal fixation of long-bone fractures. When locking screws are used, both drill bits and screws may break at the time of insertion. Screws may also fail in situ, especially in the case of delayed or non-union. Both cause a problem should the nail require removal, resulting in a large, soft-tissue dissection and cortical disruption to retrieve the broken item. Although methods have been described to push a fractured screw into the surrounding soft tissue via the use of a k-wire1 or insertion of a new screw,2 we describe below a technique for complete removal via small stab incisions.
TECHNIQUE
The patient is positioned on a radiolucent table and draped as usual. Under image intensifier guidance (an ankle is shown for example), a stab incision is made either side of the broken item and a small artery forceps is used to dissect through the soft tissue bluntly. In the case of a fractured screw, the head is removed by the use of an appropriate screwdriver. A drill bit is passed through the incision, to make a cortical hole sized to accept a 10-cm length of stainless steel tube of an appropriate diameter (Figs 1 and 2). On the other side of the limb, a smaller cortical hole is made in the same way and a thin stainless steel rod punch drives the item into the tube (Figs 3 and 4). The item is thus removed with the minimum damage to the soft tissue or bone, allowing for early mobilisation with reduced risk of fracture. The stainless steel rod and tubing used are readily available from hardware shops, can be easily cut to length to form a set of various diameters and can be effectively sterilised by autoclaving.
Figure 1.
Figure 2.
Acknowledgments
We would like to thank Mr G Matthews for preparing the illustrations.
References
- 1.Sancineto CF, Rubel IF, Seligson D, Ferro GV. Technique for removal of broken interlocking screws. J Orthop Trauma. 2001;15:132–4. doi: 10.1097/00005131-200102000-00010. [DOI] [PubMed] [Google Scholar]
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