A relatively uncommon, but well-recognised, complication of intramedullary tibial nailing is fracture of the nail itself. This presents the technical challenge of removal of the distal fragment of the nail (Fig. 1). The patient is positioned on the fracture table in the standard manner for tibial nailing. The proximal fragment of the nail is extracted following removal of the locking screws. Then, a pair of appropriately sized sigmoidoscopy biopsy forceps is passed down the medulla of the tibia into nail under fluoroscopic guidance. The forceps are then opened inside the distal fragment and withdrawn, thus removing the nail fragment (Fig. 2).
Figure 1.
Fluoroscopy image showing broken nail fragment in situ
Figure 2.
Fluoroscopy image showing removal of fragment using sigmoidoscopy forceps.