An innovative bespoke technique for the retrieval of broken distal locking bolts

Background

Broken distal locking bolts after intramedullary nailing of long bones are seen frequently in trauma practice. The retrieval of these bolts is technically demanding, especially the distal part, which is often held within the bone (Fig 1). In our tertiary fracture non-union unit, we have developed a technique for an easy, reproducible and quick removal of the broken parts. The following tips simplify the process and reduce operating time.

Figure 1.

Broken distal locking bolts held within the medial femoral cortex

Technique

The patient is placed supine without traction on a radiolucent table. Guided by an image intensifier, the nail and locking screws are removed. From the proximal entry point, the rod pusher is passed through the power drill into the nail track to act as a nail punch over the remaining screw part, if needed (Fig 2). The punch can be used to dislodge the broken part of the screw in the far cortex. A bariatric laparoscopic grasping forceps (Fig 3), which measures 45cm in length, is used to grasp the broken screw and the broken part is subsequently retrieved (Fig 4).

Figure 2.

Rod pusher, which is passed (whenever needed) through the drill to act as a nail punch

Figure 3.

Bariatric laparoscopic grasping forceps

Figure 4.

The grasping forceps is manipulated towards the broken screw (A). Using the image intensifier, the claws are closed around the broken part (B). Finally, the broken screw is retrieved from the medulla (C)

Discussion

Different techniques have been used to retrieve broken distal locking bolts.^1,2 None of them have demonstrated superior efficiency. To our knowledge, our technique has not been described elsewhere. We report a cost effective, reproducible, bespoke and safe technique that is effective in our hands.