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2025, Vol. 7, Issue 2, Part B
Removal of a bent intramedullary nail of the femur: A case report and literature review
Author(s): Ramkumar Mohan, Tan Chin Hung (Mark), Evelyn Chng, Rex Xavier Antony Premchand and DH Park
Abstract:
Background: Extraction of a bent intramedullary femur nail is not commonly performed and can be challenging for the trauma surgeon. Few methods have been described in the literature over the years but there is no common consensus on the best way for extraction.
A review of the literature was performed and different techniques for removal of a bent intramedullary nail are summarised here.
Case Presentation: We present a case of 21 year old male who was treated for bilateral femoral fractures with bilateral intramedullary nailing. His post-operative recovery was complicated by hypertrophic delayed union of the right femur. Five months following surgery he sustained another injury to his right femur following a motorcycle accident resulting in a re-fracture to his right femoral shaft, with the forces resulting in bending of his in-situ intramedullary nail.
He proceeded to surgery where the bent femoral nail was weakened by using a carbide drill bit and high speed stainless steel burr removing 50% of the cross sectional diameter of the nail. This allowed for reduction of the nail using an F bender tool followed by nail extraction and exchange of nail. He was allowed to bear weight fully post operatively and was discharged well on post-operative day 7.
Clinical Outcomes: We identified 34 case reports in the literature reporting techniques for removing bent intramedullary nails of the femur. Reported techniques included removal without any reduction (2), closed reduction prior to removal of intramedullary nail (2), and partially burring of nail prior to manual reduction (15). A commonly reported technique is full sectioning of the nail either by high speed burr or jumbo pin cutters prior to removing the nail through fracture site (10). Some have even described creation of longitudinal bone window to expose the nail totally prior to removal followed up fixation with plates and/or cables. Two case reports described using a plate and bone clamps as reduction tools prior to removal of intramedullary nail.
Discussion: There are various ways of removing a bent intramedullary nail. While there is no common consensus on the gold standard, the majority of surgeons preferred either sectioning of the nail and removing it in two separate pieces or partially sectioning the nail followed by manual reduction and removal. Pre-operative planning and knowledge of available resources (eg carbide drill bits, reduction tools, high speed stainless steel burrs) are crucial in the removal of bent intramedullary nail.
We recommend that at least half the cross sectional diameter of the nail should be burred to sufficiently weaken the nail for successful straightening and removal. We caution against breaking the nail as this would complicate removal requiring retrieval through the fracture site.
DOI: 10.22271/27078345.2025.v7.i2b.266
Pages: 78-85 | Views: 66 | Downloads: 28
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How to cite this article:
Ramkumar Mohan, Tan Chin Hung (Mark), Evelyn Chng, Rex Xavier Antony Premchand, DH Park. Removal of a bent intramedullary nail of the femur: A case report and literature review. Int J Case Rep Orthop 2025;7(2):78-85. DOI: 10.22271/27078345.2025.v7.i2b.266
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