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Case Reports
. 2016 Jul-Aug;6(3):10-12.
doi: 10.13107/jocr.2250-0685.476.

A Technical Note for Extracting an Incarcerated Femoral Kuntscher Nail

Marí R  1 , Valverde Vilamala D  1 , León García A  1 , Guirro P  1 , Marqués López F  1
Affiliations
Case Reports

A Technical Note for Extracting an Incarcerated Femoral Kuntscher Nail

Marí R et al. J Orthop Case Rep. 2016 Jul-Aug.

Abstract

Introduction: The use of the Kuntscher nail has been the most important advancement in trauma surgery. One of the problems is the difficulty to remove it. A new extraction technique is described in the present case report.

Case report: A 46-year-old man was referred for hip osteoarthritis. He had an acetabulum fracture and a femoral shaft fracture treated 30 years ago with a reamed Kuntscher femoral nail. Lateral hip approach was performed and after attempting to remove the nail with the specific tools being unsuccessful we decided to be more aggressive. Firstly, we performed a simple unicortical osteotomy on the lateral side from the proximal part to below the callus in order to decompress the femoral canal without success. Secondly, a trench in the greater trochanter around the proximal hole was performed to hit the nail from below which was still insufficient and furthermore, the hole broke when hitting the nail so we needed to drill a new hole distally. Finally, the Kuntscher nail was removed. Several cerclages closed the osteotomy and a bone graft was used to close the trench. The patient had a good evolution at one year of follow-up.

Conclusion: With this case report, we present a new salvage technique to remove an incarcerated Kuntscher nail when all the described methods have failed.

Keywords: Femoral nail; Incarcerated nail; Nail removal.

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Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
Pre-operative X-ray of the pelvic ring: Intramedullary Kuntscher nail in the left femur and osteosynthesis with three screws in the posterior wall of the acetabulum.
Figure 2
Figure 2
Pre-operative X-ray of the distal part of the femur: Fracture site healed and distal tip of the nail.
Figure 3
Figure 3
Clinicalintra operative image:Simple unicortical osteotomy in the proximal third of the femur to decompress the endomedullar canal.
Figure 4
Figure 4
Clinical intra-operative image: Detail of the moment when the nail started to move gradually until the proximal hole of the nail break.
Figure 5
Figure 5
Clinical image. Kunstcher nail. Detail of the new distal hole performednew with a diamond drill.
Figure 6
Figure 6
Clinical intraoperative image:Several cerclages closing the osteotomy with allograft bone used to close the longitudinal osteotomy.
Figure 7
Figure 7
Post-operative X-ray at 1 year of followup. Complete healing of the longitudinal osteotomy.
See this image and copyright information in PMC

References

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