A Novel Technique for the Removal of an Intramedullary Femoral Guidewire Lodged in the Femoral Canal

Abstract

Intramedullary nails are currently the most commonly used device for the fixation of intertrochanteric hip fractures. An initial threaded guidewire is used for localizing the site of entry and determining the final position of the fixation device. Hardware failure with guidewire breakage can complicate the procedure and lead to unplanned challenges for the surgeon. Predisposing mechanical properties of the hardware, along with technical surgical errors may lead to inadvertent breakage or migration of guidewires. The authors report a case of initial threaded starting guidewire migration into the femoral intramedullary canal with subsequent impaction into the distal femoral subchondral bone after advancement of the proximal femoral canal reamer. A method for antegrade removal of a lodged intramedullary guidewire through the distal femoral condyles is described. A set of key technical points to avoid this complication are also provided. Although guidewire migration during hip fracture surgery is a rare occurrence, it is important to recognize the technical measures that can be used to prevent this potentially devastating complication. Surgeons should be familiar with several different techniques for extraction of such hardware surrounding the hip, as there is no universally successful method.

Keywords: fracture fixation; guide wires; intramedullary fractures.

Figure 1:. Attempted retrieval of threaded guidewire with pituitary rongeur.

Figure 2:. AP and lateral views of the right knee demonstrating distal subchondral impaction of the threaded guidewire.

Figure 3:. Schematic illustration demonstrating bone tamp placement into the opening of the proximal femur and in direct contact with the guidewire.