Surgical management of tibia refracture with a bent intramedullary nail: A case report and review of the literature

Abstract

Intramedullary nailing is the gold standard for long bone fractures in the lower limbs. Fractures of the tibia with bending of the intramedullary nail is a very uncommon complication. Removing a bent nail is an unpredictable and challenging procedure for any trauma surgeon. We report the case of a 34-year-old man presenting a refractured tibia with a bent intramedullary nail following a motor vehicle accident. We describe the management of this patient as well as a substantial review of the literature to depict the peculiarities of this entity compared to its more commonly reported femoral counterpart. When approaching a deformed tibia nail, standard extraction techniques should be attempted and are more likely to be successful than in deformed femoral nails.

Keywords: Intramedullary nail; bent; case report; removal; review; tibia.

Figure 1.

Valgus deformity of the right leg.

Figure 2.

Radiologic assessment showing a fractured tibia and fibula with the bent intramedullary nail in situ. An overall valgus deformity of approximately 25° in the frontal plane was measured on the antero-posterior view of the leg.

Figure 3.

A well-padded bolster was fixed to the edge of the operating table at the level of the apex of the deformity. A second support against the lateral aspect of the right knee was used to counter the reducing forces (yellow arrows). A vigorous deforming force was applied on the lateral aspect of the ankle to try to straighten the bent nail (white arrow).

Figure 4.

Control X-rays showing an acceptable reduction with good alignment.

Figure 5.

On examination of the removed nail, it was found that the deformity was brought down from 25° initially to 7° in the frontal plane (a), and there was no angulation in the sagittal plane (b).