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      Removal of broken reamer stuck into femoral shaft in implanting PFNA: a case report

      , , *
      EDP Sciences
      Broken reamer, Removal, Fermoral

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          Femoral intertrochanteric fracture is very common in elderly population. The usual treatment for these patients is intra-extramedullary fixation. In normal situations, expand medullary cavity is needed, in order to implant various intramedullary implants. On rare occasion, which will in turn lead to the reamer is stuck into the medullary cavity of femoral shaft. Open or closed technique for moving of the broken nails had been reported before. We firstly report a novel technique by using handy tool which included in orthopaedic instrument set to remove the broken reamer stuck into femoral cavity when implanting a PFNA.

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          Broken intramedullary nails.

          Between 1962 and 1987, we treated fifty-six patients for sixty broken intramedullary nails, using a custom-made hook to extract the distal fragment of the nail. The charts and radiographs of all of the patients were reviewed. Thirty-nine of the nails had been inserted in a fresh fracture, which usually was comminuted; eight had been used for fixation of an osteotomy; nine, for fixation of a non-union; and four, for treatment of a pathological fracture. Several small-diameter intramedullary nails broke at the site of the fracture or non-union. In contrast, the sites of breakage in the interlocking nails were the interlocking holes and the welded junction of the top insertional portion and the proximal slot. Many of the breakages were in patients who had an unstable fracture pattern. The interval between insertion and breakage ranged from one to 120 months.
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            Extraction of broken intramedullary nails--an improvement in technique.

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              Anterograde Removal of Broken Femoral Nails without Opening the Nonunion Site: A New Technique

              OBJECTIVE: We describe a new technique for removing the distal fragments of broken intramedullary femoral nails without disturbing the nonunion site. METHODS: This technique involves the application of an AO distractor prior to the removal of the nail fragments, with subsequent removal of the proximal nail fragment in an anterograde fashion and removal of the distal fragment through a medial parapatellar approach. Impaction of the fracture site is then performed with a nail that is broader than the remaining fragmented material. RESULTS: Nails were removed from five patients using the technique described above without any complications. After a mean follow-up period of 61.8 months, none of these patients showed worsened knee osteoarthritis. CONCLUSION: The original technique described in this article allows surgeons to remove the distal fragment of fractured femoral intramedullary nails without opening the nonunion focus or using special surgical instruments.

                Author and article information

                SICOT J
                SICOT J
                EDP Sciences
                13 July 2018
                : 4
                : ( publisher-idID: sicotj/2018/01 )
                : 31
                Department of Orthopedics, Ningbo NO. 6 Hospital, NO. 1059 ZhongShan Road, 315040 Ningbo PR China
                Author notes
                [* ]Corresponding author: goshang2011@ 123456126.com
                sicotj170143 10.1051/sicotj/2018024
                © The Authors, published by EDP Sciences, 2018

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 13 December 2017
                : 6 May 2018
                Page count
                Figures: 4, Tables: 0, Equations: 0, References: 7, Pages: 3
                Lower Limb
                Case Report

                broken reamer,removal,fermoral
                broken reamer, removal, fermoral


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