Removal of a broken Kuntscher intramedullary nail for a femoral diaphyseal nonunion 17 years after injury.

ABSTRACT

INTRODUCTION: In treating nonunion, the removal of a broken nail is often difficult. We report a technique for removing a broken Kuntscher intramedullary nail. In this technique, a chisel is inserted into the lumen of the intramedullary nail, and the nail is rotated. CASE PRESENTATION A 57-year-old man presented to our hospital with femoral diaphyseal nonunion lasting 17 years after injury. The patient suffered a right femoral diaphyseal fracture at 40 years old and was treated with a Kuntscher intramedullary nail. The patient underwent two additional surgeries at another hospital for the nonunion; however, the nonunion did not heal, and the intramedullary nail broke. The patient was diagnosed with noninfectious hypertrophic nonunion and underwent surgery. We resected part of the lateral cortex of the femoral diaphyseal nonunion and reached the proximal end of the broken Kuntscher intramedullary nail. We inserted a chisel into the lumen of the intramedullary nail, held the chisel using pliers, and rotated the nail to separate it from the surrounding tissue. The proximal side of the broken intramedullary nail was easily removable. One year after surgery, the right femoral pseudarthrosis was healed with a bony callus. DISCUSSION: This procedure was possible because of the structural characteristics of the intramedullary nail, which is straight without curvature but has grooves. CONCLUSION: We removed a broken Kuntscher intramedullary nail without causing an iatrogenic fracture by fenestration of the cortex and rotation of the nail.