Sequential manual manipulation technique of closed reduction to retrieve a bent femoral intramedullary nail: a case report

Tarkik Thami; Himanshu Bhayana; Shikhar Bindal; Akshat Srivastava; Arjit Bansal; Deepak Kumar

doi:10.18203/issn.2455-4510.IntJResOrthop20243913

Authors

Tarkik Thami Sequential manual manipulation technique of closed reduction to retrieve a bent femoral intramedullary nail: a case report
Himanshu Bhayana Department of Orthopedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
Shikhar Bindal Sequential manual manipulation technique of closed reduction to retrieve a bent femoral intramedullary nail: a case report
Akshat Srivastava Department of Orthopedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
Arjit Bansal Department of Orthopedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
Deepak Kumar Department of Orthopedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20243913

Keywords:

Bent intramedullary nail, Exchange nailing, Kuntscher nail

Abstract

A bent intramedullary nail in femur can be extremely difficult to extract when a patient presents after a secondary episode of trauma following the original episode for which nailing was done. These bent nails require utmost precision while extracting them, to prevent injury to the surrounding soft tissues and neurovascular bundle of the limb. We encountered a particularly rare case of a bent Kuntscher nail who presented to us nearly 20 years (post his primary surgery in 2001) after sustaining a secondary trauma. There was a 29-degree bend in the antero-posterior view and a 106-degree procurvatum bend in the k nail on the lateral view. We followed a technique of sequential manual manipulation under radiographic guidance to correct the acute bend of the nail, taking care not to create any additional fractures. Following nail extraction, the fracture was fixed with an interlocking nail and went on to unite uneventfully. At 3-year follow up, patient was walking pain free and exhibited a good knee range of motion.

Metrics

Metrics Loading ...

References

Kuntscher G. The Marrow Nailing Method. Schoenkirchen, Stryker Trauma GmbH; 1947.

KUNTSCHER GB. The Kuntscher method of intramedullary fixation. J Bone Joint Surg Am. 1958;40-(1):17-26.

Bharti A, Kumar S, Kushwaha SS, Gupta AK Sr, Kumar N, Lal AK. Kuntscher Nail: A Forgotten Entity Yet a Reliable Modality in Treatment of Winquist Type I and II Closed Femoral Shaft Fractures. Cureus. 2020;12(9):10608.

Bekos A, Sioutis S, Kostroglou A, Saranteas T, Mavrogenis AF. The history of intramedullary nailing. Int Orthop. 2021;45(5):1355-61.

Rosa N, Marta M, Vaz M, Tavares SMO, Simoes R, Magalhães FD, Marques AT. Intramedullary nailing biomechanics: Evolution and challenges. Proc Inst Mech Eng H. 2019;233(3):295-308.

Suh YS, Lee WS, Ahn J, Choi HS, Baek MJ, Choi SW. Removal of bent intramedullary nail: Two case reports. Medicine (Baltimore). 2020;99(20):19935.

Kumar V, Singh G, Kansal R, Aggarwal S. Kuntscher's nail removal techniques: an illustrative walk-through its journey. Eur J Orthop Surg Traumatol. 2019;29(7):1377-81.

Dunleavy ML, Burton A, Reid JS, Copeland CE. Surgical management of angulated femoral intramedullary nails associated with closed fractures: A systematic review of the literature. J Orthop. 2020;21:314-20.

Canton G, Haxhaj B, Fattori R, Murena L. Bent femoral intramedullary nail: a case report and review of the literature. Acta Biomed. 2019;90(1):187-91.

Yoon RS, Liporace FA. Impact of intramedullary nailing in the treatment of femur fractures an evolutionary perspective. Bull Hosp Jt Dis. 2018;76(1):9–13.

Ohtsuka H, Yokoyama K, Tonegawa M, Higashi K, Itoman M. Technique for removing a bent intramedullary femoral nail: a case report. J Orthop Trauma. 2001;15(4):299-301.

Ng AB, Jivanjee AJ, Jasani KM, Purbach B (2010) A technique for extracting a buried Kuntscher nail from the femur during total hip arthroplasty. Hip Int. 20(2):292–5.

Zardiackas LD, Disegi J, Givan D. Torsional properties of implant grade titanium. J Biomed Mater Res. 1991;25(3):281-93.

Batra A, Setia N, Dua S, Madan H, Gogna P, Verma V. A simple technique to retrieve a bent kuntscher's nail in femur. Int J Enhan Res Med & Dental Care. 2015;2(3):35-8.

Shen PC, Chen JC, Huang PJ, Lu CC, Tien YC, Cheng YM. A novel technique to remove bent intramedullary nail. J Trauma. 2011;70(3):755-8.

Nicholson P, Rice J, Curtin J. Management of a refracture of the femoral shaft with a bent intramedullary nail in situ. Injury. 1998;29(5):393-4.

Patterson RH, Ramser JR Jr. Technique for treatment of a bent Russell-Taylor femoral nail. J Orthop Trauma. 1991;5(4):506-8.

Neimpoog S, Arunakul R. Siriraj Med J. A Simple New Technique to Remove a Bent Kuntscher Nail. 2008;60(5):267-9.

Nicolaides V, Polyzois V, Tzoutzopoulos A, Stavlas P, Grivas TB, Korres D. Bent femoral intramedullary nails: a report of two cases with need for urgent removal. Eur J Orthop Surg Traumatol. 2004;14(3):188-91.