Safe, rapid, and effortless femoral nail removal using a new third-generation universal femoral nail extraction tool.

摘要

Intramedullary nails used for fixation of femoral fractures may require removal for a variety of reasons. Some recommend that all such nails be removed after fracture hearing, whereas others prefer to remove only those that cause symptoms. Regardless of the reason, removal of an intact femoral nail can be difficult and time-consuming. Husain et al.,in a review of 45 femoral nail removals, noted that an average of 110min was required for removal of titanium nails and 84min for removal of stainless steel nails. They attributed the longer removal times for titanium nails to the removal of more locking screws than in the stainless steel nails. Femoral nails also frequently require removal of a heterotopic bone cap. Although specific retrieval difficulties are difficult to quantitate, we have found that a new universal extraction tool (Smith-Nephew, Memphis, TN, USA) allows quick, easy, and predictable removal of unbroken antegrade and retrograde femoral nails.The tool is a conical, threaded extraction device that can be attached to a bar for impaction with a slotted mallet. The extraction head is cannulated for a standard 3.2-mm guide pin or guidewire, which is used to penetrate the nail core to guide the extraction device into place.