248
Injury, 6, 248-249
How to remove a Kiintscher with no eye B. Aalami-Harandi,
nail
K. Sajadi, and A. Zahir
Department of Orthopaedic Tehran, Iran
Surgery, Shafa Rehabilitation
Summary
Removal of a Ktintscher nail is usually a simple procedure. However, this can sometimes be very difficult if there is no eye in the proximal end of the nail, either due to sawing off the end of the rod during its insertion or due to breakdown of the eye when attempting removal. This brief report describes a technique used to remove a nail when previous attempts at removal
Fig. l.-Radiograph of the left femur on admission. Before removal of the Kiintscher nail.
Hospital,
had resulted in the loss of the eye of the nail and in its burial in the greater trochanter.
CASE REPORT A 46-year-old male was admitted to Shafa Rehabilitation Hospital in January 1972 with osteomyelitis of the left femur. He had sustained
Fig. 2.-Radiograph of the left femur 2 weeks after removal of the Kiintscher nail. The fracture is healed. There is a sequestrum at the fracture site.
Aalami-Harandi et al. : How to Remove a Ktintscher Nail
Fig. 3.-Radiograph
of the left femur 1 year after removal of the Kiintscher nail and sequestrum.
a fracture of the left femur in a road accident one year before admission. It had been treated by open reduction and internal fixation with a Kiintscher nail in another hospital. He developed a postoperative infection with drainage, but it was decided to leave the nail in place and treat the patient with antibiotics until union of the
Requests Hospital,
for
J&h
reprints should be addressed Avenue, Tehran, Iran.
to:-B.
Aalami-Harandi,
249
fracture. One year after operation the fracture was healed, but the discharge continued so it was then decided to remove the nail. Four different, but unsuccessful attempts at removal of the Kiintscher nail were made in different hospitals and during the last attempt the eye was broken. On admission to Shafa Rehabilitation Hospital there was discharge from the lateral aspect of the thigh and a coagulase positive staphylococcus was cultured from the pus. Radiographs of the femur showed a united fracture of the mid-shaft of the left femur with an intramedullary rod in place, and a sequestrum was seen at the fracture site (Fig. 1). The patient underwent operation for the removal of the nail. After exposure of the greater trochanter and proximal third of the femur through a lateral approach, it was noticed that the proximal hole of the nail was broken. Furthermore it was impossible to grasp the nail firmly enough with either pliers or a wrench to withstand the hammering required to extract the nail. A gutter about 6 ems in length was made on the lateral aspect of the greater trochanter and proximal end of the shaft to expose the rod. Then using a metal drill from the hospital workshop a hole was made in the Kiintscher nail below the broken eye. Then by leaving the drill in situ and holding the nail with a pair of pliers against and distal to the drill, it was possible to hammer the nail out. Two weeks after operation when the wound was healed, the sequestrum was removed and the infection stopped (Fig. 2). Two years later the patient is well and has not had any recurrence of sepsis. M.D.,
Department
of Orthopaedic
Surgery,
Shafa
Rehabilitation
Injury, 6, 248-249
How to remove a Kiintscher with no eye B. Aalami-Harandi,
nail
K. Sajadi, and A. Zahir
Department of Orthopaedic Tehran, Iran
Surgery, Shafa Rehabilitation
Summary
Removal of a Ktintscher nail is usually a simple procedure. However, this can sometimes be very difficult if there is no eye in the proximal end of the nail, either due to sawing off the end of the rod during its insertion or due to breakdown of the eye when attempting removal. This brief report describes a technique used to remove a nail when previous attempts at removal
Fig. l.-Radiograph of the left femur on admission. Before removal of the Kiintscher nail.
Hospital,
had resulted in the loss of the eye of the nail and in its burial in the greater trochanter.
CASE REPORT A 46-year-old male was admitted to Shafa Rehabilitation Hospital in January 1972 with osteomyelitis of the left femur. He had sustained
Fig. 2.-Radiograph of the left femur 2 weeks after removal of the Kiintscher nail. The fracture is healed. There is a sequestrum at the fracture site.
Aalami-Harandi et al. : How to Remove a Ktintscher Nail
Fig. 3.-Radiograph
of the left femur 1 year after removal of the Kiintscher nail and sequestrum.
a fracture of the left femur in a road accident one year before admission. It had been treated by open reduction and internal fixation with a Kiintscher nail in another hospital. He developed a postoperative infection with drainage, but it was decided to leave the nail in place and treat the patient with antibiotics until union of the
Requests Hospital,
for
J&h
reprints should be addressed Avenue, Tehran, Iran.
to:-B.
Aalami-Harandi,
249
fracture. One year after operation the fracture was healed, but the discharge continued so it was then decided to remove the nail. Four different, but unsuccessful attempts at removal of the Kiintscher nail were made in different hospitals and during the last attempt the eye was broken. On admission to Shafa Rehabilitation Hospital there was discharge from the lateral aspect of the thigh and a coagulase positive staphylococcus was cultured from the pus. Radiographs of the femur showed a united fracture of the mid-shaft of the left femur with an intramedullary rod in place, and a sequestrum was seen at the fracture site (Fig. 1). The patient underwent operation for the removal of the nail. After exposure of the greater trochanter and proximal third of the femur through a lateral approach, it was noticed that the proximal hole of the nail was broken. Furthermore it was impossible to grasp the nail firmly enough with either pliers or a wrench to withstand the hammering required to extract the nail. A gutter about 6 ems in length was made on the lateral aspect of the greater trochanter and proximal end of the shaft to expose the rod. Then using a metal drill from the hospital workshop a hole was made in the Kiintscher nail below the broken eye. Then by leaving the drill in situ and holding the nail with a pair of pliers against and distal to the drill, it was possible to hammer the nail out. Two weeks after operation when the wound was healed, the sequestrum was removed and the infection stopped (Fig. 2). Two years later the patient is well and has not had any recurrence of sepsis. M.D.,
Department
of Orthopaedic
Surgery,
Shafa
Rehabilitation
