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Removal of broken hardware.

David J Hak¹, Matthew McElvany

¹Department of Orthopaedic Surgery, Denver Health, University of Colorado, Denver, Colorado 80204, USA.

The Journal of the American Academy of Orthopaedic Surgeons

|February 7, 2008

Summary

Removing fractured orthopedic hardware, like intramedullary nails and screws, often requires specialized techniques. Successful removal of broken or stuck implants can be challenging, necessitating diverse extraction methods.

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Area of Science:

Orthopedic Surgery
Biomedical Engineering
Materials Science

Background:

Hardware failure, such as intramedullary nail or screw breakage, is a common complication in fracture treatment.
Revision surgery for non-healing fractures frequently involves challenging hardware removal procedures.

Purpose of the Study:

To review and outline various techniques for the removal of fractured or difficult orthopedic hardware.
To provide guidance on managing complications associated with implant removal.

Main Methods:

Discussion of specific techniques for removing broken intramedullary nails (e.g., cross-locking screws, Küntscher type, cannulated, solid).
Description of methods for extracting stripped or broken screws, including screw extractors and trephines.
Exploration of strategies for overcoming challenges like cold-welded implants using specialized tools.

Main Results:

Multiple techniques exist for hardware removal, tailored to the type of implant and failure mode.
Success is not guaranteed with any single method, often requiring a combination of approaches.
Complications like cold-welding necessitate advanced tools such as carbide drills.

Conclusions:

Hardware removal is a complex and time-consuming aspect of orthopedic revision surgery.
A range of specialized tools and techniques are available, but no single method is universally effective.
Surgeons must be prepared to employ diverse strategies for successful removal of fractured or locked implants.