Reverse cutting guidewire for intramedullary nailing: a solution for a common yet undocumented and unresolved...

Area of Science:

• Orthopaedic surgery
• Trauma surgery
• Biomedical engineering

Background:

• Intramedullary nailing is a common procedure for femoral and tibial fractures.
• A complication of guidewire impaction occurs in a small percentage of cases, necessitating implant removal.
• This complication, while known, lacks previous formal reporting in scientific literature.

Purpose of the Study:

• To report the complication of ball-tipped guidewire impaction during intramedullary nailing.
• To introduce and evaluate a novel reverse cutting guidewire designed to overcome this complication.
• To avoid the need for implant removal and re-insertion in such cases.

Main Methods:

• A retrospective review of 81 patients undergoing intramedullary nailing for femoral or tibial fractures.
• Identification of cases where the ball-tipped guidewire could not be manually removed.
• In vitro development and testing of a prototype reverse cutting guidewire.
• Evaluation of the guidewire's efficacy in removing impacted guidewires.

Main Results:

• In 6 out of 81 patients (7.4%), the ball-tipped guidewire became impacted after nail implantation.
• In 4 of these cases, implant removal and re-insertion were required.
• The developed reverse cutting guidewire successfully removed the impacted guidewire in vitro, preventing the need for revision surgery.

Conclusions:

• Ball-tipped guidewire impaction is an underreported complication of intramedullary nailing.
• A reverse cutting guidewire offers a potential solution to this problem.
• This innovation can prevent additional surgical procedures, reducing patient morbidity and healthcare costs.