Incarcerated Cortical Fragments in Intramedullary Nailing

In fractures with varying degrees of comminution, it is possible for cortical bone fragments to become entrapped within the intramedullary canal. There have been prior case reports on complications associated with incarcerated fragments; however, there has been no proposed solution. The current case shows how 2 cortical fragments in the distal segment of a comminuted femur fracture impeded passage of the intramedullary reamer and induced deformity at the fracture site during the reaming. The authors describe a simple method of retrieval without having to formally open the fracture site. Recognizing the presence of an incarcerated fragment and appropriately managing it intraoperatively allows for fracture fixation to occur uneventfully. [Orthopedics. 2016; 39(3):e582-e586.].