A Simple Technique for Removal of Interlocking Screw from an Intramedullary Nail: A Case Report

Difficulties encountered during removal of implants present a common technical challenge in orthopedic surgery, for which a number of factors have been implicated. A variety of techniques and instruments have been used to overcome this. However, some of these may prove to be time consuming, expensive, and inaccessible to many surgical setups. We describe a technique used for the removal of a jammed interlocking screw from an intramedullary nail that allows for minimal damage to the hardware, bone, and surrounding soft tissue, with the added advantage of being relatively quick and technically uncomplicated with the use of simple instruments.

We describe the case of an 81-year-old female with a history of surgical fixation for a left femur intertrochanteric fracture, who presented with groin pain 13 months post-fixation. Radiographs were suggestive of avascular necrosis of the femoral head with resultant cut-in of the blade, and the patient was eventually taken up for the removal of implants and total hip replacement. Intraoperatively, difficulties were encountered in the removal of the distal interlocking screw, with failure of conventional techniques initially. A high-speed burr was then employed to shape the screw head so as to achieve better grip with extraction devices, which facilitated smooth removal.

We describe a simple method for difficult screw removal involving the use of a high-speed burr and vise grip pliers. This technique provides a quick and inexpensive option with commonly available surgical tools and may be considered when encountering difficulties with screw extraction.