Resolving Block Screw Obstruction in Tibial Intramedullary Nailing

This technical report describes a new solution for dealing with intramedullary nail blockage during tibial fracture operation. It discusses a case in which a screw obstructed nail insertion, a complication encountered during the procedure, and outlines the development of a four-step minimally invasive technique. The obstruction was localized using fluoroscopy, and a unicortical drill hole (4.5 mm) was created directly above the blocking screw. A ring handle spike instrument was introduced through the hole to act as a lever, allowing the nail to advance beyond the obstruction. Final fluoroscopic confirmation was then performed to verify the proper position of the nail.  This approach successfully achieved adequate nail placement without compromising the reduction of the fracture or significantly increasing the operative time, all while preserving the minimally invasive nature of the procedure.