Removal of bent or broken tibial intramedullary nails: A systematic review of case studies

The bending or fracture of a tibial intramedullary nail is a rare complication with a paucity of literature regarding available methods of extraction. This systematic review discusses the currently described surgical techniques for extracting deformed tibial intramedullary nails as well any potential associated challenges.

A review of the PubMed, EMBASE, and Scopus databases was conducted for articles describing the extraction of deformed tibial intramedullary nails according to the Preferred Reporting Items for Systematic Reviews guidelines. Study quality was assessed using the Joanna Briggs Institute Quality Appraisal tool.

24 case reports were identified as describing the extraction of 27 deformed tibial intramedullary nails. The most common methods of removal were the use of hook extractors (29.6 %), standard extraction (14.8 %) and grasping of broken distal segments via forceps (11.1 %). Challenges included nails with small internal diameters, nail segment tilting during extraction, poor capture of the nail, and subsidence of the proximal segment of the nail. Factors to consider during preoperative planning include the type and material of IMN, degree and direction of IMN angulation, and access to instrumentation.

There are a few core methods of removing deformed intramedullary nails depending on the nature of the deformity, nail type, material, and diameter, and tools available to the surgeon. Regardless of technique, extraction of deformed tibial intramedullary nails is associated with satisfactory patient outcomes.

Level IV, a systematic review of Level IV studies.