Percutaneous Straightening and Exchange Nailing of a Bent Intramedullary Nail Following Tibial Shaft Fracture: A Case...

Bending of tibial intramedullary (IM) nails is an extremely rare complication, usually resulting from high-energy trauma. Management options are not standardized, and removal or exchange nailing can be technically challenging.

We report the case of a 23-year-old male who sustained a displaced fracture of the left tibial shaft following a motorcycle accident. He was treated with closed reduction and IM nailing (9 mm), with uneventful recovery and fracture union at 6 months. One year later, the patient was involved in another motorcycle accident, leading to acute pain and deformity of the same tibia. Radiographs revealed significant bending of the previously implanted IM nail with a refracture at the former fracture site.Attempts to straighten the nail by counter-pressure against a tibial support and on an orthopedic traction table were unsuccessful. Using fluoroscopic guidance, the maximal bending point was identified and drilled percutaneously to weaken the nail. A Schanz pin was then inserted into the distal oval foramen after removal of a mediolateral screw, and horizontal traction was applied to gradually realign the nail. Following successful straightening, the bent nail was removed and replaced with a larger-diameter nail (10 mm) after reaming.

This case demonstrates that percutaneous straightening and subsequent exchange nailing is a safe and effective approach for managing bent IM nails. This minimally invasive technique reduces surgical morbidity while restoring stability and may serve as an alternative to complex extraction methods.