Salvage of a Broken Magnetic Tibia Nail with Plate Fixation Without Nail Removal: A Case Report

Magnetic intramedullary nails are used for deformity correction and limb lengthening because of their minimally invasive nature and reduced complication rates compared to external fixators. However, complications such as non-union and nail breakage remain rare but significant clinical challenges, particularly in cases with patient-specific risk factors. This case demonstrates a successful union after nail fracture without the removal of the intramedullary nail, using lateral plate fixation, offering a salvage option in this uncommon scenario.

A 22-year-old female with congenital left leg shortening, previously treated with two external fixator lengthening procedures and later plate fixation after a tibia fracture, presented with progressive genu valgum and 4 cm limb-length discrepancy. Deformity correction and lengthening using a magnetic intramedullary tibial nail were performed, with an uneventful 1-week latency phase and 6-week distraction phase. Because of delayed union during consolidation, bone marrow aspirate concentrate injection was performed at post-operative 5th month, followed by iliac crest autograft placement on post-operative 7th month. At post-operative 10th month, she experienced sudden pain and a snapping sensation while descending stairs, came to the emergency room, and imaging revealed nail fracture. Revision surgery was performed, and the broken nail was intentionally left in situ and stabilized with a lateral locking plate. The patient achieved uneventful recovery with progressive weight-bearing and radiographic union, regaining full function at 9th month.

Magnetic intramedullary nails, while effective for limb lengthening, can fail mechanically because of delayed union and poor adherence to rehabilitation protocols. Recognizing the complications early and actively addressing risk factors are essential to improving the outcome. Most importantly, this case report shows that plate fixation over a retained broken magnetic tibial nail can restore stability and lead to union and functional recovery without the need for implant removal, offering a practical treatment option for this uncommon but challenging complication.