Novel Technique to Remove Intramedullary Nails with Difficult End Caps Using Minimal Instrumentation: A Case Report

A 17-year-old adolescent boy undergoing removal of a piriformis-entry femoral nail had an associated end cap that was unable to be engaged. Accordingly, an appropriately sized threaded guidewire was cannulated inside the implant cap, allowing the construct to be removed as one unit.

When an intramedullary nail has a difficult-to-remove end cap, a threaded guidewire can obtain an interference fit inside of it. The wire can then pull the nail and cap together as one structure. We believe this is a reproducible technique that minimizes soft tissue injury, requires minimal instrumentation, and remains cost effective.