[Problems in removal of a broken unreamed tibial nail]

A solid AO unreamed tibial nail was found to be broken at the revision operation for a pseudoarthrosis following open tibial fracture treatment in a 17-year-old girl. The nail breakage had not been detectable in the roentgenograms. Access to the broken nail was achieved through a longitudinal osteotomy via the tibial tuberosity. A metal drill was used to drill a 5-mm hole proximally into the medial aspect of the nail. There the tip of an elevatorium could be inserted, which allowed force to be applied along the longitudinal axis of the nail. Additionally, another longitudinal osteotomy had to be performed immediately distal to the pseudoarthrosis, and a bone distractor was applied in between. Thus, the nail loosened and could be removed completely. The bony defect was filled with autologous bone graft and a 9-hole AO tibial plate was applied to stabilize the tibia. We report on the breakage of this system and the surgical management of this complication.