Revision trauma due to early failure of implant (nail)
40 yr old male presented to us
with sudden onset abnormal mobility and inability bear weight on his right leg.
He gave history of surgery on right thigh bone 1 month back outside. X rays
showed his right femur had a comminuted fracture located at mid distal third
junction. There were no signs of union. The nail used to fix the fracture had
broken at it proximal of distal screws site with fracture collapsing in varus.
In this case the surgical problems were that the make of nail was not known to
us. The nail had broken with its distal part deep in distal canal. The local skin
condition was good and all scars were well healed. The patient was taken to
operation theatre and proximal locking bolts were removed. The distal of
proximal bolts was jammed and retrieved with difficulty. The distal part of
nail was removed using a long forceps inserted from fracture site. The nail
removed was 9 mm in diameter. Over guide wire, canal reaming was done, after
provisional closure of prepared fracture site. Size 11 mm nail was inserted
with good distal fit. 2 proximal and 2 distal locking bolts were inserted.
Cortico caccellous graft from right iliac crest was put after preparation of
graft bed at fracture site. In post op period wounds healed well and sutures
were removed on time. On follow, signs were of union were visible in 6 weeks.
However on follow up, one of the distal screws started backing out. This screw
had to be replaced with longer screw. Till recent follow up, fracture union was
progressing satisfactorily.