Removal of Retained Broken Distal Femoral Nail Using a Corkscrew in a Resource-Constrained Setting. A Case Report.

Abstract

Background: Implant failure following intramedullary nailing of femoral shaft fractures, though uncommon, presents a significant surgical challenge, particularly when the distal fragment of a broken nail is retained within the medullary canal. Conventional extraction techniques are often technically demanding, may require specialized instruments, and can increase operative morbidity. This challenge is further amplified in resource-constrained settings where advanced tools may not be readily available.
Case Presentation: We report the case of a 56-year-old male who presented with a 7-month history of right thigh pain, deformity, and abnormal mobility following previous surgical interventions for femoral shaft fracture. Radiographic evaluation revealed atrophic nonunion with broken intramedullary implants (Kuntscher nail and Rush pin). During surgery, conventional extraction techniques successfully removed the proximal components; however, the distal fragment proved difficult to retrieve. A corkscrew device, obtained from a hip arthroplasty set, was introduced into the lumen of the retained nail fragment, achieving secure purchase and enabling controlled extraction. This was followed by exchange intramedullary nailing and bone grafting.
Intervention: Minimally invasive extraction of the retained distal nail fragment using a corkscrew technique, followed by definitive fixation with interlocking intramedullary nailing and autologous bone grafting.
Outcome: Postoperative recovery was uneventful. The patient commenced early mobilization and progressed from non-weight bearing to full weight bearing by 12 weeks. Follow-up radiographs demonstrated satisfactory callus formation, and the patient reported resolution of pain, restoration of limb length, and return to functional ambulation.
Conclusion: The corkscrew extraction technique is a simple, cost-effective, and minimally invasive method for removing retained distal fragments of broken intramedullary femoral nails. It is particularly valuable in resource-limited settings and should be considered a reliable alternative when conventional extraction methods fail.