Removal of a bent humeral intramedullary nail. A case study and review of removal techniques

Abstract text (incl. references and figure legends)
Case history A 65-year-old male presented with deformed arm after falling 2m from a truck. Medical history included an intramedullary nail (IMN) after midshaft humeral fracture in 2018. Clinical findings Physical examination showed an upper arm in an angle of 60 degrees with no neurovascular deficits. Investigation/Results X-rays and CT-scan showed transverse humeral midshaft fracture and bent IMN with additional proximal neck fissure (Fig 1). Diagnosis Refractured humerus with bent IMN in-situ. Therapy and Progressions During surgery a lateral approach to IMN and fracture was performed. The IMN was cut, and the IMN-segments were extracted through the fracture site (FS) using extraction-screwdriver. Fracture fixation with VA-LCP-ankle-plate. Recovery was uneventful with no wound complications. Postop; 3-months no limitation, minimal pain, 6-months no limiting pain, 12-months X-rays show progressive consolidation, 15-months pain free, fully working. Comments Bent lower extremity (LE) IMNs are reported, but humeral are not. Bent IMNs are rare and challenging. Several techniques have been described in literature. We present an overview of described techniques in Table 1. In this case, open sectioning and two-piece extraction was used; other described techniques, using external forces are not indicated, due to vulnerable radial nerve. Anatomical differences between LE vs humerus require a uniquely tailored surgical approach. There is not one ideal standard technique for removing a bent IMN. This is the first reported bent humeral IMN. References Schmidt et al. Instr Course Lect. 2003;52:607–22 Bhandari et al. Acta Orthop. 2006;77(2):279–84 Kurup et al. Cochrane Database Syst Rev. 2011 Jun 15;(6):CD005959 Berkes et al. Springer London; 2015. p. 85–94 Gupta et al. Injury; 1985;16(4):276–80 SH et al. Malays Orthop J. 2021 Jul 1;15(2):163–5

Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.)

None