https://www.facebook.com/groups/indian.ortho/
young girl, operated by me9-10 months back, several times told for surgery for nonunion , now came with this. (ipsilateral tibia was united well.)
now ??
now ??
- DrRajiv Dugar Broken nail set available but tough task and you have to open the fracture also for grafting and rose petalling
- Ashish Khandelwal ex nailing + bg has to be done.. my querry is how to come over from distal broken part of nail
Praveen Kumar Dear Ashish Khandelwal
Will u post check xray pl, when u hv performed surgery
N pl tell us what was reason for non union , so that we r benefitted from ur experience
Kir Pat Ashish Khandelwal, You are going for intrafocal so it will be easier.. for reduction/removal and bg...fix IM nail
Mahesh Telrandhe There is a special nail extractor, which can be inserted trh the same entry trh which you will remove prox broken nail. You can engage the tip of nail extractor and create thread into it. It will get locked into distal part. Then remove distal locking screws. Extract the nail. Put oversized nail after nice reaming
Kamruzzaman Manik Remove proxi part first,open # site,it is easy catch distal nail as it is above from distal part of femur,then remove distal screw & remove distal part of nail.Fresh nail with ACBG.- Praveen Kumar Broken nail extractor will be hard to get, n not easy job if never used or seen using it .
Easy way out will be to insert one or two beaded guide wires through distal end of the nail by making a 4.5 hole in distal end of femur , the guide wire will be...Ver más 
Hany Abu-Farsakh Removing the proximal price of the nail might be easy in the traditional way... For the distal part I would prefer to use a retrograde nail to push it and would extract it through the proximal entry point or the fracture site
Ashwini Sood Make an entry point in knee as we do for retrograde nailing.
Then the distal nail can be extracted very easily from the knee. I have done a very similar case around 5 years back.
Bhavin Jadav Ashish, firstly I bow to you for saying 'operated by me'; almost all cases here and most conferences are usually 'Operated Elsewhere'.- Bhavin Jadav I took out a broken nail recently that was 'operated elsewhere' with a nail removal kit from Stryker. It's just a long hook with a handle that you pass through the nail like guide wire and twist around until the hook engages the far end of the nail and...Ver más
Anuj Agrawal I wonder if one is going to open the fracture site for bone grafting, there would hardly be any difficulty removing the distal part of the nail, which can be directly grabbed at the fracture site.
- Ashish Khandelwal Dear praveen kumar..2-3 times i have already shared this case previously and having a long discussion...rt now i dont have full detail and so i look in hurry. I will find old x rays and post it. Thanks for suggestions.
- Hanuman Dh Make a hole in lower end femur as in SC Nailing. ...
Take a IM ( k nail) hit from below. ...your broken nail will be out ....from proximal femur. ... - Praveen Kumar Dr Hanuman Dh sir
Why to disturb virgin knee , just to remove the broken piece ,where other " JUGAD " R THERE - Hanuman Dh There r many methods. ...
This is one ....hv to keep in mind if you are not expertise in other methods. .....
I heard in many big corporate setups Dr's struggled hours to remove broken piece. .... 
Shakerul Kareem Its good to have healthy discussion but the xray shows broken nail already poping out of fracture site so no question of any other option but the different suggestions received will defenetly help everybody at one or the other instance
Srinath S Ranganath Broken nail extractor set is there with G-K system also. If the hook is good then nail should come out easily....
Preferably go for two mm thicker reamed nail with static locking initially then dynamisation....- Kir Pat Ashish , This case needs to be done opening #,cleaning/ reduction compression /bg so you do not need extra extraction effort or set or interventions only if you think closed removal,you will have marathon..without any advantage but disturbing whole bone /soft tissue etc
Alok Singh Why it happened needs attention
Because pt is young and site is such where u nion is never a problem...Ver más
Soran Shex Ibrahim DrRajiv Dugar regarding biomechanic what is the cause of broken implant? is it related to type of material or is it related to weight bearing??- Bhavin Jadav This has failed due to massive muscle forces across the sub-troch fracture, which leads to significant stress on the implant as well as a fair risk of non-Union. The conventional locking used in this case makes the workings length of the nail above the...Ver más
- Bhavin Jadav PFN will be very difficult because of this nail being piriformis fossa entry, but doable with care- or go straight to a compressive fixation with blade plate if you are inclined that way.
Santosh Soni I will prefer open fracture site remove broken nail clean the fracture site freshen the fracture end LC DCP compression plating with lot of autobonegraft
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