title: Anterograde removal of broken femoral nails without opening the nonunion site: a new technique.
abstract: OBJECTIVE
  We describe a new technique for removing the distal fragments of broken intramedullary femoral nails without disturbing the nonunion site.
  
  
  METHODS
  This technique involves the application of an AO distractor prior to the removal of the nail fragments, with subsequent removal of the proximal nail fragment in an anterograde fashion and removal of the distal fragment through a medial parapatellar approach. Impaction of the fracture site is then performed with a nail that is broader than the remaining fragmented material.
  
  
  RESULTS
  Nails were removed from five patients using the technique described above without any complications. After a mean follow-up period of 61.8 months, none of these patients showed worsened knee osteoarthritis.
  
  
  CONCLUSIONS
  The original technique described in this article allows surgeons to remove the distal fragment of fractured femoral intramedullary nails without opening the nonunion focus or using special surgical instruments.
authors.affiliation: Department of Orthopedics, Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil. henriquecabrita@uol.com.br
authors.forename: Henrique Antônio Berwanger
authors.initials: HA
authors.lastname: de Amorim Cabrita
authors.forename: Eduardo Angeli
authors.initials: EA
authors.lastname: Malavolta
authors.forename: Otávio Vilhena Reis
authors.initials: OV
authors.lastname: Teixeira
authors.forename: Nei Botter
authors.initials: NB
authors.lastname: Montenegro
authors.forename: Fernando Aires
authors.initials: FA
authors.lastname: Duarte
authors.forename: Rames
authors.initials: R
authors.lastname: Mattar
mesh_terms: D000328:Adult; D001858:Bone Nails; D020878:Device Removal / Q000379:methods*; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007719:Knee Joint; D008297:Male; D019857:Osteogenesis, Distraction / Q000295:instrumentation* / Q000379:methods; D011542:Pseudarthrosis / Q000000981:diagnostic imaging / Q000628:therapy*; D011859:Radiography; D016896:Treatment Outcome; D055815:Young Adult