title: Removal of a femoral nail with osseous overgrowth at the end-cap: A navigated and cannulated minimally invasive technique.
abstract: Intramedullary nail removal can be demanding, especially in cases of implant breakage or bony overgrowth at the end-cap, if the exact insertion depth of the nail is neglected in the index surgery. In the presented case, two challenging nail removals were necessary. The first was performed in a re-nailing procedure due to a pseudarthrosis with implant breakage, and the second was performed during hardware removal after fracture healing in a situation where there was deep intramedullary placement of the exchange nail. For the second implant removal a minimally invasive approach based on instrument placements over a navigated guide-wire was used to reduce the iatrogenic morbidity associated with an extensive open approach to the nail and to decrease the radiation exposure for the patient and the operating team.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Friedrich-Schiller-University Jena, Jena, Germany.
authors.forename: Ivan
authors.initials: I
authors.lastname: Marintschev
authors.forename: Sascha
authors.initials: S
authors.lastname: Rausch
authors.forename: Albert
authors.initials: A
authors.lastname: Fujak
authors.forename: Kajetan
authors.initials: K
authors.lastname: Klos
authors.forename: Gunther O
authors.initials: GO
authors.lastname: Hofmann
authors.forename: Florian
authors.initials: F
authors.lastname: Gras
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D001858:Bone Nails / Q000009:adverse effects*; D020878:Device Removal / Q000379:methods*; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D061646:Operative Time; D016348:Osseointegration / Q000502:physiology; D010147:Pain Measurement; D011475:Prosthesis Failure; D011859:Radiography; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome