Skip to main content

Advertisement

SpringerLink
Log in

Nail-extraction device mismatch: an issue in developing countries intramedullary nail removal practice

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Intramedullary nail is the gold standard in the management of long bone diaphyseal fractures of tibia and femur. The jig of these nails has corresponding extraction device whose pitch for nail coupling come in various sizes. This unlike plate and screws may be difficult to predict preoperatively and may pose a problem during removal. Difficulties in removal may arise due to the proliferation of nail brands especially in developing countries. The study aims to identify the incidence of extraction device mismatch among orthopaedic surgeons in Nigeria as well as the indications and complications associated with intramedullary nail removal.

Methods

A two-page questionnaire was administered to 87 orthopaedic surgeons attending the Annual General Meeting of the Nigerian Medical Association. The attitudes of the participants towards intramedullary nail were assessed.

Results

All participants agree to asymptomatic removal. Patients wish was the leading indication for asymptomatic removal among the participants. Sixty-one percent of the surgeons have had the need to remove a nail different from the brand in the hospital their practice. The commonest indication for symptomatic removal was infections. Forty-seven percent of the participant encountered nail extraction-device mismatch.

Conclusions

The incidence of extraction device mismatch may portend a public health issue. There may be need for patient who had intra medullary nail insertion to be told their brand. We advocate for standardization of extraction device pitch for intramedullary nail.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bekos A, Sioutis S, Kostroglou A, Saranteas T, Mavrogenis AF (2021) The history of intramedullary nailing. Int Orthop 45(5):1355–1361. https://doi.org/10.1007/s00264-021-04973-y

    Article  PubMed  Google Scholar 

  2. Rudloff MI, Smith WR (2009) Intramedullary nailing of the femur: current concepts concerning reaming. J Orthop Trauma 23(5 Suppl):S12–S17. https://doi.org/10.1097/BOT.0b013e31819f258a

    Article  PubMed  Google Scholar 

  3. Ricci WM, Gallagher B, Haidukewych GJ (2009) Intramedullary nailing of femoral shaft fractures: current concepts. J Am Acad Orthop Surg 17(5):296–305. https://doi.org/10.5435/00124635-200905000-00004

    Article  PubMed  Google Scholar 

  4. Sidky A, Buckley RE (2008) Hardware removal after tibial fracture has healed. Can J Surg 51(4):263–268

    PubMed  PubMed Central  Google Scholar 

  5. Busam ML, Esther RJ, Obremskey WT (2006) Hardware removal: indications and expectations. J Am Acad Orthop Surg 14(2):113–120. https://doi.org/10.5435/00124635-200602000-00006

    Article  PubMed  Google Scholar 

  6. Hanson B, van der Werken C, Stengel D (2008) Surgeons’ beliefs and perceptions about removal of orthopaedic implants. BMC Musculoskelet Disord 24(9):73. https://doi.org/10.1186/1471-2474-9-73

    Article  Google Scholar 

  7. Varunjikar MD, Joshi SC, Varunjikar AM, Joshi CR (2014) Implant removal: an unsolved challenge to the orthopedician. J Evol Med Dent Sci 3:4282–4286. https://doi.org/10.14260/jemds/2014/2432

    Article  Google Scholar 

  8. Hui C, Jorgensen I, Buckley R, Fick G (2007) Incidence of intramedullary nail removal after femoral shaft fracture healing. Can J Surg 50(1):13–18

    PubMed  PubMed Central  Google Scholar 

  9. Wild M, Gehrmann S, Jungbluth P, Hakimi M, Thelen S, Betsch M, Windolf J, Wenda K (2010) Treatment strategies for intramedullary nailing of femoral shaft fractures. Orthopedics 33(10):726. https://doi.org/10.3928/01477447-20100826-15

    Article  PubMed  Google Scholar 

  10. Testa G, Vescio A, Aloj DC et al (2019) Definitive treatment of femoral shaft fractures: comparison between anterograde intramedullary nailing and monoaxial external fixation. J Clin Med 8(8):1119. https://doi.org/10.3390/jcm8081119

    Article  PubMed  PubMed Central  Google Scholar 

  11. Karladani AH, Granhed H, Edshage B, Jerre R, Styf J (2000) Displaced tibial shaft fractures: a prospective randomized study of closed intramedullary nailing versus cast treatment in 53 patients. Acta Orthop Scand 71(2):160–167. https://doi.org/10.1080/000164700317413139

    Article  CAS  PubMed  Google Scholar 

  12. Echem RC, Eyimina PD (2020) Removal of locked intramedullary nails with the aid of bolts. Int J Res Med Sci 8(4):1397–1403. https://doi.org/10.18203/2320-6012.ijrms20201332

    Article  Google Scholar 

  13. Pathak SK, Maheshwari P, Prashanthraj M, Gour S, Gadi D (2016) Intramedullary nails: should it be removed after fracture healing? Int Surg J 3:1603–1605. https://doi.org/10.18203/2349-2902.isj20162755

    Article  Google Scholar 

  14. Abbas HK, Per ÅE, Hans G, Lars K, Peter N (2007) Tibial intramedullary nails—should they be removed? A retrospective study of 71 patients. Acta Orthop 78(5):668–671. https://doi.org/10.1080/17453670710014374

    Article  Google Scholar 

  15. Stenroos A, Brinck T, Handolin L (2018) Recommendation of use of checklists in tibial intramedullary nail removal: retrospective study of mechanical complications related to nail removal. Injury 49(7):1341–1347. https://doi.org/10.1016/j.injury.2018.05.005

    Article  PubMed  Google Scholar 

  16. Haseeb M, Butt MF, Altaf T, Muzaffar K, Gupta A (2017) Jallu A (2017) Indications of implant removal: a study of 83 cases. Int J Health Sci (Qassim) 11(1):1–7

    PubMed  Google Scholar 

  17. Gösling T, Hufner T, Hankemeier S, Zelle BA, Muller-Heine A, Krettek C (2004) Femoral nail removal should be restricted in asymptomatic patients. Clin Orthop Relat Res 423:222–226. https://doi.org/10.1097/01.blo.0000130208.90879.67

    Article  Google Scholar 

  18. Zenios M, Malik MHA, Al-Mesri AR et al (2004) Current intramedullary nail insertion and removal practice in the UK. Eur J Orthop Surg Traumatol 14:19–22. https://doi.org/10.1007/s00590-003-0122-1

    Article  Google Scholar 

  19. Boerger TO, Patel G, Murphy JP (1999) Is routine removal of intramedullary nails justified. Injury 30(2):79–81. https://doi.org/10.1016/s0020-1383(98)00200-9

    Article  PubMed  Google Scholar 

  20. Clough JF, Zirkle LG, Schmitt RJ (2010) The role of SIGN in the development of a global orthopaedic trauma database. Clin Orthop Relat Res 468(10):2592–2597. https://doi.org/10.1007/s11999-010-1442-1

    Article  PubMed  PubMed Central  Google Scholar 

  21. Mittal RL, Gupta R, Bither N, Masih GD, Jindal A (2012) A new low-cost universal nail extractor (Unilex system). Punjab J Orthop 13(1):22–24

    Google Scholar 

  22. Miller R, Renwick SE, DeCoster TA, Shonnard P, Jabczenski F (1992) Removal of intramedullary rods after femoral shaft fracture. J Orthop Trauma 6(4):460–463. https://doi.org/10.1097/00005131-199212000-00012

    Article  CAS  PubMed  Google Scholar 

  23. Deakin DE, Cooper JP (2008) Use of a cork-screw femoral head extractor for removal of a stuck intramedullary nail. Ann R Coll Surg Engl 90:163

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Lazaraviciute G, Medlock G, Stevenson I (2016) Removal of an incarcerated intactintra medullary nail with a cement tap extractor. Ann R College Surg Engl 98(8):589. https://doi.org/10.1308/rcsann.2016.0192

    Article  CAS  Google Scholar 

  25. Ndeleva BM, Kigera JWM (2018) Regulation of orthopaedic implants in Kenya. East Afr Orthop J 12(1):1–2

    Google Scholar 

  26. Maisel WH (2004) Medical device regulation: an introduction for the practicing physician. Ann Int Med 140(4):296–302. https://doi.org/10.7326/0003-4819-140-4-200402170-00012

    Article  PubMed  Google Scholar 

  27. Trelle S (2002) Accuracy of responses from postal surveys about continuing medical education and information behavior: experiences from a survey among German diabetologists. BMC Health Serv Res 2:15

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, College of Medicine University of Nigeria, Ituku Ozalla, Enugu, Nigeria

    Ikechukwu C. Okwesili

  2. Department of Orthopaedics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria

    Ikechukwu C. Okwesili & Blasius O. Okwara

  3. City Specialist Hospital, Enugu, Nigeria

    Ugochukwu N. Enweani

  4. Department of Orthopaedics and Traumatology, National Orthopaedic Hospital, Enugu, Nigeria

    Obiora N. Muoghalu, Damian C. Ogbu & Henry C. Ekwedigwe

  5. Department of Orthopaedics, Alex Ekwueme Federal Teaching Hospital, Abakiliki, Ebonyi, Nigeria

    Anthony A. Anagor

Authors
  1. Ikechukwu C. Okwesili
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ugochukwu N. Enweani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Obiora N. Muoghalu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Blasius O. Okwara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Damian C. Ogbu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anthony A. Anagor
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Henry C. Ekwedigwe
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

The study conception and design were by Ikechukwu C Okwesili, Ugochukwu N Enweani, and Obiora N Moughalu. Material preparation, data collection and analysis were performed by Ikechukwu Okwesili, Blasius O Okwara, Damian C Ogbu, Anthony A Anagor, and Henry C Ekwedigwe. The first draft of the manuscript was written by Ikechukwu Okwesili, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ikechukwu C. Okwesili.

Ethics declarations

Ethics approval

The Education/Research Committee of the Nigerian Orthopaedic Association granted approval the survey and confirmed no ethical approval will be required.

Consent to participate

Written informed consent accompanied the questionnaire. Participant agreed that by filling it, the anonymous data has been agreed to be used for research and publication.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

ESM 1

(SAV 14 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Okwesili, I.C., Enweani, U.N., Muoghalu, O.N. et al. Nail-extraction device mismatch: an issue in developing countries intramedullary nail removal practice. International Orthopaedics (SICOT) 48, 261–265 (2024). https://doi.org/10.1007/s00264-023-06025-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-023-06025-z

Keywords

Search

Navigation