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LETTER TO EDITOR  
Year : 2012  |  Volume : 46  |  Issue : 2  |  Page : 251
Closed retrograde retrieval of the distal broken segment of femoral cannulated intramedullary nail using a ball-tipped guide wire: A comment


1 Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
2 Department of Orthopaedics, Lady Hardinge Medical College and Associated Sucheta Kriplani Hospital, New Delhi, India

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Date of Web Publication10-Mar-2012
 

How to cite this article:
Arora S, Maini L, Sabat D, Gautam V K. Closed retrograde retrieval of the distal broken segment of femoral cannulated intramedullary nail using a ball-tipped guide wire: A comment. Indian J Orthop 2012;46:251

How to cite this URL:
Arora S, Maini L, Sabat D, Gautam V K. Closed retrograde retrieval of the distal broken segment of femoral cannulated intramedullary nail using a ball-tipped guide wire: A comment. Indian J Orthop [serial online] 2012 [cited 2020 Jan 19];46:251. Available from: http://www.ijoonline.com/text.asp?2012/46/2/251/93692
Sir,

We read with great interest the article by Metikala and Mohammed entitled "Closed retrograde retrieval of the distal broken segment of femoral cannulated intramedullary nail using a ball-tipped guide wire" [1] Apart from the technique mentioned in their article, various other techniques for retrieval of distal broken segment of femoral cannulated nail have been described in the literature. [2],[3],[4],[5],[6] The authors have reported successful retrieval in eight cases of distal broken segment of femoral nail. However, we would like to make the following points:

The authors' idea of advancing the guide wire into the naïve knee joint seems questionable. The authors have mentioned that the retrieval was performed under image guidance to ensure exit in the knee joint at roughly a point that corresponds to the entry point for a retrograde femoral nail. But, it may not always be feasible to manoeuvre the small broken distal nail fragment with the help of a guide wire from the greater trochanter so as to achieve a desired exit in the knee joint. Moreover, coronal or sagittal plane angulations of the non-union site with broken nail in situ may further preclude the described method. Because it entails the first step of the described technique, one may not be able to proceed further with this method.

The authors have identified the distal shaft as the most common fracture site and proximal of the two distal locking holes as the most common site of nail breakage. But, the illustrative case shown in the article had neither of these characteristics. [1] The case had a large broken distal nail segment that could have been extracted by other methods without violating the knee joint. For some strange reasons, the authors have not mentioned few facts that are vital for any original article. Whether the study design was prospective or retrospective, whether an approval from the institutional review board was granted, details of the preoperative and postoperative knee functional scores and their statistical analysis.

The authors had used a 5-mm cannulated drill bit from the anterior cruciate ligament (ACL) reconstruction set. We have made in vitro attempts to pass the ACL drill bits over the femoral interlocking nail guide wires of various manufacturers, but all in vain. The authors are requested to provide the manufacturers details of guide wires as well as drill bits for benefit of readers.

 
   References Top

1.Metikala S, Mohammed R. Closed retrograde retrieval of the distal broken segment of femoral cannulated intramedullary nail using a ball-tipped guide wire. Indian J Orthop 2011;45:347-50.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Maini L, Singh J, Agarwal P, Gautam VK, Dhal AK. Removal of broken Kuntscher's nail: An innovative close technique. J Trauma 2005;59:1518-20.  Back to cited text no. 2
    
3.Maini L, Jain N, Singh J, Singh H, Bahl A, Gautam VK. Removal of a multisegmental broken nail by close technique using a TEN nail. J Trauma 2009;66:e78-80.  Back to cited text no. 3
    
4.Whalley H, Thomas G, Hull P, Porter K. Surgeon versus metalwork- tips to remove a retained intramedullary nail fragment. Injury 2009;40:783-9.  Back to cited text no. 4
    
5.Tadros AM, Blachut P. Segmentally fractured femoral Küntscher nail extraction using a variety of techniques. Am J Orthop (Belle Mead NJ) 2009;38:E59-60.  Back to cited text no. 5
    
6.Oberst M, Schlegel K, Mory C, Suedkamp N. Endoscopically controlled removal of a broken intramedullary nail: A new technique. Injury Extra 2005;36:582-5.  Back to cited text no. 6
    

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Correspondence Address:
Sumit Arora
S/o Mr. Raj Kumar Arora, 126/R 23, Govind Nagar, Kanpur 208 006, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5413.93692

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This article has been cited by
1 Authoręs reply
Metikala, S. and Mohammed, R.
Indian Journal of Orthopaedics. 2012; 46(2): 252
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