Removal of Elastic Stable Intramedullary Nail

Vol 6 | Issue 2 | July-December 2020 | page: 19-21 | Vivek M. Sodhai, Sandeep A. Patwardhan, Parag K. Sancheti, Ashok K. Shyam

Authors: Vivek M. Sodhai [1], Sandeep A. Patwardhan [1], Parag K. Sancheti [1], Ashok K. Shyam [1, 2]

[1] Department of Paediatric Orthopaedics, Sancheti Institute for Orthopaedics & Rehabilitation, Shivaji Nagar, Pune, Maharashtra, India.
[2] Department of Research, Indian Orthopaedic Research Group, Thane (W), Maharashtra. India.

Address of Correspondence
Dr. Vivek M. Sodhai,
Clinical fellow, Department of Paediatric Orthopaedics, Sancheti Institute for Orthopaedics & Rehabilitation, Shivaji Nagar, Pune, Maharashtra, India.


Introduction: Removal of the elastic stable intramedullary nail (ESIN) after the union is routinely performed in the pediatric population. However, ESIN removal can be lengthy and difficult due to the strong bonding between nail and bone.
Technique: We preferred keeping the nail tip tangentially flush (<5mm) to the bone to avoid skin irritation. In our technique, after incision and subcutaneous dissection, the nail tip is identified and exposed using a 6-mm osteotome, and a trough is created around it sufficient enough to pass the hollow mill over it. In cases with buried nail tip, a rectangular cortical window may be required. The nail tip is then gently bent at 90° using the hollow mill as the lever taking care not to cause an iatrogenic fracture. The nail tip is held at the bent from sideways with a plier and the nail is removed by rotatory backward motion or reverse impaction using a mallet in cases of strong bonding between nail and bone. Using this technique, ESIN removal was successful in all 28 cases using the previous incision. Of these cases, 10 were forearm (36%), 8 were tibia (28%), 7 were femur (25%) and 3 were humerus (11%). 6 cases (21%) were considered difficult due to increased thickness of the nails, deeper location of the nail tip, and increased bone growth around the tip of nails.
Conclusion: Our technique is simple, innovative, and can be easily reproduced by all Orthopaedic Surgeons. The use of this technique is recommended for all ESIN removals.
Keywords: Diaphyseal fractures; Elastic stable intramedullary nail; Hardware removal; Paediatric long bone.


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How to Cite this article: Sodhai VM, Patwardhan SA, Sancheti PK, Shyam AK | Removal of Elastic Stable Intramedullary Nail | Trauma International | July-December 2020; 6(2): 19-21.



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