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Ewa F. Folwaczny, Klaus Michael Stürmer |
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Patients and Methods: Between January 1995 and December 1999, 279 fractures of the lower leg were stabilized by crural intramedullary nailing (ACE® interlocking nails, DePuy). Only under certain circumstances was the medullary cavity reamed. This paper reports on ten patients with whom unusual complica-tions arose during nail removal.
Results: In two cases, the nail jammed in the fracture callus during its removal, so that the nail had to be left in place. In eight further cases, the nail could only be removed with extreme difficulty and the use of special instruments; in six of these cases, however, a long fissure in the dorsal tibial shaft was visible under intra-operative X-ray fluoroscopy. Postoperative patient mobilization was achieved using either a brace (allowing full weight bearing on the leg) or crutches (partial weight bearing on the leg). The tibial medullary canal was reamed in nine of the ten patients, and a nail relatively wide in diameter (11?14 mm) was inserted.
Conclusions: The ACE® interlocking nail employed is bent 5° ventrally over the final 50 mm to the tip. This does not only facilitate nail insertion, but the nail also adapts to the physiological anteversion of the distal tibia. As a result of its bent shape and large diameter and in the case of considerable endosteal callus formation with associated narrowing of the medullary cavity the rigid titanium nail can no longer pass through. This may lead to a fissure when removing the nail, or even result in the total inability to remove the nail. Another reason is the dorsal groove in nails ≥ 11 mm in diameter, into which bone grows at the site of callus formation. When removing the nail, the distal end of the nail (with no groove) has to slide over this dorsal bony ridge, thus narrowing the available lumen of the medullary canal by about 20% in the anteroposterior direction. The manufacturer has announced a change in the nail design.
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