A Novel Closed Method to Retrieve Broken Teflon Tube During Intramedullary Nailing in Proximal Humeral Fracture

Abstract

Broken medullary tubes have been used for intramedullary (IM) nailing of femoral and tibial fractures. In these reported cases, fragments of the medullary tube were retrieved by opening the fracture sites or left in situ, which might jeopardize periosteal blood supply. We herein present the case of a 58-year-old woman who underwent IM nailing for proximal humeral fracture, which was complicated by breakage of the medullary tube intraoperatively. Different instruments including guide rods, straight forceps, and cement extract hook were used to retrieve the retained fragments from the medullary canal, but these attempts were unsuccessful. Finally, the fragments were successfully removed using an anterior cruciate ligament (ACL) ENDOBUTTON depth gauge. This case highlights that medullary tubes can break during humeral IM nailing, which could be minimized by ensuring integrity of the medullary tube prior to surgery and disposing medullary tubes with more than 100 exposures. A novel method of using ACL ENDOBUTTON depth gauge to retrieve retained tube fragments is recommended because of its long and slim design.

Keywords

• equipment failure
• fracture fixation
• humeral fracture
• intramedullary nailing
• Teflon tube