Sonographically Assisted Percutaneous Removal of Screws in Dynamization of the Interlocking Intramedullary Nail

he success of interlocking intramedullary nailing for treating diaphyseal fractures of the femur and tibia is well established. It has led to a dramatic improvement in the functional outcome and has become the treatment of choice in many medical centers. Dynamizing a static interlocking nail by removing the interlocked screw(s) farthest from the fracture site has been suggested for improving healing in femoral and tibial fractures that show delayed healing after static interlocking nailing.1–5 When removing the screw for dynamization, locating the screw depends on either palpation or radiologic images only. The dermal scar usually does not reflect the true screw position because the coronal and axial locations of the bony inlet of the screw are usually not the same as those of the incision on the skin. A palpable screw can be removed using a small incision, but a deep-seated impalpable screw always requires open dissection to find the screw first. Any new technique that can reliably identify the position of the Po-Ting Wu, MD, Cheng-Li Lin, MD, Ta-Wei Tai, MD, Chung-Jung Shao, MD, Kuo-Chen Wu, MD, Tai-Chang Chern, MD, I-Ming Jou, MD, PhD