Use of the F-Tool for the Removal of a Bent Intramedullary Femoral Nail With a Sagittal Plane Deformity

Full article available online at ORTHOSuperSite.com. Search: 20120222-32 Locked intramedullary nailing is the current standard of treatment for femoral shaft fractures and has low complication rates. Bent femoral intramedullary nails resulting from secondary trauma are rare and technically challenging. This article describes a case of a 36-year-old man who presented with a bent femoral intramedullary nail following a motorcross accident. The patient had a previous femoral shaft fracture treated with an intramedullary nail. Previous reports outlined methods to remove bent femoral nails through the fracture site and proximally; however, this article describes a novel technique combining the use of a Midas Rex MR7 high-speed burr (Medtronic, Minneapolis, Minnesota) and the F-Tool (Synthes, West Chester, Pennsylvania) to facilitate nail extraction. The patient was placed in the lateral decubitus position. After limited exposure at the fracture site, the intramedullary nail was weakened at the apex of the deformity with a Midas Rex MR7 high-speed burr. We then used the F-Tool to straighten the nail to facilitate removal through the original proximal insertion site. The F-Tool allows forces to be concentrated at the apex of the deformity and minimizes soft tissue damage. Additional advantages of our technique include limited exposure and the ability to remove the nail in 1 piece. Drs Heffernan and Li are from the Division of Orthopaedic Surgery, and Dr Leclair is from the Division of Orthopaedic Trauma Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts. Drs Heffernan, Leclair, and Li have no relevant financial relationships to disclose. Correspondence should be addressed to: Xinning Li, MD, Division of Orthopaedic Surgery, University of Massachusetts Medical Center, 55 Lake Ave N, Worcester, MA 01655 (xinning.li@gmail.com). doi: 10.3928/01477447-20120222-32 Use of the F-Tool for the Removal of a Bent Intramedullary Femoral Nail With a Sagittal Plane Deformity Michael J. heffernan, MD; Walter leclair, MD; Xinning li, MD e438 Figure: Photograph of the F-Tool (Synthes, West Chester, Pennsylvania) being used at the apex of the deformity to straighten the bent intramedullary nail after partial sectioning with the Midas Rex MR7 high-speed burr (Medtronic, Minneapolis, Minnesota).